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. 2024 Jul 23;13(3):e002595.
doi: 10.1136/bmjoq-2023-002595.

Challenges, barriers and solutions for implementing clinical practice guidelines: a qualitative study in southern Iran

Hedayat Salari  1 , Fatemeh Najm  2 , Mohammadreza Yazdankhahfard  3 , Atefeh Esfandiari  4
Affiliations

Challenges, barriers and solutions for implementing clinical practice guidelines: a qualitative study in southern Iran

Hedayat Salari et al. BMJ Open Qual. .

Abstract

Background: Identifying the challenges of implementing clinical practice guidelines (CPGs) can provide valuable information for decision-makers and health policymakers at the national and local levels. The implementation of CPGs requires the development of strategies to facilitate their use. This research aimed to determine the challenges, barriers and solutions for implementing CPGs from the expert point of view in Bushehr University of Medical Sciences.

Methods: This qualitative research uses content analysis conducted in 2022 in southern Iran. In-depth interviews were conducted with the physicians and experts in the health system. Interviewing continued until reaching the saturation level. Altogether, 22 experts were interviewed. The interview guide was used to explore experts' opinions. All the interviews were recorded and then transcribed. Finally, coding and data analysis was done using MAXQDA 2022 software.

Results: The analysis revealed 4 main themes and 20 subthemes. The four main themes included challenges related to physicians, medical education, the health system and patients. The most common themes were the lack of sufficient training (related to the medical education system), equipment and infrastructure, and the lack of adaptation of clinical guidelines (related to the health system). The solutions included 4 main themes and 19 subthemes.

Conclusion: The most mentioned topic by the experts was training CPGs in medical schools. In Iran's current medical education system, the training of CPGs is not included in the curriculum. It is proposed to reform the medical education system in Iran. In addition, health inequalities such as lack of access to equipment, supplies and insurance in under-resourced areas and disparities in research/training/medical education should be addressed to improve the validity of guidelines.

Keywords: clinical practice guidelines; evidence-based medicine; health policy; health services research; healthcare quality improvement.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Field MJ, Lohr KN. Washington, D.C: National Academy Press; 1990. Clinical practice guidelines: directions for a new program, Institute of medicine; p. 38.https://www.nap.edu/catalog/1626 Available. - PubMed
    1. Jannati A, Hajebrahimi S, Azizzadeh M. Challenges and obstacles to clinical guidelines from the perspectives of urology residents: a qualitative study. Depict Health. 2020;11:316–23. doi: 10.34172/doh.2020.40. - DOI
    1. Hakkennes S, Dodd K. Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008;17:296–300. doi: 10.1136/qshc.2007.023804. - DOI - PubMed
    1. Kimiaei Mehr F, Hosseini S, Mohammadzadeh A, et al. Investigating the effective factors on the implementation of clinical guidelines in Iran. J Mil Med. 2019;21:300–10.
    1. Estonian Health Insur Fund; 2004. The handbook of developing treatment guidelines (Ravi- JA Tegevusjuhendite Koostamise Käsiraamat)

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