Adapting clinical practice guidelines to local context and assessing barriers to their use.
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ABSTRACT:
SUBMITTER: Harrison MB
PROVIDER: S-EPMC2817341 | biostudies-literature | 2010 Feb
REPOSITORIES: biostudies-literature
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Adapting clinical practice guidelines to local context and assessing barriers to their use.
Harrison Margaret B MB Légaré France F Graham Ian D ID Fervers Béatrice B
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20091207 2
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Project description:BackgroundIn Egypt, academic organizations, professional societies, and research groups develop clinical practice guidelines (CPGs) in order to improve patient quality care and safety. Although important improvements have been made over the past years, many of these consensus-based guideline documents still lack the transparency and methodological rigor of international standards and methodologies recommended by reference evidence-based healthcare and guideline organizations like the Guidelines International Network.Main body of the abstractIn the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG), we have adopted one of the CPG formal adaptation methodological frameworks named the 'Adapted ADAPTE', relevant CPG resources (e.g., the Appraisal of Guidelines for Research and Evaluation or AGREE II Instrument), and involved key stakeholders including clinical and healthcare topic experts and guideline methodologists in producing 32 trustworthy national evidence-based CPGs and one protocol customized to the healthcare context and services provided for Egyptian children. An EPG online website was launched to make these CPGs available and accessible as CPG summaries for pediatricians and relevant healthcare providers.Short conclusionThe lessons learned, enablers, challenges, and solutions relevant to Egyptian National Pediatric CPGs identified in this paper could be used to address and enrich the debate on pediatric high-quality CPGs, especially for countries of similar contexts and systems.Supplementary informationThe online version contains supplementary material available at 10.1186/s42269-023-01059-0.
| S-EPMC10262930 | biostudies-literature
Project description:BACKGROUND:The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. METHODS:We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. RESULTS:The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. CONCLUSION:Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care.
| S-EPMC6003001 | biostudies-literature
Project description:ObjectivesClinical practice guidelines (CPGs) have been shown over the years to reduce morbidity and mortality and improve patients' survival and quality of care. However, CPG adherence is still a challenge despite its benefits. The awareness of CPGs, utilisation and associated barriers and facilitators to their use were assessed among physicians in Nigeria.DesignThis was a cross-sectional study carried out among physicians in Nigeria through a self-administered questionnaire that assessed awareness, utilisation, barriers and facilitators of CPGs. Ordinal logistic regression was used to assess factors associated with CPG utilisation. A p-value of <0.05 was considered significant.SettingsPrivate and government health institutions in Nigeria.ParticipantsPhysicians working in Nigeria.ResultsA total of 574 physicians consisting of 184 (32.1%) females with a mean age of 40.03±9.60 years participated in the study. About 91% and 78.4% of respondents were aware of international and national guidelines related to their practice. The identified barriers to the use of CPGs were non-applicability to local settings (39.0%), not being easily accessible (22%), complexity and difficulty in interpretation (11%) and not being concise (11%). The most common format for CPGs was soft copy (38%). About 71% frequently used guidelines in their clinical practice. The significant factors associated with CPG utilisation on logistic regression were working in a tertiary hospital (adjusted OR, AOR: 0.461; CI: 0.24 to 0.88; p=0.019); specialisation (AOR: 2.60; CI: 1.06 to 6.42; p=0.038); being very confident in understanding CPGs (AOR: 12.33; CI: 6.99 to 21.74; p≤0.001) and previous training on CPG use (AOR: 2.54; CI: 1.70 to 3.78; p≤0.001).ConclusionThe majority of physicians in Nigeria are aware of CPGs. Addressing the identified barriers to CPG utilisation, organising training on the use of CPGs and making CPGs readily available in soft copy versions and in a simple, concise and easily adaptable format may improve their use.
| S-EPMC11873348 | biostudies-literature
Project description:ObjectivesThe objective of this study was to explore barriers and facilitators to the use of clinical practice guidelines (CPGs) in osteoarthritis (OA) care among German physiotherapists.DesignQualitative semistructured interviews were conducted with German physiotherapists. An interview topic guide based on the Theoretical Domains Framework (TDF) was developed to explore perceived barriers and facilitators to the use of CPGs in OA care. Interviews were audio-recorded and transcribed verbatim. In a first step, the data were coded inductively using thematic analysis. Subsequently, the emerged themes were deductively reassigned to the relevant domains of the TDF and categorised as barriers and facilitators.SettingOutpatient physiotherapy practices in Germany.ParticipantsPhysiotherapists working in an outpatient setting in Germany and involved in the management of patients with hip and knee OA were eligible to participate.ResultsEleven physiotherapists (7 women, 4 men) were interviewed between February and September 2023. The mean age was 34.2 years (± 9.9, range 23-57). Most factors influencing guideline-recommended care were identified in the TDF domains 'knowledge', 'beliefs about consequences', 'environmental context and resources' and 'social influences'. For example, physiotherapists perceived low awareness of existing CPGs, loss of individuality in treatment, time constraints and dissonant patient expectations as barriers to the use of CPGs. Discussion of guideline recommendations within the team and the expectation of improved patient outcomes and resource savings were reported as facilitators.ConclusionsMultiple factors were identified that were perceived to influence clinical practice in Germany. The results of this study can inform the development of theory-based interventions aimed at changing physiotherapists' behaviour to support them in providing optimal OA care.Trial registrationGerman Clinical Trials Register (DRKS00030800). Registered 12 December 2022.
