BACKGROUND: Consensus-derived guidelines for hypertension and diabetes management were introduced by the National Department of Health to improve quality of care. However, the incorporation of guidelines into clinical practice is largely dependent on the attitudes of health professionals. OBJECTIVE: To audit the responses and examine the attitudes of health professionals in primary care towards the diabetes and hypertension care guidelines. DESIGN: Qualitative focus group, in-depth discussions and clinic observations. SETTING: Four community health centres (CHCs) in the Western Cape. SUBJECTS: Fifteen doctors and 10 professional nurses. METHODS: The responses of health professionals to the guidelines were audited. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on these themes were conducted at 3 other CHCs. Clinic consultations were observed to validate the responses. RESULTS: The guidelines were not systematically implemented at local CHCs and individual doctors consulted the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines, including the consultation process by which the guidelines were developed, time constraints, scepticism about durability of the guidelines, conflict with local practices, health system problems, and patient beliefs. CONCLUSION: The usefulness of passive dissemination of guidelines to health professionals in primary care should be reviewed as several attitudinal barriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.
BACKGROUND: Consensus-derived guidelines for hypertension and diabetes management were introduced by the National Department of Health to improve quality of care. However, the incorporation of guidelines into clinical practice is largely dependent on the attitudes of health professionals. OBJECTIVE: To audit the responses and examine the attitudes of health professionals in primary care towards the diabetes and hypertension care guidelines. DESIGN: Qualitative focus group, in-depth discussions and clinic observations. SETTING: Four community health centres (CHCs) in the Western Cape. SUBJECTS: Fifteen doctors and 10 professional nurses. METHODS: The responses of health professionals to the guidelines were audited. Their attitudes were evaluated at a single pilot CHC using focus group discussions and in-depth interviews. Semi-structured interviews based on these themes were conducted at 3 other CHCs. Clinic consultations were observed to validate the responses. RESULTS: The guidelines were not systematically implemented at local CHCs and individual doctors consulted the guidelines infrequently. Several themes were identified as barriers to the application of the guidelines, including the consultation process by which the guidelines were developed, time constraints, scepticism about durability of the guidelines, conflict with local practices, health system problems, and patient beliefs. CONCLUSION: The usefulness of passive dissemination of guidelines to health professionals in primary care should be reviewed as several attitudinal barriers to implementation may exist. Guidelines may be adopted more readily if these barriers are addressed.
Authors: Julian T Hertz; Francis M Sakita; Preeti Manavalan; Deng B Madut; Nathan M Thielman; Blandina T Mmbaga; Catherine A Staton; Sophie W Galson Journal: Ethn Dis Date: 2019-10-17 Impact factor: 1.847