The effect of provider- and workflow-focused strategies for guideline implementation on provider acceptance

<p>Abstract</p> <p>Background</p> <p>The effective implementation of clinical practice guidelines (CPGs) depends critically on the extent to which the strategies that are deployed for implementing the guidelines promote provider acceptance of CPGs. Such implementation strategies can be classified into two types based on whether they primarily target providers (<it>e.g.</it>, academic detailing, grand rounds presentations) or the work context (<it>e.g.</it>, computer reminders, modifications to forms). This study investigated the independent and joint effects of these two types of implementation strategies on provider acceptance of CPGs.</p> <p>Methods</p> <p>Surveys were mailed to a national sample of providers (primary care physicians, physician assistants, nurses, and nurse practitioners) and quality managers selected from Veterans Affairs Medical Centers (VAMCs). A total of 2,438 providers and 242 quality managers from 123 VAMCs participated. Survey items measured implementation strategies and provider acceptance (<it>e.g.</it>, guideline-related knowledge, attitudes, and adherence) for three sets of CPGs--chronic obstructive pulmonary disease, chronic heart failure, and major depressive disorder. The relationships between implementation strategy types and provider acceptance were tested using multi-level analytic models.</p> <p>Results</p> <p>For all three CPGs, provider acceptance increased with the number of implementation strategies of either type. Moreover, the number of workflow-focused strategies compensated (contributing more strongly to provider acceptance) when few provider-focused strategies were used.</p> <p>Conclusion</p> <p>Provider acceptance of CPGs depends on the type of implementation strategies used. Implementation effectiveness can be improved by using both workflow-focused as well as provider-focused strategies.</p

Resuming European Détente and European Integration

International audienceFrance and the INF Treaty In 1987, the two superpowers signed the INF Treaty, thus officially ending the Euromissile crisis. Though neither the French President nor any other French representative sat at the negotiation table, France itself was present-for throughout the Euromissile crisis, French diplomacy had played a decisive role. Pursuing his own Ostpolitik, in which he always took a tough line with Moscow, President François Mitterrand had actively encouraged Ronald Reagan and Mikhail Gorbachev to resume the U. S.-Soviet dialogue on détente and disarmament, which had come to a standstill at the beginning of the 1980s. Mitterrand had held extensive conversations with both Reagan and Gorbachev in 1984/85 and had offered both of them advice on how to get back into meaningful negotiations.1 This was important to Mitterrand's own policy aims. The return to confrontation between the superpowers at the end of the 1970s considerably reduced France's room for maneuver in the field of East-West cooperation. It also hindered progress towards European integration. So, from the French perspective, any improvement in the area of détente and disarmament between the two superpowers and any steps forward towards ending the Euromissile crises would make better conditions for cooperation within Europe-both between the Eas