Session number: 1113
Abstract title: Provider Perceived Barriers and Facilitators to IHD Guideline Adherence
Author(s):
G Powell-Cope - James A. Haley VAMC
S Luther - James A. Haley VAMC
B Neugaard - James A. Haley VAMC
A Nelson - James A. Haley VAMC
J Vara - West Palm Beach VAMC
Objectives: Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. To develop an intervention to improve provider adherence to the VA Ischemic Heart Disease (IHD) clinical practice guidelines, we conducted a series of focus groups to determine barriers and facilitators to following the guidelines in the area of medical management.
Methods: As part of a larger study to test the effects of an intervention on provider adherence to IHD guidelines, we conducted five focus groups at three VAMCs with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories.
Results: The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of usefulness of the guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients that interfered with the ability to adequately use multiple guidelines. While all providers agreed on the benefits of aspirin, beta-blockers and ace inhibitors, frequently reported barriers for use of these medications were lack of consensus and misunderstandings about absolute and relative contraindications, difficulty in providing close follow-up during medication titration, and lack of patient compliance with medications and follow-up. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision.
Conclusions: While results validated some of what is known about the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider compliance.
Impact statement: The barrier identification process was used to develop interventions to improve provider compliance to the guidelines. An advisory panel reviewed results and, using a nominal group process, chose implementation strategies targeting key barriers. Evaluation of these strategies is underway using a randomized controlled trial. Interventions being testing are case management and patient education.