[Pitfalls in research into guideline implementation]

Research studies into the implementation of clinical practice guidelines often reveal only modest effects. These studies could have greater relevance if the following pitfalls were to be considered in advance. Firstly, there is a lack of awareness of the fact that physicians are overloaded with guidelines and need time for implementation, particularly when the guideline involves additional effort. Secondly, there is a lack of ownership of guidelines that were developed with involvement of many stakeholders. Thirdly, there is a lack of tailored implementation strategies focusing on specific recommendations rather than the whole guideline. Fourthly, guideline adherence is used as an outcome measure while there may be legitimate reasons to deviate from the guideline in individual cases. The future challenge for research into guideline implementation is to study how guidelines really could assist physicians in delivering personalised care.