title: Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice.
abstract: Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality/value This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.
authors.affiliation: Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences, Delhi, India.
authors.forename: Sangeeta
authors.identifier: http://orcid.org/0000-0001-7411-5335
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Faculty of Management Studies, University of Delhi , Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Pandit
authors.affiliation: Department of Pharmacology, Institute of Human Behaviour and Allied Sciences, New Delhi, India.
authors.forename: Fauzia
authors.initials: F
authors.lastname: Tabassum
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001364:Awareness; D003142:Communication; D004059:Diffusion of Innovation; D004777:Environment; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D012931:Social Environment; D013997:Time Factors
keywords: Clinical guidelines; Education; Evidence-based practice; Guideline adoption; Guideline adoption barriers; Guideline adoption facilitators; Quality healthcare; Rational medicine use; Standard treatment guidelines