Liu Xian-Liang, Wang Tao, Tan Jing-Yu, Stewart Simon, Chan Raymond J, Eliseeva Sabina, Polotan Mary Janice, Zhao Isabella
College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia.
Torrens University Australia, Wakefield Campus, Adelaide, SA, 5000, Australia.
BMC Prim Care. 2022 Mar 1;23(1):36. doi: 10.1186/s12875-022-01641-x.
Sustainability of adherence to clinical practice guidelines (CPGs) represents an important indicator of the successful implementation in the primary care setting.
To explore the sustainability of primary care providers' adherence to CPGs after receiving planned guideline implementation strategies, activities, or programmes.
Cochrane Central Register of Controlled Trials (CENTRAL); Cumulative Index to Nursing and Allied Health Literature (CINAHL); EMBase; Joanna Briggs Institute; Journals@Ovid; Medline; PsycoINFO; PubMed, and Web of Science were searched from January 2000 through May 2021 to identify relevant studies. Studies evaluating the sustainability of primary care providers' (PCPs') adherence to CPGs in primary care after any planned guideline implementation strategies, activities, or programmes were included. Two reviewers extracted data from the included studies and assessed methodological quality independently. Narrative synthesis of the findings was conducted.
Eleven studies were included. These studies evaluated the sustainability of adherence to CPGs related to drug prescribing, disease management, cancer screening, and hand hygiene in primary care. Educational outreach visits, teaching sessions, reminders, audit and feedback, and printed materials were utilized in the included studies as guideline implementation strategies. None of the included studies utilized purpose-designed measurements to evaluate the extent of sustainability. Three studies showed positive sustainability results, three studies showed mixed sustainability results, and four studies reported no significant changes in the sustainability of adherence to CPGs. Overall, it was difficult to quantify the extent to which CPG-based healthcare behaviours were fully sustained based on the variety of results reported in the included studies.
Current guideline implementation strategies may potentially improve the sustainability of PCPs' adherence to CPGs. However, the literature reveals a limited body of evidence for any given guideline implementation strategy. Further research, including the development of a validated purpose-designed sustainability tool, is required to address this important clinical issue.
The study protocol has been registered at PROSPERO (No. CRD42021259748 ).
坚持临床实践指南（CPGs）的可持续性是其在初级保健环境中成功实施的一项重要指标。
探讨初级保健提供者在接受计划好的指南实施策略、活动或项目后，坚持CPGs的可持续性。
检索了考克兰对照试验中央注册库（CENTRAL）、护理及相关健康文献累积索引（CINAHL）、EMBase、乔安娜·布里格斯循证卫生保健中心、Ovid电子期刊全文数据库、医学期刊数据库（Medline）、心理学文摘数据库（PsycoINFO）、美国国立医学图书馆医学期刊数据库（PubMed）以及科学引文索引数据库（Web of Science），检索时间范围为2000年1月至2021年5月，以确定相关研究。纳入评估在任何计划好的指南实施策略、活动或项目后，初级保健提供者（PCPs）在初级保健中坚持CPGs的可持续性的研究。两名综述员从纳入研究中提取数据并独立评估方法学质量。对研究结果进行叙述性综合分析。
纳入11项研究。这些研究评估了初级保健中与药物处方、疾病管理、癌症筛查和手部卫生相关的CPGs坚持的可持续性。纳入研究中采用了教育外展访问、教学课程、提醒、审核与反馈以及印刷材料作为指南实施策略。纳入研究中均未使用专门设计的测量方法来评估可持续性的程度。三项研究显示出积极的可持续性结果，三项研究显示出混合的可持续性结果，四项研究报告称CPGs坚持的可持续性没有显著变化。总体而言，根据纳入研究报告的各种结果，很难量化基于CPG的医疗行为得到充分维持的程度。
当前的指南实施策略可能会提高初级保健提供者坚持CPGs的可持续性。然而，文献显示针对任何特定指南实施策略的证据有限。需要进一步的研究，包括开发经过验证的专门设计的可持续性工具，以解决这一重要的临床问题。
该研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42021259748）。
