title: Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice.
abstract: OBJECTIVE
  In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease.
  
  
  METHODS
  A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed.
  
  
  RESULTS
  Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P < .001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities.
  
  
  CONCLUSIONS
  This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines.
authors.affiliation: Procome Research Group; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mikael
authors.identifier: http://orcid.org/0000-0002-3678-7154
authors.initials: M
authors.lastname: Kakeeto
authors.affiliation: Procome Research Group; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.|Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Lundmark
authors.affiliation: Procome Research Group; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Medicine (CES), Stockholm County Council, Sweden.
authors.forename: Henna
authors.initials: H
authors.lastname: Hasson
authors.affiliation: Procome Research Group; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: von Thiele Schwarz
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: guideline adherence; health planning guidelines; health policy; programme evaluation/methods