Abstract:
BACKGROUND:Venous Thromboembolism (VTE) is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. METHODS:Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. RESULTS:Analysis of interviews revealed that barriers to evidence based practice include i) the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii) the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. CONCLUSIONS:Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Chapman NH,Lazar SP,Fry M,Lassere MN,Chong BHdoi
10.1186/1472-6963-11-240subject
Has Abstractpub_date
2011-09-28 00:00:00pages
240issn
1472-6963pii
1472-6963-11-240journal_volume
11pub_type
杂志文章,多中心研究abstract:BACKGROUND:This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975-1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-26
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journal_title:BMC health services research
pub_type: 杂志文章
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journal_title:BMC health services research
pub_type: 已发布勘误
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更新日期:2019-10-22 00:00:00
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,随机对照试验
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更新日期:2011-11-16 00:00:00
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更新日期:2014-02-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2016-09-20 00:00:00
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