Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

BMC Health Services Research

Robyn O’Halloran¹  Emma Power³  Kathleen A Hadely² 

[1] Department of Human Communication Sciences, La Trobe University, PO Box 199, Bendigo VIC 3552, Australia;Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe NSW 2141, Australia;Centre for Clinical Research Excellence in Aphasia Rehabilitation, Brisbane, Australia

关键词: Implementation;    Facilitators;    Barriers;    Knowledge to action framework;    Knowledge translation;    Clinical practice guideline;    Rehabilitation;    Stroke;    Speech pathologist;   

Others  :  1133465
DOI  :  10.1186/1472-6963-14-110

 received in 2013-08-07, accepted in 2014-02-20,  发布年份 2014

【 摘 要 】

Background

Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs.

Methods

Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.

Results

320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.

Conclusions

There are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

【 授权许可】

   
2014 Hadely et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

Figure 11.

Figure 12.

【 参考文献 】

• [1]World Health Organization: The Atlas of Heart Disease and Stroke. Geneva: World Health Organization; 2004.
• [2]Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S: Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil 2010, 91:196-202.
• [3]Vidović M, Sinanović O, Sabaskić L, Haticić A, Brkić E: Incidence and types of speech disorders in stroke patients. Acta Clin Croat 2011, 50:491-493.
• [4]Riepe MW, Riss S, Bittner D, Huber R: Screening for cognitive impairment in patients with acute stroke. Dement Geriatr Cogn Disord 2004, 17:49-53.
• [5]Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R: Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005, 36:2756-2763.
• [6]Hilari K: The impact of stroke: are people with aphasia different to those without? Disabil Rehabil 2011, 33:211-218.
• [7]Altman KW, Yu GP, Schaefer SD: Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. JAMA Otolaryngol Head Neck Surg 2010, 136:784-789.
• [8]McCurtin A, Roddam H: Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession. Int J Lang Commun Disord 2012, 47:11-26.
• [9]O’Connor S, Pettigrew CM: The barriers perceived to prevent the successful implementation of evidence-based practice by speech and language therapists. Int J Lang Commun Disord 2009, 44:1018-1035.
• [10]Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006, 26:13-24.
• [11]Straus SE, Tetroe J, Graham I: Defining knowledge translation. CMAJ 2009, 181:165-168.
• [12]Institute of Medicine: Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press; 2011.
• [13]Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA: Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Arch Phys Med Rehabil 2012, 93:965-971.
• [14]National Stroke Audit Rehabilitation Services Report 2012 [http://www.strokefoundation.com.au/ webcite]
• [15]National Sentinel Stroke Audit 2010 Public Report [http://www.rcplondon.ac.uk webcite]
• [16]National Report Stroke Services in Scottish Hospitals 2012. [http://www.strokeaudit.scot.nhs.uk webcite]
• [17]Francke AL, Smit MC, de Veer AJE, Mistiaen P: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 2008, 8:38-49. BioMed Central Full Text
• [18]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004, 8(iii-iv):1-72.
• [19]Prior M, Guerin M, Grimmer-Somers K: The effectiveness of clinical guideline implementation strategies: a synthesis of systematic review findings. J Eval Clin Pract 2008, 14:888-897.
• [20]Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P: Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. Int J Evid Based Healthc 2010, 8:79-89.
• [21]Hakkennes S, Dodd K: Guideline implementation in allied health professions: a systematic review of the literature. BMJ Qual Saf 2008, 17:296-300.
• [22]Bayley MT, Harrison M, Graham ID, Hurdowar A, Richards CL, Korner-Bitensky N, Wood-Dauphinee S, Eng JJ, McKay-Lyons M, Harrison E, Teasell R: Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project. Disabil Rehabil 2012, 34:1633-1638.
• [23]Otterman NM, van der Wees PJ, Bernhardt J, Kwakkel G: Physical therapists’ guideline adherence on early mobilization and intensity of practice at dutch acute stroke units: a country-wide survey. Stroke 2012, 43:2395-2401.
• [24]Poitras S, Durand MJ, Côté AM, Tousignant M: Use of low-back pain guidelines by occupational therapists: a qualitative study of barriers and facilitators. Work 2011, 39:465-475.
