Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods
Open accessAbstract
BACKGROUND: Theories of behaviour change indicate that an analysis of factors that facilitate or impede change is helpful when trying to influence professional practice. The aim of this study was to identify barriers to implementing evidence-based guidelines for urinary tract infection and sore throat in general practice in Norway, and to tailor interventions to address these barriers. METHODS: We used a checklist to identify barriers and possible interventions to address these in an iterative process that included a review of the literature, brainstorming, focus groups, a pilot study, small group discussions and interviews. RESULTS: We identified at least one barrier for each category. Both guidelines recommended increased use of telephone consultations and reduced use of laboratory tests, and the barriers and the interventions were similar for the two guidelines. The complexity of changing routines involving patients, general practitioners and general practitioner assistants, loss of income with telephone consultations, fear of overlooking serious disease, perceived patient expectations and lack of knowledge about the evidence for the guidelines were the most prominent barriers. The interventions that were tailored to address these barriers included support for change processes in the practices, increasing the fee for telephone consultations, patient information leaflets and computer-based decision support and reminders. CONCLUSION: A systematic approach using qualitative methods helped identify barriers and generate ideas for tailoring interventions to support the implementation of guidelines for the management of urinary tract infections and sore throat. Lack of resources limited our ability to address all of the barriers adequately.
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1 retracted
O’Brien, M. A., Oxman, A. D., Davis, D., Haynes, R. B., Freemantle, N., & Harvey, E. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000260 · Cited by 123 · see citing works
Self-citationRetractedIn search of how people change: Applications to addictive behaviors.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992) · American Psychologist · doi:10.1037/0003-066x.47.9.1102 · Cited by 8,596 · see citing works
Focus Groups: A Practical Guide for Applied Research
Billson, J. M. (1989) · Human Biology · Cited by 8,560 · see citing works
Qualitative research. Introducing focus groups.
Kitzinger, J. (1995) · BMJ · doi:10.1136/bmj.311.7000.299 · Cited by 6,939 · see citing works
A Controlled Trial to Improve Care for Seriously III Hospitalized Patients
Connors, A. F. (1995) · JAMA · doi:10.1001/jama.274.20.1591 · Cited by 3,416 · see citing works
Davis, D., O'Brien, M. A. T., Freemantle, N., Wolf, F. M., Mazmanian, P., & Taylor-Vaisey, A. (1999) · JAMA · doi:10.1001/jama.282.9.867 · Cited by 2,364 · see citing works
Forsetlund, L., Bjørndal, A., Rashidian, A., Jamtvedt, G., O'Brien, M. A., Wolf, F. M., Davis, D., Odgaard-Jensen, J., & Oxman, A. D. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003030.pub2 · Cited by 1,849 · see citing works
Self-citationOxman, A. D., Thomson, M., Davis, D. A., & Haynes, R. B. (1995) · PubMed Central · Cited by 1,847 · see citing works
Self-citationGrimshaw, J., Shirran, L., Thomas, R. E., Mowatt, G., Fraser, C. M., Bero, L. A., Grilli, R. G., Harvey, E., Oxman, A., & O’Brien, M. A. (2001) · Medical Care · doi:10.1097/00005650-200108002-00002 · Cited by 1,794 · see citing works
Self-citation(2001) · PubMed · Cited by 1,709 · see citing works
Hunt, D. L., Haynes, R. B., Hanna, S., & Smith, K. (1998) · JAMA · doi:10.1001/jama.280.15.1339 · Cited by 1,684 · see citing works
Educational outreach visits: effects on professional practice and health care outcomes
