Home About us Contact
|
Home About us Contact | ||
|
|
||
Provider Adherence (provider + adherence)
Selected AbstractsMultilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care ClinicsHEALTH SERVICES RESEARCH, Issue 1 2009Dorothy Y. Hung Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04,5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69,30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components. [source] Multilevel factors affecting tuberculosis diagnosis and initial treatmentJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008Wilawan Thongraung BSc Abstract Objectives, The study aims to assess provider adherence to national tuberculosis programme guidelines on diagnosis, initial regimens and dosages, and to examine independent effects of factors at patient, staff and hospital levels influencing adherence. Methods, A review of 383 medical records of new tuberculosis (TB) patients and interviews with related staff were carried out. The study was conducted in 16 public hospitals of seven provinces of southern Thailand. The outcome variables were provider adherence to the guidelines on diagnostic procedure, initial regimen and dosage. Independent variables consisted of patient, staff and hospital factors. Multilevel logistic regression was used to identify factors associated with adherence. Results, The proportions of adherence to the diagnostic procedure, initial regimen and initial dosage prescribed were 70.0%, 100.0% and 57.1%, respectively. Most of diagnosis non-adherence was anti-TB drugs being prescribed for smear-negative patients without prior antibiotic trial (12.5%). The anti-TB drug with the highest percentages of patients receiving non-adhered dosage was ethambutol (33.6%). In contrast to single-level analysis, which showed significant influence of up to five factors, multilevel analysis confirmed only strong effect of male patients receiving better adhered diagnosis and of non-doctors and TB clinics providing better dosage adherence. Conclusions, Adherence to TB diagnostic procedures was not good, and adherence to initial dosage, especially for ethambutol, was poor. TB clinics, the key factor of adherence, should be expanded. Female patients should be reviewed more carefully because they tend to receive poorer diagnosis adherence. [source] Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherenceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2004Gail M. Powell-Cope PhD ARNP Abstract Rationale, aims and 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. Method, As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers 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 ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. 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 the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers. [source] Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008J. M. CAVAZOS Summary Background, Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. Aim, To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. Methods, We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Results, Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. Conclusions, A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope. [source] | ||||||||||