Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
Department of Pharmacy, Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China; Department of Pharmacy, Yantai Yuhuangding Hospital, Shandong, China.
J Clin Epidemiol. 2023 Oct;162:169-181. doi: 10.1016/j.jclinepi.2023.08.017. Epub 2023 Aug 30.
To identify barriers and facilitators of clinical practice guidelines (CPGs) implementation, and map those factors to the theoretical domains framework (TDF) and behavior change wheel (BCW).
We conducted an umbrella review of systematic reviews. PubMed, Embase, and the Cochrane Library were searched. Two investigators independently screened the studies, extracted the data, and assessed the methodological quality. The identified barriers and facilitators of CPG implementation were categorized and mapped to the TDF domains and BCW components.
Thirty-seven studies were included, and 193 barriers and 140 facilitators were identified. Intrinsic aspects (35 barriers and 28 facilitators) mainly included the CPGs' impracticality, complexity, and inaccessibility. Extrinsic aspects (158 barriers and 113 facilitators) mainly included lack of resources, training, funding, or awareness of CPG content in barriers; audits and feedback; strong leadership and management support; and educating and training about CPGs in facilitators. Environmental context and resources (n = 97, 19.48%) were the most reported barriers in TDF domains. Physical opportunity and social opportunity were the most frequently mentioned models in BCW.
Multiple barriers and facilitators for healthcare CPG implementation are identified, with further links to TDF and BCW. Future knowledge translation strategies should be developed accordingly in specified health care settings.
确定临床实践指南（CPG）实施的障碍和促进因素，并将这些因素映射到理论领域框架（TDF）和行为改变轮（BCW）。
我们进行了系统综述的伞式审查。在 PubMed、Embase 和 Cochrane Library 中进行了检索。两名调查员独立筛选研究、提取数据并评估方法学质量。确定了 CPG 实施的障碍和促进因素，并将其分类并映射到 TDF 领域和 BCW 组件。
共纳入 37 项研究，确定了 193 个障碍因素和 140 个促进因素。内在方面（35 个障碍因素和 28 个促进因素）主要包括 CPG 的不切实际、复杂性和难以获取。外在方面（158 个障碍因素和 113 个促进因素）主要包括缺乏资源、培训、资金或对 CPG 内容的认识不足；审核和反馈；强有力的领导和管理支持；以及对 CPG 的教育和培训。环境背景和资源（n=97，19.48%）是 TDF 领域报告最多的障碍因素。物理机会和社会机会是 BCW 中最常提到的模型。
确定了多个与 TDF 和 BCW 相关的医疗保健 CPG 实施的障碍和促进因素。未来应在特定的医疗保健环境中制定相应的知识转化策略。
