Identification of barriers for good adherence to a guideline on recurrent miscarriage.
OBJECTIVE
Guidelines on recurrent miscarriage are poorly implemented in daily clinical practice. To ensure proper implementation, we identified existing barriers and facilitators for guideline adherence according to professionals and patients.


METHODS
Qualitative research.


METHODS
Two different regions in the Netherlands.


METHODS
Forty-two professionals: gynecologists, residents in obstetrics and gynecology, fertility doctors and clinical geneticists. Ten patients with recurrent miscarriage.


METHODS
Focus group interviews were performed with professionals and individual in-depth interviews with patients. Reports from the interviews were analyzed and barriers were identified.


METHODS
Identified barriers, categorized in four domains, including characteristics of: (I) the guideline, (II) professionals, (III) patients, (IV) organization.


RESULTS
Ninety-six barriers, at all four domains, were identified among professionals. The most frequently mentioned barriers were: guideline being too complicated in the consultancy room and finding it difficult to refuse demands of insistent patients. Patients mentioned 40 barriers, of which lack of up-to-date patient information and lack of detailed knowledge about family history were most frequently mentioned. Potential facilitators, such as an electronic decision tool and patient questionnaires prior to their first visit, were mentioned by both professionals and patients. All participants agreed that complete adherence to the guideline was theoretically achievable.


CONCLUSIONS
Both professionals and patients experienced barriers and facilitators for guideline adherence in recurrent miscarriage. Guideline implementation strategies should take these identified barriers into account.
Academic Medical Center, Centre for Reproductive Medicine, Amsterdam, The Netherlands. e.vandenboogaard@amc.uva.nl
Emmy
E
Van Den Boogaard
Rosella P M G
RP
Hermens
Nico J
NJ
Leschot
Ruth
R
Baron
Jos H A
JH
Vollebergh
Rob E
RE
Bernardus
Fulco
F
Van Der Veen
Jan A M
JA
Kremer
Mariëtte
M
Goddijn
D000026:Abortion, Habitual / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy