Barriers to and facilitators for the use of an evidence-based occupational therapy guideline for older people with dementia and their carers.
SourceInternational Journal of Geriatric Psychiatry, 27, 7, (2012), pp. 742-8
01 juli 2012
Article / Letter to editor
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Primary and Community Care
International Journal of Geriatric Psychiatry
SubjectDCN PAC - Perception action and control NCEBP 11: Alzheimer Centre; NCEBP 10: Human Movement & Fatigue DCN PAC - Perception action and control; NCEBP 11: Alzheimer Centre; NCEBP 4: Quality of hospital and integrated care; NCEBP 7: Effective primary care and public health; NCEBP 7: Effective primary care and public health ONCOL 5: Aetiology, screening and detection
OBJECTIVE: Implementing evidence-based guidelines is not a simple task. This study aimed to define barriers to and facilitators for implementing the proven and effective Community Occupational Therapy in Dementia (COTiD) guideline for older people with dementia and their carers. METHODS: The qualitative method we used was the grounded theory. We collected data from focus group interviews with 17 occupational therapists (OTs) and telephone interviews with 10 physicians and 4 managers. We analysed the data with the constant comparative method by identifying codes, categories, and main themes. RESULTS: The main themes in barriers that OTs encountered were that they did not feel competent in treating older people with dementia at home according to the guideline; they had difficulties prioritising in this complex treatment, both for the client and themselves; and they were unsure about the minimal criteria for guideline adherence. The intensity of this programme was the main barrier. The barriers that confronted physicians and managers were lack of knowledge about occupational therapy and its reimbursement and lack of available trained OTs. For the OTs, the guideline's content and focus, evidence, and external support facilitated the use of the guideline. For physicians and managers, the guideline's evidence base and its benefits for clients and carers were the main facilitators. CONCLUSIONS: This study generates knowledge for applying innovations in health care settings. Improvement of the OTs' knowledge and self-confidence is needed for using the guideline. We expect that more competent OTs will motivate their physicians and managers to use this successful COTiD intervention. Copyright (c) 2011 John Wiley & Sons, Ltd.
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