Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol

Abstract

IntroductionThe uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference.Methods and analysisWe will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis.Discussion and disseminationIn this review, we will assess the impact of implementation strategies and contextual factors on physician adherence to HF CPGs. We will explore why some interventions may succeed in one setting and fail in another. We will disseminate our findings through briefing reports, publications and presentations.Trial registration numberCRD42015017155.

Prescription patterns and adequacy of blood pressure control among adult hypertensive patients in Kenya; findings and implications

“…Antihypertensive therapy has demonstrated clear benefits through reducing the risk of adverse health outcomes (13). The use of treatment guidelines typically enhances the appropriate use of medicines, although there are concerns with adherence rates to guidelines in practice across countries (14)(15)(16)(17)(18). The current Kenyan Standard Treatment Guidelines (STGs) recommend the use of diuretics, beta blockers, calcium channel blockers (CCDs), angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for patients with hypertension.…”

Competencia de los cuidadores familiares para cuidar a los pacientes con falla cardíaca

“…Las guías de práctica clínica establecen como elemento clave, el apoyo de la familia o cuidador para promover autocuidado, señalando la necesidad de valorar la capacidad y la preparación del cuidador [5][6] . Sin embargo, existen pocos estudios que evalúen la competencia de cuidado del cuidador familiar y el efecto directo sobre la experiencia de la enfermedad.…”

Evaluating the clinical application of a leaflet for clinical practice guideline in patients with lumbar herniated intervertebral discs

“…[ 6 ] Despite the existence of CPGs, the application of recommendations into routine clinical practice remains very slow. [ 7 ] However, the utility of CPGs is more important in developing its widespread use.…”

“…Recently, several studies have examined the implementation of evidence or guidelines. [ 7 – 9 ] Among several methods for the implementation of CPGs, there are clinical studies that have demonstrated the applicability of CPGs to clinical fields. [ 8 , 10 – 13 ]…”