Even High-Quality CPGs Seldom Include Implementation Strategies

Luciana Pereira de Vasconcelos; Daniela Oliveira De Melo; Airton Tetelbom Stein; Heráclito Barbosa de Carvalho

doi:10.3389/fphar.2020.593894

Even High-Quality CPGs Seldom Include Implementation Strategies

Front Pharmacol. 2021 Jan 12:11:593894. doi: 10.3389/fphar.2020.593894. eCollection 2020.

Authors

Luciana Pereira de Vasconcelos¹, Daniela Oliveira De Melo², Airton Tetelbom Stein³, Heráclito Barbosa de Carvalho¹

Affiliations

¹ Department of Preventive, Medicine Medical School, São Paulo University, São Paulo, Brazil.
² Department of Pharmaceutical Science, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil.
³ Department of Collective Health, Federal University of Health Sciences of Porto Alegre, São Paulo, Brazil.

Abstract

Background: Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs). Methods: NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy. Results: Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%). Conclusion: Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.

Keywords: agree Ⅱ; applicability; appraisal (evaluation); clinical practice guideline; implementation strategies; implementation tools; non communicable chronic diseases.