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Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice
Umeå University, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Learning Informat Management & Eth, Procome Res Grp, Stockholm, Sweden.
2017 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 4, 830-838 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives 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. Material and 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.

Place, publisher, year, edition, pages
WILEY , 2017. Vol. 23, no 4, 830-838 p.
Keyword [en]
guideline adherence, health planning guidelines, health policy, programme evaluation/methods
National Category
Psychology
Identifiers
URN: urn:nbn:se:umu:diva-138415DOI: 10.1111/jep.12726ISI: 000406299200020OAI: oai:DiVA.org:umu-138415DiVA: diva2:1135542
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2017-08-23Bibliographically approved

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CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf