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Abstract：
BACKGROUND: Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers.
OBJECTIVE: We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice.
METHODS: We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers.
METHODS: We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia.
METHODS: We recruited general practitioners (15) and practice nurses (20).
METHODS: We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners\' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains.
RESULTS: Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes.
CONCLUSIONS: We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
OBJECTIVE: We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice.
METHODS: We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers.
METHODS: We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia.
METHODS: We recruited general practitioners (15) and practice nurses (20).
METHODS: We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners\' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains.
RESULTS: Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes.
CONCLUSIONS: We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
摘要：
背景：腿部静脉溃疡是澳大利亚初级保健中最常见的慢性伤口问题。尽管这种情况很普遍，下肢静脉性溃疡的诊断和治疗均存在证据与实践的差距.
目的：我们使用理论领域框架来确定初级保健医生在临床实践中实施静脉性腿部溃疡指南时所感知的障碍和促成因素。
方法：我们收集了数据，以探讨执业护士和全科医生在静脉性腿部溃疡管理中使用临床实践指南的相关经验。
方法：我们招募了来自维多利亚州大城市和农村地区的初级医疗机构的参与者，澳大利亚。
方法：我们招募了全科医生（15名）和执业护士（20名）。
方法：我们进行了35次半结构化的面对面和电话访谈。对健康从业者的陈述进行了内容分析，并在理论领域框架理论领域中绘制了实施临床实践指南的障碍。
结果：来自理论领域框架的六个主要领域（环境背景和资源，知识,技能,社会影响,社会/职业角色以及对能力的认同和信念）最好地解释了这些障碍和推动者。许多参与者不知道静脉性腿部溃疡临床实践指南。那些知道的人，指出，寻找和访问指南具有挑战性，大多数参与者依赖于其他信息来源。下肢静脉溃疡的管理受到专业经验和同事建议的极大影响。其他障碍包括繁忙的临床实践，没有手持式多普勒超声检查，技能不足和缺乏信心相关的技术，以排除动脉受累之前的压迫应用，一项与静脉性腿部溃疡管理相关的特殊技能，将影响愈合结果。
结论：我们发现了一些障碍和缺乏因素，这些障碍和因素影响了初级保健中静脉性腿部溃疡临床实践指南的摄取。本文在理论上增加了一个声音，了解和解决行为改变所需的系统方法，以改善静脉性腿部溃疡临床实践指南在临床实践中的翻译。Tweetable摘要：优化静脉腿部溃疡临床实践指南（CPG）的需求从未如此之大，因为目前对健康成本的估计为30亿澳元，并且由于糖尿病和肥胖症的流行而不断增加。我们发现大多数初级保健医生不知道CPG，这将影响澳大利亚初级保健的健康和愈合结果。
目的：我们使用理论领域框架来确定初级保健医生在临床实践中实施静脉性腿部溃疡指南时所感知的障碍和促成因素。
方法：我们收集了数据，以探讨执业护士和全科医生在静脉性腿部溃疡管理中使用临床实践指南的相关经验。
方法：我们招募了来自维多利亚州大城市和农村地区的初级医疗机构的参与者，澳大利亚。
方法：我们招募了全科医生（15名）和执业护士（20名）。
方法：我们进行了35次半结构化的面对面和电话访谈。对健康从业者的陈述进行了内容分析，并在理论领域框架理论领域中绘制了实施临床实践指南的障碍。
结果：来自理论领域框架的六个主要领域（环境背景和资源，知识,技能,社会影响,社会/职业角色以及对能力的认同和信念）最好地解释了这些障碍和推动者。许多参与者不知道静脉性腿部溃疡临床实践指南。那些知道的人，指出，寻找和访问指南具有挑战性，大多数参与者依赖于其他信息来源。下肢静脉溃疡的管理受到专业经验和同事建议的极大影响。其他障碍包括繁忙的临床实践，没有手持式多普勒超声检查，技能不足和缺乏信心相关的技术，以排除动脉受累之前的压迫应用，一项与静脉性腿部溃疡管理相关的特殊技能，将影响愈合结果。
结论：我们发现了一些障碍和缺乏因素，这些障碍和因素影响了初级保健中静脉性腿部溃疡临床实践指南的摄取。本文在理论上增加了一个声音，了解和解决行为改变所需的系统方法，以改善静脉性腿部溃疡临床实践指南在临床实践中的翻译。Tweetable摘要：优化静脉腿部溃疡临床实践指南（CPG）的需求从未如此之大，因为目前对健康成本的估计为30亿澳元，并且由于糖尿病和肥胖症的流行而不断增加。我们发现大多数初级保健医生不知道CPG，这将影响澳大利亚初级保健的健康和愈合结果。