O'Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., et al. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000409.pub2 · Cited by 1,279 · see citing works
Self-citationRenders, C. M., Valk, G. D., Griffin, S. J., Wagner, E. H., Eijk van, J. T., & Assendelft, W. J. J. (2001) · Diabetes Care · doi:10.2337/diacare.24.10.1821 · Cited by 1,066 · see citing works
Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., & Robertson, N. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005470.pub2 · Cited by 1,003 · see citing works
Self-citationImproving Drug-Therapy Decisions through Educational Outreach
Avorn, J., & Soumerai, S. B. (1983) · New England Journal of Medicine · doi:10.1056/nejm198306163082406 · Cited by 854 · see citing works
Personal paper: Beliefs and evidence in changing clinical practice
Grol, R. P. T. M. (1997) · BMJ · doi:10.1136/bmj.315.7105.418 · Cited by 826 · see citing works
Renders, C. M., Valk, G. D., Griffin, S. J., Wagner, E. H., van Eijk, J. T. M., & Assendelft, W. J. (2000) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001481 · Cited by 492 · see citing works
Soumerai, S. B., McLaughlin, T. J., Gurwitz, J. H., Guadagnoli, E., Hauptman, P. J., Borbas, C., Morris, N., McLaughlin, B., Gao, X., Willison, D. J., et al. (1998) · JAMA · doi:10.1001/jama.279.17.1358 · Cited by 479 · see citing works
A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes
Avorn, J., Soumerai, S. B., Everitt, D. E., Ross-Degnan, D., Beers, M. H., Sherman, D., Salem-Schatz, S. R., & Fields, D. (1992) · New England Journal of Medicine · doi:10.1056/nejm199207163270306 · Cited by 397 · see citing works
Mittman, B. S., Tonesk, X., & Jacobson, P. (1992) · QRB - Quality Review Bulletin · doi:10.1016/s0097-5990(16)30567-x · Cited by 350 · see citing works
O’Brien, M. A., Freemantle, N., Oxman, A. D., Wolfe, F., Davis, D., & Herrin, J. S. (2001) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003030 · Cited by 340 · see citing works
Self-citationSingle and Combined Strategies for Implementing Changes in Primary Care: A Literature Review
Wensing, M., & Grol, R. P. T. M. (1994) · International Journal for Quality in Health Care · doi:10.1093/intqhc/6.2.115 · Cited by 285 · see citing works
Computerized advice on drug dosage to improve prescribing practice
Durieux, P., Trinquart, L., Colombet, I., Niès, J., Walton, R. T., Rajeswaran, A., Rège-Walther, M., Harvey, E., & Burnand, B. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002894.pub2 · Cited by 251 · see citing works
Promoting cancer screening. A randomized, controlled trial of three interventions
McPhee, S. J. (1989) · Archives of Internal Medicine · doi:10.1001/archinte.149.8.1866 · Cited by 214 · see citing works
A Controlled Trial of Educational Outreach to Improve Blood Transfusion Practice
Soumerai, S. B. (1993) · JAMA · doi:10.1001/jama.1993.03510080065033 · Cited by 199 · see citing works
Implementation Barriers for General Practice Guidelines on Low Back Pain
Schers, H., Wensing, M., Huijsmans, Z., van Tulder, M. W., & Grol, R. P. T. M. (2001) · Spine · doi:10.1097/00007632-200108010-00013 · Cited by 167 · see citing works
Improving care for minority children with asthma: professional education in public health clinics
Evans, D., Mellins, R., Lobach, K., Ramos-Bonoan, C., Pinkett-Heller, M., Wiesemann, S., Klein, I., Donahue, C., Burke, D., Levison, M., et al. (1997) · Pediatrics · doi:10.1542/peds.99.2.157 · Cited by 159 · see citing works
Flottorp, S., Oxman, A. D., Håvelsrud, K., Treweek, S., & Herrin, J. (2002) · BMJ · doi:10.1136/bmj.325.7360.367 · Cited by 154 · see citing works
Self-citationO’Brien, M. A., Freemantle, N., Oxman, A., Wolf, F. M., Davis, D., & Herrin, J. S. (2001) · BMC News and views · doi:10.1186/2048-4623-1-s3-pc118 · Cited by 153 · see citing works
