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

Article


Wang, Tao, Tan, Jing-Yu (Benjamin), Liu, Xian-Liang and Zhao, Isabella. 2023. "Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews." BMJ Open. 13 (1). https://doi.org/10.1136/bmjopen-2022-062158
Article Title

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

ERA Journal ID200230
Article CategoryArticle
AuthorsWang, Tao, Tan, Jing-Yu (Benjamin), Liu, Xian-Liang and Zhao, Isabella
Journal TitleBMJ Open
Journal Citation13 (1)
Article Numbere062158
Number of Pages18
Year2023
PublisherBMJ
Place of PublicationUnited Kingdom
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2022-062158
Web Address (URL)https://bmjopen.bmj.com/content/13/1/e062158
Abstract

Objectives To 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.

Design An overview of systematic reviews.

Data sources Nine 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 criteria Systematic 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 synthesis Two 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.

Results Twelve 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.

Conclusion Policy-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.

KeywordsHealth policy; Organisation of health services; Primary care; Protocols & guidelines
ANZSRC Field of Research 2020420503. Community and primary care
420304. General practice
Byline AffiliationsCharles Darwin University
Queensland University of Technology
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Wang, Tao, Molassiotis, Alex, Chung, Betty Pui Man and Tan, Jing-Yu. 2018. "Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review." BMC Palliative Care. 17 (1). https://doi.org/10.1186/s12904-018-0346-9
Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis
Ge, Li, Zheng, Qing-Xiang, Liao, Yan-Tan, Tan, Jing-Yu, Xie, Qiu-Lin and Rask, Mikael. 2017. "Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis." Complementary Therapies in Clinical Practice. 29, pp. 35-47. https://doi.org/10.1016/j.ctcp.2017.08.005
Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials
Li, Rong-Qing, Li, Zhuang-Miao, Tan, Jing-Yu, Chen, Gu-Lan and Lin, Wen-Ying. 2017. "Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials." Complementary Therapies in Clinical Practice. 28, pp. 75-84. https://doi.org/10.1016/j.ctcp.2017.05.009
Auricular therapy for lactation: A systematic review
Chen, Melissa Li-Sha, Tan, Jing-Yu and Suen, Lorna Kwai-Ping. 2017. "Auricular therapy for lactation: A systematic review." Complementary Therapies in Clinical Practice. 29, pp. 169-184. https://doi.org/10.1016/j.ctcp.2017.09.006
Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire
Tan, Jing-Yu, Yorke, Janelle, Harle, Amelie, Smith, Jacky, Blackhall, Fiona, Pilling, Mark and Molassiotis, Alex. 2017. "Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire." Journal of Pain and Symptom Management. 53 (2), pp. 208-215. https://doi.org/10.1016/j.jpainsymman.2016.08.009
Effectiveness of disease-specific self-management education on health outcomes in patients with chronic obstructive pulmonary disease: An updated systematic review and meta-analysis
Wang, Tao, Tan, Jing-Yu, Xiao, Lily Dongxia and Deng, Renli. 2017. "Effectiveness of disease-specific self-management education on health outcomes in patients with chronic obstructive pulmonary disease: An updated systematic review and meta-analysis." Patient Education and Counseling. 100 (8), pp. 1432-1446. https://doi.org/10.1016/j.pec.2017.02.026
Acupoints Stimulation for Anxiety and Depression in Cancer Patients: A Quantitative Synthesis of Randomized Controlled Trials
Wang, Tao, Deng, Renli, Tan, Jing-Yu and Guan, Feng-Guang. 2016. "Acupoints Stimulation for Anxiety and Depression in Cancer Patients: A Quantitative Synthesis of Randomized Controlled Trials." Evidence-Based Complementary and Alternative Medicine. 2016. https://doi.org/10.1155/2016/5645632
