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Table 1 Characteristics of included studies

From: Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews

Study (article title) Objective Number of studies/clinical area Country/setting AMSTAR
“The effectiveness of interventions designed to increase the uptake of clinical practice guidelines and best practices among musculoskeletal professionals: a systematic review” [51] To summarize and assess evidence about the effectiveness of knowledge translation interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal disorders and healthcare professionals 11 studies
Musculoskeletal disorders
Netherlands, United Kingdom, Australia, United States, Switzerland, Ireland
– Setting: NR
Low
“A review of quantitative studies of adherence to mental health clinical practice guidelines” [38] To identify and review all published peer-reviewed reports providing quantitative information on rates of adherence to specific mental health guidelines 41 studies
Mental health
United States, United Kingdom, Australia, Scotland, France, Canada
– Primary care or other medical clinics, medical centres, nursing homes, acute medical ward, community-based sampling
Critically low
“Implementation of treatment guidelines for specialist mental health care” [26] To examine the efficacy of guideline implementation strategies in improving process outcomes (performance of healthcare providers) and patient outcomes and the specific components of different guideline implementation strategies that could influence them 6 studies
Schizophrenia-spectrum disorders
Denmark, German, United States, United Kingdom
– Psychiatric units, hospitals
Critically low
“Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU member states: a systematic review” [56] To evaluate the effectiveness of strategies for implementing clinical guidelines for chronic disease management in primary care in EU member states 21 studies
Chronic disease
EU member states: Finland, France, Germany, Italy, Spain, Sweden, United Kingdom, Denmark, Netherlands
– Primary care level
Low
“Health professions digital education on clinical practice guidelines: a systematic review by digital health education collaboration” [63] To evaluate the effectiveness of digital education in improving clinical practice guideline adoption 17 studies
Several areas
Except for one study from an upper-middle-income country, all studies were from high-income countries, with 10 studies from the United States
– Setting: NR
Critically low
“Evidence-based strategies for implementing guidelines in obstetrics: a systematic review” [43] To determine which strategies have been effective for implementing clinical practice guidelines in obstetric care, and to identify barriers to change and facilitators in obstetrics 33 studies
Obstetric care
Low-, middle- and high-resource settings
– Obstetric care
Critically low
“Implementing a hospital guideline on pneumonia: a semi-quantitative review” [47] To classify guideline implementation interventions used to improve treatment of community-acquired pneumonia and to quantify the impact of different interventions and their intensity of use on several processes of care and clinical and/or economic outcomes 27 studies
Pneumonia
United States, United Kingdom, Canada, Australia
– Hospital setting
Critically low
“The effectiveness of computerized clinical guidelines in the process of care: a systematic review” [66] To determine the impact of computerized clinical guidelines on the process of care compared with non-computerized clinical guidelines 45 studies
Acute and chronic
Europe, United States, Oceania
– Academic and nonacademic centres
Critically low
“Information and communication technologies for the dissemination of clinical practice guidelines to health professionals: a systematic review” [61] To identify studies on the perceived usability and practice behaviour change among health professionals with regard to information and communication technologies for the dissemination of clinical practice guidelines 21 studies
NR
United States, Canada, Europe, and one international study
– Setting: NR
Low
“A systematic review of the implementation and impact of asthma protocols” [41] To determine the most widely used method of guideline implementation (paper, computer-generated or computerized) reported in the literature, which methods significantly improved clinical care, and the factors most commonly associated with successful and sustainable implementation of asthma guidelines 104 studies
Asthma
United States, United Kingdom, Canada, Australia, Netherlands, Singapore, New Zealand, Brazil, Saudi Arabia, Germany, France, Oman, Switzerland, Italy, Iran, Japan, Taiwan, Korea, Thailand and United Arab Emirates
– Outpatients, emergency department and inpatients, patients in other settings
Critically low
“Implementing guidelines in nursing homes: a systematic review” [53] To systematically review the effects of interventions for improving the implementation of guidelines in nursing homes 5 studies
Several areas
United States, Germany, Netherlands, Australia, Belgium
– Nursing homes
Moderate
“Evidence-based guideline implementation in low- and middle-income countries: lessons for mental health care” [25] To investigate studies on the effectiveness of evidence-based clinical practice guideline implementation across physical and mental healthcare in order to inform the provision of mental healthcare in low- and middle-income countries, and to identify transferable lessons from other noncommunicable diseases to mental health 6 studies
Mental healthcare and physical health
Brazil, China, Thailand, Nepal, South Africa and Egypt
