Almazrou Saja H, Almoajil Hajar, Alghamdi Sara, Althenyan Ghadeer, Alqahtani Abdulhadi, Amer Yasser Sami
College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia.
Physical Therapy Department, College of Applied Medical Sciences, Imam Abdulrahamn bin Faisal University, Dammam 34212, Saudi Arabia.
J Clin Med. 2023 Aug 3;12(15):5113. doi: 10.3390/jcm12155113.
Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA).
A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected.
We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals.
Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.
临床实践指南（CPG）可改善临床决策并提高患者治疗效果，但CPG的实施情况不佳。CPG的成功受到与障碍和促进因素相关的几个因素的影响。因此，探索中东和北非（MENA）地区CPG实施的关键障碍和促进因素可能非常有用。
采用参与临床实践指南的30位专家的意见进行了三轮德尔菲研究。在前两轮中，要求参与者根据五点李克特量表对与CPG实施的障碍或促进因素相关的每条陈述进行评分。这些陈述是从现有的系统评价和专家意见中确定的。在第三轮中，参与者对从第一轮和第二轮中确定的最重要的障碍和促进因素进行了排名。使用频率、百分比和中位数对障碍和促进因素陈述进行描述性分析，以总结收集到的变量。
我们确定了中东和北非地区CPG实施的10个独特障碍和13个独特促进因素。排名最高的两个障碍与沟通以及现有研究和技能有关。最重要的促进因素是为医疗保健专业人员提供培训课程。
临床实践指南实施的关键障碍和促进因素似乎存在于专业、组织和外部环境中，为了提高中东和北非地区的实施成功率，所有这些都应予以考虑。本研究结果有助于设计未来的实施策略，以克服障碍并利用促进因素。
