Determinants of successful guideline implementation: A national cross-sectional survey

Abstract Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results: The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043). Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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Determinants of successful guideline implementation: a national cross-sectional survey

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01382-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying-hui Jin ◽

Li-Ming Tan ◽

Khalid S. Khan ◽

Tong Deng ◽

Chao Huang ◽

...

Keyword(s):

Guideline Development ◽

Guideline Implementation ◽

Medical Specialty ◽

Cross Sectional Survey ◽

The West ◽

Cross Sectional ◽

Adherence To Guidelines ◽

Multi Stage ◽

Geographical Regions ◽

Tertiary Hospitals

Abstract Background CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China. Methods This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2–5 provinces were selected from each region. 2–3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P < 0.001; the west P = 0.02; the middle P < 0.001 compared with the east), hospital grades (P = 0.028), length of practitioners’ practice (P = 0.006), education background (Ph.D., P = 0.027; Master, P = 0.002), evidence-based medicine skills acquired in work unit (P = 0.012), and medical specialty of practitioner (General Practice, P = 0.006; Surgery, P = 0.043). Conclusion Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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Determinants of Successful Guideline Implementation: A National Cross-Sectional Survey

10.21203/rs.3.rs-37357/v1 ◽

2020 ◽

Author(s):

Ying-hui Jin ◽

Li-Ming Tan ◽

Khalid S. Khan ◽

Tong Deng ◽

Chao Huang ◽

...

Keyword(s):

Guideline Development ◽

Guideline Implementation ◽

Medical Specialty ◽

Cross Sectional Survey ◽

The West ◽

Cross Sectional ◽

Adherence To Guidelines ◽

Multi Stage ◽

Geographical Regions ◽

Tertiary Hospitals

Abstract Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. To investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. At last, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results: The questionnaire consisted of four sections: knowledge on methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043). Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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Determinants of successful guideline implementation: A national cross-sectional survey

10.21203/rs.3.rs-37357/v2 ◽

2020 ◽

Author(s):

Yinghui Jin ◽

Li-Ming Tan ◽

Khalid S. Khan ◽

Tong Deng ◽

Chao Huang ◽

...

Keyword(s):

Guideline Development ◽

Guideline Implementation ◽

Medical Specialty ◽

Cross Sectional Survey ◽

The West ◽

Cross Sectional ◽

Adherence To Guidelines ◽

Multi Stage ◽

Geographical Regions ◽

Tertiary Hospitals

Abstract Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. At last, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results: The questionnaire consisted of four sections: knowledge on methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043). Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

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Evaluation of health system in Iraq from people's point of view: a comparative study of two different eras

Journal of Ideas in Health ◽

10.47108/jidhealth.vol4.iss2.100 ◽

2021 ◽

Vol 4 (2) ◽

pp. 380-387

Author(s):

Saad Ahmed Ali Jadoo ◽

Adil H. Alhusseiny ◽

Shukr Mahmood Yaseen ◽

Mustafa Ali Mustafa Al-Samarrai ◽

Anmar Shukur Mahmood

Keyword(s):

Health System ◽

Health Sector ◽

Health Resources ◽

Sampling Technique ◽

Point Of View ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Current Health ◽

Multi Stage ◽

Geographical Regions

Background: Since the 2003 United States–British Coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion. Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self-administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study. Results: A total of 365 heads of households (response rate: 71.7%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Young age group (p = 0.003), men (p = < 0.001), unmarried (p = 0.001), high educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001), and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system. Conclusions: Most Iraqis surveyed expressed disappointment from the health system after the 2003 US-led invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high-quality, efficient, and effective health system.

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Barriers to ESC guideline implementation: results of a survey from the European Council on Cardiovascular Nursing and Allied Professions (CCNAP)

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117710097 ◽

2017 ◽

Vol 16 (8) ◽

pp. 678-686 ◽

Cited By ~ 14

Author(s):

Gabrielle McKee ◽

Mary Kerins ◽

Glenys Hamilton ◽

Tina Hansen ◽

Jeroen Hendriks ◽

...

