Implementation of coherent, evidence-based pathways in Danish rehabilitation practice

Abstract

Aim: Studies have shown that evidence-based practice improves outcomes, both for patients and for staff organisational systems. However, the incorporation of evidence-based guidelines in a health care practice requires a specific, targeted approach on all organisational levels. Purpose: To gain a deeper understanding of how to facilitate the implementation of coherent and evidence-based guidelines in Danish rehabilitation contexts. Method: The study was based on a phenomenological hermeneutic approach and on theories within knowledge translation. Fifteen municipalities and four hospitals volunteered to participate. Facilitators were appointed locally. Data concerning factors facilitating the implementation were generated in three focus group interviews. Results: Evidence-based rehabilitation was implemented with local adaptation for each participating setting, resulting in context-dependent variations. Conclusion: The PARIHS framework is based on concepts that capture factors of impact on clinical decision-making and interventions which enhance changes of daily practice in the participating rehabilitation settings. The rehabilitation pathways reinforced the foundation and ownership of the daily practice and created an impetus for raising the quality of clinical practice. The facilitators constituted important actors in anchoring the implementation. Moreover, it was important for the local implementation to be an integrated element of a common workforce agenda.

Implications for Rehabilitation

• Evidence-based rehabilitation pathways updated the professional knowledge and reinforced the therapists’ ownership of the daily practice.

• Appointed facilitators are key stakeholders and important elements in anchoring an implementation.

• Local implementation processes being part of a cross-sectoral enhancement support successful implementation.

• Evidence-based clinical guidelines
• occupational therapy
• physiotherapy
• rehabilitation pathways