title: Perceived barriers to and facilitators of the implementation of priority clinical preventive services guidelines.
abstract: OBJECTIVE
  To obtain feedback from contracted health plan (HP) clinicians responsible for implementing preventive services regarding an established set of priority guidelines identified by a coalition of medical directors and to identify barriers to and facilitators of the implementation of these priority guidelines in clinician practice.
  
  
  METHODS
  Qualitative design using a focus group approach.
  
  
  METHODS
  Three focus group meetings among contracted HP clinicians were conducted in New Jersey in 3 geographic regions (northern, central, and southern New Jersey). Clinicians directly involved in delivering preventive services to pediatric, adult, and geriatric patients participated.
  
  
  RESULTS
  Barriers to guideline implementation were identified by the clinicians regarding payment and cost, time, legal issues, inconsistency among HP tools, tracking, a lack of internalization, and the patient-clinician relationship. In addition, facilitators of guideline implementation, including HP support, patient materials, clinician awareness, and tool consistency, were identified.
  
  
  CONCLUSIONS
  Clinicians' perceived barriers to guideline implementation are in themselves a barrier to the delivery of preventive care services. If clinicians perceive barriers to implementing priority recommendations, they may be unlikely to make the conscious effort to deliver preventive care. There needs to be better dialogue between HPs and contracted clinicians to minimize the perceptions of barriers and to increase clinician awareness of and sensitivity to preventive care for priority implementation. To improve the delivery of preventive services in clinician practice, competing HPs must communicate in a single voice with contracted clinicians in the area of preventive care.
authors.affiliation: Rutgers College of Nursing, Rutgers, The State University of New Jersey, 180 University Ave, Newark, NJ 07102, USA. cgayres@rutgers.edu
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Ayres
authors.forename: Hurdis M
authors.initials: HM
authors.lastname: Griffith
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002675:Child, Preschool; D003144:Communication Barriers; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009515:New Jersey; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000592:standards* / Q000600:supply & distribution; D012307:Risk Factors; D017749:Total Quality Management