| S-EPMC11492947 | biostudies-literature
Project description:PurposeThis study aimed to evaluate the current clinical practice patterns regarding the utilization of "Urolithiasis Guidelines" in Turkey and to identify critical factors influencing their application by urologists.MethodsThe study targeted practicing urologists in Turkey, primarily those involved in the management of urolithiasis, to assess their perspectives and experiences regarding the clinical application of established guidelines. A total of 415 urology specialists were invited to participate in a survey-based study conducted via Google Forms. Participation was voluntary, and 65.08% of the invited urologists completed the survey.ResultsAmong the respondents, 84.7% reported utilizing the available guidelines in their routine clinical practice, with varying frequencies of reference. The primary motivations for guideline use were the prevention of potential complications and the avoidance of legal risks, as indicated by 90.5% of respondents. While 56.9% of participants adhered to the guidelines as a clinically standardized practice, 41.6% reported applying the recommendations on a case-by-case basis. Notably, 41.0% of respondents emphasized the need for locally adapted versions of guideline texts. Additionally, nearly half of the participants reported receiving no formal education or training on the significance, content, and practical application of these guidelines. Furthermore, 12.7% expressed skepticism about the evidence-based foundation of the guidelines, questioning whether the recommendations were derived from rigorously conducted studies.ConclusionThe available urolithiasis guidelines are recognized as valuable resources offering key recommendations for the effective and safe management of urolithiasis. However, findings from this survey highlight significant variability in clinical practice patterns due to local conditions and the individual experience and attitudes of practicing urologists. The application of guideline recommendations is further influenced by perceptions regarding their development, content, and practicality. Insights gathered from this study may contribute to improving the preparation, dissemination, and implementation of urolithiasis guidelines, particularly in adapting them to local clinical settings.
| S-EPMC11790800 | biostudies-literature
Project description:BackgroundCommunication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists' implementation of stroke CPGs. This study aimed to describe speech pathologists' experiences and current use of guidelines, and to identify what factors influence speech pathologists' implementation of stroke CPGs.MethodsSpeech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data.Results320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline "somewhat useful" or "very useful". Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided.ConclusionsThere are many different factors that can influence speech pathologists' implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.
| S-EPMC4015602 | biostudies-literature
Project description:INTRODUCTION:Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE:To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS:A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS:The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION:This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
| S-EPMC7413113 | biostudies-literature
Project description:BackgroundThe implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs.MethodsA systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies.ResultsDatabase searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed.ConclusionsThe use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context.Trial registrationPROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.
| S-EPMC11305041 | biostudies-literature
Project description:Assessing barriers before implementing an evidence-based practice can increase the chances of successful implementation. This project evaluated measures of intervention characteristics that could affect implementation: evidence strength and quality; relative advantage; adaptability; trialability; complexity; design quality and packaging; perceived cost; compatibility; observability; risk; and burden. Measures (109 items total) for each intervention characteristic were developed in a previous study, using prior measures, and expert feedback. Measures were scored such that higher scores meant a more positive view. Healthcare personnel implementing a new practice (n = 175) completed two surveys, 1 month apart. Participants completed the intervention characteristic item banks and questions on the use of the evidence-based practice. Reliability and validity were assessed for each item bank. All measures had Cronbach's alphas over 0.7 (range: 0.700-0.932) indicating good reliability. Frequent users of the practice reported better levels of each determinant at the first (Cohen's d range: -0.239 to -0.687) and second surveys (Cohen's d range: -0.043 to -1.081) except for costs (0.096) with use on the second survey. This preliminary test of measures to assess determinants of implementing evidence-based practice supports the validity and reliability of these tools. Additional studies are needed to further test the psychometric properties of the measures and develop short forms of each intervention characteristic measure.
| S-EPMC11056881 | biostudies-literature
Project description:BackgroundAs Clinical Practice Guidelines (CPGs) provide effective guidance for providing medical care for individuals with alcohol use disorder (AUD), the evidence behind them should be robust.ObjectiveOur primary objective was to critically appraise the methodological and reporting quality of systematic reviews cited within CPGs regarding the treatment of AUD. Our secondary objective was to determine how frequently Cochrane Reviews were cited as justification and to evaluate appraisals between Cochrane and non-Cochrane reviews.MethodsWe searched PubMed to identify CPGs for the treatment of AUD published between 2015 and 2021. Systematic reviews included in each CPG were evaluated using the Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses (PRISMA) and a validated quality assessment tool (AMSTAR-2). Additional study characteristics were recorded.ResultsFrom the screening process, 98 systematic reviews from 6 CPGs met inclusion criteria. PRISMA adherence ranged from 72% to 85% (mean of 79%). AMSTAR-2 adherence ranged from 52% to 73% (mean of 68%). AMSTAR appraisal ratings found 32 (35.6%) critically low, 10 (11.1%) low, 35 (38.9%) moderate, and only 13 (14.4%) high systematic reviews. Cochrane systematic reviews displayed greater PRISMA (0.92 vs. 0.75: p < 0.001) and AMSTAR-2 (0.90 vs. 0.61.; p < 0.001) scores compared to the non-Cochrane studies.ConclusionSystematic reviews included in CPGs for AUD treatment showed variable adherence to PRISMA and AMSTAR-2 guidelines, with almost half of the systematic reviews being critically low to low methodological quality. Given the prevalence of alcohol use disorder, methodological and reporting quality recommendations are important to strengthening evidence informing CPGs.
| S-EPMC8885851 | biostudies-literature