Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence.
OBJECTIVE
Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines.


METHODS
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.
Powell-Cope
Gail M
GM
James A. Haley Veterans Administration Medical Center, Tampa, FL, USA. gail.powell-cope@med.va.gov
Luther
Stephen
S
Neugaard
Britta
B
Vara
John
J
Nelson
Audrey
A
D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D017202:Myocardial Ischemia / Q000628:therapy*; D014481:United States