What do Hong Kong's family physicians think of clinical guidelines? - A questionnaire survey

Objective: To study the current use of and attitude towards clinical guidelines (CGs) among Hong Kong's family physicians, and to explore the attributes that may enhance implementation. Design: Postal questionnaire survey. Subjects: A questionnaire was posted to all 1427 members of the Hong Kong College of Family Physicians (HKCFP) in the period from March to July, 2010. Main outcome measures: Response to a questionnaire on the current usage of and attitude towards CGs, respondents' demographic data. Results: 617 completed questionnaires were received (response rate 43.2%). Ninety-one percent of respondents had used CGs in patient care and 85% had used them within a month. Sixty-three percent of respondents gave the internet as the first answer to the question of where they found the clinical guidelines. "Contradicting recommendations" was ranked highest as a barrier to guideline use (82%), followed by "CGs not tailored for individual patient's needs" (77%), and "mistrust guidelines sponsored by pharmaceutical companies" (75%). There was a very high degree of agreement on what constituted a good CG: evidence-based (99%), simple and easy to use (99%), applicable to the local population (99%) and the primary care setting (98%), regularly updated (98%) and with cost effective recommendations (93%). On strategies thought to be useful in promoting the use of CGs, 96% of respondents agreed on effective dissemination, 93% on a central system for adoption of CGs, 90% on involving primary care doctors in drafting CGs and 71% on providing financial incentives. Conclusion: Most respondents were using and supportive of CGs, and would like to have a central system for guideline adoption and effective dissemination. They wished to be more involved in the development process. They thought a good CG should be evidence-based, simple and easy to use and applicable in the local setting. Family physicians' views about CGs are important and relevant for Hong Kong's guideline development policy.published_or_final_versio

Characteristics and impact of interventions to support healthcare providers’ compliance with guideline recommendations for breast cancer: a systematic literature review

BackgroundBreast cancer clinical practice guidelines (CPGs) offer evidence-based recommendations to improve quality of healthcare for patients. Suboptimal compliance with breast cancer guideline recommendations remains frequent, and has been associated with a decreased survival. The aim of this systematic review was to characterize and determine the impact of available interventions to support healthcare providers' compliance with CPGs recommendations in breast cancer healthcare.MethodsWe searched for systematic reviews and primary studies in PubMed and Embase (from inception to May 2021). We included experimental and observational studies reporting on the use of interventions to support compliance with breast cancer CPGs. Eligibility assessment, data extraction and critical appraisal was conducted by one reviewer, and cross-checked by a second reviewer. Using the same approach, we synthesized the characteristics and the effects of the interventions by type of intervention (according to the EPOC taxonomy), and applied the GRADE framework to assess the certainty of evidence.ResultsWe identified 35 primary studies reporting on 24 different interventions. Most frequently described interventions consisted in computerized decision support systems (12 studies); educational interventions (seven), audit and feedback (two), and multifaceted interventions (nine). There is low quality evidence that educational interventions targeted to healthcare professionals may improve compliance with recommendations concerning breast cancer screening, diagnosis and treatment. There is moderate quality evidence that reminder systems for healthcare professionals improve compliance with recommendations concerning breast cancer screening. There is low quality evidence that multifaceted interventions may improve compliance with recommendations concerning breast cancer screening. The effectiveness of the remaining types of interventions identified have not been evaluated with appropriate study designs for such purpose. There is very limited data on the costs of implementing these interventions.ConclusionsDifferent types of interventions to support compliance with breast cancer CPGs recommendations are available, and most of them show positive effects. More robust trials are needed to strengthen the available evidence base concerning their efficacy. Gathering data on the costs of implementing the proposed interventions is needed to inform decisions about their widespread implementation

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

Overlooked and Underused: Clinical Practice Guidelines and Malpractice Liability for Independent Physicians

This paper discusses how the use of Clinical Practice Guidelines (CPGs) can improve the quality and delivery of healthcare in America. The author states that with the passage of the Patient Protection and Affordable Care Act of 2010 the American healthcare system is in need of re-alignment, specifically challenging the established norms for promulgating CPGs. The article explores the legal evolution of CPGs and new legal avenues for their promulgation by examining their history and purpose. The author concludes by identifying three accountability models and arguing in favor of a private competitive regime for CPGs

Primary Care Provider Adherence to the Canadian Diabetes Association Clinical Practice Guideline for Chronic Kidney Disease

Background: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) requiring dialysis and contributes to one-half of all new dialysis cases each year in Canada. Despite the ability to stop or slow the progression of CKD through early detection and intervention, CKD continues to rise, in part, due to providers’ lack of knowledge of and adherence to established national clinical practice guidelines (CPGs). Methods: A quality improvement project was implemented in a rural, primary care clinic to enhance provider knowledge of the current CPG recommendations for CKD screening before and after a provider-specific educational intervention. Results: The educational intervention improved provider knowledge of and confidence in screening for renal disease in diabetic patients. The average numbers of diabetic patients screened for renal disease improved each year, with 85.5% being screened in 2015-2016, resulting in a net increase of 31.5%. In addition, modifiable risk factor screening by providers also improved in the same period, including measures of weight, blood pressure, lipids, and glycosylated hemoglobin levels. Conclusion: Increasing primary provider awareness and knowledge, through education, can foster early recognition and management of CKD in diabetes and ultimately improve renal health outcomes in the diabetic population

Barriers to Implementation and Strategies to Improve Adherence to the Sepsis Bundles

Sepsis is associated with high mortality and morbidity. Immediate recognition and treatment is crucial to prevent complications that can be highly detrimental and cause a significant impact on the U.S. healthcare economy. Numerous studies have been conducted to improve patient outcomes and lower healthcare costs from sepsis and septic shock. Many of these studies were focused on exploring healthcare providers\u27 knowledge and compliance to the Surviving Sepsis Campaign (SSC) guidelines. This study aimed to explore and identify barriers to the implementation of the sepsis bundles and strategies to enhance healthcare providers\u27 adherence to these bundles. A systematic review of articles was conducted using the ACE Star Model of Knowledge Transformation. Studies such as randomized controlled trials (RTC\u27s), systematic reviews, retrospective studies, and prospective observational studies conducted in Intensive Care Units (ICUs) within the past 10 years were utilized, guided by the American Association of Critical Care Nurses\u27 (AACN\u27s) grading system. Sources of evidence were obtained from PubMed, CINAHL, and GoogleScholar. The results of this study are aimed at helping support the evidence-based clinical practice among providers caring for patients with sepsis and septic shock in an ICU setting using evidence-based guidelines. The results of this study provide an opportunity for healthcare systems to relieve financial burdens from sepsis and thus contribute to po