Objectives To identify the barriers and enablers to implementing clinical practice guidelines (CPGs) recommendations in primary care and to provide recommendations that could facilitate the uptake of CPGs recommendations. Design An overview of systematic reviews. Data sources Nine electronic databases (PubMed, Cochrane Library, CINAHL, MEDLINE, PsycINFO, Web of Science, Journals @Ovid Full Text, EMBase, JBI) and three online data sources for guidelines (Turning Research Into Practice, the National Guideline Clearinghouse and the National Institute for Health and Care Excellence) were searched until May 2021. Eligibility criteria Systematic reviews, meta-analyses or other types of systematic synthesis of quantitative, qualitative or mixed-methods studies on the topic of barriers and/or enablers for CPGs implementation in primary care were included. Data extraction and synthesis Two authors independently screened the studies and extracted the data using a predesigned data extraction form. The methodological quality of the included studies was appraised by using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Content analysis was used to synthesise the data. Results Twelve systematic reviews were included. The methodological quality of the included reviews was generally robust. Six categories of barriers and enablers were identified, which include (1) political, social and culture factors, (2) institutional environment and resources factors, (3) guideline itself related factors, (4) healthcare provider-related factors, (5) patient-related factors and (6) behavioural regulation-related factors. The most commonly reported barriers within the above-mentioned categories were suboptimal healthcare networks and interprofessional communication pathways, time constraints, poor applicability of CPGs in real-world practice, lack of knowledge and skills, poor motivations and adherence, and inadequate reinforcement (eg, remuneration). Presence of technical support (‘institutional environment and resources factors’), and timely education and training for both primary care providers (PCPs) (‘healthcare provider-related factors’) and patients (‘patient-related factors’) were the frequently reported enablers. Conclusion Policy-driven strategies should be developed to motivate different levels of implementation activities, which include optimising resources allocations, promoting integrated care models, establishing well-coordinated multidisciplinary networks, increasing technical support, encouraging PCPs and patients’ engagement in guideline development, standardising the reporting of guidelines, increasing education and training, and stimulating PCPs and patients’ motivations. All the activities should be conducted by fully considering the social, cultural and community contexts to ensure the success and sustainability of CPGs implementation.

https://bmjopen.bmj.com/content/bmjopen/13/1/e062158.full.pdf

Barriers and enablers to implementing clinical practice guidelines in primary care: an overview of systematic reviews

Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents

Methodological approaches for developing, reporting, and assessing evidence-based clinical practice guidelines: A systematic survey.

Reporting quality of polycystic ovary syndrome practice guidelines based on the RIGHT checklist.

Background Gastric cancer is the fifth most common type of cancer globally. We aimed to evaluate the reporting quality of clinical practice guidelines in the field of gastric cancer. Methods We searched Medline (via PubMed), China Biology Medicine, Chinese National Knowledge Infrastructure and WanFang databases and the websites of the main guideline development organizations from 2018 to 2020 for guidelines on gastric cancer. Data were extracted and the reporting quality evaluated by two researchers independently using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. We assessed the compliance of the guidelines to each of the 35 items of RIGHT and summarized the reporting proportions of the seven domains of RIGHT. Results Eighteen guidelines were included. The mean proportion of appropriately reported RIGHT items was 52.4%. Among the seven domains of the RIGHT checklist, Basic information had the highest reporting rate (78.7%), and Review and quality assurance domain the lowest rate (16.7%). The domains Evidence (40.0%), Funding and declaration and management of interests (43.1%), and Other information (31.5%) had also reporting rates below 50%. Two RIGHT items (17 and 19b) were not reported by any of the guidelines. Conclusions The reporting quality of gastric cancer guidelines published in the years 2018-2020 was suboptimal, especially regarding the reporting of review, quality assurance and evidence. Guideline developers should pay attention on rigorous reporting following international standard to improve the quality of guidelines.

/pdf/evaluation-of-the-reporting-quality-of-guidelines-for-21i39z7v9i.pdf

Evaluation of the reporting quality of guidelines for gastric cancer using the RIGHT checklist.

A clinical practice guideline (CPG) reporting checklist is used to assist CPG developers in recording what content should be provided in a CPG report. Recently, two checklists have become available on the Enhancing the QUAlity and Transparency Of health Research Network website: AGREE (Appraisal of Guidelines, Research and Evaluation) published in 2016 and RIGHT (Reporting Items for practice Guidelines in HealThcare) published in 2017. The objective of this study was to describe the advantages and disadvantages of these two CPG reporting checklists. Two epidemiologists who lacked experience using both AGREE and RIGHT but were familiar with evidence-based medicine methodology independently compared AGREE with RIGHT on an item-by-item basis. Their assessments were compiled on a pre-designed data form and any disagreements were resolved through discussion. Three other co-authors independently compared AGREE with RIGHT and decided if they agreed with the results of comparison of the two CPG reporting checklists from the first two co-authors. Finally, another co-author reviewed the comparison results to ensure that the description was clear and understandable. The following six relationships between the two checklists were observed: (1) 11 items from AGREE completely matched with 12 items from RIGHT; (2) four items were listed in AGREE only; (3) 12 items were listed in RIGHT only; (4) three items in AGREE were partially covered by three items in RIGHT; (5) six items in RIGHT were partially covered by three items in AGREE; and (6) two items intersected across AGREE and RIGHT. Based on the comparison results, the potential impact analysis of selecting either checklist is described. We recommend that CPG developers use either AGREE plus items unique to RIGHT or RIGHT plus items unique to AGREE.

/pdf/a-comparison-of-agree-and-right-which-clinical-practice-2obgwdifua.pdf

A Comparison of AGREE and RIGHT: which Clinical Practice Guideline Reporting Checklist Should Be Followed by Guideline Developers?

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A Comparison of AGREE and RIGHT: which Clinical Practice Guideline Reporting Checklist Should Be Followed by Guideline Developers?