Opinión de los fisioterapeutas sobre los factores que influyen en el uso de los protocolos. Estudio cualitativo

[Achievement of technological and scientific capacity in Physical Therapy services of Bucaramanga and Floridablanca]

Objective To identify the achievement of the condition of technological and scientific capacity of a sample of physical therapy and respiratory services from the urban area of Floridablanca and Bucaramanga. Methodology A descriptive study was performed with a set of samples not based on probabilities out of convenience. The sample consisted of four health service provider institutions in the town of Floridablanca and three institutions from the urban area of Bucaramanga. During the year 2011, two check lists were applied in order to verify the fulfillment of standards of habilitation and to find the reasons for their non-compliance in some of their requisites. Results Three institutions in Floridablanca belong to the first level of care and one to the second level of care; the standards with the lowest fulfillments are: Risk follow-up with a median fulfillment score of 0 (Range: 0-12); Medical Records of care with a median of 9.5 (Range: 0-100) and the standard of priority procedures with a median of 18 (Range: 9-27). In Bucaramanga, two institutions belong to the second level of care and one to the third level of care. The lowest standards in fulfillment were: Medications and devices with zero for one institution, Priority procedures with a median of 60 (Range: 0-89) and physical installations with a median of 73 (Range: 64-84). Conclusions The results show a non-compliance with the essential requisites of habilitation even though these are demanded by the territorial organizations in each health department, district, and municipality.

A qualitative application of the diffusion of innovations theory to examine determinants of guideline adherence among physical therapists

BACKGROUND

Evidence-based practice has become a major issue in physical therapy. Many evidence-based guidelines, however, are not used extensively after dissemination, and interventions aimed at increasing guideline adherence often have limited effects.

OBJECTIVE

As a prerequisite for changing this situation, the aims of this study were to gain an in-depth understanding of the determinants of guideline adherence among physical therapists in the Netherlands and to evaluate the opportunities of a theoretical framework in this respect.

DESIGN AND METHODS

This observational study consisted of 3 focus group interviews (n=12, 10, and 8) between November 2002 and January 2003. Physical therapists were asked to discuss their opinions about and experiences with the Dutch guidelines for low back pain. Data were analyzed qualitatively using a directed approach to content analysis. Both the interview route and the analysis of the interviews were informed by Rogers' Diffusion of Innovations Theory.

RESULTS

Our study yielded in-depth insights into the various determinants of guideline adherence. Overall, the participants had rather unfavorable opinions about issues related to the dissemination of the guidelines (first phase of the diffusion process) and provided relatively little information on the subsequent adoption process (second phase of the diffusion process). The theoretical framework appeared to be a useful tool to properly structure the focus group interviews, to systematically analyze the data collected, and to determine that supplementary interviews would be necessary to cover the entire diffusion process.

CONCLUSIONS

Our findings indicated that the diffusion process of guidelines among physical therapists was not yet completed. The use of theory can provide added value to guideline implementation studies.