Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review.

Autor: Thoonsen AC; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands. Electronic address: a.thoonsen@amsterdamumc.nl., van Schoten SM; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands., Merten H; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands., van Beusekom I; Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands., Schoonmade LJ; Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, NL-1081 HV Amsterdam, the Netherlands., Delnoij DMJ; Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands; Erasmus Universiteit Rotterdam, Erasmus School of Health Policy & Management Health Care Governance, Burgemeester Oudlaan 50, NL-3062 PA Rotterdam, the Netherlands., de Bruijne MC; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Health policy (Amsterdam, Netherlands) [Health Policy] 2024 Oct; Vol. 148, pp. 105135. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1016/j.healthpol.2024.105135
Abstrakt: Background: The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts.
Methods: We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics.
Results: Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements.
Conclusion: Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.
Competing Interests: Declaration of competing interest We would like to disclose that, in addition to their roles as researchers, DD and IvB are employed by a guideline organization (Zorginstituut Nederland). In principle, this could present a source of bias or conflicts of interest. Nevertheless, we have taken measures to address this concern by repeatedly and explicitly discussing this matter in our group discussions regarding the interpretation of the results.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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