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Barriers to the implementation of practice guidelines in managing patients with nonvariceal upper gastrointestinal
Sean M Hayes1, Suzanne Murray, Martin Dupuis
1AXDEV Group Inc, Brossard, Quebec. hayess@axdevgroup.com
Insights
Healthcare providers in Canada face barriers to implementing nonvariceal upper gastrointestinal bleeding (NVUGIB) guidelines. Lack of awareness and attitudinal factors hinder adherence, impacting patient care.
Area of Science:
- Gastroenterology
- Health Services Research
- Medical Education
Background:
- Nonvariceal upper gastrointestinal bleeding (NVUGIB) management guidelines are inconsistently applied.
- Suboptimal care and patient outcomes may result from inconsistent guideline application.
- A needs assessment identified barriers to guideline implementation among Canadian healthcare providers.
Purpose of the Study:
- To assess healthcare providers' barriers to implementing NVUGIB guidelines in Canada.
- To understand factors influencing adherence to NVUGIB management guidelines.
Main Methods:
- Semistructured telephone interviews conducted with 22 healthcare professionals treating NVUGIB patients.
- Participants included emergency room physicians, intensivists, gastroenterologists, nurses, and administrators.
- Sampled from six Canadian hospitals involved in a national NVUGIB audit.
Main Results:
- Lack of knowledge of NVUGIB guidelines among ER physicians, intensivists, and nurses.
- Limited belief in guideline value and implementation tools among ER, ICU, and GI specialists.
- Poor interprofessional collaboration and variable skill sets identified as key barriers.
- Perceived overuse of intravenous proton pump inhibitors without adequate cost-benefit consideration.
Conclusions:
- ER, ICU, and nurses' non-adherence stems from lack of awareness of NVUGIB guidelines.
- Gastroenterologists' non-adherence is influenced by attitudinal and contextual barriers.
- Findings support developing educational and behavioral interventions for guideline dissemination and practice implementation.
Background/Objective:
Guidelines for the management of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) are inconsistently applied by health care providers, potentially resulting in suboptimal care and patient outcomes. A needs assessment was performed to assess health care providers' barriers to the implementation of these guidelines in Canada.
Methods:
Semistructured telephone interviews were conducted by trained research personnel with 22 selectively sampled health care professionals actively treating and managing NVUGIB patients, including emergency room physicians (ER), intensivists (ICU), gastroenterologists (GI), gastroenterology nurses and hospital administrators. Participants were chosen from a representative sample of six Canadian community- and academic-based hospitals that participated in a national Canadian audit on the management of NVUGIB.
Results:
Participants reported substantive gaps in the implementation of NVUGIB guidelines that included the following: lack of knowledge of the specifics of the NVUGIB guidelines (ER, ICU, nurses); limited belief in the value of guidelines, especially in areas where evidence is lacking (ER, ICU); limited belief in the value of available tools to support implementation of guidelines (GI); lack of knowledge of the roles and responsibilities of health care professions and disciplines, and lack of effective collaboration skills (ER, ICU and GI); variability of knowledge and skills of health care professionals within professions (eg, variability of nurses' knowledge and skills in endoscopic procedures); and perceived overuse of intravenous proton pump inhibitor treatment, with limited concern regarding cost or side effect implications (all participants).
Conclusions:
In the present study population, ER, ICU and nurses did not adhere to NVUGIB guidelines because they were neither aware of nor familiar with them, whereas the GI lack of adherence to NVUGIB guidelines was influenced more by attitudinal and contextual barriers. These findings can guide the design of multifaceted educational and behavioural interventions when attempting to effectively disseminate existing guidelines, and for guideline implementation into practice.
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