Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany

BMC Health Services Research

Research

Bastian Wein¹  Oliver Bruder²  Dirk Müller³  Yana Seleznova³  Stephanie Stock³  Marie Naumann³  Simon Robin Scharfenberg³  Dusan Simic³  Benjamin Scheckel³ 

[1] Cardiology – Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany;Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany;Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany;Ruhr University Bochum, Bochum, Germany;Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany;

关键词: Ambulatory care;    Cardiologists;    Clinical practice guidelines;    Coronary artery disease;    Chronic coronary syndrome;    General practitioners;    Guideline adherence;    Interviews;    Qualitative content analysis;    Qualitative research;   

DOI  :  10.1186/s12913-023-09587-1

 received in 2023-03-14, accepted in 2023-05-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundChronic coronary syndrome (CCS) is a potentially progressive clinical presentation of coronary artery disease (CAD). Clinical practice guidelines (CPGs) are available for prevention, diagnosis, and treatment. Embedded in the “ENLIGHT-KHK” healthcare project, a qualitative study was conducted to identify factors that influence guideline adherence from the perspective of general practitioners (GPs) and cardiologists (CA) in the ambulatory care sector in Germany.MethodsGPs and CAs were surveyed via telephone using an interview guide. The respondents were first asked about their individual approach to caring for patients with suspected CCS. Subsequently, the accordance of their approach with guideline recommendations was addressed. Finally, potential measures for assisting with guideline adherence were discussed. The semi-structured interviews were transcribed verbatim and analysed using a qualitative content analysis in accordance with Kuckartz and Rädiker. Factors influencing adherence to CPGs were categorised by assessing whether they (i) inhibited or facilitated guideline adherence, (ii) played a role in patients at risk of CCS or with suspected or known CCS, (iii) were mentioned in implicit or explicit thematic reference to CPGs, and (iv) were declared a practical problem.ResultsBased on interviews with ten GPs and five CAs, 35 potential influencing factors were identified. These emerged at four levels: patients, healthcare providers, CPGs, and the healthcare system. The most commonly cited barrier to guideline adherence among the respondents was structural aspects at the system level, including reachability of providers and services, waiting times, reimbursement through statutory health insurance (SHI) providers, and contract offers. There was a strong emphasis on interdependencies between factors acting at different levels. For instance, poor reachability of providers and services at the system level may result in inexpedience of guideline recommendations at the CPG level. Likewise, poor reachability of providers and services at the system level may be aggravated or alleviated by factors such as diagnostic preferences at the patient level or collaborations at the provider level.ConclusionsTo assist with adherence to CPGs regarding CCS, promoting measures may be needed that account for interdependencies between barriers and facilitators at various healthcare levels. Respective measures should consider medically justified deviations from guideline recommendations in individual cases.Trial registrationGerman Clinical Trials Register: DRKS00015638; Universal Trial Number (UTN): U1111-1227-8055.

【 授权许可】

CC BY   
© The Author(s) 2023

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