Paper
Friday, July 23, 2004
10:00 AM - 10:30 AM
Friday, July 23, 2004
3:00 PM - 3:30 PM
Collaborative Approach To Delivering Clinical Preventive Services: A Three-Phase Developmental Study
Hurdis M. Griffith, PhD, RN, FAAN and Cynthia Guerrero-Ayres, PhD, RN. Rutgers, College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
Objective(s): Three-phase study was conducted with overall objective to develop consistent approach to increase delivery of clinical preventive services (CPS). Phase 1. Reach agreement among NJ HPs on consistent set of CPS guidelines. Phase 2. Identify facilitators and barriers to guideline implementation. Phase 3. Evaluate clinicians' knowledge and use of CPS guidelines before and after receiving health plan consensus guidelines (HPCG). Design: Phase 1. Quasi-experimental pretest-posttest design. Phase 2. Descriptive study. Phase 3. Within subjects, repeated measures design. Sample, Population, Setting, Years: Phase 1. Nine NJ HP Medical Directors. Phase 2. Three focus groups consisting of clinicians (N=29) that deliver CPS. Phase 3. All NJ nurse practitioners and physicians providing preventive services. Intervention and Outcome Variable(s): Phase 1. Expected outcome was consensus on priority guidelines. Phase 2. Expected outcome was identification of facilitators and barriers to guideline implementation. Phase 3. Expected outcome was improvement in clinicians' knowledge and use of CPS guidelines between time prior to receiving HPCG and after. Methods: Phase 1. Delphi Method used to reach consensus on CPS guidelines. Interventions included consultation of experts and feedback of group ratings from initial surveys. Phase 2. Three focus groups used to identify facilitators and barriers. Phase 3. Clinicians were sent two questionnaires three months apart, assessing knowledge and use of CPS guidelines. Findings: Phase 1. Eighteen CPS priority guidelines identified. Phase 2. Themes revealed barriers and facilitators regarding cost and reimbursement, time constraints, inconsistency among HPs tools, tracking issues, internalization of guidelines, and issues affecting the patient-clinician relationship. Phase 3. HPCG significantly improved clinician delivery of CPS. Conclusions: Study provides approach for HPs nationwide to reach consensus on guidelines that support clinicians in delivery of CPS. Implications: This approach provides clinicians, including nurses, with organizational support to access and synthesize the best evidence to deliver preventive services in practice.
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Sigma Theta Tau International
July 22-24, 2004