Variables Influencing Adoption of Practice-Based Guidelines in Canadian Renal Dietetic Practice
published online 05 October 2009. Corrected Proof
Objective
We sought to determine the variables influencing the adoption of practice-based guidelines by Canadian renal registered dietitians (RRDs) for the identification and treatment of protein-energy malnutrition (PEM) in adult patients with chronic kidney disease on dialysis.
Design
A web-based, cross-country survey was distributed to 288 RRDs via the Canadian Association of Renal Dietitians. The survey consisted of open-ended and close-ended questions addressing variables (facilitators and barriers) influencing RRDs' adoption of evidenced-based practice guidelines (EBPGs), along with questions related to practitioner practice (focused on organization, practitioners, and patients).
Results
Seventy-four (51 full and seven partial) RRDs responded to the survey (for a 25% response rate); 16 responses not meeting the inclusion criteria were excluded from data analysis. Whereas 97% of respondents reported guideline utilization in daily practice, only 24% (n=14) used all of the recommendations within the EBPGs used by RRDs for the identification and treatment of PEM in adults on dialysis. The most commonly cited reasons for using EBPGs were perceived clinical benefits to the patient, and the applicability of guideline recommendations to daily practice. The most common barriers to the adoption of EBPGs were organizational (lack of time or staff and healthcare team support) and practitioner-based (practitioner-perceived conflicts regarding the evidence).
Conclusions
The variables influencing RRDs' adoption of EBPGs were multifactorial (organizationally focused, practitioner-focused, and patient-focused). The development of up-to-date EBPGs for the identification and treatment of PEM in adult patients is urgently needed. The examination of these variables is important to ensure that EBPGs are feasible, applicable, and evidence-based.
∗Nutrition Services, Alberta Health Services, Edmonton and Area, Alberta, Canada
†Northern Alberta Renal Program, Alberta Health Services, Edmonton and Area, Alberta, Canada
‡Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
§Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Address reprint requests to Diana Mager, PhD, RD, Department of Agricultural, Food, and Nutritional Science, University of Alberta Nutrition Services, Alberta Health Services-Edmonton and Area, 3-18A Agriculture Forestry Centre, University of Alberta, Edmonton, Alberta T6G 2P5, Canada.
ABSTRACT