Verónica Ciro Correa|Luz Helena Lugo?Agudelo|Daniel Camilo Aguirre?Acevedo|Jesús Alberto Plata Contreras|Ana María Posada Borrero|Daniel Felipe Patiño-Lugo|Dolly Andrea Castaño Valencia
Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview
Universidad de Antioquia|Universidad de Antioquia|Universidad de Antioquia|Universidad de Antioquia|Universidad de Antioquia|Universidad de Antioquia|Universidad de Antioquia
abstract introduction clinical practice guidelines cpgs designed improve quality care reduce unjustified individual variation clinical practice knowledge barriers facilitators influence implementation cpg recommendations first step creating strategies improve health outcomes present systematic metareview sought explore barriers facilitators implementation cpgs methods search conducted pubmed embase cochrane health system evidence international guideline library gin databases systematic reviews qualitative quantitative mixedmethods studies identified barriers facilitators implementation cpgs included selection title abstract evaluation full text extraction data quality assessment carried two independent reviewers summarise evidence grouped barriers facilitators according following contexts political social health organisational system guidelines health professionals patients results overall 25 systematic reviews selected relevant barriers socialpolitical context absence leader difficulties teamwork lack agreement colleagues relevant barriers health system lack time financial problems lack specialised personnel barriers cpgs included lack clarity lack credibility evidence regarding health professional lack knowledge cpg confidence oneself relevant regarding patients negative attitude towards implementation lack knowledge cpg sociocultural beliefs played role frequent facilitators consistent leadership commitment members team administrative support institution existence multidisciplinary teams application technology improve practice education regarding guidelines conclusions barriers facilitators described review factors influence implementation evidence clinical practice knowledge factors contribute development theoretical basis creation cpg implementation strategies improve professional practice health outcomes patients