Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Staffordshire, UK.
Musculoskeletal Care. 2020 Jun;18(2):101-110. doi: 10.1002/msc.1452. Epub 2020 Jan 30.
Implementation of evidence-based health guidelines in primary care is challenging. This systematic review aimed to synthesize qualitative evidence that investigates the factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care.
A systematic review of qualitative studies. MEDLINE, EMBASE, CINAHL, HMIC, PsychINFO, Web of Science and Assia were searched (from 2000 to March 2019). The methodological quality of the included studies was assessed by two independent reviewers. Data were analyzed and synthesized using thematic synthesis.
1612 articles were screened and four articles with a total of 87 participants (46 patients, 28 GPs, 13 practice nurses) were included. Three of the studies were conducted in England within the context of an implementation trial and one was conducted in the Netherlands. The thematic synthesis revealed three overarching themes. Best practice was not enough to achieve 'buy-in' to implementation but a range of tacit motivators to implementation were identified. Healthcare professionals used patient reasons to justify engaging or not engaging with implementation. Engaging with the whole practice was important in achieving implementation. A disconnect between research and 'real-world' primary care practice influenced long-term implementation.
Despite the relative paucity of current evidence, this systematic review has identified a series of possible disconnects may impact uptake of interventions to improve osteoarthritis care, existing between clinicians and patients, researchers and clinicians, clinicians and guidelines and within general practice itself. There remains a need to further explore the experiences of key stakeholders, including patients involved in implementation for osteoarthritis in primary care.
在基层医疗中实施基于证据的健康指南具有挑战性。本系统评价旨在综合定性证据，调查影响基层医疗中骨关节炎循证指南实施的因素。
对定性研究进行系统评价。检索了 MEDLINE、EMBASE、CINAHL、HMIC、PsychINFO、Web of Science 和 Assia（从 2000 年到 2019 年 3 月）。两名独立评审员评估纳入研究的方法学质量。使用主题综合法分析和综合数据。
筛选出 1612 篇文章，纳入了 4 篇文章，共 87 名参与者（46 名患者，28 名全科医生，13 名执业护士）。其中 3 项研究在英格兰进行，是实施试验的一部分，1 项在荷兰进行。主题综合揭示了三个总体主题。最佳实践不足以实现“认同”实施，但确定了一系列实施的隐性动机。医疗保健专业人员使用患者的理由来证明是否参与实施。参与整个实践对于实现实施很重要。研究与“真实世界”基层医疗实践之间的脱节影响了干预措施的长期实施。
尽管目前证据相对较少，但本次系统评价已确定了一系列可能的脱节，这些脱节可能会影响改善骨关节炎护理的干预措施的采用，包括临床医生和患者、研究人员和临床医生、临床医生和指南以及一般实践本身之间的脱节。仍有必要进一步探索关键利益相关者的经验，包括参与基层医疗中骨关节炎实施的患者。
