Improving the development, implementation and use of guidelines
Aim
Guidelines synthesize scientific evidence on a given condition, disease, procedure or therapy, but are widely under-utilized, leading to suboptimal health care, poor patient outcomes, and increased costs for health systems. We developed insight on how to improve guideline implementability.
Key Findings
- Revealed the absence of guidance on how to make guidelines implementable [Implement Sci 2012;7:67; BMC Health Serv Res 2012;12:404].
- Demonstrated that guidelines generated internationally on a variety of clinical conditions scored poorly for implementability [BMJ Open 2015;5:e007047].
- Generated a Framework of Guideline Implementability [Implement Sci 2011;6:26].
- Established criteria and considerations for developing guideline implementation tools [Implementation Science 2014;9:98; CMAJ Open 2015;3:e127-33].
- Evaluated 178 questionnaires used from 2005 to 2015 to pre-identify barriers of guideline implementation, found that none were reliable or valid; and developed and validated a more comprehensive survey instrument: Clinician Guideline Determinants Questionnaire [J Clin Epidemiol 2017;86:25-38; J Clin Epidemiol 2019;113:129-36].
- Reviewed trends in guideline implementation prior to 2014, and from 2014 to 2021, identifying an increase in pre-planning (e.g. barrier identification, theory use) and use of a wider range of interventions [Implement Sci 2017;12:26; Implement Sci 2022;17:50].
Impact
This research resulted in an increase in guideline implementability content from 30% in 2011 to 67.5% in 2017, and international recognition as a guideline implementation expert [Implement Sci 2017;12:136]. International groups have used the Clinician Guideline Determinants Questionnaire: American Thyroid Association; Vaud University Hospital Centre at Université de Lausanne, Switzerland (translated into Swiss French and Swiss German); and Drs. Petra Karlsson and Margaret Wallen from the Australian Cerebral Palsy Association and Australian Catholic University, respectively.