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Open Access Research article

Main barriers to effective implementation of stroke care pathways in France: a qualitative study

Kristel Gache1, Henri Leleu1, Gérard Nitenberg1*, France Woimant2, Marie Ferrua1 and Etienne Minvielle1

Author Affiliations

1 Compaq-HPST, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif 94805, France

2 Agence régionale de Santé Ile-de-France, Paris, France

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BMC Health Services Research 2014, 14:95  doi:10.1186/1472-6963-14-95

Published: 28 February 2014

Abstract

Background

Stroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.

Methods

We selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.

Results

Four main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.

Conclusion

Lack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.

Keywords:
Stroke; Clinical pathways; Quality of care; Care coordination; Implementation barriers