Die Implementierung komplexer medizinischer Interventionen in der Hausarztpraxis

The successful implementation of complex medical innovations in General Practitioners (GPs) daily practice makes an important contribution to an evidence-based and lasting patient care. Despite the benefit arose by the interventions use, its enduring anchoring in daily practice is often a challenge. Thus, this dissertation deals with several research questions in the context of complex medical innovations to verify and expand results gained in other implementation research. Firstly, the theoretical background of the three studies is described. The first study focusses on the qualitative evaluation of a treatment pathway for patients with coronary heart disease (CHD) regarding the factors influencing the implementation. Beside the deduction of practical implications which should enhance the pathway use in daily practice the identified factors were classified in a multi-dimensional model. In the second study with three study arms (pathway developers, users, control group) the associations between several demographic, disease and pathway related variables and health related quality of life in patients with CHD were investigated by linear mixed models. With the exception of the pathway related variable the assumptions could be verified. Due to its explorative character, the study gave important impulses for further research. In the third study the evaluation and validation of a generic questionnaire based on the Theory of planned behaviour was presented using the example of arriba-lib, an electronic library of decision aids. The postulated factorial structure could not be shown in the confirmatory factor analysis. Also the assumption regarding the predictive value of the theory components for the target behaviour could not be documented. In the last chapter of the dissertation the results of the three studies are recapitulatorily discussed and further research projects are suggested.