title: Perception and use of guidelines and interprofessional dynamics: assessing their roles in guideline adherence in delivering medications in nursing homes.
abstract: OBJECTIVE
  Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.
  
  
  METHODS
  Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.
  
  
  RESULTS
  Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.
  
  
  CONCLUSIONS
  This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.
authors.affiliation: Buehler Center on Aging, Health & Society, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. D-Lau@Northwestern.edu
authors.forename: Denys T
authors.initials: DT
authors.lastname: Lau
authors.forename: Jane
authors.initials: J
authors.lastname: Banaszak-Holl
authors.forename: Amit
authors.initials: A
authors.lastname: Nigam
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008503:Medical Staff / Q000523:psychology; D008509:Medication Systems / Q000592:standards*; D008824:Michigan; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D009740:Nursing Staff / Q000523:psychology; D010595:Pharmacists / Q000523:psychology; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D016896:Treatment Outcome