Barriers of Clinical Guidelines Implementation in China: A Systematic Review

Session Type
Synthesis of evidence without meta-analysis
Tian C1, Ge L1
1Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, China

Background: Guideline implementation is critical of translating knowledge into practice. However, the strategies and barriers to guideline implementation are still unclear in China.
Objectives:This study aimed to systematically review the current status of strategies and barriers to the implementation of the guidelines in China, so as to better promote the better application of the guidelines in the clinical practice.
Methods: We searched China National Knowledge Infrastructure, China Biomedical Literature Database, WanFang Database, PubMed, Embase, and Web of Science electronic databases up to 22 October 2022. Our reviewers performed literature screening, data extraction, quality assessment of included surveys in duplicate. Potential barriers and strategies were mapped based on evidence, target population, organizations, and resource and environment.
Results: We included 16 surveys involving a total of 7,147 health care providers. Two third of included surveys was moderate to high quality. Thirty-one barriers were grouped into four categories, including evidence (11 barriers), target population (8 barriers), organization (6 barriers), and resources and environment (6 barriers). Lack of applicability (95.42%, 4 surveys, 1244 participants), ambiguous recommendations (59.64%, 4 surveys, 3147 participants), and less convenient (48.75%, 1 survey, 359 participants) were the main evidence-related barrier factors. The top 3 barriers related to the target population included the lack of awareness (26.06%, 4 surveys, 2701 participants), language barriers (26.01%, 3 surveys, 3799 participants), and patients’ attitude towards healthcare workers (28.31%, 1 survey, 438 participants). The most common organization-related barriers were insufficient publicity (42.54%, 2 studies, 269 participants) and insufficient training/education (41.67%, 3 studies, 3878 participants). Lack of resources and non-applicability to primary hospitals were factors hindering the implementation of the guideline at the level of resources and environment. Establishing a national guideline database and involving primary care physicians in the guideline development process were considered by many respondents to be effective strategies for promoting guideline implementation.
Conclusions: In China, the implementation of guidelines is hindered mainly due to lack of applicability, ambiguous recommendation, and lack of education or training. The solution might be establishing multidisciplinary collaborative teams, building a national guideline clearinghouse, and increasing education and training.

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