Keyword(s):

Clinical Guideline ◽

Guideline Development ◽

Guideline Implementation ◽

Evidence Based ◽

Clinical Environment ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Esc Guidelines ◽

Prevention Guidelines ◽

Evidence Based Care

Background: The European Society of Cardiology (ESC) has a comprehensive clinical guideline development programme, relevant for all clinicians. However, implementation of guidelines is not always optimal. Aim: The aim of this study was to determine nurses’ and allied professionals’ awareness and barriers regarding clinical guideline implementation. Methods: A cross-sectional survey was administrated online and in print at EuroHeartCare 2015. A questionnaire was developed which examined awareness and barriers to implementation of ESC guidelines on cardiovascular disease prevention in clinical practice (2012) and ESC guidelines in general. Results: Of the 298 respondents, 12% reported that the prevention guidelines were used in their practice area. Respondents identified, in order of magnitude, that lack of leadership, workload, time, resources and a perception that they were unable to influence current practice were barriers to the use of the prevention guidelines. When asked to rank barriers to use of any ESC guidelines, time (22%) and leadership (23%) were ranked highest. Conclusions: Implementation of ESC guidelines by nurses, the majority responders in this survey, is a serious problem, requiring urgent improvement to ensure patients receive optimal evidence based care. Issues of leadership, workload, time and resources are significant barriers to guideline implementation. It is of concern that these professionals perceive both that they have little influence on implementation decisions and lack of leadership regarding guideline implementation. Educational and organisational strategies to improve leadership skills are imperative. These will build self-efficacy and empower nurses and allied professionals to advocate for evidence-based care in the clinical environment.

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Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2017-017757 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017757 ◽

Cited By ~ 6

Author(s):

Ingrid Hjulstad Johansen ◽

Valborg Baste ◽

Judith Rosta ◽

Olaf G Aasland ◽

Tone Morken

Keyword(s):

Relative Risk ◽

Workplace Violence ◽

Medical Specialty ◽

Cross Sectional Survey ◽

Work Time ◽

Cross Sectional ◽

Medical Specialties ◽

Work Settings ◽

Representative Samples ◽

Violence Against Doctors

ObjectivesThe aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades.DesignRepeated cross-sectional survey.SettingAll healthcare levels and medical specialties in Norway.ParticipantsRepresentative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158).Main outcome measuresRelative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty.ResultsThere were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95).ConclusionsA substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors’ education and within work settings.

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Commitment and the emigration intentions of South African professional nurses

Health SA Gesondheid ◽

10.4102/hsag.v18i1.512 ◽

2013 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Jeffrey J. Bagraim

Keyword(s):

South Africa ◽

South African ◽

Employee Commitment ◽

Western Cape ◽

Public Health Services ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Tertiary Hospitals ◽

Quantitative Design ◽

The Relationship

The emigration of skilled nurses from South Africa exacerbates the crisis in the provision of public health services. A descriptive, quantitative design was applied to investigate the relationship between intention to emigrate and employee commitment. Over 400 registered nurses (N = 419), working within public sector tertiary hospitals in the Western Cape, responded to a cross-sectional survey questionnaire. Three foci of employee commitment (organisational, professional and national) were examined but only national commitment significantly helped predict intention to emigrate from South Africa in the regression model (beta = -0.0525, p < 0.0001). The implications of the results obtained in this study are discussed.Die emigrasie van verpleegkundiges uit Suid-Afrika vererger die krisis in die verskaffing van gesondheidsorgdienste in die land. ’n Beskrywende, kwantitatiewe ontwerp is gebruik om die verwantskap tussen werknemertoewyding en die voorneme om te emigreer te ondersoek. Meer as 400 verpleegsters (N = 419) wat in openbare tersiêre hospitale in die Wes-Kaap werk, het op die vraelys gereageer. Drie fokusareas van toewyding (organisatories, professioneel en nasionaal) is gemeet, maar net nasionale toewyding het daartoe bygedra om emigrasievoorneme te voorspel (beta = -0.0525, p < 0.0001). Die implikasies van hierdie resultate word bespreek.

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Soil-transmitted helminthiasis among school-aged children in Myanmar: the result of 14 years after the implementation of deworming

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205671 ◽

2020 ◽

Vol 8 (1) ◽

pp. 9

Author(s):

Soe Min Oo ◽

Aung Tun ◽

Thi Thi Htoon ◽

Phyo Phyo Kyaw ◽

Win Lae Htut ◽

...

