Abstract
BackgroundTranslating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Factors influencing the effective implementation of guidelines remain poorly understood. Understanding of barriers and facilitators is important for development of effective implementation strategies. The aim of this study was to determine perceived facilitators and barriers to guideline implementation and clinical compliance to guidelines for depression in psychiatric care.MethodsThis qualitative study was conducted at two psychiatric clinics in Stockholm, Sweden. The implementation activities at one of the clinics included local implementation teams, seminars, regular feedback and academic detailing. The other clinic served as a control and only received guidelines by post. Data were collected from three focus groups and 28 individual, semi-structured interviews. Content analysis was used to identify themes emerging from the interview data.ResultsThe identified barriers to, and facilitators of, the implementation of guidelines could be classified into three major categories: (1) organizational resources, (2) health care professionals' individual characteristics and (3) perception of guidelines and implementation strategies. The practitioners in the implementation team and at control clinics differed in three main areas: (1) concerns about control over professional practice, (2) beliefs about evidence-based practice and (3) suspicions about financial motives for guideline introduction.ConclusionsIdentifying the barriers to, and facilitators of, the adoption of recommendations is an important way of achieving efficient implementation strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals actively participate in an ongoing implementation process and identify efficient strategies to overcome barriers on an organizational and individual level. Getting evidence into practice and implementing clinical guidelines are dependent upon more than practitioners' motivation. There are factors in the local context, e.g. culture and leadership, evaluation, feedback on performance and facilitation, -that are likely to be equally influential.
Highlights
Translating scientific evidence into daily practice is complex
As part of a larger programme evaluation we used a qualitative study design to explore the implementation of clinical guidelines in psychiatric care in Stockholm, Sweden
It was suspected that financial motives often lay behind clinical guidelines, and there were concerns that cost control and standardization of care might threaten the doctor or therapeutic-patient relationship
Summary
Translating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Clinical guidelines are “systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances” [3], and are often used tools for promoting evidence-based practice [4]. They may lead to improved quality of care by decreasing inappropriate variation in clinical practice and ensuring that recent advances in medical knowledge are disseminated rapidly into everyday clinical practice [5]. It remains uncertain how these clinical guidelines can best be implemented and used in clinical settings [7]
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