Current evidence on traditional Chinese exercises for cancer-related fatigue: a quantitative synthesis of randomized controlled trials
Ma, Hai-Li, Tan, Jing-Yu, Yang, Liu, Huang, Tao and Liao, Qiao-Jing. 2016. "Current evidence on traditional Chinese exercises for cancer-related fatigue: a quantitative synthesis of randomized controlled trials." European Journal of Integrative Medicine. 8 (5), pp. 707-714. https://doi.org/10.1016/j.eujim.2016.05.007
Psychometric assessment of the Chinese version of the MASCC Antiemesis Tool (MAT) for measuring chemotherapy-induced nausea and vomiting
Tan, Jing-Yu, Suen, Lorna and Molassiotis, Alex. 2016. "Psychometric assessment of the Chinese version of the MASCC Antiemesis Tool (MAT) for measuring chemotherapy-induced nausea and vomiting." Supportive Care in Cancer. 24 (9), pp. 3729 - 3737. https://doi.org/10.1007/s00520-016-3181-7
Auricular therapy for chronic pain management in adults: A synthesis of evidence
Zhao, Hong-Jia, Tan, Jing-Yu, Wang, Tao and Jin, Lang. 2015. "Auricular therapy for chronic pain management in adults: A synthesis of evidence." Complementary Therapies in Clinical Practice. 21 (2), pp. 68-78. https://doi.org/10.1016/j.ctcp.2015.03.006
Interventions for cough in cancer
Molassiotis, Alex, Bailey, Chris, Caress, Ann and Tan, Jing-Yu. 2015. "Interventions for cough in cancer." Cochrane Database of Systematic Reviews. 2015 (5). https://doi.org/10.1002/14651858.CD007881.pub3
Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: A systematic review
Zhou, L., Liu, X.-L., Tan, J.-Y., Yu, H.-P., Pratt, J. and Peng, Y.-Q.. 2015. "Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: A systematic review." International Nursing Review. 62 (2), pp. 218-230. https://doi.org/10.1111/inr.12172
Sham acupressure controls used in randomized controlled trials: A systematic review and critique
Tan, Jing-Yu, Suen, Lorna K. P., Wang, Tao and Molassiotis, Alexander. 2015. "Sham acupressure controls used in randomized controlled trials: A systematic review and critique." PLoS One. 10 (7). https://doi.org/10.1371/journal.pone.0132989
Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Liu, Xian-Liang, Tan, Jing-Yu, Molassiotis, Alex, Suen, Lorna and Shi, Yan. 2015. "Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Evidence-Based Complementary and Alternative Medicine. 2015. https://doi.org/10.1155/2015/657809
Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials
Liu, Xian-Liang, Tan, Jing-Yu, Wang, Tao, Zhang, Qi, Zhang, Min, Yao, Li-Qun and Chen, Jin-Xiu. 2014. "Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials." Rehabilitation Nursing. 39 (1), pp. 36-59. https://doi.org/10.1002/rnj.112
Adverse events of auricular therapy: A systematic review
Tan, Jing-Yu, Molassiotis, Alexander, Wang, Tao and Suen, Lorna K. P.. 2014. "Adverse events of auricular therapy: A systematic review." Evidence-Based Complementary and Alternative Medicine. 2014 (2014). https://doi.org/10.1155/2014/506758
Current evidence on auricular therapy for chemotherapy-induced nausea and vomiting in cancer patients: A systematic review of randomized controlled trials
Tan, Jing-Yu, Molassiotis, Alexander, Wang, Tao and Suen, Lorna K. P.. 2014. "Current evidence on auricular therapy for chemotherapy-induced nausea and vomiting in cancer patients: A systematic review of randomized controlled trials." Evidence-Based Complementary and Alternative Medicine. 2014 (2014). https://doi.org/10.1155/2014/430796
Progress towards the development of animal models of chemotherapy-induced gastrointestinal mucositis
Zhang, Min, Chen, Jin-Xiu, Tan, Jing-Yu and Liu, Xian-Liang. 2012. "Progress towards the development of animal models of chemotherapy-induced gastrointestinal mucositis." World Chinese Journal of Digestology. 20 (8), pp. 649-655. https://doi.org/10.11569/wcjd.v20.i8.649