Main barriers to effective implementation of stroke care pathways in France: a qualitative study
-
Published:2014-02-28
Issue:1
Volume:14
Page:
-
ISSN:1472-6963
-
Container-title:BMC Health Services Research
-
language:en
-
Short-container-title:BMC Health Serv Res
Author:
Gache Kristel,Leleu Henri,Nitenberg Gérard,Woimant France,Ferrua Marie,Minvielle Etienne
Abstract
Abstract
Background
Stroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.
Methods
We selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.
Results
Four main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.
Conclusion
Lack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.
Publisher
Springer Science and Business Media LLC
Reference65 articles.
1. Donnan GA, Fisher M, Macleod M, Davis SM: Stroke. Lancet. 2008, 371: 1612-1623. 10.1016/S0140-6736(08)60694-7. 2. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009, 8: 355-369. 10.1016/S1474-4422(09)70025-0. 3. Zhang Y, Chapman AM, Plested M, Jackson D, Purroy F: The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US: A Literature Review. Stroke Res Treat. 2012, 436125-doi: 10.1155/2012/436125. Epub 2012 Mar 1 4. Bejot Y, Benatru I, Rouaud O, Fromont A, Besancenot JP, Moreau T, Giroud M: Epidemiology of stroke in Europe: geographic and environmental differences. J Neurol Sci. 2007, 262: 85-88. 10.1016/j.jns.2007.06.025. 5. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al: Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011, 123: e18-e209. 10.1161/CIR.0b013e3182009701.
Cited by
25 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|