Facilitators and Barriers to Clinical Pathway Uptake and Utilization among Primary Care Providers in Saskatchewan – A Qualitative Study
Bibliographic record
Abstract
Abstract Background: Clinical Pathways (CPWs) are multidisciplinary, evidence based, complex interventions designed to standardize patient care. In Saskatchewan, development, implementation, and evaluation of seven provincial CPWs (Hip & Knee, Spine, Pelvic Floor, Prostate Assessment, Fertility Care, Lower Extremity Wound Care, and Acute Stroke) present significant challenges, leading to lower uptake and utilization. This study aimed to identify facilitators and barriers to CPW uptake and utilization by Family Physicians in Saskatchewan. Methods: A qualitative interpretive approach was used consisting of eight one-on-one key informant (KI) interviews and five focus groups (FG) in identifying the facilitators and barriers to CPWs. KIs had been involved in the design and implementation of CPWs. FGs were held with 30 Family Physicians in two urban and two rural Saskatchewan cities. All interviews were audio recorded and transcribed. Inductive, thematic analysis of the interviews based on the Theoretical Domain Framework (TDF) for behavioral changes was used to identify facilitators and barriers to CPW uptake and utilization by Family Physicians.Results: KI interviews informed the FG interview guide. From 5 FG discussions, 51 themes emerged and were mapped under 14 TDF domains. Family Physicians notably emphasized the barriers for utilizing CPWs. Major barriers were: system-level (knowledge & communication, social/professional identity, Family Physician engagement and education); objective clarification (goals, belief about consequences of implementing CPW) and technical and resource related (administrative, access to local specialists, enforcement and incentives). The most prominent barrier was lack of systematic CPW promotion and inconsistencies in communication between: organization to practitioner; organization to organization; and practitioner to practitioner. Facilitators were recognized to mitigate barriers and ranged from need for optimized and integrated IT services (i.e. Electronic Medical Records), to optimism towards CPW usage and patient outcomes. Conclusions: Informed by data from KIs and FGs, this exploratory study identified specific improvements required to promote uptake of CPWs based on perceived facilitators and barriers. Recommendations are provided to enhance uptake among FPs. These initial findings will inform the creation of a theory-based, province -wide survey instrument to further evaluate CPWs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.009 | 0.003 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".