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Enhancing prevention in primary care: are interventions targeted towards consumers' and providers' perceived needs?
Marie-Dominique Beaulieu1, Yves Talbot, Alejandro R. Jadad
1Professor and Chair, Department of Family Medicine, Université de Montreal, Groupe Interdisciplinaire de Recherche en Santé (GRIS) and Centre de Recherche Centre Hospitalier de l'Université de Montréal; Associate Professor, Department of Family and Community Medicine, University of Toronto; Professor, Department of Clinical Epidemiology and Biostatistics and Head of the Health Information Research Unit, McMaster University; Assistant Professor, Department of Family Medicine, Université de Sherbrooke.
Abstract:
OBJECTIVE: To explore perceived barriers to the implementation of prevention guidelines, with a particular interest to perceived information needs from the point of view of health professionals and consumers. STUDY DESIGN: Focus group. SETTING AND PARTICIPANTS: Eight focus groups were held in three Canadian cities: three with consumer, three with family physician, and two with primary care nurses. ANALYSIS: Inductive analysis based on transcribed interviews. The material was analysed by two of the investigators. Agreement on interpretation was checked independently by three other researchers on 10% of the material. RESULTS: Lack of motivation, discontinuity of care and lack of adequate remuneration were perceived as the strongest barriers to prevention implementation. Computerized information management systems were not perceived by physicians and nurses as strong facilitating factors. Consumers expressed strongly a need for information on non-traditional preventive interventions. Physicians and nurses expressed a need for patient education material more than for practice guidelines. Research evidence was not considered as the first criteria to judge the value of preventive information. CONCLUSIONS: Evidence-based medicine has triggered a massive effort to develop technologies to support the dissemination of evidence-based information on the assumption that poor access to such information is an important barrier to implementation of effective practices. Our results suggest that such an assumption may not be correct. Providing only evidence-based information from the realm of traditional medicine will appear restrictive to most users, particularly to consumers, and may not be as valued as anticipated considering the expressed scepticism toward research evidence.