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Do guidelines offer implementation advice to target users? A systematic review of guideline applicability
Anna R Gagliardi1, Melissa C Brouwers2
1University Health Network, Toronto, Ontario, Canada.
BMJ Open
|February 20, 2015
Summary
Clinical practice guidelines published after 2008 still lack implementation support, hindering their use. Research is needed to develop effective tools for healthcare providers and patients to improve guideline applicability.
Area of Science:
- Health Services Research
- Clinical Practice Guidelines
Background:
- Clinical practice guidelines (CPGs) are crucial for healthcare delivery.
- Guidelines published before 2008, assessed using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument, showed poor applicability due to a lack of implementation support.
Purpose of the Study:
- To examine the applicability of CPGs published from 2008 onwards.
- To identify factors associated with the applicability of these guidelines.
Main Methods:
- A systematic review was conducted on studies using the AGREE instrument to assess CPGs published from 2008 to July 2014.
- MEDLINE and EMBASE databases were searched, and reference lists were reviewed.
- Multilevel regression analysis identified factors associated with applicability.
Main Results:
- Twenty studies, evaluating 137 guidelines, were included.
- The mean applicability score was 43.6%, which did not significantly improve compared to earlier guidelines.
- Applicability scored lower than other AGREE domains.
- Guideline applicability was associated with country (UK) and developer type (disease-specific foundation, non-profit healthcare system) when assessed with AGREE II.
Conclusions:
- Despite recognized needs, CPGs continue to lack essential implementation tools.
- Further research is required to determine the necessary types of implementation tools for healthcare providers and consumers.
- Developing high-quality implementation tools is essential for improving healthcare delivery and outcomes.
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