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Factors Influencing Uptake of Changes to Clinical Preventive Guidelines
Vivian Jiang1, E Marshall Brooks2, Sebastian T Tong2
1From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (VJ, EMB, AHK); Department of Family Medicine, Oregon Health Sciences University, Portland, OR (JH); Oregon Community Health Information Network (OCHIN), Portland OR (JH). Vivian.Jiang@cuanschutz.edu.
Background:
Despite widespread recognition that adherence to clinical preventive guidelines improves patient outcomes, clinicians struggle to implement guideline changes in a timely manner. Multiple factors influence guideline adoption and effective implementation. However, few studies evaluate their collective and inter-related effects. This qualitative study provides a comprehensive picture of the interplay between multiple factors on uptake of new or changed preventive guidelines.
Methods:
Semistructured interviews conducted in 2018 with a diverse sample of clinicians and practice leaders sought to understand patient, clinician, practice, health system, environment, and guideline factors of influence. An immersion-crystallization approach was used to identify emergent themes.
Results:
Interviewees expressed motivation to adhere to guidelines but also valued sharing decisions with patients. Personal biases and fears affected both clinician and patient guideline adoption. Practices facilitated implementation through workflow optimization and encouraging a culture of evidence-based practice while a key health system function was to maintain electronic health record alerts. More traditional environmental factors, such as insurance coverage or transportation, were less of a barrier to guideline adoption and implementation than the influence of media and specialists. Various specific guideline characteristics also affected ease of adoption and implementation. Different settings expressed greater health system, practice, or clinician-centric approaches to guideline implementation.
Conclusions:
Guideline uptake is influenced by a complex interplay of multiple levels of factors including the patient, clinician, practice, health system, environment, and guideline levels. Comprehensively understanding all levels of influence for each specific clinical setting may help to determine the optimal intervention(s) for improving uptake of evidence-based guidelines.
Insights
Clinicians face challenges implementing new preventive guidelines due to complex patient, clinician, and system factors. Understanding these influences is key to improving guideline adoption and patient outcomes.
Area of Science:
- Clinical Practice Guidelines
- Healthcare Implementation Science
- Qualitative Research Methods
Background:
- Clinicians face challenges in timely adoption of updated clinical preventive guidelines.
- Multiple interconnected factors influence guideline implementation, yet few studies examine their combined effects.
- This study explores the interplay of various factors affecting the uptake of new or revised preventive guidelines.
Purpose of the Study:
- To comprehensively investigate the multifaceted factors influencing the adoption and implementation of clinical preventive guidelines.
- To understand the collective and inter-related effects of patient, clinician, practice, health system, environmental, and guideline-specific factors.
- To provide insights for optimizing interventions to improve guideline uptake in diverse clinical settings.
Main Methods:
- Qualitative study utilizing semistructured interviews with clinicians and practice leaders in 2018.
- Employed an immersion-crystallization approach to identify emergent themes from interview data.
- Investigated influences across patient, clinician, practice, health system, environment, and guideline levels.
Main Results:
- Clinicians are motivated to follow guidelines but balance this with shared decision-making.
- Personal biases, practice workflow, and health system support (e.g., EHR alerts) significantly impact implementation.
- Media and specialist influence, along with specific guideline characteristics, were more impactful than traditional environmental factors like insurance or transportation.
- Different clinical settings exhibited distinct approaches to guideline implementation (clinician-centric, practice-centric, or health system-centric).
Conclusions:
- Guideline uptake is shaped by a complex interplay of factors across multiple levels.
- A thorough understanding of these multilevel influences within specific clinical contexts is essential.
- Identifying these determinants can guide the development of optimal interventions to enhance the implementation of evidence-based guidelines.
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