Sustainability of healthcare professionals’ adherence to clinical practice guidelines in primary care

Clinical practice guidelines are carefully developed to assist GPs, nurses, and all health professionals with decision-making for improved patient outcomes. However, this literature analysis found a significant lack of adherence to guidelines in primary care across the globe. Eleven studies conducted in countries including the UK, US, Netherlands, Japan, and Spain were included in the review. These studies were mostly randomized controlled trials that focused on adherence to various clinical practice guidelines by health professionals in primary care (such as GPs and nurses) or primary care centres as a whole. None of the studies implemented the same guidelines. They investigated adherence to guidelines related to: drug prescribing in general practice, disease management, cancer screening and hand hygiene. A range of strategies were employed to implement clinical practice guidelines, for example, educational outreach visits, seminars, reminders, audit and feedback. Sustainability of the implementation was commonly  measured by routine collection of behavioural data from health professionals, or a cluster RCT design for primary care centres. The authors found that certain studies used implementation strategies that provided sustainable improvements, while others did not show significant improvement. However, only three studies had a lower risk of bias in terms of methodological quality; none of the studies used more rigorous methods such as purpose-designed measurements or structural methods. This affected the level of evidence in most studies included in this review due to a considerable risk of bias. In summary, the authors found a low sustainability of adherence to clinical practice guidelines in primary care. Further implementation strategies should be developed to improve level of sustainability, which should be evaluated with robust methodology. The key barriers and facilitators to sustainable implementation of clinical practice guidelines need to be identified in future research. Sustainability of adherence to clinical practice guidelines is a crucial measure of evidence-based practice, and ensuring a high level of sustainability will help improve patient outcomes in primary care. Read the original article here.
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