Table 2 Other barriers for the implementation of Clinical Practice Guidelines
Contexts | Other barriers |
|---|---|
Political and social context | • Difficulties in prioritising the health problem [16, 20, 29] • Lack of access to information, lack of mechanisms and systems to support storing of information [6, 13, 16, 20] |
Health organisational system context | • Lack of protocols and processes that clearly define the roles within the institution to implement guidelines [19, 28, 29, 34, 35] • Additional workload [6, 14, 16, 18,19,20, 27, 28, 34] • Difficulty accessing health services [18, 21, 28, 29, 32] • Difficulties with availability of medicines [13, 18, 24, 27] • Deficiency in staff continuous education [18, 20, 27, 28] • Deficiencies in the referral of patients to services [18, 23, 27] • Lack of skill and specialist knowledge within services • Insufficient support from institutions [15, 18, 30] • High turnover of staff that prevents a continuous training process [18, 20, 23] • Limitations of infrastructure [18, 20, 29] • Lack of availability of interpreters in services [20, 28, 29] • Lack of access to information, lack of mechanisms and systems to support storing of information [13, 16, 20] |
Guidelines context | • Lack of awareness of the existence of guidelines and clarity of guidelines [13, 16,17,18,19, 23, 28] • Beliefs that the guidelines evidence is incorrect or not enough to be reported [17, 19, 27, 35] • Beliefs that CPG is too rigid, may not always be practical and cannot be applied on a day-to-day [16, 19, 29, 32] • Guidelines restrict clinical judgment and challenge professional autonomy and limits treatment options [18, 20] |
Health professional context | • Greater confidence in clinical experience than in guidelines recommendations [17, 19, 20, 24, 27, 31] • Lack of effective communication, research and self-learning skills [16, 17, 20, 23, 25, 28,29,30] • Resistance to change caused by disagreement with the recommendations of the CPG, doubts about the efficacy of interventions and clinical outcomes [16, 18, 22, 24, 29, 32] • Physician’s reluctance to use CPG because of patient factors, self-belief or fear of complications [16, 18, 20, 23, 26, 29] • Little familiarity with guideline recommendations [18, 23, 28, 29, 32] • Negative attitudes of physicians towards the implementation of the guideline or to EBM [16, 17, 19, 24, 27] • Lack of autonomy and authority [17, 18] • Belief that intervention was not part of their role [16, 26, 30] |
Patient context | • Language and literacy problems [18, 20, 24] • Lack of motivation, compliance and knowledge to follow the recommendations [20, 25, 28, 29] • Patient comorbidities, mobility problems, polypharmacy and self-empowerment capacity [20, 26, 28, 29] • Patients’ financial situation and occupational status [20] |