Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change
Open accessAbstract
Background: We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions. Methods: We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention. Results: A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention. Conclusions: A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.
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Among the papers that covered barrier identification, the methods used included observations, interviews and/or focus groups, surveys, literature reviews, structured reflection by researchers, job analysis and expert consensus, and predictive studies to identify factors influencing behaviour.
“In the papers where barrier identification was covered, the methods included observations, interviews and/or focus groups [14, 18, 30–32], surveys [32], literature reviews [24], structured reflection by the researchers [32], job analysis and expert consensus [18], and undertaking a predictive study to identify factors influencing the behaviour [28].”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [32]
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Self-citation
- Authors
- Fretheim, A., Oxman, A. D., & Flottorp, S.
- Corresponding author
- Fretheim, Atle
- Venue
- BMC Health Services Research
- Published
- 2004-09-03
- Volume
- 4
- Issue
- 1
- Pages
- 23-23
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC517506
- OpenAlex
- W1491348571
- Cited by
- 26
- References
- 40
- Citations by year
- 2026: 2 · 2024: 1 · 2019: 2 · 2017: 1 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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 › Primary Care and Health Outcomes
- Keywords
- barriers to change, hypertension, hypercholesterolemia, antihypertensive drugs, cholesterol-lowering drugs, drug prescribing, structured reflection, multicomponent intervention, quality improvement, general practitioners, physician survey
- MeSH terms
- Anticholesteremic Agents, Antihypertensive Agents, Benzothiadiazines, Diuretics, Drug Utilization, Education, Medical, Continuing, Family Practice, Humans, Hypercholesterolemia, Hypertension, Practice Patterns, Physicians', Primary Health Care, Practice Guidelines as Topic, Risk Assessment, Guideline Adherence, Sodium Chloride Symporter Inhibitors
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