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P300 Theory-Informed Tailored Implementation Of Guidelines In Swedish Primary Care Physiotherapy: Development Of A Strategy
  1. S Bernhardsson1,2,
  2. K Johansson2,
  3. P Nilsen3,
  4. B Öberg2,
  5. M Larsson1,4
  1. 1Region Västra Götaland, Primary Care, Gothenburg, Sweden
  2. 2Linköping University, Department of Medical & Health Sciences, Div of Physiotherapy, Linköping, Sweden
  3. 3Linköping University, Department of Medical & Health Sciences, Div of Healthcare, Linköping, Sweden
  4. 4Sahlgrenska Academy at Gothenburg University, Inst of Neuroscience & Physiology, Gothenburg, Sweden

Abstract

Background There is little knowledge about effective guideline implementation strategies in primary care physiotherapy. The use of theory for the development of implementation strategies is advocated by some, a pragmatic approach by others.

Objectives To adapt a theoretical model to Swedish primary care physiotherapy using a pragmatic approach, to identify barriers and facilitators for the use of guidelines in physiotherapy, and to tailor an intervention to address these.

Methods We searched the literature for evidence of effectiveness of implementation strategies. We analysed various implementation theories and selected the Grol 5-step model to guide our implementation process. We adapted the model to the context in which we wanted to introduce the guidelines. We identified barriers and facilitators and possible intervention components to address these via a survey and a literature review.

Results The adaptation and addressing the identified barriers and facilitators resulted in a tailored, evidence-based, theory-informed implementation strategy. The most important barriers identified were lack of time, low awareness, knowledge, and access to guidelines. An active, multifaceted implementation intervention was developed. The main implementation activity was a seminar with group discussions. Other components were a website, email reminders, email support, and patient information leaflets.

Discussion Using a model to systematically develop a strategy and a pragmatic approach to adapt it to the context in which it was to be implemented, helped to identify barriers and facilitators and to tailor an implementation intervention to Swedish primary care physiotherapy.

Implications for Guideline Developers/Implementers A theory-informed but pragmatic approach can be recommended.

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