scholarly journals Why are clinical practice guidelines not followed?

2016 ◽  
Vol 54 (7) ◽  
Author(s):  
Julian H. Barth ◽  
Shivani Misra ◽  
Kristin Moberg Aakre ◽  
Michel R. Langlois ◽  
Joseph Watine ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Laboratory Medicine ◽  
Financial Resource ◽  
Added Value ◽  
Front Line ◽  
Educational Materials ◽  
Sufficient Detail

AbstractClinical practice guidelines (CPG) are written with the aim of collating the most up to date information into a single document that will aid clinicians in providing the best practice for their patients. There is evidence to suggest that those clinicians who adhere to CPG deliver better outcomes for their patients. Why, therefore, are clinicians so poor at adhering to CPG? The main barriers include awareness, familiarity and agreement with the contents. Secondly, clinicians must feel that they have the skills and are therefore able to deliver on the CPG. Clinicians also need to be able to overcome the inertia of “normal practice” and understand the need for change. Thirdly, the goals of clinicians and patients are not always the same as each other (or the guidelines). Finally, there are a multitude of external barriers including equipment, space, educational materials, time, staff, and financial resource. In view of the considerable energy that has been placed on guidelines, there has been extensive research into their uptake. Laboratory medicine specialists are not immune from these barriers. Most CPG that include laboratory tests do not have sufficient detail for laboratories to provide any added value. However, where appropriate recommendations are made, then it appears that laboratory specialist express the same difficulties in compliance as front-line clinicians.

scholarly journals Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Samantha Chakraborty ◽  
Bianca Brijnath ◽  
Jacinta Dermentzis ◽  
Danielle Mazza
Keyword(s):  
Qualitative Research ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
International Guideline ◽  
Novel Approach ◽  
Clinical Questions ◽  
Key Questions

Abstract Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

scholarly journals Red flag screening for low back pain: nothing to see here, move along: a narrative review

2017 ◽  
Vol 52 (8) ◽  
pp. 493-496 ◽  
Author(s):  
Chad E Cook ◽  
Steven Z George ◽  
Michael P Reiman
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Negative Likelihood Ratio ◽  
Low Back ◽  
Red Flags ◽  
Red Flag

Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. We share four major reasons why red flag screening is not consistent with best practice in LBP management: (1) clinicians do not actually screen for red flags, they manage the findings; (2) red flag symptomology negates the utility of clinical findings; (3) the tests lack the negative likelihood ratio to serve as a screen; and (4) clinical practice guidelines do not include specific processes that aid decision-making. Based on these findings, we propose that clinicians consider: (1) the importance of watchful waiting; (2) the value-based care does not support clinical examination driven by red flag symptoms; and (3) the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.

scholarly journals What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review

2019 ◽  
Vol 54 (2) ◽  
pp. 79-86 ◽  
Author(s):  
Ivan Lin ◽  
Louise Wiles ◽  
Rob Waller ◽  
Roger Goucke ◽  
Yusuf Nagree ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
Quality Care ◽  
Surgical Care ◽  
High Quality ◽  
Eligibility Criteria ◽  
Evidence Database

ObjectivesTo identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).DesignSystematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.Eligibility criteriaIncluded MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sourcesFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.Results6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.ConclusionThese 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

11 Best-Practice-Empfehlungen für die muskuloskelettale Therapie

2020 ◽  
Vol 24 (01) ◽  
pp. 6-6
Author(s):  
Arne Vielitz
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Musculoskeletal Pain ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
High Quality ◽  
Practice Care

Lin I, Wiles L, Waller R et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2019 Mar 2. pii: bjsports-2018–099878. doi: 10.1136/bjsports-2018–099878. [Epub ahead of print]

scholarly journals Stroke Rehabilitation and Patients with Multimorbidity: A Scoping Review Protocol

2015 ◽  
Vol 5 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Michelle L.A. Nelson ◽  
Linda Kelloway ◽  
Deirdre Dawson ◽  
J. Andrew McClure ◽  
Kaileah A. McKellar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Stroke Rehabilitation ◽  
Mixed Methods Research ◽  
Best Practice ◽  
Healthcare Delivery ◽  
Stroke Care ◽  
Current Evidence ◽  
Medical Diagnoses

Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing “best practice” stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.

scholarly journals Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program

2020 ◽  
Vol 17 (17) ◽  
pp. 6248
Author(s):  
Antonio Jesús Ramos-Morcillo ◽  
David Harillo-Acevedo ◽  
David Armero-Barranco ◽  
César Leal-Costa ◽  
José Enrique Moral-García ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Health Professionals ◽  
Best Practice ◽  
Research Study ◽  
Structured Interviews ◽  
Qualitative Research Study ◽  
Implementation Program

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

Critical review of laboratory investigations in clinical practice guidelines: proposals for the description of investigation

2013 ◽  
Vol 51 (6) ◽  
Author(s):  
Kristin M. Aakre ◽  
Michel R. Langlois ◽  
Joseph Watine ◽  
Julian H. Barth ◽  
Hannsjörg Baum ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Development Process ◽  
Guideline Development ◽  
Laboratory Medicine ◽  
Sample Handling ◽  
Guideline Development Process ◽  
Comprehensive List ◽  
Laboratory Investigations

AbstractCorrect information provided by guidelines may reduce laboratory test related errors during the pre-analytical, analytical and post-analytical phase and increase the quality of laboratory results.Twelve clinical practice guidelines were reviewed regarding inclusion of important laboratory investigations. Based on the results and the authors’ experience, two checklists were developed: one comprehensive list including topics that authors of guidelines may consider and one consisting of minimal standards that should be covered for all laboratory tests recommended in clinical practice guidelines. The number of topics addressed by the guidelines was related to involvement of laboratory medicine specialists in the guideline development process.The comprehensive list suggests 33 pre- analytical, 37 analytical and 10 post-analytical items. The mean percentage of topics dealt with by the guidelines was 33% (median 30%, range 17%–55%) and inclusion of a laboratory medicine specialist in the guideline committee significantly increased the number of topics addressed. Information about patient status, biological and analytical interferences and sample handling were scarce in most guidelines even if the inclusion of a laboratory medicine specialist in the development process seemingly led to increased focus on, e.g., sample type, sample handling and analytical variation. Examples underlining the importance of including laboratory items are given.Inclusion of laboratory medicine specialist in the guideline development process may increase the focus on important laboratory related items even if this information is usually limited. Two checklists are suggested to help guideline developers to cover all important topics related to laboratory testing.

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