Keyword(s):

Coastal Region ◽

Hemoglobin Concentration ◽

Cross Sectional Study ◽

Infection Prevalence ◽

Cross Sectional ◽

School Aged Children ◽

School Based ◽

Multi Stage ◽

Hilly Region ◽

Geographical Regions

Background: Soil-transmitted helminth (STH) infections were the most common infections among school-aged children (SAC) in Myanmar. The routine school-based mass drug administration (MDA) with twice a year frequency has started in 2005.Methods: This cross-sectional study aimed to determine the prevalence and intensity of STH infection among SAC as the follow-up study after 14 years of MDA. In August 2019, 1000 school-aged children attending Grades 4 and 5 from four geographical regions across the country were enrolled using a multi-stage sample random sampling. The anthropometry and hemoglobin concentration was measured, and stool specimens were detected parasite eggs using the Kato Katz technique.Results: The intensity of infection was classified according to WHO criteria. Infection prevalence was 17% for any STH infections, 10.4% for A. lumbricoides, 17% for T. trichiura, and 2% for the hookworm. All STH infections were virtually not detected in the hilly region. The highest prevalence of A. lumbricoides and T. trichiura infection were seen in the coastal region. The hookworm was seen only in the plain region. The underweight prevalence was 9% and anemia prevalence was 38% while there were huge differences across regions. The finding showed that STH infections continued to be endemic among SAC throughout the country except for the hilly region after 14 years of MDA.Conclusions: The regular deworming program should be reduced to once a year frequency in Myanmar. Triple-dose regimens should be considered to eliminate the whipworms. The burden of anemia among SAC should also be addressed in cooperation with MDA.

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The Moderating Effect of Job Satisfaction on Physicians’ Motivation to Adhere to Financially Incentivized Clinical Practice Guidelines

Medical Care Research and Review ◽

10.1177/1077558716628354 ◽

2016 ◽

Vol 74 (2) ◽

pp. 148-177 ◽

Cited By ~ 3

Author(s):

Anthony C. Waddimba ◽

Howard B. Beckman ◽

Thomas L. Mahoney ◽

James F. Burgess

Keyword(s):

Structural Equation ◽

Census Data ◽

Pay For Performance ◽

Population Characteristics ◽

Equation Modeling ◽

Moderating Effects ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Adherence To Guidelines ◽

Primary Physicians

We examined moderating effects of professional satisfaction on physicians’ motivation to adhere to diabetes guidelines associated with pay-for-performance incentives. We merged cross-sectional survey data on attitudes, from 156 primary physicians, with prospective medical record-sourced data on guideline adherence and census data on ambulatory-care population characteristics. We examined moderating effects by testing theory-driven models for satisfied versus discontented physicians, using partial least squares structural equation modeling. Results show that attitudes motivated, while norms suppressed, adherence to guidelines among discontented physicians. Separate models for satisfied versus discontented physicians revealed motivational differences. Satisfied physicians disregarded intrinsic and extrinsic influences and biases. Discontented physicians, alienated by social pressure, favored personal inclinations. To improve adherence to guidelines among discontented physicians, incentives should align with personal attitudes and incorporate promotional campaigns countering resentment of peer and organizational pressure.

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A Cross-Sectional Survey of Low Back Pain in Nurses Working in Orthopedic Departments

Workplace Health & Safety ◽

10.1177/2165079918807231 ◽

2018 ◽

Vol 67 (5) ◽

pp. 218-230 ◽

Cited By ~ 2

Author(s):

Lingli Li ◽

Xiaofan Deng ◽

Hongxia Zhang ◽

Hui Yang ◽

Jiali Chen ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sichuan Province ◽

Annual Number ◽

Low Back ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Fear Avoidance Beliefs ◽

Tertiary Hospitals ◽

Disability Questionnaire

The study aimed to gain knowledge about low back pain (LBP) in nurses working in the orthopedic departments of tertiary hospitals in Sichuan province, China. We used a cross-sectional survey to examine the prevalence of LBP among 797 inpatient nurses who had worked for 1 year in an orthopedic department in one of 29 hospitals (Grade 3A) in Sichuan province. The survey included a questionnaire to determine the prevalence of LBP and factors related to LBP, a screening graph of LBP symptoms, the Roland Morris Disability Questionnaire (RMDQ), and the Fear Avoidance Beliefs Questionnaire (FABQ) for LBP. The 1-year period prevalence of LBP in the nursing population was 66.8% and the point prevalence was 51.3%. Among the 523 nurses who had experienced LBP, the mean total number of days that LBP had been experienced during the past year was 20.2 ± 16.3 days (range = 1-90 days). The annual number of episodes of LBP was 5.7 ± 4.5 times/year (range = 1-20 times/year). More than half the orthopedic nurses (51.1%) planned to quit, and 5.8% thought of leaving their job due to LBP. These study findings indicate that nurses in this region experience a burden of LBP similar to those in other regions in the world.

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