Barriers to Implementing Evidence-Based Clinical Guidelines: A Survey of Early Adopters

Abstract

Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed.

Evidence Based Dental Care: Integrating Clinical Expertise with Systematic Research

“…The most common barriers to implementation of early-adopting dentists are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research [7].…”

“…Unfortunately, just 32% of children aged 6 to 19 years have sealants. This may be due to the relatively slow translation of current biomedical science into dental practice [7].…”

Humanizing clinical dentistry through a person-centred model

“…48 This issue is at the heart of the expressed scepticism by many practitioners: one of the most common barriers to implementation of EBD is the lack of trust in evidence or research. 49 Carlsen and colleagues found that general practitioners' trust in guidelines is outweighed by their concerns with widespread guideline implementation -primarily because of differences between real patients and those portrayed in the guidelines. According to some professionals, guidelines…”

“…50 Other barriers to the EBD implementation are a lack of up-to-date evidence, a lack of clear answers to clinical questions, and contradictory information in the scientific literature. 49,51 Those flaws particularly affect dentistry since dental research funding is inferior to other medical fields where mortality/morbidity is higher. Also, instead of prescribing medication, the main interventions in dentistry involve complex manual manipulations (e.g.…”

Assessing adherence to the 2010 antiretroviral guidelines at the antiretroviral rollout clinic in 1 Military Hospital, South Africa: A retrospective, cross sectional study

“…[3] Antiretroviral treatment (ART), in the form of highly active anti retroviral therapy, consists of a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonNRTI or a protease inhibitor. The South African (SA) 2004 antiretroviral (ARV) guidelines recommended a combination of stavudine (d4T) and lamivudine (3TC) as the NRTI backbone in the firstline regimen and a combination of zidovudine (AZT) and didanosine (DDI) as the backbone in the secondline regimen.…”