Differing views of clinical practice guidelines: Variation by role responsibility.

Session number: 1116

Abstract title: Differing views of clinical practice guidelines: Variation by role responsibility.

Author(s):
T Tripp-Reimer - Gerontological Nursing Interventions Research Center, University of Iowa College of Nursing
J DeWitt - Drake University College of Pharmacy
BJ BootsMiller - Program in Health Services Research, Iowa City VAMC and Department of Internal Medicine, The University of Iowa College of Medicine
TE Vaughn - Department of Health Management and Policy, University of Iowa College of Public Health
MM Ward - Department of Health Management and Policy, University of Iowa College of Public Health
BN Doebbeling - Program in Health Services Research, Iowa City VAMC, Departments of Internal Medicine and Epidemiology, Colleges of Medicine and Public Health

Objectives: Clinical Practice Guidelines (CPGs) represent a key mechanism for the translation of scientific evidence in health care. This paper presents key issues in implementation of national practice guidelines as viewed by 3 groups of key VHA stakeholders: administrators, physicians, and nurses.

Methods: The research design followed standard naturalistic investigation methodology for focus group interviews. A national sample of VHA hospitals was selected using a systematic process identifying maximal variation in specified characteristics. Fifty focus groups, representing the 3 stakeholder groups (3/facility), were conducted at 18 sites. Group participation was voluntary and represented individuals who could provide diverse information on CPGs. The focus groups explored perceived facilitators and barriers from each group's perspective. Participant comments were taped, transcribed, coded using computer-assisted text analysis software, and categories sorted yielding crosscutting themes and recurring patterns.

Results: Overall, physicians and nurses addressed problems and barriers related to CPGs; administrators addressed facilitators/benefits. Primary concerns about outcomes from CPGs varied by group. Physicians discussed continuity of care; administrators compliance with guidelines; and clinicians patient benefits. All expressed concerns regarding time constraints, implementation, documentation, dissemination and compatibility of practice of CPGs. Administrators and nurses spoke about population characteristics, illogical challenges, CPG availability and educational approaches. Physicians and nurses discussed issues of leadership, workload, and organizational structure. They also were concerned about CPG clarity and the volume of material. Physicians and administrators voiced concerns with CPG credibility, acceptance and engaging colleagues to manage CPGs.

Conclusions: Open discussions by stakeholders about facilitators and barriers elicited role similarities that can aid and role differences that can block translation of CPGs to practice. Most facilitators and barriers expressed by the stakeholder were of concern to two, but not all three roles. Clinical practice settings require harmony in the organization, determination and direct delivery of patient care. This is true with the use of CPGs.

Impact statement: Articulation of CPG facilitators and barriers as perceived by significant stakeholders will enhance implementation of communication. Improved communication of issues will allow translation of evidence to care delivery.