A systematic review using the Theoretical Domains Framework to identify barriers and facilitators to the adoption of prescribing guidelines

Paksaite, Paulina; Watson, Margaret; Crosskey, Joel; Sula, Eni; West, Celine

doi:10.1111/ijpp.12654

Cited by 20 publications

(19 citation statements)

References 25 publications

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“…Facilitators for implementation. Facilitators towards intervention implementation identified in this study such as being able to easily understand and use the components, belief in the intervention, feelings of ownership, experiencing the benefits and being a good fit with individual and organisational goals and reforms in practice have also been reflected in the findings of other work [35,36,39]. These factors are also thought to operate optimally within a culture that has clear objectives, good teamwork, time for reflection and a vision of how financially incentivised initiatives can be of benefit to patients [39].…”

Section: Barriers To Implementationmentioning

confidence: 80%

“…In relation to perceived or experienced barriers, it has also been found that lack of awareness or understanding, time restraints and workload concerns have often been given as reasons for not adopting or fully engaging with an intervention [ 35 , 36 ]. A systematic review conducted by Lau et al [2015] concluded that implementation of interventions can be optimised if the main contextual barriers, which they acknowledged can change over time, are considered and addressed accordingly [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Understanding factors influencing uptake and sustainable use of the PINCER intervention at scale: A qualitative evaluation using Normalisation Process Theory

Laing

Salema²,

Jeffries³

et al. 2022

PLoS ONE

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Introduction Medication errors are an important cause of morbidity and mortality. The pharmacist-led IT-based intervention to reduce clinically important medication errors (PINCER) has demonstrated improvements in primary care medication safety, and whilst now the subject of national roll-out its optimal and sustainable use across health contexts has not been fully explored. As part of a qualitative evaluation we aimed to identify factors influencing successful adoption, embedding and sustainable use of PINCER across primary care settings in England, UK. Methods Semi-structured face-to-face or telephone interviews, including follow-up interviews and an online survey were conducted with professionals knowledgeable of PINCER. Interview recruitment targeted four early adopter regions; the survey was distributed nationally. Initial data analysis was inductive, followed by analysis using a coding framework. A deductive matrix approach was taken to map the framework to the Normalisation Process Theory (NPT). Themes were then identified. Results Fifty participants were interviewed, 18 participated in a follow-up interview. Eighty-one general practices and three Clinical Commissioning Groups completed the survey. Four themes were identified and interpreted within the relevant NPT construct: Awareness & Perceptions (Coherence), Receptivity to PINCER (Cognitive Participation), Engagement [Collective Action] and Reflections & Adaptations (Reflexive Monitoring). Variability was identified in how PINCER awareness was raised and how staff worked to operationalise the intervention. Facilitators for use included stakeholder investment, favourable evidence, inclusion in policy, incentives, fit with individual and organisational goals and positive experiences. Barriers included lack of understanding, capacity concerns, operational difficulties and the impact of COVID-19. System changes such as adding alerts on clinical systems were indicative of embedding and continued use. Conclusions The NPT helped understand motives behind engagement and the barriers and facilitators towards sustainable use. Optimising troubleshooting support and encouraging establishments to adopt an inclusive approach to intervention adoption and utilisation could help accelerate uptake and help establish ongoing sustainable use.

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Section: Barriers To Implementationmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Understanding factors influencing uptake and sustainable use of the PINCER intervention at scale: A qualitative evaluation using Normalisation Process Theory

Laing

Salema²,

Jeffries³

et al. 2022

PLoS ONE

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“…These factors may lead to guideline adherence worse than the 30-70% non-adherence to guidelines reported in non-rare disease areas (9)(10)(11)(12). Frequently identi ed factors in existing systematic reviews include health professional level factors, a lack of knowledge (13), awareness of guidelines (13)(14)(15) and agreement with recommendations (13,15). In uencing factors at the organisational level include the absence of leadership/senior support (13,16,17), di culties with teamwork (13,17), disagreements with colleagues (13,14) and insu cient communication (13).…”

Section: Background and Objectivesmentioning

confidence: 99%

Barriers and facilitators to the implementation of guidelines in rare diseases: A systematic review

