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APPENDIX
APPENDIX
BARRIERS
• Barriers to Clinical Practice Guideline Implementation Among Physicians: A Physician Survey
Three factors were identified as major barriers to guideline adherence: complexity of guideline
documents (61%, n=240), high number of weak or conditional recommendations (62%, n=245),
and time constraints due to clinical responsibilities (65%, n=255). Factors that would improve
guideline adherence included access to relevant guidelines at the point of care (87%)!
• Barriers and Strategies in Guideline Implementation - A Scoping Review
The publication and dissemination of guidelines does not, on its own, automatically result in their
use. Therefore, some kind of implementation is needed.
• A scoping review of theories used to investigate clinician adherence to clinical practice
guidelines
Key barriers to adherence were TDF domains of environmental context and resources (e.g.,
outdated guidelines, burdensome guidelines, lack of resources), belief of consequences (e.g.,
adhering would not deliver clinical gains claimed), belief of capabilities (e.g., ability to apply CPGs)
and knowledge (e.g., existence of CPGs).
• Why are we (doctors) deviating from guidelines?
Over 20 years ago a study was already investigating the barriers to physician adherence to clinical
practice guidelines (Cabana 1999). Based on a systematic review, including 76 articles, they found
plenty of "good reasons" for clinicians not following guidelines. For example, a lack of awareness
("I didn't know that was a guideline!"), lack of familiarity ("I don't know what's inside the guideline"),
or lack of agreement regarding the guidelines ("I'm not too sure it's going to improve my patient's
outcome").
IMPLEMENTATION
• Physicians show lack of knowledge on latest updates to asthma management guidelines
Without proper strategies and implementations to address the lack of understanding, it could take
years for physicians to fully understand the key points of the guidelines and translate them into
the clinical setting. Narrowing the knowledge gap in physicians is one of the most important steps
that need to happen for guideline adherence and implementation. There needs to be concerted
efforts on educating and training healthcare professionals on the new guidelines.
• Implementation of treatment guidelines for specialist mental health care
Adherence of both professionals and organizations to guidelines can be improved when they are
developed locally or adapted to the local context, taking into account issues such as value
judgments, use of resources, characteristics of the local context, and feasibility.
Copyright © 2023 International Guidelines Center, Inc., All rights reserved.