– General hospitals in urban areas
– Primary healthcare centres
Low
“Health professionals’ adherence to stroke clinical guidelines: a review of the literature” [44] To review the literature on adherence to clinical guidelines including the impact of adherence on achieving quality indicators for stroke care, and to identify actual and perceived facilitators and barriers with respect to adherence to best practice 27 studies
Stroke care
United States, Australia, United Kingdom, Scotland
– National, regional, local and clinical institution level
Critically low
“Tools developed and disseminated by guideline producers to promote the uptake of their guidelines” [54] To evaluate the effectiveness of implementation tools developed and disseminated by guideline producers, which accompany or follow the publication of a clinical practice guideline, to promote uptake. Secondarily, to determine which approaches to guideline implementation are most effective 4 studies
Several areas
Netherlands, France, United States and Canada
– Private physiotherapy practices, hospitals, family practice
Low
“Effectiveness and efficiency of guideline dissemination and implementation strategies” [58] (1) To perform a systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies
(2) To estimate the resource implications of different development, dissemination and implementation strategies
(3) To develop a framework for determining when it is efficient to develop and introduce clinical guidelines based upon the potential costs and benefits of the targeted clinical activity and the effectiveness and costs of guideline development and introduction
235 studies
NR
Most in United States, United Kingdom, Canada, Australia and Netherlands
– Primary care, inpatient settings and generalist outpatient or ambulatory care settings, mixed settings, nursing homes or long-term care facilities, emergency departments, specialist outpatient care and a military medical clinic
Low
“Implementing practice guidelines for appropriate antimicrobial usage: a systematic review” [50] To identify the best methods for changing prescribing practices and to facilitate better implementation of these guidelines 40 studies
Antimicrobial usage
NR Critically low
“A systematic review of the outcomes of educational interventions relevant to nurses with simultaneous strategies for guideline implementation” [77] To systematically review the literature regarding outcomes of educational interventions relevant to nurses with respect to guideline implementation 13 studies
Several areas
United States, Australia, Iran, Singapore
– Nursing units
Critically low
“Guideline implementation in allied health professions: a systematic review of the literature” [57] To evaluate the effects of the introduction of clinical guidelines for allied health professionals, and the effectiveness of the guideline dissemination and implementation strategies used 14 studies
NR
United States, Australia, Netherlands, United Kingdom
– Clinical institution level, provider level
Critically low
“Effectiveness of electronic guideline-based implementation systems in ambulatory care settings – a systematic review” [64] To perform a systematic and comprehensive search of the literature for studies that evaluated the effectiveness of computer-based systems for guideline implementation in ambulatory care settings, with the multidimensionality of the guideline (the guideline had to consist of several aspects or steps) and real-time interaction with the system during consultation as important inclusion criteria 27 studies
Chronic and acute diseases and tobacco use cessation
United States, four in the United Kingdom, five in the Netherlands, two in Norway, one in France, and one in Finland
– Ambulatory care, of which four were performed in the emergency department
Low
“A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries” [42] To evaluate whether strategies for promoting the use of guidelines could improve obstetric practices in low- and middle-income countries 9 studies
Obstetric care
Georgia, Syria, China and Pakistan, Senegal, Mali, Benin, Malawi, Mexico, Thailand, Argentina, Guatemala, India, Pakistan, Kenya and Zambia
– Health centres and hospitals, health facilities
Low
“Interventions to improve adherence to cardiovascular disease guidelines: a systematic review” [29] To synthesize evidence on the effectiveness of interventions targeting healthcare providers to improve adherence to cardiovascular disease guidelines and patient outcomes 38 studies
Cardiovascular
United States, Netherlands, Italy, England, and Norway, Canada, South Africa, Brazil, Asia–Pacific area and Virgin Islands
– Setting: NR
Low
“Implementation strategies for guidelines at ICUs: a systematic review” [49] To conduct a systematic review on implementation strategies for clinical practice guidelines in the intensive care unit, in order to assist critical care practitioners in the use of implementation strategies for clinical practice guidelines in the ICU 8 studies
Critical care
Canada, Australia, England and Taiwan, and United States
– Adult and neonatal ICUs
Critically low
“Use of theory to plan or evaluate guideline implementation among physicians: a scoping review” [65] To summarize current research in the field of guideline implementation to determine whether and how theory has been used to plan or evaluate the implementation and use of guidelines among physicians, as frequent target users of guidelines 42 studies
Several areas
United States, United Kingdom, Australia, Netherlands, Canada, Iran, Belgium, Germany and Saudi Arabia
– Setting: NR
Critically low
