Factors influencing the implementation of evidence‐based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis

Abstract

Introduction: Implementation of evidence-based health guidelines in primary care is challenging. This systematic review aimed to synthesize qualitative evidence that investigates the factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care. Methods: A systematic review of qualitative studies. MEDLINE, EMBASE, CINAHL, HMIC, PsychINFO, Web of Science and Assia were searched (from 2000 to March 2019). The methodological quality of the included studies was assessed by two independent reviewers. Data were analyzed and synthesized using thematic synthesis.Results: 1612 articles were screened and four articles with a total of 87 participants (46 patients, 28 GPs, 13 practice nurses) were included. Three of the studies were conducted in England within the context of an implementation trial and one was conducted in the Netherlands. The thematic synthesis revealed three overarching themes. Best practice was not enough to achieve 'buy-in' to implementation but a range of tacit motivators to implementation were identified. Healthcare professionals used patient reasons to justify engaging or not engaging with implementation. Engaging with the whole practice was important in achieving implementation. A disconnect between research and 'real-world' primary care practice influenced long-term implementation.Conclusions: Despite the relative paucity of current evidence, this systematic review has identified a series of possible disconnects may impact uptake of interventions to improve osteoarthritis care, existing between clinicians and patients, researchers and clinicians, clinicians and guidelines and within general practice itself. There remains a need to further explore the experiences of key stakeholders, including patients involved in implementation for osteoarthritis in primary care.

Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed‐Methods Study Using an Interrupted Time Series Approach

“…This implied the institutionalization of collaborative work, where the making of decisions was conducted in a decentralized manner, favoring the consensus and coordination among healthcare professionals. Cooperative interorganizational networks was the sixth factor, and in our results the participation of the members from Investen-isciii, the university, and BF support groups was key, as observed in other studies, since it maximizes the potential for successful implementation through collaborative partnerships (Swaithes, Paskins, Dziedzic, & Finney, 2020).…”

Patient and physician perceptions of knee and hip osteoarthritis care: A qualitative study

“…Management is frustrating for both patients and physicians and many patients do not receive recommended treatment 21,22 . Previous studies have identified barriers to recommended OA care including physician and patient perceptions of OA and recommended treatments, time and belief that OA is not a serious disease 30,31 . Several new themes emerged from this study that improve our understanding of barriers and facilitators to implementing OARSI guideline‐recommended care, including differences in what physicians and their patients identified as barriers.…”

“…21,22 Previous studies have identified barriers to recommended OA care including physician and patient perceptions of OA and recommended treatments, time and belief that OA is not a serious disease. 30,31 Several new themes emerged from this study that improve our understand- Physicians felt that patients were the main barrier; they wanted medications for a "quick fix" and were not interested in engaging in other treatment options. Both physicians and patients identified some similar barriers including cost of treatments, feeling that no effective treatments exist and that the guideline-recommended treatments were either ineffective or had temporary benefits and thus not worth the effort.…”

“…[27][28][29] Two recent systematic reviews identified barriers including patient preference, provider work load, sentiment that OA was not a serious disease and sense that recommended guidelines were not effective. 30,31 All of the studies included in these reviews were outside of the United States and the total number of participants is small.…”

“…Barriers to receiving recommended care have been studied from the patient and physician perspective, but research is limited and difficult to generalise across health systems 27‐29 . Two recent systematic reviews identified barriers including patient preference, provider work load, sentiment that OA was not a serious disease and sense that recommended guidelines were not effective 30,31 . All of the studies included in these reviews were outside of the United States and the total number of participants is small.…”