Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study.
OBJECTIVE
A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care.


METHODS
We conducted a modified focus group with elements of a workshop of three hours duration. Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation. Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF. The content of the discussions was analysed qualitatively according to Mayring and categorised thematically.


RESULTS
Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g. time management) and attitude (dissatisfaction with time-money-relation).


METHODS
individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs). Doctor and patient: Adherence and barriers of communication. Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education.


CONCLUSIONS
For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary. It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related. Additional elements should include support in the implementation of organisational processes in the practice and patient education.
University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany.
Frank
F
Peters-Klimm
Iris
I
Natanzon
Thomas
T
Müller-Tasch
Sabine
S
Ludt
Christoph
C
Nikendei
Nicole
N
Lossnitzer
Joachim
J
Szecsenyi
Wolfgang
W
Herzog
Jana
J
Jünger
D000328:Adult; D003479:Curriculum; D003661:Decision Support Techniques; D004493:Education; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000193:education*; D005858:Germany; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D010817:Physician-Patient Relations