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Diabetes Res Clin Pract. 2018 Jun;140:314-323. doi: 10.1016/j.diabres.2018.02.041. Epub 2018 Apr 4.

Impact of the Canadian Diabetes Association guideline dissemination strategy on clinician knowledge and behaviour change outcomes.

Author information

1
Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto M5B 1W8, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Electronic address: yuca@smh.ca.
2
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada. Electronic address: LillieE@smh.ca.
3
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada. Electronic address: MascarenhasA@smh.ca.
4
Canadian Diabetes Association, Toronto, Canada. Electronic address: Carolyn.gallcasey@diabetes.ca.
5
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto M5B 1W8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Diabetes Association, Toronto, Canada; Knowledge Translation Program, St. Michael's Hospital, Toronto M5B 1W8, Canada; Division of Geriatric Medicine, University of Toronto, Toronto, Canada; Department of Health Policy Management and Evaluation, University of Toronto, Canada. Electronic address: Sharon.straus@utoronto.ca.

Abstract

AIM:

Implementation of clinical practice guideline (CPG) into clinical practice remains limited. Using the Knowledge-To-Action framework, a guideline dissemination and implementation strategy for the Canadian Diabetes Association's 2013 CPG was developed and launched to clinicians and people with diabetes.

METHODS:

The RE-AIM framework guided evaluation of this strategy clinician; we report here one aspect of the effectiveness dimension using mixed methods. We measured impact of the strategy on clinican knowledge and behaviour change constructs using evaluation forms, national online survey and individual interviews.

RESULTS:

After attending a lecture, clinician confidence (n = 915) increased (3.7(SD 0.7) to 4.5 (SD 0.6) on a 5-point scale (p < 0.001)), with 55% (n = 505) intending to make a practice change (e.g. clinical management regarding glycemic control). Ninety-four percent of survey respondents (n = 907) were aware of the guidelines, attributed to communications from professional associations, continuing professional development events, and colleagues. Forty to 98% of respondents (total n 462-485) were correct in their interpretation of CPG messages, and 33-65%(total n 351-651) reported that they had made changes to their practice. Interviews with 28 clinicians revealed that organizational credibility, online access to tools, clarity of tool content, and education sessions facilitated uptake; lack of time, team-based consensus, and seamless integration into care and patient complexity were barriers.

CONCLUSION:

The complexity of diabetes care requires systemic adoption of organization of care interventions, including interprofessional collaboration and consensus. Augmenting our strategy to include scalable models for professional development, integration of guidelines into electronic medical records, and expansion of our target audience to include health care teams and patients, may optimize guideline uptake.

KEYWORDS:

Continuing professional development; Guideline; Implementation Diabetes mellitus; Information dissemination; Qualitative research; RE-AIM framework

PMID:
29626591
DOI:
10.1016/j.diabres.2018.02.041
[Indexed for MEDLINE]

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