“Educational interventions for implementation of arthritis clinical practice guidelines in primary care: effects on health professional behavior” [27] To evaluate the influence of educational programmes to implement clinical practice guidelines for osteoarthritis and rheumatoid arthritis in primary care 7 studies
Osteoarthritis and rheumatoid arthritis
Country: NR
– Primary care environment
Critically low
“Improving adherence to guidelines for the diagnosis and management of pelvic inflammatory disease: a systematic review” [46] To examine the strategies that may improve adherence to guidelines for pelvic inflammatory disease diagnosis and management 3 studies
Pelvic inflammatory disease
United States
– Hospital and outpatient facilities
Critically low
“Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice” [60] To synthesize the literature relevant to guideline dissemination and implementation strategies for healthcare teams and team-based practice 89 studies
Not reported
United States and the United Kingdom, Canada, Australia
– Setting: NR
Critically low
“Enhancing prescribing of guideline-recommended medications for ischaemic heart diseases: a systematic review and meta-analysis of interventions targeted at healthcare professionals” [39] To evaluate whether interventions targeted at healthcare professionals are effective in enhancing prescribing and health outcomes in patients with ischaemic heart diseases 13 studies
Cardiology
North America and Europe
– Setting: NR
Low
“Interventions to modify health care [provider adherence to asthma guidelines: a systematic review” [28] To determine whether interventions targeting healthcare providers improve adherence to asthma care guidelines and thereby improve outcomes. Healthcare process outcomes such as patients receiving appropriate treatment, and clinical outcomes such as hospitalizations were considered 68 studies
Asthma
Country: NR
– Clinical institution level, provider level
Critically low
“Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review” [40] To examine the effectiveness of implementing interventions in increasing physician adherence to the specified heart failure guideline recommendations. Secondarily, to assess the effect of implementation interventions on clinical outcomes, and to identify process and contextual factors that influence implementation success 38 studies
Cardiology
United States, Europe and Australia
– Inpatient settings, outpatient settings and mixed settings
Low
“Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations” [59] (1) To identify evaluations in any setting of clinical practice guidelines and related dissemination and implementation strategies in nursing, midwifery, health visiting and other professions allied to medicine, including podiatry, speech and language therapy, physiotherapy, occupational therapy, dietetics, clinical psychology, pharmacy and radiography
(2) To estimate the effectiveness and cost-effectiveness of clinical practice guidelines for promoting improved professional practice and enhanced patient outcomes in nursing and professions allied to medicine
18 studies
Pneumococcal and influenza vaccinations, use and follow-up of medications, urinary catheter care
Country: NR
– Ambulatory medical practices
Critically low
“Implementation of pressure ulcer guidelines: what constitutes a successful strategy?” [48] To identify studies on the effectiveness of strategies in implementing evidence-based guidelines and recommendations for the prevention and/or management of pressure ulcers and the characteristics associated with sustainable implementation of these strategies 20 studies
Pressure ulcer
United States, German, United Kingdom, Australia
– Hospitals, nursing homes, community care centres, residential homes, universities, tertiary care hospital, long-term care setting, regional healthcare system
Critically low
“Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review” [30] To compare different implementation strategies for guidelines targeting primary or secondary prevention and treatment of cardiovascular diseases 52 studies
Cardiovascular disease
Canada, United States, European countries, Israel, Pakistan and Taiwan
– Setting: NR
Critically low
“Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review” [45] To determine the effectiveness of strategies to increase the implementation of physiotherapy clinical guidelines 3 studies
Physiotherapy clinical
Australia, Netherlands, United Kingdom
– Institutional and provider level (physiotherapists)
Critically low
“Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review” [55] To synthesize the literature on the implementation of clinical guidelines in community pharmacy 22 studies
Several areas
Australia, United States United Kingdom, Netherlands, Belgium, Canada, Finland, Germany and Switzerland
– Community pharmacy setting
Low
“Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review” [37] To summarize the evidence pertaining to the benefits of mental health guidelines with respect to specific implementation strategies 18 studies
Psychiatric
United States, United Kingdom, Denmark and Canada
– Primary care, general hospital, specialist mental healthcare settings, mental health clinicians of a managed behavioural healthcare organization
Critically low
“Implementing guidelines and innovations in general practice: which interventions are effective?” [62] To evaluate the effectiveness of interventions in promoting the implementation of guidelines and adoption of innovations in general practice 143 studies
NR
United States, United Kingdom, Canada and several other countries
– Setting: NR
Critically low
  1. EU European Union, ICU intensive care unit, NR not reported