Volume 10, Number 3—March 2004
Dispatch
Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands
Peter G.M. Mol*†
, Willem J.M.J. Rutten†, Rijk O.B. Gans†, John E. Degener†, and Flora M. Haaijer-Ruskamp*
, Willem J.M.J. Rutten†, Rijk O.B. Gans†, John E. Degener†, and Flora M. Haaijer-Ruskamp*
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) |
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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