College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
Int J Clin Pharm. 2023 Feb;45(1):52-63. doi: 10.1007/s11096-022-01490-9. Epub 2022 Nov 16.
Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors.
To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps.
In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed.
The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators.
There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.
常规应用基于证据的临床实践指南（CPGs）是优化患者护理和减少实践差异的有效策略。医疗保健专业人员不遵守 CPG 会给患者和医疗保健系统的可持续性带来风险。将理论整合到研究中来调查遵守情况，可以更深入地了解导致行为不佳的复杂原因。
确定文献中围绕在 CPG 遵守研究中使用理论的覆盖范围，报告主要发现并确定知识空白。
2021 年 4 月，检索了三个文献数据库，以查找自 2010 年 1 月以来发表的采用理论来研究卫生专业人员遵守 CPG 的研究。两名评审员独立筛选文章以确定其是否符合入选标准，并对数据进行图表绘制。采用叙述性方法进行综合分析。
综述共纳入 12 篇文章。这些研究主要限于对医生的调查、定量设计、单一疾病状态和少数几个国家。行为理论的应用有助于汇集关于遵守 CPG 的障碍和促进因素的数据。一些报告理论的领域和结构被包含在理论领域框架（TDF）中；最常见的障碍与 TDF 的环境背景和资源领域一致，较少的研究报告了促进因素。
越来越多的研究采用行为理论来调查医生对 CPG 的遵守情况。尽管数量有限，但这些研究提供了关于常见障碍和促进因素的具体见解，从而为完善现有的和未来的实施策略提供了有价值的证据。值得对其他卫生专业人员进行类似的调查。
