Determinants of Successful Guideline Implementation: A National Cross-Sectional Survey

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. To investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.<jats:bold>Methods: </jats:bold>This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. At last, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).<jats:bold>Results: </jats:bold>The questionnaire consisted of four sections: knowledge on methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast <jats:italic>P</jats:italic>＜0.001; the west <jats:italic>P</jats:italic>=0.02; the middle <jats:italic>P</jats:italic>＜0.001 compared with the east), hospital grades(<jats:italic>P</jats:italic>=0.028), length of practitioners’ practice (<jats:italic>P</jats:italic> =0.006), education background (PhD, <jats:italic>P</jats:italic>=0.027; Master,<jats:italic> P</jats:italic>=0.002), evidence-based medicine skills acquired in work unit (<jats:italic>P</jats:italic>=0.012), and medical specialty of practitioner (General Practice, <jats:italic>P</jats:italic>=0.006; Surgery, <jats:italic>P</jats:italic>=0.043). <jats:bold>Conclusion: </jats:bold>Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.</jats:p>

Management of Gastroesophageal Reflux Disease in Esophageal Atresia Patients: A Cross-Sectional Survey amongst International Clinicians

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Influencing mechanism of the use behavior of clinical practice guidelines on antimicrobials: evidence from the integration of theory of reasoned action and organizational readiness for change

“…For example, in China, one of the countries with the largest antimicrobials consumption especially in the tertiary and secondary hospitals of its health system, the Guiding Principles for Clinical Application of Antimicrobials have been issued since 2015 with the AMS main interventions of audit and monitoring, education and training of physicians' prescribing behavior, even taking advantage of the national policy context with various financial and economic incentives to reduce inappropriate prescribing, such as implementation of the zero-margin drug policy in tertiary and secondary hospitals, reform in medical insurance payment system, and so on [9,[14][15][16][17][18]. However, the per capita use of antibacterials was still much higher than the international level of 30% [16], and the low adherence of CPGs on antimicrobials was often reported in previous studies [19,20]. Multiple sets of factors were considered as the causes of this phenomenon, such as misunderstanding of regarding CPGs' importance, low intention to use CPGs in clinical practice, and so on at the physician level; lack of providing medication guidance or related training, inadequate prescription monitor and feedback, and so on at the hospital level [21].…”

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