title: [Challenges in the implementation of clinical practice guidelines in major public health institutions in Mexico: A multiple case study].
abstract: OBJECTIVE
  To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish).
  
  
  METHODS
  We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire.
  
  
  RESULTS
  The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment.
  
  
  CONCLUSIONS
  The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.
authors.affiliation: Instituto de Ciencias de la Salud, Universidad Veracruzana, Jalapa, Veracruz, México.
authors.forename: Gaudencio
authors.initials: G
authors.lastname: Gutiérrez-Alba
authors.affiliation: Facultad de Ciencias de la Salud, Universidad Anáhuac México Norte, México, Distrito Federal, México.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: González-Block
authors.affiliation: Hospital Infantil de México Federico Gómez, México, Distrito Federal, México.
authors.forename: Hortensia
authors.initials: H
authors.lastname: Reyes-Morales
mesh_terms: D000047:Academies and Institutes; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D019983:Guideline Adherence; D006270:Health Facility Administrators / Q000523:psychology; D006282:Health Personnel / Q000523:psychology; D006284:Health Plan Implementation; D006291:Health Policy; D006295:Health Resources; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D008800:Mexico / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011634:Public Health; D036301:Qualitative Research; D058996:Quality Improvement