Journal Article

Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview

Aguirre-Acevedo, Daniel Camilo, Borrero, Ana María Posada, Lugo-Agudelo, Luz Helena, Contreras, Jesús Alberto Plata, Patiño-Lugo, Daniel F., Valencia, Dolly Andrea Castaño, Correa, Verónica Ciro

2020

Overview

Introduction Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. Methods A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. Results Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. Conclusions The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Attitudes / Barriers / Clinical medicine / Clinical outcomes / Clinical practice guidelines / Credibility / Data quality / Economic problems / Evidence-based practice / Extraction / Government Programs / Guidelines / Health Administration / Health aspects / Health care industry / Health Personnel / Health planning / Health Policy / Health services / Health Services Research / Health status / Humans / Identification methods / Implementation / Implementation science / Individual differences / Interdisciplinary aspects / Knowledge / Leadership / Medical personnel / Medicine / Medicine & Public Health / Multidisciplinary teams / Nurses / Patient care / Patients / Political factors / Practice guidelines (Medicine) / Professional Practice / Professionals / Public Health / Qualitative Research / Quality / Quality assessment / Quality control / Quality of care / R & D/Technology Policy / Review / Sociocultural factors / Systematic review / Teamwork