Self-citationMcPhee, S. J. (1989) · Archives of Internal Medicine · doi:10.1001/archinte.1989.00390080116025 · Cited by 140 · see citing works
Educational outreach visits: effects on professional practice and health care outcomes
O'Brien, M., Oxman, A. D., Davis, D. A., Haynes, R. B., Freemantle, N., & Harvey, E. (1997) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000409 · Cited by 130 · see citing works
Self-citationLeviton, L. C., Goldenberg, R. L., Baker, C. S., Schwartz, R. M., Freda, M. C., Fish, L. J., Cliver, S. P., Rouse, D. J., Chazotte, C., Merkatz, I. R., et al. (1999) · JAMA · doi:10.1001/jama.281.1.46 · Cited by 128 · see citing works
The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies
ROSS-DEGNAN, D., SOUMERAI, S. B., GOEL, P. K., BATES, J., MAKHULO, J., DONDI, N., SUTOTO, ADI, D., FERRAZ-TABOR, L., & HOGAN, R. (1996) · Health Policy and Planning · doi:10.1093/heapol/11.3.308 · Cited by 123 · see citing works
Changing professional practice: Theory and practice of clinical guidelines implementation
Thorsen, T., & Mākelä, M. (1999) · Research at the University of Copenhagen (University of Copenhagen) · Cited by 115 · see citing works
Small group intervention vs formal seminar for improving appropriate drug use
Santoso, B. (1996) · Social Science & Medicine · doi:10.1016/0277-9536(95)00390-8 · Cited by 106 · see citing works
Baker, R., Reddish, S., Robertson, N., Hearnshaw, H., & Jones, B. (2001) · Europe PMC (PubMed Central) · Cited by 105 · see citing works
Hux, J. E., Melady, M. P., & DeBoer, D. P. (1999) · Europe PMC (PubMed Central) · Cited by 100 · see citing works
Hadiyono, J. E. P., Suryawati, S., Danu, S. S., Sunartono, & Santoso, B. (1996) · Social Science & Medicine · doi:10.1016/0277-9536(95)00391-6 · Cited by 94 · see citing works
The Physician as Learner: Linking Research to Practice
Nelson, M. S. (1995) · JAMA · doi:10.1001/jama.1995.03530090111036 · Cited by 89 · see citing works
Flottorp, S. A., Håvelsrud, K., & Oxman, A. D. (2003) · Family Practice · doi:10.1093/fampra/cmg316 · Cited by 87 · see citing works
Self-citationvan der Weijden, T., Grol, R. P. T. M., & Knottnerus, J. A. (1999) · International Journal for Quality in Health Care · doi:10.1093/intqhc/11.2.131 · Cited by 51 · see citing works
Jennett, P. A., Laxdal, O. E., Hayton, R. C., Klaassen, D. J., Swanson, R. W., Wilson, T. W., Spooner, H. J., Mainprize, G. W., & Wickett, R. E. Y. (1988) · Medical Education · doi:10.1111/j.1365-2923.1988.tb00424.x · Cited by 47 · see citing works
Computerised advice on drug dosage to improve prescribing practice
Walton, R. T., Harvey, E., Dovey, S. M., & Freemantle, N. (2001) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002894 · Cited by 47 · see citing works
Implementation of local guidelines for cost-effective management of hypertension
Aucott, J. N., Pelecanos, E., Dombrowski, R. C., Fuehrer, S. M., Laich, J., & Aron, D. C. (1996) · Journal of General Internal Medicine · doi:10.1007/bf02600265 · Cited by 45 · see citing works
Active Sick Leave for Patients With Back Pain
Scheel, I. B., Hagen, K. B., & Oxman, A. D. (2002) · Spine · doi:10.1097/00007632-200203150-00016 · Cited by 40 · see citing works
Self-citationDurability of improved physician early detection of cancer after conclusion of intervention support.
Dietrich, A. J., Sox, C. H., Tosteson, T. D., et al. (1994) · PubMed · Cited by 35 · see citing works
Forsetlund, L., & Bjørndal, A. (2002) · Journal of Health Services Research & Policy · doi:10.1258/1355819021927629 · Cited by 33 · see citing works
Cranney, M., Barton, S., & Walley, T. (1999) · PubMed · Cited by 31 · see citing works
Parkerson, G. R., Bridges‐Webb, C., Gérvas, J., et al. (1996) · Family Practice · doi:10.1093/fampra/13.3.303 · Cited by 25 · see citing works
[Guidelines for diagnosis and treatment of acute urinary tract problems in women].
