Strategies for the Implementation of Guidelines
Synopsis eines systematischen Reviewsgerman translation / full article
Synopsis of a Systematic Review
Background: Numerous guidelines aim to improve safety, effectiveness and efficacy of cardiovascular diseases (CVD) in primary care. For their successful implementation in daily practice and benefit for patients, not only methodological quality is crucial but also acceptance and adherence by providers of care.
Methods: We are providing a synopsis of a systematic review and extensive heterogeneity-analyses about guideline implementation strategies on CVD (PROSPERO 2011:CRD42011001793), focusing on provider-adherence and aspects relevant for the discussion about allocation of resources for guideline dissemination in primary care.
Results: 75 trials met our predefined inclusion criteria – 54 arms among them compared single strategies and 30 combined strategies to usual care. The use of implementation strategies for the distribution of guidelines on CVD can be convincingly effective on provider adherence, with three categories of strategies in favour: organizational changes in the primary care team, patient education and provider education. Improvement of adherence could be achieved if physicians accepted support from nonmedical health professionals.
Conclusions: The results underline the importance of the whole primary care team as an addressee of guideline implementation strategies. Although adherence of providers is an important parameter of process quality, it is not necessarily followed by improvements in adherence of patients and patient orientated endpoints.