• Nancy D Sharp, Sandra L Pineros, Clarissa Hsu, Helene Starks, and Anne E Sales.
• VA Puget Sound Health Care System and Department of Health Services, University of Washington, Seattle 98108, USA. Nancy.Sharp@med.va.gov
• Worldviews Evid Based Nurs. 2004 Jan 1;1(2):129-39.

ObjectiveTo identify barriers and facilitators to implementation of pilot interventions designed to improve measurement and management of low-density lipoprotein cholesterol (LDL-c) levels in coronary heart disease patients using the evidence/context/facilitation model of implementation of evidence-based practice.DesignTheory-based conceptual content analysis of structured interviews conducted between January and April 2001.SettingSix medical centers in the United States Veterans Health Administration Northwest Network.ParticipantsFifty-one of 64 individuals (physicians, nurses, pharmacists, dieticians, quality managers, and other clinical and nonclinical staff) who participated in planning and/or implementing pilot interventions.Main FindingsBarriers to successful implementation related primarily to the intervention process and secondarily to characteristics of the intervention context. Interview responses indicated that planning, including identification of resources and assessment of potential barriers and facilitators, was a critical and universally underutilized step in the intervention process.ConclusionsOrganized team process, documented plans for intervention activities, and ongoing evaluation are essential for sustaining intervention activities. A top priority for facilitating interventions should be the development of educational materials, such as "how to" guides, that teach intervention teams how to anticipate barriers and make plans to address them, as well as identifying and fostering local experts in planning and implementing interventions.

36 keywords...

hide…