• [25]Poitras S, Durand M, Côté A, Tousignant M: Guidelines on low back pain disability: interprofessional comparison of use between general practitioners, occupational therapists, and physiotherapists. Spine (Phila Pa 1976) 2012, 37:1252-1259.
• [26]Verweij LM, Proper KI, Leffelaar ER, Weel ANH, Nauta AP, Hulshof CTJ, van Mechelen W: Barriers and facilitators to implementation of an occupational health guideline aimed at preventing weight gain among employees in the Netherlands. J Occup Environ Med 2012, 54:954-960.
• [27]SurveyMonkey [http://www.surveymonkey.com webcite]
• [28]Kajermo K, Boström A-M, Thompson DS, Hutchinson AM, Estabrooks CA, Wallin L: The BARRIERS scale–the barriers to research utilization scale: a systematic review. Implement Sci 2010, 5:32-54. BioMed Central Full Text
• [29]Richardson J: Design and conduct a survey. Complement Ther Med 2005, 13:47-53.
• [30]Braithwaite D, Emery J, De Lusignan S, Sutton S: Using the internet to conduct surveys of health professionals: a valid alternative? Fam Pract 2003, 20:545-551.
• [31]WINPEPI [http://www.brixtonhealth.com/pepi4windows.html webcite]
• [32]General Membership Survey [http://www.speechpathologyaustralia.org.au webcite]
• [33]Elo S, Kyngäs H: The qualitative content analysis process. J Adv Nurs 2008, 62:107-115.
• [34]Hsieh H, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res 2005, 15:1277-1288.
• [35]Krippendorff K: Reliability in content analysis: some common misconceptions and recommendations. Hum Comm Res 2004, 30:411-433.
• [36]Côté AM, Durand MJ, Tousignant M, Poitras S: Physiotherapists and use of low back pain guidelines: a qualitative study of the barriers and facilitators. J Occup Rehabil 2009, 19:94-105.
• [37]Hendrick P, Mani R, Bishop A, Milosavljevic S, Schneiders AG: Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions: a national survey of manipulative and sports physiotherapists in New Zealand. Man Ther 2013, 18:136-142.
• [38]Bahtsevani C, Willman A, Stoltz P, Östman M: Experiences of the implementation of clinical practice guidelines: interviews with nurse managers and nurses in hospital care. Scand J Caring Sci 2010, 24:514-522.
• [39]Huberman M: Linking the practitioner and researcher communities for school improvement. Sch Eff Sch Improv 1993, 4:1-16.
• [40]Colón-Emeric CS, Lekan D, Utley-Smith Q, Ammarell N, Bailey D, Corazzini K, Piven ML, Anderson RA: Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc 2007, 55:1404-1409.
• [41]Forsner T, Hansson J, Brommels M, Wistedt AT, Forsell Y: Implementing clinical guidelines in psychiatry: a qualitative study of perceived facilitators and barriers. BMC Psychiatry 2010, 10:8-18. BioMed Central Full Text
• [42]Toal-Sullivan D: New graduates’ experiences of learning to practise occcupational therapy. Br J Occup Ther 2006, 69:513-513.
• [43]Lizarondo LM, Grimmer-Somers K, Kumar S, Crockett A: Does journal club membership improve research evidence uptake in different allied health disciplines: a pre-post study. BMC Res Notes 2012, 5:558-597. BioMed Central Full Text
• [44]Strope SA, Elliott SP, Saigal CS, Smith A, Wilt TJ, Wei JT: Urologist compliance with AUA best practice guidelines for benign prostatic hyperplasia in medicare population. Urology 2011, 78:3-9.
• [45]Hill K, Middleton S, O’Brien E, Lalor E: Implementing clinical guidelines for acute stroke management: do nurses have a lead role? Aust J Adv Nurs 2009, 26:53-58.
• [46]Strasser DC, Falconer JA, Stevens AB, Uomoto JM, Herrin J, Bowen SE, Burridge AB: Team training and stroke rehabilitation outcomes: a cluster randomized trial. Arch Phys Med Rehabil 2008, 89:10-15.
• [47]Schouten LMT, Hulscher MEJL, Akkermans R, van Everdingen JJE, Grol RPTM, Huijsman R: Factors that influence the stroke care team’s effectiveness in reducing the length of hospital stay. Stroke 2008, 39:2515-2521.
• [48]Fervers B, Burgers JS, Haugh MC, Latreille J, Mlika-Cabanne N, Paquet L, Coulombe M, Poirier M, Burnand B: Adaptation of clinical guidelines: literature review and proposition for a framework and procedure. Int J Qual Health Care 2006, 18:167-176.
• [49]Ivers N, Oxman AD, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012, 6:CD000259.
• [50]van der Geest LGM, Krijnen P, Wouters MWJM, Erkelens WGW, Marinelli AWKS, Nortier HJWR, Tollenaar RAEM, Struikmans H: Improved guideline compliance after a 3-year audit of multidisciplinary colorectal cancer care in the western part of the Netherlands. J Surg Oncol 2012, 106:1-9.