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标题：Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study
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作者：Frank Peters-Klimm ; Iris Natanzon ; Thomas Müller-Tasch 等
期刊名称：GMS Zeitschrift für Medizinische Ausbildung
印刷版ISSN：1860-3572
出版年度：2012
卷号：29
页码：1-17
DOI：10.3205/zma000816
出版社：German Medical Science
摘要：Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice.The implementation of heart failure (HF) CPGs represents a challenge in general practice.As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care. Methods: We conducted a modified focus group with elements of a workshop of three hours duration.Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation.Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF.The content of the discussions was analysed qualitatively according to Mayring and categorised thematically. Results: Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g.time management) and attitude (dissatisfaction with time-money-relation).Patients: individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs).Doctor and patient: Adherence and barriers of communication.Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education. Conclusion: For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary.It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related.Additional elements should include support in the implementation of organisational processes in the practice and patient education.
关键词：heart failure; family practice; clinical practice guidelines; qualitative research; continuing medical education