Local clinical pathways: from ‘good ideas’ to ‘practicality’ for general practitioners
Anel Reyneke 1 , Chrystal Jaye 1 , Tim Stokes 11 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Correspondence to: Anel Reyneke, Papamoa Pines Medical Centre, 53 Domain Road, Papamoa, 3118, New Zealand. Email: anelreyneke@live.com
Journal of Primary Health Care 10(3) 215-223 https://doi.org/10.1071/HC18023
Published: 5 September 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: There has been increased interest in the utility of clinical pathways by primary health care in New Zealand, although evaluation of their use has been limited.
AIM: To identify barriers and facilitators for the use of clinical pathways in one health region.
METHODS: Interviews with 15 general practitioners in the Western Bay of Plenty. A qualitative thematic analysis was undertaken, informed by the Diffusion of Innovation Framework.
RESULTS: Four themes were identified: learning to use the pathways, persuasion and decision to use, implementation and sustainability. Barriers to using the pathways included time pressure; scepticism; difficulty in portraying patients’ clinical picture within a set pathway; technical difficulties and lack of support in obtaining knowledge; and practical implementation of the pathways in daily work. Facilitators included endorsement by opinion leaders; pathways directing workup and treatment stepwise towards referral; centralised information with resources available in the consultation; and reported increased acceptance of referrals by secondary care if pathways were used.
DISCUSSION: The development and implementation of health care initiatives requires an understanding of the local context. Knowledge about the specific, locally appreciated barriers and facilitators can inform future health-care developments. The Diffusion of Innovation Framework offers a practical model to understand effective implementation.
KEYWORDS: clinical pathways; general practice; diffusion of innovation; barriers; facilitators
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