title: Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods.
abstract: BACKGROUND
  The tailoring of implementation interventions includes the identification of the determinants of, or barriers to, healthcare practice. Different methods for identifying determinants have been used in implementation projects, but which methods are most appropriate to use is unknown.
  
  
  METHODS
  The study was undertaken in five European countries, recommendations for a different chronic condition being addressed in each country: Germany (polypharmacy in multimorbid patients); the Netherlands (cardiovascular risk management); Norway (depression in the elderly); Poland (chronic obstructive pulmonary disease--COPD); and the United Kingdom (UK) (obesity). Using samples of professionals and patients in each country, three methods were compared directly: brainstorming amongst health professionals, interviews of health professionals, and interviews of patients. The additional value of discussion structured through reference to a checklist of determinants in addition to brainstorming, and determinants identified by open questions in a questionnaire survey, were investigated separately. The questionnaire, which included closed questions derived from a checklist of determinants, was administered to samples of health professionals in each country. Determinants were classified according to whether it was likely that they would inform the design of an implementation intervention (defined as plausibly important determinants).
  
  
  RESULTS
  A total of 601 determinants judged to be plausibly important were identified. An additional 609 determinants were judged to be unlikely to inform an implementation intervention, and were classified as not plausibly important. Brainstorming identified 194 of the plausibly important determinants, health professional interviews 152, patient interviews 63, and open questions 48. Structured group discussion identified 144 plausibly important determinants in addition to those already identified by brainstorming.
  
  
  CONCLUSIONS
  Systematic methods can lead to the identification of large numbers of determinants. Tailoring will usually include a process to decide, from all the determinants that are identified, those to be addressed by implementation interventions. There is no best buy of methods to identify determinants, and a combination should be used, depending on the topic and setting. Brainstorming is a simple, low cost method that could be relevant to many tailored implementation projects.
authors.forename: Jane
authors.initials: J
authors.lastname: Krause
authors.forename: Jan
authors.initials: J
authors.lastname: Van Lieshout
authors.forename: Rien
authors.initials: R
authors.lastname: Klomp
authors.forename: Elke
authors.initials: E
authors.lastname: Huntink
authors.forename: Eivind
authors.initials: E
authors.lastname: Aakhus
authors.forename: Signe
authors.initials: S
authors.lastname: Flottorp
authors.forename: Cornelia
authors.initials: C
authors.lastname: Jaeger
authors.forename: Jost
authors.initials: J
authors.lastname: Steinhaeuser
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.forename: Anna
authors.initials: A
authors.lastname: Kowalczyk
authors.forename: Shona
authors.initials: S
authors.lastname: Agarwal
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D003863:Depression / Q000628:therapy; D005858:Germany; D006801:Humans; D009426:Netherlands; D009664:Norway; D011044:Poland; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016730:Program Development; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D006113:United Kingdom
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