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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs’ and radiologists’ perspectives

Authors: Ann Mari Gransjøen, Siri Wiig, Kristin Bakke Lysdahl, Bjørn Morten Hofmann

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.

Methods

Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.

Results

Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.

Conclusion

There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.
Appendix
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Literature
1.
Saxebøl GOHM. Strålebruk i Norge - Nyttig bruk og godt strålevern for samfunn, menneske og miljø. In: nrpa.no: Statens Strålevern; 2014.
2.
Pérez I, Guillén F, editors. Unnecessary radiology in primary care. Anales del sistema sanitario de Navarra. 2006;30(1):53–60.
3.
Dammas S, Patz EF, Goodman PC. Identification of small lung nodules at autopsy: implications for lung cancer screening and overdiagnosis bias. Lung Cancer. 2001;33(1):11–6.CrossRefPubMed
4.
Oikarinen H, Karttunen A, Pääkkö E, Tervonen O. Survey of inappropriate use of magnetic resonance imaging. Insights into imaging. 2013;4(5):729–33.CrossRefPubMedPubMedCentral
5.
Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am Coll Radiol. 2010;7(3):192–7.CrossRefPubMed
6.
Kennedy SA, Fung W, Malik A, Farrokhyar F, Midia M. Effect of governmental intervention on appropriateness of lumbar MRI referrals: a Canadian experience. J Am Coll Radiol. 2014;11(8):802–7.CrossRefPubMed
7.
Tahvonen P, Oikarinen H, Niinimäki J, Liukkonen E, Mattila S, Tervonen O. Justification and active guideline implementation for spine radiography referrals in primary care. Acta Radiol. 2017;58(5):586–92.CrossRefPubMed
8.
Malone J, Guleria R, Craven C, Horton P, Järvinen H, Mayo J, et al. Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency consultation. Br J Radiol 2014; 85(1013): 523–538.
9.
Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS. Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci. 2009;4(1):54.CrossRefPubMedPubMedCentral
10.
Schectman JM, Schroth WS, Verme D, Voss JD. Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain. J Gen Intern Med. 2003;18(10):773–80.CrossRefPubMedPubMedCentral
11.
Wilson IB, Dukes K, Greenfield S, Kaplan S, Hillman B. Patients' role in the use of radiology testing for common office practice complaints. Arch Intern Med. 2001;161(2):256–63.CrossRefPubMed
12.
13.
Barth JH, Misra S, Aakre KM, Langlois MR, Watine J, Twomey PJ, et al. Why are clinical practice guidelines not followed? Clinical Chemistry and Laboratory Medicine (CCLM) 2016;54(7):1133–1139.
14.
15.
Berg AO, Atkins D, Tierney W. Clinical practice guidelines in practice and education. J Gen Intern Med. 1997;12(s2):25–33.CrossRef
16.
Thompson RS, Kirz HL, Gold RA. Changes in physician behavior and cost savings associated with organizational recommendations on the use of “routine” chest X rays and multichannel blood tests. Prev Med. 1983;12(3):385–96.CrossRefPubMed
17.
Oakeshott P, Kerry SM, Williams JE. Randomized controlled trial of the effect of the Royal College of Radiologists' guidelines on general practitioners' referrals for radiographic examination. Br J Gen Pract. 1994;44(382):197–200.PubMedPubMedCentral
18.
Cobo ME, Vicente A, Corres J, Royuela A, Zamora J. Implementing a guideline for the request of chest and abdominal x-rays in nontrauma pathologic conditions in an ED. Am J Emerg Med. 2009;27(1):76–83.CrossRefPubMed
19.
Fowkes F, Williams L, Cooke B, Evans R, Gehlbach S, Roberts C. Implementation of guidelines for the use of skull radiographs in patients with head INTURIES. Lancet. 1984;324(8406):795–7.CrossRef
20.
Kerry S, Oakeshott P, Dundas D, Williams J. Influence of postal distribution of the Royal College of Radiologists' guidelines, together with feedback on radiological referral rates, on X-ray referrals from general practice: a randomized controlled trial. Fam Pract. 2000;17(1):46–52.CrossRefPubMed
21.
Bussières AE, Sales AE, Ramsay T, Hilles SM, Grimshaw JM. Impact of imaging guidelines on X-ray use among American provider network chiropractors: interrupted time series analysis. Spine J. 2014;14(8):1501–9.CrossRefPubMed
22.
Dowie R. A review of research in the United Kingdom to evaluate the implementation of clinical guidelines in general practice. Fam Pract. 1998;15(5):462–70.CrossRefPubMed
23.
Bussières AE, Patey AM, Francis JJ, Sales AE, Grimshaw JM. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains 2012; 7(1):82.
24.
Clement CM, Stiell IG, Lowe MA, Brehaut JC, Calder LA, Vaillancourt C, et al. Facilitators and barriers to application of the Canadian C-spine rule by emergency department triage nurses. International emergency nursing 2016;27:24–30.
25.
Bessen T, Clark R, Shakib S, Hughes G. A Multifaceted Strategy for Implementation of the Ottawa Ankles Rules in Two Emergency Departments. BMJ Group. 2009;b3056:339.
26.
Guiberteau MJ, Wilcox PA, Bjork S. Practice guidelines: the radiology perspective. J Am Coll Radiol. 2004;1(2):92–7.CrossRefPubMed
27.
Helsedirektoratet. Nasjonal faglig retningslinje for bildediagnostikk ved ikke-traumatiske muskel-og skjelettlidelser - Anbefalinger for primærhelsetjenesten. Helsedirektoratet.no: Helsedirektoratet; 2014.
28.
29.
Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, et al. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013;56(11):1669–86.
30.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.CrossRefPubMedPubMedCentral
31.
Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scandinavian journal of public health. 2012;40(8):795–805.CrossRefPubMed
32.
Ekeland T-J. Evidenstyranniet. Dagens medisin, Kronikk. 2007;2007:21.
33.
Grove A, Clarke A, Currie G. The barriers and facilitators to the implementation of clinical guidance in elective orthopaedic surgery: a qualitative study protocol. Implement Sci. 2015;10(1):81.CrossRefPubMedPubMedCentral
34.
Lau L. National, regional and global radiology and medical imaging referral guidelines: issues and opportunities. In: Radiological safety and quality. Springer; 2014. p. 105–22.
35.
Espeland A, Baerheim A. Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers–a qualitative study. BMC Health Serv Res. 2003;3(1):8.CrossRefPubMedPubMedCentral
36.
Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, et al. Addressing overutilization in medical imaging 1. Radiology 2010;257(1):240–245.
37.
Love TE, Ehrenberg N. Addressing unwarranted variation: literature review on methods for influencing practice. Health Quality & Safety Commision New Zealand. 2014;
38.
Saini V, Garcia-Armesto S, Klemperer D, Paris V, Elshaug AG, Brownlee S, et al. Drivers of poor medical care. Lancet 2017; 390 (100090):178–190.
Metadata
Title
Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs’ and radiologists’ perspectives
Authors
Ann Mari Gransjøen
Siri Wiig
Kristin Bakke Lysdahl
Bjørn Morten Hofmann
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3372-7

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