Journal of evaluation in clinical practice
-
Randomized Controlled Trial Clinical Trial
Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial.
Important barriers to the wider implementation of shared decision making (SDM) and risk communication in practice remain. The attitudes of professionals undergoing training in these approaches may inform how to overcome these barriers, but there are few such data yet available. ⋯ Professionals appear receptive to patient involvement, and willing to acquire the relevant skills. SDM and risk communication training did not appear to contribute differentially to this. Practical barriers such as time constraints should probably be addressed with greater priority than the precise content of training or continuing professional development initiatives if 'involvement' is to become a commoner experience for patients in primary care.
-
Information retrieval technology tends to become nothing less than crucial in physician daily practice, notably in family medicine. Nevertheless, few studies examine impacts of this technology and their results appear controversial. ⋯ Findings indicate six types of impact: practice improvement, reassurance, learning, confirmation, recall and frustration. These findings are interpreted in accordance with both a medical and organizational perspective. The fit with the literature on inter-organizational memory supports the transferability of the findings. In turn, this fit suggests how information retrieval technology may change physician routine. This study suggests a new basis for evaluating the impact of information retrieval technology in daily clinical practice. In conclusion, our paper encourages policy-makers to develop, and physicians to use, this technology.
-
The reorganized out-of-hours general practitioner (GP) service, resulting in the creation of out-of-hours cooperatives has been widely welcomed by the medical profession. However, GP satisfaction remains only one aspect of this reorganized service and patients' views and levels of satisfaction must have a contribution to make to the organization and delivery of the service. ⋯ The population should be made fully aware of the services provided by out-of-hours cooperatives to enable them to have realistic expectations. With realistic expectations, patients are more likely to receive the medical contact they request and consequently will be more satisfied with the service provided. High satisfaction level is an important outcome measure of any out-of-hours service as it increases patient confidence and compliance and ultimately clinical outcome.
-
To describe the attitudes, awareness and use of evidence across key professional groups working in primary care. ⋯ While all professional groups welcome and support evidence-based practice, there are clear differences in the starting point and perspectives across the groups. These need to recognized and addressed to ensure that learning the skills of evidence-based practice and implementing evidence are effective. This will also enhance the ability of primary care organizations to develop robust mechanisms for supporting key aspects of clinical governance.
-
Randomized Controlled Trial Clinical Trial
Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence.
Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. ⋯ While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers.