Background The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts. Methods We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics. Results Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals’ time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements. Conclusion Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.

Objectives: To identify barriers and facilitators of clinical practice guidelines (CPGs) implementation, and map those factors to the theoretical domains framework (TDF) and behavior change wheel (BCW).Methods: We conducted an umbrella review of systematic reviews. PubMed, Embase, and the Cochrane Library were searched. Two investigators independently screened the studies, extracted the data, and assessed the methodological quality. The identified barriers and facilitators of CPG implementation were categorized and mapped to the TDF domains and BCW components.Results: Thirty-seven studies were included, and 193 barriers and 140 facilitators were identified. Intrinsic aspects (35 barriers and 28 facilitators) mainly included the CPGs' impracticality, complexity, and inaccessibility. Extrinsic aspects (158 barriers and 113 facilitators) mainly included lack of resources, training, funding, or awareness of CPG content in barriers; audits and feedback; strong leadership and management support; and educating and training about CPGs in facilitators. Environmental context and resources (n 5 97, 19.48%) were the most reported barriers in TDF domains. Physical opportunity and social opportunity were the most frequently mentioned models inConclusion: Multiple barriers and facilitators for healthcare CPG implementation are identified, with further links to TDF and BCW. Future knowledge translation strategies should be developed accordingly in specified health care settings. (c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background The process of implementation of clinical guidelines i.e. getting guidelines into practice has been extensively reviewed and meta-reviewed from a generic perspective. However, in relation to stroke care, there has been no review of these studies to date, although implementing stroke clinical guidelines is a topic of great interest within the stroke literature. This review aims to identify stroke studies that have addressed adherence to generic and specific stroke care clinical guidelines. Method A computer search was conducted using PubMed, CINAHL, PsychINFO, Web of Science and the Cochrane Systematic Reviews databases. Search terms included those relevant to the implementation of stroke clinical guidelines. We assessed all studies retrieved against specific inclusion criteria and collated only those studies that emphasized adherence to stroke clinical guidelines. Results Eighty-eight articles were selected for further review from 153 articles retrieved. Of those, 27 were studies on adherence to stroke clinical guidelines and were included in this review – 16 were categorized as generic stroke guidelines and 11 were on specific aspects of stroke care. Each category was further divided into studies that assessed adherence to stroke guidelines only and those that intervened to improve adherence. Adherence was generally greater for studies that included an intervention. Specific stroke care guidelines were poorly adhered to compared to generic stroke guidelines but these studies were better at identifying organizational and team barriers to implementation. Most studies conducted audits of patient medical records and a limited number assessed health professionals’ views or used a behavioural framework to assess adherence. Discussion Adherence to stroke guidelines varied in the studies reviewed. Given the evidence that implementation of clinical guidelines in stroke care leads to better quality of care and improved health outcomes for patients, there is a need to increase adherence behaviours of health professionals towards recommended guidelines, in particular for long term stroke care.