1
|
Wiles L, Hibbert PD, Zurynski Y, Smith CL, Arnolda G, Ellis LA, Lake R, Easpaig BNG, Molloy C, Middleton S, Braithwaite J, Hill K, Turner T. Is it possible to make 'living' guidelines? An evaluation of the Australian Living Stroke Guidelines. BMC Health Serv Res 2024; 24:419. [PMID: 38570788 PMCID: PMC10988967 DOI: 10.1186/s12913-024-10795-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Keeping best practice guidelines up-to-date with rapidly emerging research evidence is challenging. 'Living guidelines' approaches enable continual incorporation of new research, assisting healthcare professionals to apply the latest evidence to their clinical practice. However, information about how living guidelines are developed, maintained and applied is limited. The Stroke Foundation in Australia was one of the first organisations to apply living guideline development methods for their Living Stroke Guidelines (LSGs), presenting a unique opportunity to evaluate the process and impact of this novel approach. METHODS A mixed-methods study was conducted to understand the experience of LSGs developers and end-users. We used thematic analysis of one-on-one semi-structured interview and online survey data to determine the feasibility, acceptability, and facilitators and barriers of the LSGs. Website analytics data were also reviewed to understand usage. RESULTS Overall, the living guidelines approach was both feasible and acceptable to developers and users. Facilitators to use included collaboration with multidisciplinary clinicians and stroke survivors or carers. Increased workload for developers, workload unpredictability, and limited information sharing, and interoperability of technological platforms were identified as barriers. Users indicated increased trust in the LSGs (69%), likelihood of following the LSGs (66%), and frequency of access (58%), compared with previous static versions. Web analytics data showed individual access by 16,517 users in 2016 rising to 53,154 users in 2020, a threefold increase. There was also a fourfold increase in unique LSG pageviews from 2016 to 2020. CONCLUSIONS This study, the first evaluation of living guidelines, demonstrates that this approach to stroke guideline development is feasible and acceptable, that these approaches may add value to developers and users, and may increase guideline use. Future evaluations should be embedded along with guideline implementation to capture data prospectively.
Collapse
Affiliation(s)
- Louise Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia.
- South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- NHMRC Partnership Centre for Health System Sustainability, Sydney, Australia
| | - Carolynn L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- NHMRC Partnership Centre for Health System Sustainability, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- NHMRC Partnership Centre for Health System Sustainability, Sydney, Australia
| | - Rebecca Lake
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | | | - Charlotte Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- NHMRC Partnership Centre for Health System Sustainability, Sydney, Australia
| | | | - Tari Turner
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Voigt W, Trautwein M. Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures? Curr Opin Oncol 2023; 35:68-77. [PMID: 36367223 DOI: 10.1097/cco.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Despite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine. RECENT FINDINGS Some studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability. SUMMARY In principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.
Collapse
Affiliation(s)
- Wieland Voigt
- Wieland Voigt, Medical Innovations and Management, Steinbeis University Berlin, Berlin
| | - Martin Trautwein
- Martin Trautwein, Senior Medical Advisor, Cognostics GmbH, Munich, Germany
| |
Collapse
|