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.

OBJECTIVE: This study provides a comprehensive overview of the knowledge structure and research hotspots regarding barriers and strategies for the implementation of clinical practice guidelines. METHODS: Publications on barriers and strategies for guideline implementation were searched for on Web of Science Core Collection from database inception to October 24, 2022. R package bibliometrix, VOSviewer, and CiteSpace were used to conduct the analysis. RESULTS: The search yielded 21,768 records from 3,975 journals by 99,998 authors from 3,964 institutions in 186 countries between 1983 and 2022. The number of published papers had a roughly increasing trend annually. The United States, the United Kingdom, and Canada contributed the majority of records. The University of Toronto, the University of Washington, and the University of Sydney were the biggest node in their cluster on the collaboration network map. The three journals that published the greatest number of relevant studies were Implementation Science, BMJ Open, and BMC Health Services Research. Grimshaw JM was the author with the most published articles, and was the second most co-cited author. Research hotspots in this field focused on public health and education, evidence-based medicine and quality promotion, diagnosis and treatment, and knowledge translation and barriers. Challenges and barriers, as well as societal impacts and inequalities, are likely to be key directions for future research. CONCLUSIONS: This is the first bibliometric study to comprehensively summarize the research trends of research on barriers and strategies for clinical practice guideline implementation. A better understanding of collaboration patterns and research hotspots may be useful for researchers. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A247.

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/).

Objectives Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP implementation can involve engagement from multiple levels of government; however, factors contributing or hindering HiAP implementation at the local level are largely unexplored. Local is defined as the city or municipal level, wherein government is uniquely positioned to provide leadership for health and where many social determinants of health operate. This paper presents the results of a scoping review on local HiAP implementation. Methods Peer reviewed articles and grey literature were systematically searched using the Arksey and O’Malley framework. Characteristics of articles were then categorized, tallied and described. Results 23 scholarly articles and four government documents were identified, ranging in publication year from 2002 to 2016 and originating from 14 countries primarily from North America and Europe. A wide range of themes emerged relating to HiAP implementation locally including: funding, shared vision, national leadership, ownership and accountability, local leadership and dedicated staff, Health Impact Assessment, and indicators. Conclusion Common themes were found in the literature regarding HiAP implementation locally. However, to better clarify these factors to contribute to theory development on HiAP implementation, further research is needed that specifically investigates the facilitators and barriers of HiAP locally within their political and policy context.

Purpose Understanding why policies to improve care for people with chronic conditions fail to be implemented is a pressing issue in health system reform. We explore reasons for the relatively high uptake of disease management programmes (DMPs) in Germany, in contrast to low uptake in Austria. We focus on the motivation, information and power of key stakeholder groups (payers, physician associations, individual physicians and patients). Methods We conducted a comparative stakeholder analysis using qualitative data from interviews (n = 15 in Austria and n = 26 in Germany), legal documents and media reports. Results Stakeholders in Germany appeared to have systematically stronger motivation, exposure to more positive information about DMPs and better ability to implement DMPs than their counterparts in Austria. Policy in Austria focused on financial incentives to physicians only. In Germany, limited evidence about the quality improvement and cost savings potential of DMPs was mitigated by strong financial incentives to sickness funds but proved a fundamental obstacle in Austria. Conclusions Efforts to promote DMPs should seek to ensure the cooperation of payers and patients, not just physicians, using a mix of financial and non-financial instruments suited to the context. A singular focus on financially incentivising providers is unlikely to stimulate uptake of DMPs.

Introduction Clinical guidelines are advocated to improve the quality of care, especially for chronic diseases. However, the regulatory basis of clinical guidelines, their development, quality control, implementation and use as well as evaluation within countries across the European Union is not systematically known. Methods Using information collected from key informants in each country by means of a structured questionnaire, this mapping exercise illustrates the varied status of guideline production in European Union countries. Results Most European Union countries have an established national, regional or local clinical guideline programme, and a substantial proportion have developed guidelines on the prevention and management of chronic diseases. Several countries have mechanisms in place to ensure the quality of scientific evidence used for the development of guidelines is high and that the process is consistent and transparent. Others are only now taking an interest in guideline development and are taking the first steps towards establishing ways of implementing them. The majority of countries have no legal basis for the development of guidelines and those that have well established systems mostly implement them on a voluntary basis. The process of guideline development varies in its degrees of decentralisation across countries with many different types of organisations taking on this responsibility. There is general acceptance of the value of the instrument developed by the AGREE collaboration for evaluating the methodological robustness of guidelines. However, the extent to which guidelines are implemented in Europe is unknown, as there is no systematic data collection and, in most countries, no structure to enable it. There are few examples of formal evaluations of the development, quality, implementation and use of guidelines. Conclusions Our findings call for renewed efforts to respond to the severe lack of standardized guideline terminology and accessibility as well as rigorous studies to evaluate the relationship between different ways to develop guidelines and their methodological quality, between their quality and the actual implementation and usage, and finally between implementation and health outcomes.

The movement in recent years towards evidence-based practice (EBP) in health care systems and policy has permeated the substance abuse treatment system, leading to a growing number of federal and statewide initiatives to mandate EBP implementation. Nevertheless, due to a lack of consensus in the addiction field regarding procedures or criteria to identify EBPs, the optimal processes for disseminating empirically based interventions into real-world clinical settings have not been identified. Although working lists of interventions considered to be evidence-based have been developed by a number of constituencies advocating EBP dissemination in addiction treatment settings, the use of EBP lists to form policy-driven mandates has been controversial. This article examines the concept of EBP, critically reviews criteria used to evaluate the evidence basis of interventions, and highlights the manner in which such criteria have been applied in the addictions field. Controversies regarding EBP implementation policies and practices in addiction treatment are described, and suggestions are made to shift the focus of dissemination efforts from manualized psychosocial interventions to specific skill sets that are broadly applicable and easily learned by clinicians. Organizational and workforce barriers to EBP implementation are delineated, with corresponding recommendations to facilitate successful dissemination of evidence-based skills.

Integrated Management of Childhood Illness (IMCI) is a pediatric care management strategy that has been shown to improve health care service quality and increase health care cost savings in multi-country evaluations. However, many countries have faced significant training, health system, political, and financial constraints to national implementation and, as a result, have not been able to observe sustained benefits of IMCI. This article reviews the literature for evidence of IMCI health impacts, common implementation constraints, and policy strategies for health system strengthening and successful implementation.

Objective To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. Method A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms ‘Total Quality Management’ and ‘Quality Assurance Health Care’, combined with the term ‘hospital’ and ‘implement*’, we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. Results An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. Conclusions Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.