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Volume 10, Number 3—March 2004

Dispatch

Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands

Peter G.M. Mol*†Comments to Author , Willem J.M.J. Rutten†, Rijk O.B. Gans†, John E. Degener†, and Flora M. Haaijer-Ruskamp*
Author affiliations: *University of Groningen, Groningen, the Netherlands; †University Hospital Groningen, Groningen, the Netherlands

Main Article

Table 2

Barriers and proposed interventions

Barriers identified Proposed interventions
Guideline
1. Dissemination
2. Credibility of content
1. Develop and actively distribute hard-copy and electronic version
2. Incorporate departmental policies, and update regularly
− For both 1 and 2, organize meetings to introduce guidelines and set up an active outreach committee
Physician
Readiness to change or use the guideline
Supervising specialists
3. No need for a guideline, because
     − Routine prescribing
     − No perceived resistance problems
4. Autonomy
3. A combination of group and individual feedback (“academic detailing”) to supervisors and residents
4. Incorporate specialists/departmental views in guideline (see 2, above)
Residents
5. Insufficient knowledge
     − Of culture results
     − Low self-efficacy regarding streamlining
5. Active educational support on interpretation of culture-results and for streamlining therapy
Infectious disease consultants
6. Overestimate the feasibility of an intervention
6. Check support before implementation of an intervention
Social and institutional context 7. Residents are not independent decision makers and their prescribing decisions are supervised by specialists
8. Infectious disease consultant secondary to supervisor
9. Different guidelines between departments 7. Target both residents and supervising specialists
8. Target supervisor, formalize advice of consultants
9. Incorporate departmental policies (see 2 and 5, above)

Main Article

1A paper “critical-pathway” combines an antimicrobial drug order form with a decision support tool. Filling out a few relevant case-characteristics guides the prescriber to the guideline’s recommendation for that specific case.

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