Optimizing the language and format of guidelines to improve guideline uptake

Gupta, Samir; Rai, Navjot; Bhattacharrya, Onil; Cheng, Alice; Connelly, Kim A.; Boulet, Louis‐Philippe; Kaplan, Alan; Brouwers, Melissa; Kastner, Monika

doi:10.1503/cmaj.151102

Cited by 54 publications

(57 citation statements)

References 62 publications

(81 reference statements)

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“…The CTS Canadian Respiratory Guidelines Committee (CRGC) Chair then vetted the recommendations to optimize language with a view to improving likelihood of uptake. 16,17 Recommendations were then voted upon by electronic survey using a six-point voting scale, whereby it was defined a priori that a recommendation would only be accepted if each panel member voted for option 1, 2 or 3 (wholeheartedly agree, agree or can support). For a recommendation to be accepted, it had to be voted on by 75% of the eligible panel members and achieve ratings 1, 2 or 3 by 80% of the voting panelists.…”

Section: Update Of Recommendations and Classificationmentioning

confidence: 99%

Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence

Bourbeau

Bhutani

Hernández

et al. 2019

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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Section: Update Of Recommendations and Classificationmentioning

confidence: 99%

Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence

Bourbeau

Bhutani

Hernández

et al. 2019

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…Changes to the guidelines themselves may be beneficial. Currently, OA guidelines lack specific exercise and weight management recommendations and are open to variable interpretation [56, 57] potentially resulting in GPs feeling ill equipped to deliver lifestyle interventions [22]. Further research to identify optimal exercise types and dosage, and effective weight loss interventions is required, however it is currently feasible to suggest specific exercise programs based on existing exercise science and general exercise and physical activity recommendations [58, 59], and to provide guidance on how to have effective conversations with patients to facilitate adoption of lifestyle change recommendations based on principles of patient-centred care and health behaviour change [29, 60].…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care

et al. 2018

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Background Osteoarthritis (OA) is diagnosed and managed primarily by general practitioners (GPs). OA guidelines recommend using clinical criteria, without x-ray, for diagnosis, and advising strengthening exercise, aerobic activity and, if appropriate, weight loss as first-line treatments. These recommendations are often not implemented by GPs. To facilitate GP uptake of guidelines, greater understanding of GP practice behaviour is required. This qualitative study identified key factors influencing implementation of these recommendations in the primary-care setting. Methods Semi-structured interviews with eleven GPs were conducted, transcribed verbatim, coded by two independent researchers and analysed with an interpretive thematic approach using the COM-B model (Capability/Opportunity/Motivation-Behaviour) as a framework. Results Eleven themes were identified. Psychological capability themes: knowledge gaps, confidence to effectively manage OA, and skills to facilitate lifestyle change. Physical opportunity themes: system-related factors including time limitations, and patient resources. Social opportunity theme: influences from patients. Reflective motivation themes: GP’s perceived role, and assumptions about people with knee OA. Automatic motivation themes: optimism, habit, and unease discussing weight. The findings demonstrated diverse and interacting influences on GPs’ practice. Conclusion The identified themes provide insight into potential interventions to improve OA management in primary-care settings. Key suggestions include: improvements to OA clinical guidelines; targeting GP education to focus on identified knowledge gaps, confidence, and communication skills; development and implementation of new models of service delivery; and utilising positive social influences to facilitate best-practice behaviours. Complex, multimodal interventions that address multiple factors (both barriers and facilitators) are likely to be necessary.

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“…The CDSS development process is described elsewhere [21–23]. This included development of medication escalation/de-escalation logic rules through a review of existing international asthma guidelines [21], establishment of evidence-based rules for AAP yellow zone medications through a systematic review [22], and application of evidence-based methods to optimise the language and format of provided guidance [23]. The AAP populated by the eAMS was the same as that used in the baseline phase (see earlier details).…”

Section: Methodsmentioning

confidence: 99%

The Electronic Asthma Management System (eAMS) improves primary care asthma management

et al. 2019

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A high prevalence of suboptimal asthma control is attributable to known evidence–practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System (eAMS)) to address major care gaps and sought to measure its impact on care in adults with asthma.This was a 2-year interrupted time-series study of usual care (year 1)versuseAMS (year 2) at three Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.Action plan delivery (primary outcome) improved from zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 0.14–0.22)). Time-series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14–12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visitsversus126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.

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Optimizing the language and format of guidelines to improve guideline uptake

Cited by 54 publications

References 62 publications

Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence

Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence

General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care

The Electronic Asthma Management System (eAMS) improves primary care asthma management

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