Building adherence to clinical practices has to be preceded by a thorough assessment of existing barriers/obstacles, prior to conceiving interventions/policies for change. After doing your gaps in care analysis (including both the evaluation of practice and the thorough assessment of barriers/obstacles), you can now decided, with your team, what are the specific targets that you would like to work on.

• For each gap in care, you have to discuss the possible barriers/obstacles that are causing it and identify potential solutions based on the strengths/opportunities of your institution and health care organization. Identification of obstacles specific to a given setting also allows for customizing guidelines to improve acceptance and adherence.

Several approaches to assess barriers/obstacles and to elaborate potential solutions, including chart audits, surveys, focus groups and individual interviews, have been used to identify obstacles and solutions. However, individual interviews and focus groups also provide insight into the interplay of various barriers to, and facilitators of, optimal care. ^1,2

• Focus groups (you may need more than one focus group, especially if you have targeted different settings) may reveal aspects of the reality of your practice that you may not be aware of. In addition, the early involvement of these people will enable the project to receive the supported of appropriate resources and will help ensure its continuity over time.

 

[1] Singleton AF, Bazargan M, Ilagan B, Yan L, Eugenio J. Using resident focus groups to improve subspecialty consultations in a pediatric urgent care setting. J Natl Med Assoc 2006;98:1478-82.

[2] Vallano A, Cereza G, Pedros C, Agusti A, Danes I, Aguilera C, et al. Obstacles and solutions for spontaneous reporting of adverse drug reactions in the hospital. Br J Clin Pharmacol 2005;60:653-8

By identifying obstacles to adherence, and including healthcare professional perspectives on potential barriers and their solutions to bridge the gaps in care, a more successful intervention can be achieved.