BMJ open
Volume 8, Issue 9, 2018

Factors hindering the adherence to clinical practice guideline for diabetes mellitus in the Palestinian primary healthcare clinics: a qualitative study (Article) (Open Access)

Radwan M. , Akbari Sari A. , Rashidian A. , Takian A. , Elsous A. , Abou-Dagga S.
  • a Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (IC-TUMS), International CampusTehran, Iran, International Cooperation Directorate, Palestinian Ministry of HealthGaza Strip, Palestine
  • b Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (IC-TUMS), International CampusTehran, Iran
  • c Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (IC-TUMS), International CampusTehran, Iran
  • d Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (IC-TUMS), International CampusTehran, Iran, Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS)Tehran, Iran
  • e Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (IC-TUMS), International CampusTehran, Iran
  • f Department of Research Affairs and Graduates Studies, Islamic University of GazaGaza Strip, Palestine

Abstract

OBJECTIVE: Despite a high number of the internationally produced and implemented clinical guidelines, the adherence with them is still low in healthcare. This study aimed at exploring the perspectives and experiences of senior doctors and nurses towards the barriers of adherence to diabetes guideline. SETTING: The Palestinian Primary Health Care-Ministry of Health (PHC-MoH) and Primary Health Care-United Nations Relief and Works Agency for Palestine Refugees in the Near East (PHC- UNRWA) in Gaza Strip. PARTICIPANTS: Individual face-to-face in-depth interviews were conducted with 20 senior doctors and nurses who were purposefully selected. METHODS: Qualitative design was employed using the theoretical framework by Cabana et al to develop an interview guide. Semi-structural and audio-recorded interviews were conducted. Data were transcribed verbatim and thematically analysed. RESULTS: The key theme barriers identified by participants that emerged from the analysed data were in regard of the PHC-MoH lack reimbursement, lack of resources and lack of the guideline trustworthiness, and in regard of PHC-UNRWA the time constraints and the lack of the guideline trustworthiness. The two key subthemes elicited from the qualitative analysis were the outdated guideline and lack of auditing and feedback. CONCLUSION: The analysis identified a wide range of barriers against the adherence to diabetes guideline within the PHC-MoH and PHC-UNRWA. The environmental-related and guideline-related barriers were the most prominent factors influencing the guideline adherence. Our study can inform the policy makers and senior managers to develop a tailored interventions that can target the elicited barriers through a multifaceted implementation strategy. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Author Keywords

Primary care qualitative research general diabetes quality in health care

Index Keywords

health care planning nurse economics motivation human middle aged Relief Work Middle East Practice Guidelines as Topic diabetes mellitus protocol compliance reimbursement time factor Health Resources Time Factors United Nations feedback system Reimbursement, Incentive Guideline Adherence Medical Audit Feedback Physicians Nurses clinical audit qualitative research interview Humans Trust Interviews as Topic male female adult physician practice guideline primary health care
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069587951&doi=10.1136%2fbmjopen-2017-021195&partnerID=40&md5=1556b5a8d90eadf2ed6c3a8beda6550b
DOI: 10.1136/bmjopen-2017-021195
ISSN: 20446055
Original Language: English