ID Sector Yrs CPG-K Time barrier SoC Supporting quotation
P01 Pvt 3 2 Y Con ”…it comes down to the education these days and less contact between the lecturers and the students… some conditions slip through that these students don’t see at all… they must be able to treat those conditions and so if they can read up on what are the guidelines for these conditions…”
P02 Ed 2 1 N Act “I don’t have much sympathy for the arguments that there isn’t time. Change the narrative to not be something in addition to what you are already doing but it’s part of your practice… the best clinicians in the world who are not only also loaded with patients, they still find time to attend conferences, to publish, engage with the literature, develop guidelines… Are they complaining about their case load? No, they have got time so why don’t you have time”
P03 Pvt 1 2 Y Con ”I think it does take a lot of extra effort because it is extra reading that needs to go into it and everything so it’s not always during the day, it’s almost forms part of an extra part of the day or separate to the day’s work and then doing a little bit of research and then implementing it in the clinical setting…”
P04 Pub 2 1 Y P-con “I may have a very busy workload and other commitments I might only be able to do four of the five aspects of the guideline… there is a challenge when it comes to workload and implementing a full guideline without hindering patient care”
P05 Pub 1 2 Y P-con “…in my setting I have a big load, so I won’t always use [CPGs] but I think there is a place for specific patients”
P06 Ed 3 1 N Act “…that would help more than just emailing someone a guideline and then they need to manoeuvre through the guideline on their own… sometimes people don’t even know of the availability of guidelines and so information workshops about guidelines and the fact that guidelines need to be updated… it’s information being provided, and I just need to think about how I could apply some of this. people always see something new or different as extra work…how one introduces a guideline is important…”
P07 Ed 2 2 N Prep “if you are sensitive when which guideline is appropriate, it could actually ease your load…but if you are only one clinician at a clinic where you have to do all the admin and appointments…you don’t have time…”
P08 Ed 2 1 D Act ”…I do use a clinical guideline on the management of adhesive capsulitis within a third-year case that I facilitate with the students… I’m always disappointed because they don’t take up that information…”
P09 Ed 3 1 D Act ”…I’ve never sat and worked with a guideline and worked with the patient… I’ve just checked is that in agreement with my approach…”
P10 Ed 2 1 Y P-con “…it is much more difficult to actually have that extra time to maybe complete a health-related quality of life questionnaire. the distribution of human resources because you should actually have more people where the majority of patients are… so there is a little more of equalisation. your daily interaction with your patients because as soon as it can become sort of your habit of dealing with the patient, it doesn’t become something like… I have to do it because management forced us to do it”
P11 Pvt 2 2 N Act “…it is very easy to go and refer to a guideline, so it was easy access to get a guideline, to Google a guideline and then apply it… in my workload”
P12 Pub 3 1 D P-con “It sort of differs because of the unexpected interruptions in my day to day work that suddenly comes from above and then I have to adjust the program. There’re many unplanned things coming to my table that wasn’t part of physio’s plan in for today or for this week, and then you have to adjust”
P13 Pvt 1 1 D Con “I have seen people’s attitude where you have, just mention the word guideline, they are like, oh, if it is big, if it looks bulky and intense and long and forms and then immediately there is a negative attitude towards it. I have had that before where I have seen a guideline and I think, oh, there are so many papers to fill in. So something concise, easy to use…”
P14 Pvt 3 1 D Main ”…that is very much my job, writing guidelines for clinical practice, so I think it is quite a good thing to have it, but you know, one needs to be very careful that you do not become too prescriptive…”
P15 Pvt 2 1 Y P-con ”I will try not to sound too negative. So guidelines are I think just generated by institutions in the first world. The issue of guideline… they tend to become prescriptive rather than descriptive…I think it is going to form part of the armour because we are doing it to benchmark every now and then what the current best practice is. At the moment they have become like sticks to beat people with, so if you haven’t got to actually increase the range by week two post-operative then all hell breaks loose…”
P16 Ed 3 2 N Act ”…It plays a role in guiding the appropriateness of the techniques that we use and hence once you are using techniques that are tailor-made, you are definitely improving the quality of care. Sometimes if they are structured, you are including spending even lesser time than you used to. Secondly, another advantage for the role that guidelines play, remember, you will have maybe a maximum of an hour with a patient as a physio, so even that we are talking who is the client that we are dealing with…”
P17 Pvt 2 1 D Prep …”I am not fantastically good at using guidelines, so that is definitely something that I need to and have to improve on… if you have guidelines as to the type of treatment that is effective at different stages, you can also explain that to a patient…”
P18 Pub 2 1 N Act ”…physiotherapists have access to a specific file for physiotherapy in itself and then with that the physiotherapist whenever he is on the wards you can go through the guidelines… You can run with the patient through it or just a guideline as a quick reference, not having to run to a book or, I mean, if you can use an APP that’s even better. But I mean, you don’t always have the coverage for Wi-Fi… in that way we have guidelines available to us…
