Format

Send to

Choose Destination
J Eval Clin Pract. 2017 Feb;23(1):165-172. doi: 10.1111/jep.12660. Epub 2016 Nov 14.

Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective.

Author information

1
Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000, Leuven, Belgium.
2
Watertorenlaan 2, 1930, Zaventem, Belgium.
3
Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
4
Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium.
5
IQ Healthcare, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

Abstract

RATIONALE, AIMS AND OBJECTIVES:

Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.

METHODS:

Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software.

RESULTS:

In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers.

CONCLUSIONS:

Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.

KEYWORDS:

decision making; facilitators; implementation; knee osteoarthritis; nonadherence; qualitative research

PMID:
27859970
DOI:
10.1111/jep.12660
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center