Attitudes of Palestinian Health-Care Professionals in Gaza to Clinical Practice Guideline for Diagnosis and Treatment of Diabetes Mellitus

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2017 Nov 23

PMID 29163359

Citations 5

Authors

Mahmoud Radwan

Ali Akbari Sari

Arash Rashidian

Amirhossein Takian

Sanaa Abou-Dagga

Aymen Elsous

Affiliations

Soon will be listed here.

Abstract

Background: Despite the huge numbers of the internationally produced and implemented Clinical Practice Guidelines (CPGs), the compliance with them is still low in health care. This study aimed at assessing the attitudes of Palestinian health-care professionals toward the most perceived factors influencing the adherence to the CPG for Diabetes Mellitus in the Primary Health-care centers of the Ministry of Health (PHC-MoH) and the Primary Health-care centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) using a validated questionnaire.

Methods: A cross-sectional design was employed with a census sample of all Palestinian family doctors and nurses ( = 323). The Cabana theoretical framework was used to develop a study questionnaire. A cross cultural adaptation framework was followed to develop the Arabic version questionnaire. The psychometric properties of Arabic version were finally assessed.

Results: The Arabic version questionnaire showed a good construct validity and internal consistency reliability. The overall adherence level to the diabetic guideline was disappointingly suboptimal 51.5% (47.3% in the PHC-MoH and 55.5% in the PHC-UNRWA) = 0.000. The most frequently perceived barriers in the PHC-MoH were lack of incentives, lack of resources, and lack of guideline trustworthiness, whereas the lack of time and the lack of guideline trustworthiness were the most prominent barriers in the PHC-UNRWA. In spite of the lack of trustworthiness of the diabetic guideline, most respondents in both settings had a positive attitude toward guidelines in general, but this attitude was not a predictor of guideline adherence.

Conclusion: The good validity and reliability of our questionnaire can provide support for the accuracy of our findings. Multifaceted implementation strategies targeting the main barriers elicited from this study are required for addressing the lack of incentives, organizational resources, lack of confidence in the guideline, and time constraints.

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References

Cabana M, Rand C, Powe N, Wu A, Wilson M, Abboud P . Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282(15):1458-65. DOI: 10.1001/jama.282.15.1458. View

Chimeddamba O, Peeters A, Ayton D, Tumenjargal E, Sodov S, Joyce C . Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences. Implement Sci. 2015; 10:112. PMC: 4531849. DOI: 10.1186/s13012-015-0307-0. View

Birrenbach T, Kraehenmann S, Perrig M, Berendonk C, Huwendiek S . Physicians' attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians. Adv Med Educ Pract. 2016; 7:673-680. PMC: 5167524. DOI: 10.2147/AMEP.S115149. View

Mounesan L, Nedjat S, Majdzadeh R, Rashidian A, Gholami J . Only One Third of Tehran's Physicians are Familiar with 'Evidence-Based Clinical Guidelines'. Int J Prev Med. 2013; 4(3):349-57. PMC: 3634175. View

Lugtenberg M, Burgers J, Westert G . Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Health Care. 2009; 18(5):385-92. DOI: 10.1136/qshc.2008.028043. View

Huang J, Yin S, Lin Y, Jiang Q, He Y, Du L . Impact of pay-for-performance on management of diabetes: a systematic review. J Evid Based Med. 2013; 6(3):173-84. DOI: 10.1111/jebm.12052. View

Mulley A . Inconvenient truths about supplier induced demand and unwarranted variation in medical practice. BMJ. 2009; 339:b4073. DOI: 10.1136/bmj.b4073. View

Lugtenberg M, Zegers-van Schaick J, Westert G, Burgers J . Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci. 2009; 4:54. PMC: 2734568. DOI: 10.1186/1748-5908-4-54. View

Raaijmakers L, Martens M, Bagchus C, De Vries N, Kremers S . Perceptions of Dutch health care professionals regarding the Care Standard for diabetes. BMC Res Notes. 2013; 6:417. PMC: 4015353. DOI: 10.1186/1756-0500-6-417. View

10.

Ratsep A, Kalda R, Oja I, Lember M . Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: cross-sectional study. BMC Fam Pract. 2006; 7:36. PMC: 1513575. DOI: 10.1186/1471-2296-7-36. View

11.

Husseini A, Abu-Rmeileh N, Mikki N, Ramahi T, Ghosh H, Barghuthi N . Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory. Lancet. 2009; 373(9668):1041-9. DOI: 10.1016/S0140-6736(09)60109-4. View

12.

McGlynn E, Asch S, Adams J, Keesey J, Hicks J, DeCristofaro A . The quality of health care delivered to adults in the United States. N Engl J Med. 2003; 348(26):2635-45. DOI: 10.1056/NEJMsa022615. View

13.

Grimshaw J, Thomas R, MacLennan G, Fraser C, Ramsay C, Vale L . Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004; 8(6):iii-iv, 1-72. DOI: 10.3310/hta8060. View

14.

Widyahening I, van der Graaf Y, Soewondo P, Glasziou P, van der Heijden G . Awareness, agreement, adoption and adherence to type 2 diabetes mellitus guidelines: a survey of Indonesian primary care physicians. BMC Fam Pract. 2014; 15:72. PMC: 4000317. DOI: 10.1186/1471-2296-15-72. View

15.

Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N . Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005; 58(2):107-12. DOI: 10.1016/j.jclinepi.2004.09.002. View

16.

Joosen M, van Beurden K, Terluin B, van Weeghel J, Brouwers E, van der Klink J . Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. BMC Med Educ. 2015; 15:82. PMC: 4469464. DOI: 10.1186/s12909-015-0364-8. View

17.

Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C . The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Prev Med. 2003; 36(3):291-9. DOI: 10.1016/s0091-7435(02)00052-x. View

18.

Goderis G, Borgermans L, Mathieu C, Van Den Broeke C, Hannes K, Heyrman J . Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program. Implement Sci. 2009; 4:41. PMC: 2719589. DOI: 10.1186/1748-5908-4-41. View

19.

Dijkstra R, Braspenning J, Uiters E, van Ballegooie E, Grol R . Perceived barriers to the implementation of diabetes guidelines in hospitals in The Netherlands. Neth J Med. 2000; 56(3):80-5. DOI: 10.1016/s0300-2977(99)00123-0. View

20.

Donnellan C, Sweetman S, Shelley E . Implementing clinical guidelines in stroke: a qualitative study of perceived facilitators and barriers. Health Policy. 2013; 111(3):234-44. DOI: 10.1016/j.healthpol.2013.04.002. View