P19 Pvt 1 2 Y Con “With the workload it can become a bit difficult to follow the guidelines. Say I have to get the patient out in a chair and you know he must be back in two hours then it’s a little difficult to organise your day in such a manner that you … we travel back and forth between different hospitals, so it is very very difficult to schedule your day in order to fit everything in. Most of the days it works, but it doesn’t always work”
P20 Pvt 2 2 Y P-con “…if it’s going to take a lot of time it will be difficult, yes. Because we see a patient every half an hour, and half an hour before and after work for admin, I think that would be a bit difficult if we are not familiar with the guidelines. One will have to first get used to them. It sounds like something that one has to look for on a computer and I struggle to switch the computer on”
P21 Ed 2 1 Y Main ”…If you really use it well and you follow those steps or those systematic statements in the order that it’s been given you actually realise that it helps you to use your broad knowledge but to come into the specifics and to treat each patient differently…”
P22 Ed 2 1 N Act “…a practical way is just to engage with, even if you don’t implement the whole guideline with every single patient, but to try and think about what guideline with regards to set patient, with regards to set guideline, whether there are multiple, could I try and enforce on a daily basis in my patients or in my practice, and stick to it and be good about that… And then just encouraging others or making others aware of that…”
P23 Ed 2 1 D P-con “…you’re just trying to clear the bench, and as soon as the patients have been seen and you’re shipping them off to the next institution…because you’re dealing here with a bench of 60 patients for the day…even workloads are so different… there’s days I saw thirty-five patients in a day, thirty-eight patients in a day and then there were days I saw twelve in a day. So it would run differently on those different days”
P24 Pub 1 1 D Main ”…If you really use it well and you follow those steps or those systematic statements in the order that it’s been given you actually realise that it helps you to use your broad knowledge but to come into the specifics and to treat each patient differently…”
P25 Ed 2 2 D Prep “I think within our own profession it’s possible. It also depends who you’re dealing with, but it’s trickier when it now gets to kind of take this information to other professions and saying look, let’s go maybe tell the doctors what we’re doing, or the nurses… we aren’t really doing that. I think we have one lecture that one of my staff teaches to the med students, just to kind of tell them what physiotherapy is”
P26 Pvt 1 1 D Act “there’s always a hiccup in the beginning and there’s always the usual little teething issues, but once we get the hang of it, it just becomes part of the flow, and you don’t often think twice about it once you’re used to it”
P27 Pub 1 2 D Con “moderately easy to start implementing [CPGs], but it would also just be consistency… it’s easy to implement something and to start doing it, but to carry on doing it I feel is often a difficult thing, especially when you’re working in a place like in public where you have people coming and going… you’re not always the same team…”
P28 Pub 2 1 D Con “…If we are only two physios in the hospital and we have a particular number of patients in the wards, it means I might not be able to really go through whatever that I have to go through because I’m rushing to see the next patient so that I can cover everything…the shortage of staff would be a barrier… if we are talking about out-patients we usually manage it… so that everything can be accommodated in a day.”
P29 Pub 2 1 N Main ”…I don’t want the outcomes of treatment to be dependent on the physiotherapists themselves that are seeing the patient…I want that patient to receive the same quality of care than if that patient would have been seen by a physiotherapist that specialises in that. A patient does not be at a disadvantage just because of logistical reasons…”
P30 Pub 1 1 D P-con “If the guidelines can make my life easier then it will be easy but if the guidelines will be a very lengthy process then it will make it challenging. I think especially in our setting, I work in a government institution and it’s the age-old thing of being short-staffed but for example, we can’t see a patient twice a day. I can’t guarantee that I will be able to see a patient twice a day where in a private institution that is almost the norm… I think if guidelines caused me to take more time with my patients, that will be really difficult to implement because I still have twenty others also to see”
P31 Pub 1 1 D Act “Technically it should make my clinical load easier because if I have a guideline to work upon, it’s something that should make seeing patients sort of easier…but sometimes I do feel like time wise, I don’t know, maybe for example you don’t have time to do ten repetitions times three sets for the patient and so you show them all the exercise but you only do one set and then you show them how to walk.”
Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance Key: ID=Participant identifier; Yrs=Years in practice; CPG-K=CPG knowledge; SOC=Stage of change; Pub=Public; Pvt=Private; Ed=Education; Y=Agree; N=Disagree; D=Do not know; P-con=Pre-contemplation; Prep=Preparation; Con=Contemplation; Act=Action; Main=Maintenance
Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs Yrs in practice: 0-10=1; 11-20=2; 21+=3. CPG knowledge: 1=Understand concept of CPGs; 2=Does not understand concept of CPGs