Exploring Barriers and Facilitators to Clinical Practice Guideline Application in Mexican Mutual Aid Groups
Introduction: The rate of lifestyle induced chronic diseases has increased rapidly over the last few decades. Diseases related to obesity such as Type 2 Diabetes, cardiovascular disease, and hypertension, have become leading causes of death worldwide. The effect of these diseases is becoming increasingly apparent in low and middle-income countries such as Mexico. In response to the rise in obesity and non-communicable diseases, the Mexican government enacted a policy called the Grupos de Ayuda Mutua (GAM), which looks to treat, manage, and prevent chronic diseases. A GAM is a peer-support group of patients with lifestyle-induced chronic diseases that receive guidance and oversight by a multidisciplinary group of health professionals. The health professionals are guided by evidence-based clinical practice guidelines (CPGs) to provide the best quality of care to their patients, however, when CPGs are applied in real world contexts, unforeseen challenges to adherence and application are observed (Larme & Pugh, 2001). Purpose: The purpose of this study is to explore the barriers and facilitators to CPG application from the perspective of physicians in Mexican GAMs. Methods: Working in collaboration with the Secretariat of Health in Jalisco, physicians (n = 24) were recruited to participate in semi-structured interviews, which were guided by the Clinical Practice Guideline Framework for Improvement (Cabana et al., 1999). Deductive thematic analysis was conducted to identify themes from the physician verbatim. Inductive analysis was used to identify facilitators to CPG application and recommendations from participants regarding how the GAMs and application of CPGs could be improved. Results: Physicians identified a variety of barriers and facilitators to CPG application in the GAMs. Barriers included lack of medication, lack of regional guidance, institutional culture, and more. Facilitators included creativity, seeing results, choosing the “right” patients, and more. Discussion: This study is one of the first to explore barriers and facilitators to CPG application in GAMs. Recommendations and considerations from participants on how the GAMs and application of CPGs could be improved are also reported. Study findings can be used by state health officials to improve the GAM strategy and facilitate the use of evidence-based methods in the GAMs.
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