title: Tailored implementation of evidence-based practice for patients with chronic diseases.
abstract: BACKGROUND
  When designing interventions and policies to implement evidence based healthcare, tailoring strategies to the targeted individuals and organizations has been recommended. We aimed to gather insights into the ideas of a variety of people for implementing evidence-based practice for patients with chronic diseases, which were generated in five European countries.
  
  
  METHODS
  A qualitative study in five countries (Germany, Netherlands, Norway, Poland, United Kingdom) was done, involving overall 115 individuals. A purposeful sample of four categories of stakeholders (healthcare professionals, quality improvement officers, healthcare purchasers and authorities, and health researchers) was involved in group interviews in each of the countries to generate items for improving healthcare in different chronic conditions per country: chronic obstructive pulmonary disease, cardiovascular disease, depression in elderly people, multi-morbidity, obesity. A disease-specific standardized list of determinants of practice in these conditions provided the starting point for these groups. The content of the suggested items was categorized in a pre-defined framework of 7 domains and specific themes in the items were identified within each domain.
  
  
  RESULTS
  The 115 individuals involved in the study generated 812 items, of which 586 addressed determinants of practice. These largely mapped onto three domains: individual health professional factors, patient factors, and professional interactions. Few items addressed guideline factors, incentives and resources, capacity of organizational change, or social, political and legal factors. The relative numbers of items in the different domains were largely similar across stakeholder categories within each of the countries. The analysis identified 29 specific themes in the suggested items across countries.
  
  
  CONCLUSIONS
  The type of suggestions for improving healthcare practice was largely similar across different stakeholder groups, mainly addressing healthcare professionals, patient factors and professional interactions. As this study is one of the first of its kind, it is important that more research is done on tailored implementation strategies.
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Elke
authors.initials: E
authors.lastname: Huntink
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kowalczyk
authors.affiliation: Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Jäger
authors.affiliation: Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Jost
authors.initials: J
authors.lastname: Steinhäuser
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Aakhus
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Signe
authors.initials: S
authors.lastname: Flottorp
authors.affiliation: Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Eccles
authors.affiliation: University of Leicester, Leicester, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D057285:Precision Medicine