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Purpose: This mixed-methods study examined the perceived barriers to and facilitators of implementing best-practice guidelines (BPGs) and adhering to provincial Quality-Based Procedures (QBPs) by Ontario physiotherapists working with patients after total knee replacement (TKR), total hip replacement (THR), and hip fracture (HF). Method: Using snowball sampling, 93 hospital and home care physiotherapists working with patients after TKR, THR, or HF completed a Web-based survey. A subset of these participated in follow-up semi-structured telephone interviews. Results: The perception of QBP adherence varied, with self-reported adherence rates across identified practice standards for TKR, THR, and HF reported as 62%, 69%, and 60%, respectively. Physiotherapists generally believed that BPGs improved outcomes; however, they identified clinical experience as their primary guide to practice. Only 66% perceived that their institutions met provincial standards. Barriers to BPG implementation and QBP adherence included insufficient time, lack of access to QBPs, and limited awareness of current BPGs. Qualitative themes included awareness and knowledge, flexibility and funding, communication, and availability of and equitable access to outpatient and community-based physiotherapy services. Conclusions: Physiotherapists reported that they primarily used clinical experience to inform care after TKR, THR, and HF, but they were also supportive of BPGs and QBPs. The results suggest that increased access to and education about QBPs, as well as supportive resources, could increase their integration into clinical practice.
Objectif : cette étude à méthodologie mixte se penche sur les facteurs qui entravent ou facilitent l'application des lignes directrices sur les pratiques exemplaires (LDPE) et des actes médicaux fondés sur la qualité (AMFQ), tels que perçus par les physiothérapeutes de l'Ontario qui traitent des patients ayant subi une arthroplastie totale du genou (ATG), une arthroplastie totale de la hanche (ATH) ou une fracture de la hanche (FH). Méthodologie : à l'aide d'une méthode d'échantillonnage cumulative, 93 physiothérapeutes qui travaillent à l'hôpital et en soins à domicile auprès de patients ayant subi une ATG, une ATH ou une FH ont répondu à un sondage en ligne. Un sous-ensemble de ces répondants a participé à des entrevues téléphoniques de suivi semi-structurées. Résultats : l'adhérence perçue aux AMFQ est variable, les taux de respect autodéclaré des normes de pratique ciblées pour l'ATG, l'ATH et la FH se situant à 62 %, 69 % et 60 %, respectivement. Les physiothérapeutes sont généralement d'avis que les LDPE améliorent les résultats ; cependant, ils considèrent que leur pratique est principalement guidée par l'expérience clinique. Seuls 66 % des répondants sont d'avis que leur établissement respecte les normes provinciales. Les obstacles à l'application des LDPE et des AMFQ comprennent le manque de temps, l'accès limité aux LDPE et la mauvaise connaissance des LDPE actuelles. Les thèmes qualitatifs dégagés comprennent la sensibilisation et les connaissances, la flexibilité et le financement, la communication, la disponibilité des services ambulatoires de physiothérapie ainsi que l'accès équitable à ces derniers. Conclusions : les physiothérapeutes ont indiqué qu'ils ont recours principalement à l'expérience clinique pour guider leurs soins aux patients ayant subi une ATG, une ATH ou une FH, mais qu'ils appuient également les LDPE et les AMFQ. Les résultats laissent penser qu'un meilleur accès aux AMFQ, une meilleure formation sur ceux-ci ainsi que des ressources de soutien pourraient augmenter leur intégration dans la pratique clinique.
RESUMO
INTRODUCTION: Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective. METHODS: A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role. RESULTS: Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences. DISCUSSION: An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.
