title: Sustainability of professionals' adherence to clinical practice guidelines in medical care: a systematic review.
abstract: To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals' adherence to guideline recommendations in medical practice.
  
  
  
  Systematic review.
  
  
  
  Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers.
  
  
  
  Studies needed to be focused on sustainability and on professionals' adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST).
  
  
  
  The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5-maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals' adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals' adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained.
  
  
  
  (2) Professionals' adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals' adherence to guidelines in medical practice can be drawn.
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Stephanie M C
authors.initials: SM
authors.lastname: Ament
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Jeanny J A
authors.initials: JJ
authors.lastname: de Groot
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Department of Patient & Integrated Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: José M C
authors.initials: JM
authors.lastname: Maessen
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands Kleijnen Systematic Reviews Ltd, York, UK.
authors.forename: Jos
authors.initials: J
authors.lastname: Kleijnen
mesh_terms: D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D013997:Time Factors