Abstract
BackgroundPractice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption.MethodsThe attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension) and institutional care (chronic ulcer, chronic heart failure) topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies.DiscussionPrevious research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective outcomes reflecting the adoption of processes and associated patient care outcomes could be evaluated.
Highlights
Research, practice, and policy in the health care sector focus on improving the organization, delivery, and outcomes of care, while optimizing efficiency
The results of this study may provide a useful framework by which others can examine their capacity for guideline development and implementation
With respect to policy and practice, this research may highlight that guideline development programs are not equipped to undertake implementation
Summary
Developing a conceptual framework of guideline implementability The attributes hypothesized to facilitate adoption will be assessed and expanded by thematic analysis of the content of current guidelines. Published practice guidelines will be selected from among those reviewed (or the most recent version) by the Guidelines Advisory Committee http://www.gacguidelines.ca, a program in Ontario, Canada that identifies, appraises using the AGREE instrument, endorses and synthesizes guidelines, and were judged as high quality for two topics reflecting primary care (diabetes, hypertension) and two topics reflecting institutional care (chronic ulcer, chronic heart failure) Eligible guidelines include those that cover comprehensive management of these conditions, and are publicly available. Individuals involved in sponsoring, developing, or implementing Canadian guidelines for four topics examined by content analysis will be identified on organizational web sites and through preliminary discussions with key contacts at those organizations (known sponsor approach). Coded transcript text will be tabulated by theme and professional role
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