Toronto General Research Institute, 200 Elizabeth Street, 13EN-235, Toronto, Ontario, M5G2C4, Canada.
Implement Sci. 2009 Jul 2;4:36. doi: 10.1186/1748-5908-4-36.
Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption.
The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension) and institutional care (chronic ulcer, chronic heart failure) topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies.
Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective outcomes reflecting the adoption of processes and associated patient care outcomes could be evaluated.
实践指南可以改善医疗保健服务和结果，但有几个问题挑战了指南的采用，包括其内在属性，以及是否以及如何实施。似乎指南的格式可能会影响可及性和易用性，这可能会克服指南采用的态度障碍，并且对所有利益相关者都很重要。指南的内容可以促进与不同利益相关者相关的各种形式的关于指南采用的决策。指南发起者对指南的了解、态度、实施的动机和能力可能会影响他们是否以及如何制定包含这些特征的指南，并进行实施。对这些问题的研究可能会为改善指南的采用提供机会。
假设有助于采用的属性将通过主题分析扩展，并对国际初级保健（糖尿病、高血压）和机构护理（慢性溃疡、慢性心力衰竭）主题的指南内容进行定量和定性总结。通过对与指南制定机构相关的个人进行访谈的定性分析，探讨影响指南是否以及如何实施的因素。
以前的研究通过测量对建议的遵守率或相关结果来检查指南的实施情况，但这对如何改进指南本身或其实施情况几乎没有提供任何见解。这项研究将为进行实验研究建立一个理论基础，以比较增强指南制定和实施能力的干预措施的成本效益。此类研究可以首先检查短期结果，这些结果可以预测指南的使用情况，例如记忆、对、信心和采用意图。如果成功，然后可以评估反映采用过程和相关患者护理结果的长期客观结果。
