Abstract
BackgroundThe implementation of high-quality guidelines is essential to improve clinical practice and public health. The World Health Organisation (WHO) develops evidence-based public health and other guidelines that are used or adapted by countries around the world. Detailed implementation plans are often necessary for local policymakers to properly use the guidelines developed by WHO. This paper describes the plans for guideline implementation reported in WHO guidelines and indicates which of these plans are evidence-based.MethodsWe conducted a content analysis of the implementation sections of WHO guidelines approved by the WHO guideline review committee between December 2007 and May 2015. The implementation techniques reported in each guideline were coded according to the Cochrane Collaboration’s Effective Practice and Organisation of Care (EPOC) taxonomy and classified as passive, active or policy strategies. The frequencies of implementation techniques are reported.ResultsThe WHO guidelines (n = 123) analysed mentioned implementation techniques 800 times, although most mentioned implementation techniques very briefly, if at all. Passive strategies (21 %, 167/800) and general policy strategies (62 %, 496/800) occurred most often. Evidence-based active implementation methods were generally neglected with no guideline mentioning reminders (computerised or paper) and only one mentioning a multifaceted approach. Many guidelines contained implementation sections that were identical to those used in older guidelines produced by the same WHO technical unit.ConclusionsThe prevalence of passive and policy-based implementation techniques as opposed to evidence-based active techniques suggests that WHO guidelines should contain stronger guidance for implementation. This could include structured and increased detail on implementation considerations, accompanying or linked documents that provide information on what is needed to contextualise or adapt a guideline and specific options from among evidence-based implementation strategies.
Highlights
The implementation of high-quality guidelines is essential to improve clinical practice and public health
This study aims to describe plans for guideline implementation contained in all World Health Organisation (WHO) guidelines approved by the Guidelines Review Committee (GRC) from its inception in December 2007 to May 2015
The findings of this study add to the body of knowledge about the implementation techniques suggested in WHO guidelines
Summary
The implementation of high-quality guidelines is essential to improve clinical practice and public health. The World Health Organisation (WHO) develops evidence-based public health and other guidelines that are used or adapted by countries around the world. The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective and efficient manner and policymakers design optimal programmes. In response to criticism of its guideline quality and processes used for development [3], WHO established the Guidelines Review Committee (GRC) in 2007 to ensure and improve the quality of their guidelines. This committee meets on a monthly basis to review guideline. The WHO Handbook for guideline development (2nd edition, 2014) [5] describes the current WHO methods and standards
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