Why Do Clinical Practice Guidelines Get Stuck during Implementation and What Can Be Done: A Case Study in Pediatric Rehabilitation

Restall, Gayle; Diaz, Francis; Wittmeier, Kristy

doi:10.1080/01942638.2019.1660447

Cited by 14 publications

(10 citation statements)

References 30 publications

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“…The support from management was found to be important both regarding compliance with the guidelines for all health care personnel and also regarding knowledge, evaluation and development. Such findings on management support are not surprising or new but it rather confirms previous research [ 32 , 53 – 55 ]. Even so, it is important to study the ways in which management is important since this can differ between different contexts.…”

Section: Discussionsupporting

confidence: 90%

Physiotherapists’ experiences of osteoarthritis guidelines in primary health care – an interview study

et al. 2021

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Background Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists’ experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. Methods Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. Results The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow. Conclusion The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

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Section: Discussionsupporting

confidence: 90%

Physiotherapists’ experiences of osteoarthritis guidelines in primary health care – an interview study

et al. 2021

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“…However, it has already been shown that the publication of guidelines alone is not sufficient to optimize physicians' prescription and treatment behavior 32,33 . We did not study reasons for non‐adherence, but previous studies have noted different barriers to physicians adherence such as poor attitudes about and lack of agreement with the guidelines 34–37 . Instead, developing guidelines in a working group that includes representatives from all teaching hospitals might help to reach a broad consensus in all regions and to implement them 33,38,39 .…”

Section: Discussionmentioning

confidence: 98%

Acute bronchiolitis in Switzerland – Current management and comparison over the last two decades

Hartog¹,

Ardura‐Garcia

Hammer

et al. 2021

Pediatric Pulmonology

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Background Although international guidelines and Cochrane reviews emphasize that therapies do not alter the natural course of acute viral bronchiolitis (AVB), they are still prescribed frequently. This survey evaluated self‐reported management of AVB by Swiss pediatricians in 2019 and compared it with previous surveys. Methods We performed a cross‐sectional online survey of all board‐certified pediatricians in Switzerland in November 2019 and compared the reported use of therapies with that reported in the 2001 and 2006 surveys. We used multivariable ordered logistic regression to assess factors associated with reported prescription of bronchodilators, corticosteroids, antibiotics, and physiotherapy. Results Among 1618 contacted board‐certified pediatricians, 884 returned the questionnaires (55% response rate). After exclusions were applied, 679 were included in the final analysis. Pediatricians working in primary care reported using therapeutics more frequently than those working in a hospital setting, either always or sometimes: bronchodilators 53% versus 38%, corticosteroids 37% versus 23%, and antibiotics 39% versus 22%. The opposite occurred with physiotherapy: 53% reported prescribing it in hospital and 44% in primary care. There was an overall decrease in the prescription of therapeutics and interventions for AVB from 2001 to 2019. The proportion who reported “always” prescribing corticosteroids decreased from 71% to 2% in primary care, and of those “always” prescribing bronchodilators from 55% to 1% in hospitals. Conclusion Although we observed a significant decrease since 2001, more effort is required to reduce the use of unnecessary therapies in children with AVB.

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“…In a systematic review of CPG implementation in pediatric palliative care, common barriers were training of healthcare professionals and formation of multi-disciplinary teams [ 29 ]. Pediatric rehabilitation therapists felt that clinician confidence, resource availability, and organizational support were important to CPG implementation [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to clinical practice guideline-consistent supportive care at pediatric oncology institutions: a Children’s Oncology Group study

Sugalski

Beauchemin

et al. 2021

Implement Sci Commun

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Background Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions. Methods Healthcare professionals at 26 pediatric, Children's Oncology Group-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. Supportive care CPG implementation facilitators and barriers were solicited using nominal group technique (NGT), and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from an analysis of NGT items were identified, first from each focus group and then across all focus groups. Results Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were organizational factors including charging teams with CPG implementation, individual factors including willingness to standardize care, user needs and values including mentorship, system factors including implementation structure, and implementation strategies including a basis in science. The top five barriers of CPG implementation identified were organizational factors including tolerance for inconsistencies, individual factors including lack of trust, system factors including administrative hurdles, user needs and values including lack of inclusivity, and professional including knowledge gaps. Conclusions Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs, and eliminate implementation barriers. Trial registration ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016.

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Why Do Clinical Practice Guidelines Get Stuck during Implementation and What Can Be Done: A Case Study in Pediatric Rehabilitation

Cited by 14 publications

References 30 publications

Physiotherapists’ experiences of osteoarthritis guidelines in primary health care – an interview study

Physiotherapists’ experiences of osteoarthritis guidelines in primary health care – an interview study

Acute bronchiolitis in Switzerland – Current management and comparison over the last two decades

Facilitators and barriers to clinical practice guideline-consistent supportive care at pediatric oncology institutions: a Children’s Oncology Group study

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