Gittus

Chong

Sutton

et al. 2022

Preprint

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Background:Rare diseases are individually rare but collectively common. They present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases. We systematically identified barriers and facilitators to the implementation of guidelines in rare diseases from existing literature: A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Cochrane library and Web of Science from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search.We identified and trialled frameworks for the narrative synthesis of barriers and facilitators selecting the Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, 57 potential determinants. It was developed as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies. Results:Thirty-nine studies were included, most of which were conducted in North America (56.4%). There were 154 barriers across 35 determinants (33 studies) and 52 facilitators across 24 determinants (22 studies). Fourteen diseases were included across seven WHO ICD-11 disease categories.Individual health professional factors and guideline factors were the most commonly reported domains (56.5% of barriers and 65.4% of facilitators). Overall, the three most reported barriers were the awareness/familiarity with the recommendation, domain knowledge and availability of necessary resources. The three most reported facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Particularly relevant to rare disease health technologies, the domain of incentives and resources included barriers to implementation in the form of technology costs, ancillary staff costs and more cost-effective alternatives. There was no mention in the included studies of influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation. Conclusion:Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.

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“…Investigating this problem and the underlying causes usually starts with identifying the barriers and facilitators to implementation. [1][2][3][4][5][6][7][8][9] In a scoping review, Fisher et al grouped the barriers into three levels: personal factors that relates to physicians' knowledge and attitudes, guideline-related factors and external factors. [3] A previous systematic review identified similar items with the additional element of patient barriers and classified them into seven categories, namely cognitive-behavioral barriers, attitudinal or rational-emotional barriers, professional barriers, barriers embedded in the guidelines or evidence, patient barriers, support or resources and system and process barriers.…”

Section: Introductionmentioning

confidence: 99%

“…[3] A previous systematic review identified similar items with the additional element of patient barriers and classified them into seven categories, namely cognitive-behavioral barriers, attitudinal or rational-emotional barriers, professional barriers, barriers embedded in the guidelines or evidence, patient barriers, support or resources and system and process barriers. [9] These factors do not seem to vary much in the different areas of healthcare, be it general practice [5], long-term care [6] or for example prescribing [1].…”

Section: Introductionmentioning

confidence: 99%

An intermediate step in bridging the gap between evidence and practice: developing and applying a methodology for “general good practices”

Safadi

Lám

Baranyi

et al. 2022

Preprint

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The gap between evidence and clinical practice has been in the focus of researches for decades. Although successful implementation means the new knowledge must work in particular environments, it doesn’t mean that the entire process should exclusively be executed by the individual institutes. This is the point where we assumed that an intermediate step, the “general good practice”, could help to ensure that translation is done in a more professional way.The development of the general good practice methodology was based on our infinitE model, which organized the factors of successful translation into an evidence-editing-embedding-effect on practice framework, using tools from the disciplines of Evidence-Based Medicine, Quality Improvement and Change Management.The methodology organised the editing and embedding part of the development into a process involving three full-day sessions carried out with different health professionals, experts and moderators. After pilot testing, it was finalized and applied to other topics as well.The methodology presented in detail in this paper, centred on flow chart, process analysis, failure mode identification and Kotter’s 8-step model. Beside the pilot topic of the institutional process of resuscitation, the methodology has also proved applicable to more than ten other topics, meaning that at least all the core elements of the proposed bundle of general good practice have been produced in the development process.Compared to the guidelines, general good practices demonstrate the evidence in operation, helping to develop workflows, responsibilities, documentation, trainings, etc. and can also be a starting point for the digitalisation of care processes.The next step is to examine how healthcare institutions can build on these in their own editing and embedding activities, and what the results will be. Further studies could explore the applicability of the development methodology in different healthcare systems or at different levels of maturity in terms of quality.

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A systematic review using the Theoretical Domains Framework to identify barriers and facilitators to the adoption of prescribing guidelines

Cited by 20 publications

References 25 publications

Understanding factors influencing uptake and sustainable use of the PINCER intervention at scale: A qualitative evaluation using Normalisation Process Theory

Understanding factors influencing uptake and sustainable use of the PINCER intervention at scale: A qualitative evaluation using Normalisation Process Theory

Barriers and facilitators to the implementation of guidelines in rare diseases: A systematic review

An intermediate step in bridging the gap between evidence and practice: developing and applying a methodology for “general good practices”

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