Thoonsen Andrea C, Gans Anika, Broeders Toby T, van Beusekom Ilse, Delnoij Diana M J, de Bruijne Martine C, Merten Hanneke
Amsterdam UMC, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, The Netherlands.
Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA, Diemen, The Netherlands.
BMC Health Serv Res. 2025 Jan 27;25(1):150. doi: 10.1186/s12913-025-12270-2.
Although the number of Dutch guidelines is growing, their uptake and impact in clinical practice lag behind. Dutch guideline organizations, including guideline developers, governmental agencies, health insurers and other national organizations, play a crucial role in developing, authorizing and/or supporting the use of guidelines. They influence end users' awareness, accessibility, understanding, acceptability and applicability of guidelines. In this study, we explored the barriers and facilitators that representatives of guideline organizations perceive in nationwide guideline implementation.
In this qualitative study, we conducted semi-structured interviews with 35 representatives of 24 different guideline organizations. We employed framework analysis, using the updated Consolidated Framework for Implementation Research (CFIR), and thematic analysis to guide our data analysis and synthesis.
We found 45 different implementation barriers and 35 implementation facilitators. We identified seven overarching themes of interrelated barriers and facilitators that extended across the stakeholders involved and domains within the updated CFIR. These included 1) healthcare demand and resource availability, 2) implementation knowledge and expertise, 3) guideline characteristics: representation, evidence base and design, 4) partnerships and collaboration, 5) characteristics of guideline implementation planning, execution and evaluation strategies, 6) characteristics of healthcare professionals: need, capability, opportunity and motivation, and 7) legal and regulatory compliance.
We obtained valuable insights into the complex dynamics of barriers and facilitators perceived by guideline organizations in nationwide guideline implementation. Our findings help explain why healthcare professionals and healthcare facilities may (not), slowly or inconsistently adhere to guideline recommendations in practice. The identified barriers and facilitators provide guidance for policymakers to re-evaluate and improve nationwide quality and guideline implementation policies, to eventually improve clinical practice and health outcomes for patients.
尽管荷兰指南的数量在不断增加，但其在临床实践中的应用和影响却滞后。包括指南制定者、政府机构、健康保险公司和其他国家组织在内的荷兰指南组织在制定、授权和/或支持指南的使用方面发挥着关键作用。它们影响终端用户对指南的认知、获取、理解、接受和适用性。在本研究中，我们探讨了指南组织代表在全国范围内实施指南时所感知到的障碍和促进因素。
在这项定性研究中，我们对24个不同指南组织的35名代表进行了半结构化访谈。我们采用框架分析，使用更新后的实施研究综合框架（CFIR），并进行主题分析来指导我们的数据分析和综合。
我们发现了45个不同的实施障碍和35个实施促进因素。我们确定了七个相互关联的障碍和促进因素的总体主题，这些主题贯穿于相关利益者以及更新后的CFIR中的各个领域。其中包括1）医疗保健需求和资源可用性，2）实施知识和专业技能，3）指南特征：代表性、证据基础和设计，4）伙伴关系与合作，5）指南实施规划、执行和评估策略的特征，6）医疗保健专业人员的特征：需求、能力、机会和动机，以及7）法律法规合规性。
我们对指南组织在全国范围内实施指南时所感知到的障碍和促进因素的复杂动态有了宝贵的见解。我们的研究结果有助于解释为什么医疗保健专业人员和医疗保健机构在实践中可能（不）、缓慢或不一致地遵循指南建议。所确定的障碍和促进因素为政策制定者重新评估和改进全国性的质量和指南实施政策提供了指导，最终改善患者的临床实践和健康结果。
