Table 3 Facilitators and barriers to implementation of the guideline
CFIR framework | Facilitating factors | Barrier factors |
|---|---|---|
Coding | Coding | |
Intervention characteristics | Â | Â |
Intervention Source | The physician support | A lack of practicality |
Unnecessary clinical practice | ||
Evidence Strength & Quality | The physician trust | / |
Relative advantage | More advantageous than comparable existing Chinese similar guidelines | / |
Adaptability | Â | A need for context-specific adaptation |
Trialability | / | A poor trialability in non-children’s Hospitals |
Complexity | / | A poor feasibility in primary Hospitals |
Some complicated recommendations | ||
Cost | / | A need for some cost |
Outer setting | Â | Â |
Patient Needs & Resources | Meet children’s treatment needs | / |
Cosmopolitanism | Pharmaceutical companies participate in and promote clinical trials | A lack of patients understanding |
pharmaceutical industry off-label promotion | ||
Peer Pressure | The Guangdong Pharmaceutical Society, the Shandong Pharmaceutical Society, and similar guidelines from other countries | Â |
External Policy & Incentives | The Physicians Law of the People’s Republic of China | Non-reimbursement by health insurance |
The occurrence of off-label drug use disputes in children raises concerns in this area | A risk of legal conflicts | |
Unique improvement campaigns | A lack of administrative & policy promotion | |
Inner setting | Â | Â |
Structural Characteristics | Graded management | The low priority of pediatrics in non-children’s hospitals |
A dedicated person to drive | / | |
The addition of prescription review rules | / | |
Networks & Communications | A promotion by societies or associations | The unfavorable social environment and conflict between doctors and patients |
A promotion by medical associations | A lack of communication between pharmacists and clinicians | |
Culture | Cultural alignment with the hospital | / |
Implementation Climate | High urgency | A lack of no priority in comparison to other daily work |
Fitting firmly with the hospital’s management | A lack of personal gain | |
Availability of punishments | A low-physician compliance | |
Alignment with hospital management goals | Complex management procedures | |
A better learning environment | / | |
Readiness for Implementation | Proper off-label drugs coverage by the hospital | A lack of attention from hospital leadership |
A special team of off-label drug management | A lack of specialized training | |
A database of off-label drug use | / | |
clinical pharmacists’ support | / | |
characteristics of individuals | Â | Â |
Knowledge & Beliefs about the Intervention | / | A lack of understanding of the Benefit and Risk Assessment framework |
Self-efficacy | An alignment with personal beliefs | / |
Individual Stage of Change | Physician confidence | Low titles |
A willingness to promote | A lack of passion and innovation of pharmacists | |
A high degree of professional restraint and self-defense of pediatric doctors | A wide range of technical competence | |
/ | A few physicians’ poor ethical principles | |
/ | An ignorance of physicians’ management of off-label use drugs | |
/ | Physicians’ empiricism with drug use |