Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews

Abstract

ObjectivesTo identify the barriers and enablers to implementing clinical practice guidelines (CPGs) recommendations in primary care and to provide recommendations that could facilitate the uptake of CPGs recommendations.DesignAn overview of systematic reviews.Data sourcesNine electronic databases (PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, Web of Science, Journals @Ovid Full Text, EMBase, JBI) and three online data sources for guidelines (Turning Research Into Practice, the National Guideline Clearinghouse and the National Institute for Health and Care Excellence) were searched until May 2021.Eligibility criteriaSystematic reviews, meta-analyses or other types of systematic synthesis of quantitative, qualitative or mixed-methods studies on the topic of barriers and/or enablers for CPGs implementation in primary care were included.Data extraction and synthesisTwo authors independently screened the studies and extracted the data using a predesigned data extraction form. The methodological quality of the included studies was appraised by using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Content analysis was used to synthesise the data.ResultsTwelve systematic reviews were included. The methodological quality of the included reviews was generally robust. Six categories of barriers and enablers were identified, which include (1) political, social and culture factors, (2) institutional environment and resources factors, (3) guideline itself related factors, (4) healthcare provider-related factors, (5) patient-related factors and (6) behavioural regulation-related factors. The most commonly reported barriers within the above-mentioned categories were suboptimal healthcare networks and interprofessional communication pathways, time constraints, poor applicability of CPGs in real-world practice, lack of knowledge and skills, poor motivations and adherence, and inadequate reinforcement (eg, remuneration). Presence of technical support (‘institutional environment and resources factors’), and timely education and training for both primary care providers (PCPs) (‘healthcare provider-related factors’) and patients (‘patient-related factors’) were the frequently reported enablers.ConclusionPolicy-driven strategies should be developed to motivate different levels of implementation activities, which include optimising resources allocations, promoting integrated care models, establishing well-coordinated multidisciplinary networks, increasing technical support, encouraging PCPs and patients’ engagement in guideline development, standardising the reporting of guidelines, increasing education and training, and stimulating PCPs and patients’ motivations. All the activities should be conducted by fully considering the social, cultural and community contexts to ensure the success and sustainability of CPGs implementation.

Deprescribing in primary care without deterioration of health‐related outcomes: A real‐life, quality improvement project

“…Thus, the specific context, in which the intervention is to be implemented, should be fully considered, as adaptions may be needed to achieve success and sustainability. 41…”

Effective deprescribing in primary care without deterioration of health-related outcomes

“…In this real-life quality improvement project, the GPs in the GPF decided to construct a new Chronic Care Model, including the person-centred medication review intervention, to systematize the care of patients with chronic diseases. It has been advocated to integrate clinical practice guidelines more systematically into existing care models to minimise the burden on health systems and primary care providers 35 . Thus, the developed Chronic Care Model employed in this study may have been an important enabler for intervention implementation.…”

“…However, it soon became clear that the GPs performed the medication reviews themselves and took ownership of the process in close collaboration with the pharmacist, the nurses, and frontline staff at the care homes. Ownership, flexibility, and autonomy of the primary care providers have been identified as important enablers for implementation of clinical practice guidelines 35 . Additional enablers reported include a well-organised practice and clarification about the role of primary care providers in disease management.…”

“…Additional enablers reported include a well-organised practice and clarification about the role of primary care providers in disease management. Importantly, multidisciplinary collaborations between different care levels should also be considered to support the primary care providers' recognition of their role and responsibility for clinical practice guidelines implementation 35 . In our study, this was attempted through the cross-sectoral communication model that was established alongside the Chronic Care Model.…”

“…Furthermore, both private and public stakeholders exist in most countries and may be highly dissimilar in their organization and available resources. Thus, the specific context, in which the intervention is to be implemented, should be fully considered, as adaptions may be needed to achieve success and sustainability 35 .…”