Barriers and enablers for the implementation of clinical practice guidelines in Latin America: A scoping review

Article type
Authors
Villegas Arbelaez E1, Medina Rodríguez M2, Isaza López M3, Andrenacci P4, Escobar Liquitay C5, Ariel Franco J6
1Clínica Ces, Medellín, Antioquia, Colombia
2Medellín Science, Technology and Innovation District, Medellín, Antioquia, Colombia
3Clínica Universitaria Bolivariana, Medellín, Antioquia, Colombia
4Cochrane Hepato-Biliary Group, Wheelwright, Santa Fe, Argentina
5Instituto Universitario Hospital Italiano, Buenos Aires, Buenos Aires, Argentina
6Heinrich Heine University Düsseldorf, Düsseldorf, Düsseldorf, Germany
Abstract
Background
Evidence-based Clinical Practice Guidelines (CPGs) include recommendations that aim to optimise patient care. Applying a CPG is a complex process that depends on multiple factors, considering the characteristics of the implementation setting and the barriers and enablers of change. There are currently no reviews on the topic focusing on the Latin American Region.

Objectives
Identify the barriers and enablers for implementing Clinical Practice Guidelines in Latin America.

Relevance and importance to patients
Identifying barriers and enablers can aid the implementation of patient-centred and evidence-informed healthcare in the Region.

Methods
Our scoping review follows the guidance of the JBI, and the protocol was registered (osf.io/rs23x). We followed the Population, Context, and Concept (PCC) approach for defining eligibility: healthcare professionals from the Latin America (all levels of healthcare settings) and barriers and enablers. Qualitative, quantitative or mixed-methods primary studies were included. Narrative reviews, studies of implementation tools, studies that describe the current CPG practice in the Latin America region, the extent of compliance with CPGs, or clinician attitude toward the guidelines without describing the barriers or enablers were excluded. We searched MEDLINE and LILACS in February 2024.

Results
This is an ongoing review. We have preliminarily included four studies. Three used a qualitative approach, one from Colombia and two from Mexico. One quantitative study was found, which reports barriers to implementing one CPG in Brazil, Venezuela, and Mexico, focusing on the differences in clinical settings compared with the CPG development. We are currently mapping the main barriers and enablers identified in the included studies, which so far include: stigma, lack of integration, ignorance of CPG, resistance to the implementation, limited resources, and lack of training. Having the CPG printed at the point of care and easy-to-follow recommendations were identified as enablers.

Conclusions
The full results of the review will be presented at the GES 2024. We will provide an overview of the current knowledge and evidence gaps on this topic, especially the research needs to promote further the implementation of the use of CPG in the region.