Flottorp, S. A., Ad, O., Cooper, J. G., et al. (2000) · PubMed · Cited by 24 · see citing works
Self-citationA controlled trial of educational outreach to improve blood transfusion practice
Soumerai, S. B. (1993) · JAMA · doi:10.1001/jama.270.8.961 · Cited by 21 · see citing works
[Guidelines for diagnosis and treatment of sore throat].
Flottorp, S. A., Oxman, A., Cooper, J. G., et al. (2000) · PubMed · Cited by 9 · see citing works
Self-citationRetningslinjer for diagnostikk og behandling av sår hals
Flottorp, S. A., Oxman, A. D., Cooper, J. G., et al. (2000) · Tidsskrift for Den Norske Laegeforening · Cited by 4 · see citing works
Self-citationRetningslinjer for diagnostikk og behandling av akutte vannlatingsplager hos kvinner
Flottorp, S. A., Oxman, A. D., Cooper, J. G., et al. (2000) · Tidsskrift for Den Norske Laegeforening · Cited by 4 · see citing works
Self-citationUsing electronic medical records to evaluate healthcare interventions
Treweek, S. P., & Flottorp, S. A. (2001) · Health Informatics Journal · doi:10.1177/146045820100700207 · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Rogers EM Diffusions of innovations. New York, The Free Press 1995 4th
Cited by
Sorted by citations
Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., & Robertson, N. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005470.pub2 · Cited by 1,003 · see citing works
Self-citationTailored interventions to address determinants of practice
Baker, R., Camosso-Stefinovic, J., Gillies, C., Shaw, E. J., Cheater, F., Flottorp, S., Robertson, N., Wensing, M., Fiander, M., Eccles, M. P., et al. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005470.pub3 · Cited by 711 · see citing works
Self-citationColquhoun, H. L., Squires, J. E., Kolehmainen, N., Fraser, C., & Grimshaw, J. M. (2017) · Implementation Science · doi:10.1186/s13012-017-0560-5 · Cited by 283 · see citing works
Tailoring quality improvement interventions to identified barriers: a multiple case analysis
Bosch, M., Van Der Weijden, T., Wensing, M., & Grol, R. (2007) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2006.00660.x · Cited by 272 · see citing works
Rational prescribing in primary care (RaPP): a cluster randomized trial of a tailored intervention
Fretheim, A., Oxman, A. D., Håvelsrud, K., Treweek, S., Kristoffersen, D. T., & Bjørndal, A. (2006) · PLoS Medicine · doi:10.1371/journal.pmed.0030134 · Cited by 99 · see citing works
Self-citationThe Use of Electronic Health Information Systems in Home Care: Facilitators and Barriers
Stolee, P., Steeves, B., Glenny, C., & Filsinger, S. (2010) · Home Healthcare Nurse · doi:10.1097/01.nhh.0000369769.32246.92 · Cited by 31 · see citing works
Fretheim, A., Oxman, A. D., & Flottorp, S. (2004) · BMC Health Services Research · doi:10.1186/1472-6963-4-23 · Cited by 26 · see citing works
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- Authors
- Flottorp, S., & Oxman, A. D.
- Affiliations
- Norwegian Directorate of Health (NO)
- Corresponding author
- Flottorp, Signe
- Venue
- BMC Health Services Research
- Published
- 2003-02-04
- Volume
- 3
- Issue
- 1
- Pages
- 3-3
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC150569
- OpenAlex
- W1817162255
- Cited by
- 62
- References
- 55
- Citations by year
- 2026: 1 · 2021: 1 · 2020: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 6 · 2012: 2
- FWCI
- 9.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, other-oa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Norske Legeforening
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- urinary tract infection, sore throat, guideline implementation, implementation barriers, personalized interventions, behavior change, telephone consultation, general practice, computer-based decision support, patient information leaflets, professional practice change
- MeSH terms
- Adolescent, Adult, Family Practice, Female, Humans, Middle Aged, Norway, Pharyngitis, Referral and Consultation, Telephone, Urinary Tract Infections, Focus Groups, Practice Guidelines as Topic, Evidence-Based Medicine, Decision Support Systems, Clinical, Qualitative Research
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