Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
Int J Pharm Pract. 2021 Feb 10;29(1):3-11. doi: 10.1111/ijpp.12654.
Evidence-based guidelines have the potential to reduce variation and increase prescribing quality. Identifying the key determinants to their uptake, using a theory-based approach, may assist in the design of successful interventions to increase their adoption into practice. This systematic review investigated barriers and facilitators identified using the Theoretical Domains Framework (TDF) to the implementation of prescribing guidelines.
Electronic databases (EMBASE, PubMed) were searched. Studies were included if they used the TDF to identify key determinants of guideline implementation. Only studies published in English were included.
Of the 407 studies identified, 15 were included. A range of patient populations and therapeutic categories were represented. Multiple determinants were identified that affected guideline implementation, with similarities and differences identified across studies. Barriers to guideline adoption included time restriction, lack of awareness, guideline complexity, lack of clinical evidence, social influences and disagreement. Facilitators included peer influence, guideline simplicity, confidence and belief about the positive consequences derived from guideline adoption, for examples improved care and patient outcomes.
Multiple behavioural factors affect the adoption of prescribing guidelines. The results aided the understanding of factors that may be targeted to increase guideline compliance. However, barriers and facilitators can vary significantly in different environments; therefore, research that targets particular healthcare settings and patient populations may provide further evidence to increase the specificity and credibility of intervention strategies.
循证指南有可能减少差异并提高处方质量。使用基于理论的方法确定其采用的关键决定因素，可能有助于设计成功的干预措施，以增加其在实践中的应用。本系统评价调查了使用理论领域框架（TDF）确定的处方指南实施的障碍和促进因素。
电子数据库（EMBASE、PubMed）进行了搜索。如果研究使用 TDF 来确定指南实施的关键决定因素，则将其纳入研究。仅纳入发表英文的研究。
在确定的 407 项研究中，纳入了 15 项研究。研究涉及多种患者人群和治疗类别。确定了多种影响指南实施的决定因素，不同研究之间存在相似和不同之处。指南采用的障碍包括时间限制、缺乏意识、指南复杂性、缺乏临床证据、社会影响和意见不合。促进因素包括同伴影响、指南简单性、对从指南采用中获得积极结果的信心和信念，例如改善护理和患者结局。
多种行为因素会影响处方指南的采用。结果有助于了解可能针对增加指南依从性的因素。然而，障碍和促进因素在不同环境中可能有很大差异；因此，针对特定医疗保健环境和患者人群的研究可能会提供进一步的证据，以增加干预策略的特异性和可信度。
