PMID- 22584032
OWN - NLM
STAT- MEDLINE
DCOM- 20130409
LR  - 20211021
IS  - 1471-2296 (Electronic)
IS  - 1471-2296 (Linking)
VI  - 13
DP  - 2012 May 14
TI  - Qualitative evaluation of a local coronary heart disease treatment pathway: 
      practical implications and theoretical framework.
PG  - 36
LID - 10.1186/1471-2296-13-36 [doi]
AB  - BACKGROUND: Coronary heart disease (CHD) is a common medical problem in general 
      practice. Due to its chronic character, shared care of the patient between 
      general practitioner (GP) and cardiologist (C) is required. In order to improve 
      the cooperation between both medical specialists for patients with CHD, a local 
      treatment pathway was developed. The objective of this study was first to 
      evaluate GPs' opinions regarding the pathway and its practical implications, and 
      secondly to suggest a theoretical framework of the findings by feeding the 
      identified key factors influencing the pathway implementation into a 
      multi-dimensional model. METHODS: The evaluation of the pathway was conducted in 
      a qualitative design on a sample of 12 pathway developers (8 GPs and 4 
      cardiologists) and 4 pathway users (GPs). Face-to face interviews, which were 
      aligned with previously conducted studies of the department and assumptions of 
      the theory of planned behaviour (TPB), were performed following a semi-structured 
      interview guideline. These were audio-taped, transcribed verbatim, coded, and 
      analyzed according to the standards of qualitative content analysis. RESULTS: We 
      identified 10 frequently mentioned key factors having an impact on the 
      implementation success of the CHD treatment pathway. We thereby differentiated 
      between pathway related (pathway content, effort, individual flexibility, 
      ownership), behaviour related (previous behaviour, support), interaction related 
      (patient, shared care/colleagues), and system related factors (context, health 
      care system). The overall evaluation of the CHD pathway was positive, but did not 
      automatically lead to a change of clinical behaviour as some GPs felt to have 
      already acted as the pathway recommends. CONCLUSIONS: By providing an account of 
      our experience creating and implementing an intersectoral care pathway for CHD, 
      this study contributes to our knowledge of factors that may influence physicians' 
      decisions regarding the use of a local treatment pathway. An improved adaptation 
      of the pathway in daily practice might be best achieved by a combined 
      implementation strategy addressing internal and external factors. A simple, 
      direct adaptation regards the design of the pathway material (e.g. layout, PC 
      version), or the embedding of the pathway in another programme, like a Disease 
      Management Programme (DMP). In addition to these practical implications, we 
      propose a theoretical framework to understand the key factors' influence on the 
      pathway implementation, with the identified factors along the microlevel (pathway 
      related factors), the mesolevel (interaction related factors), and system- 
      related factors along the macrolevel.
FAU - Kramer, Lena
AU  - Kramer L
AD  - Department of General Practice/Family Medicine, University of Marburg, 
      Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany. 
      lena.kramer@staff.uni-marburg.de
FAU - Schlossler, Kathrin
AU  - Schlossler K
FAU - Trager, Susanne
AU  - Trager S
FAU - Donner-Banzhoff, Norbert
AU  - Donner-Banzhoff N
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120514
PL  - England
TA  - BMC Fam Pract
JT  - BMC family practice
JID - 100967792
SB  - IM
MH  - Adult
MH  - Aged
MH  - Clinical Competence
MH  - Computers, Handheld
MH  - Coronary Disease/*therapy
MH  - *Critical Pathways
MH  - Female
MH  - Germany
MH  - Group Practice/statistics & numerical data
MH  - Guideline Adherence
MH  - Humans
MH  - Interviews as Topic
MH  - Male
MH  - Middle Aged
MH  - Models, Theoretical
MH  - Monitoring, Ambulatory
MH  - Physicians, Family/*psychology/statistics & numerical data
MH  - Private Practice/statistics & numerical data
MH  - Professional Practice Location/statistics & numerical data
MH  - Qualitative Research
PMC - PMC3489869
EDAT- 2012/05/16 06:00
MHDA- 2013/04/10 06:00
PMCR- 2012/05/14
CRDT- 2012/05/16 06:00
PHST- 2011/11/24 00:00 [received]
PHST- 2012/04/24 00:00 [accepted]
PHST- 2012/05/16 06:00 [entrez]
PHST- 2012/05/16 06:00 [pubmed]
PHST- 2013/04/10 06:00 [medline]
PHST- 2012/05/14 00:00 [pmc-release]
AID - 1471-2296-13-36 [pii]
AID - 10.1186/1471-2296-13-36 [doi]
PST - epublish
SO  - BMC Fam Pract. 2012 May 14;13:36. doi: 10.1186/1471-2296-13-36.