How does policy support guideline implementation? The role of policy, political, and health systems considerations in clinical practice guideline implementation

Abstract

Clinical practice guidelines (CPGs) provide recommendations based on the best available evidence to ensure that decisions about patient care are well-informed. Extensive research within implementation science has highlighted the factors and strategies that are most important in CPG implementation across a variety of settings. The uptake of evidence-based practice however, is quite complex, and there still exist gaps in knowledge about how those factors and strategies are affected by the policy context. In particular, we know little about how considerations about the role of policy, politics, and health systems affect whether and how CPGs are used. The objective of this dissertation is to advance the use of policy, political, and health systems considerations in the implementation of CPGs through three original scientific contributions. First, a critical interpretive synthesis of existing literature was used to enrich two existing implementation frameworks (the Knowledge-to-Action Framework and the Consolidated Framework for Implementation Research) from a policy context perspective. Second, a multiple explanatory case study of guideline implementation processes was used to investigate how the enriched frameworks could be used to identify policy context-related factors and strategies needed to support CPG implementation. Third, a formative evaluation study design was utilized to explore how to improve upon and support the use of these enriched frameworks from the perspective of expert guideline developers and guideline implementers across the six World Health Organization regions. Collectively, these studies contribute theoretical, substantive, and methodological insights toward understanding the policy context relevant factors and strategies that support effective implementation of CPGs. A better understanding of the policy, political, and health systems considerations that impact CPG implementation can translate into more fit-for-purpose CPGs being developed and more tailored implementation strategies being employed, as well as more patients benefiting from clinical care informed by the best available evidence.