Spinal cord injury providers' perceptions of barriers to implementing selected clinical practice guideline recommendations.
OBJECTIVE
Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)--Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury--at their sites.


METHODS
A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting.


RESULTS
Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nonacute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG.


CONCLUSIONS
Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.
Guihan
Marylou
M
Midwest Center for Health Services and Policy Research, Edward Hines, Jr, Veterans Administration Hospital, Hines, Illinois 60141, USA. guihan@research.hines.med.va.gov
Simmons
Barbara
B
Nelson
Audrey
A
Bosshart
Helen T
HT
Burns
Stephen P
SP
D000328:Adult; D001291:Attitude of Health Personnel; D005242:Fecal Incontinence / Q000209:etiology* / Q000628:therapy*; D017144:Focus Groups; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006787:Hospitals, Veterans; D006801:Humans; D010465:Perception; D017410:Practice Guidelines as Topic; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*