Patterns of leakage in clinical guidelines

Clinical practice guidelines are a useful strategy to synthesise research evidence and summarise clinical practice recommendations. However, scientific research evidence is necessary but insufficient to change behavior of healthcare professionals. It has been suggested that research evidence leaks, in a pattern where physicians are not aware of, do not agree with, do not adopt, and finally do not consistently adhere to specific recommendations.
A systematic review was conducted in June 2010 to summarise the extent of this problem, from published papers. Patterns of leakage were summarised from 11 primary studies reporting on 29 recommendations. It was found to be progressive, culminating in a median adherence from all recommendations of 34%. This suggests that 2/3 of research evidence is lost before it is appropriately used with patients.

However, there was considerable variation across different types of guidelines. This suggests there may be different factors influencing clinicians at each step of this pathway. We summarised factors that were reported as barriers, for each included study and inferred recommendations. Clinician awareness and agreement may be improved by ensuring that guidelines are consistently and clearly understood across appropriate clinical groups. Clinician adoption and adherence to guidelines may be improved through better recognition of patient needs and values, and the use of strategies to manage environmental obstacles.

We cautioned about making assumptions that barriers and facilitators influence all four steps equally, and suggested that a deeper investigation of change was required at each step.

Impact
This paper has been cited 12 time using Web of Science and 25 times according to Google Scholar. Patterns of leakage need further investigation to understand specific barriers and facilitators to guideline adherence in different countries, health care systems and for specific patient groups and groups of clinicians. The complexity identified requires a multifaceted approach for understanding and management.

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