Article type
Abstract
Background
Clinical practice guidelines (CPGs) often fail to be fully implemented in practice. One barrier to CPG implementation is inconsistency between recommendations and existing practice patterns. This can include patients, personnel, structure, availability of resources, and cultural and ethical values. To account for this, it is feasible to tailor national CPGs to a regional or local context (eg, hospital). Local ownership can be beneficial and help to implement the guideline without affecting guideline validity. This process is also known as guideline adaptation.
Objectives
To identify randomized controlled trials (RCTs) investigating the effectiveness of locally adapted CPGs.
Methods
We performed a scoping review, following the JBI guidance. The scoping review was registered with the Open Science Framework (https://osf.io/3ed2w). The intervention had to be a locally adapted guideline (locally meaning adapted to any delineated area and/or entity at a subnational and/or transnational level). Cointerventions were accepted. We did not restrict the control group. As we considered locally adapted guidelines as an intervention, and it seems feasible to test locally adapted guidelines in trials, we only considered RCTs, including cluster RCTs. MEDLINE and Embase were searched in October 2023. Two reviewers independently screened titles and abstracts, full-text articles, and charted data. Conflicts were resolved by involving a third reviewer. Data were summarized descriptively.
Results
Five cluster RCTs reported in 6 publications and published between 2000 and 2010 were included. The trials originated from the UK (n = 2), Australia, the US, and the Netherlands. The adapted CPGs focused on diabetes, asthma, smoking cessation, mental disorders, and menorrhagia and urinary incontinence. The number of sites (eg, practices) ranged from 4 to 30. Reporting was mostly insufficient to understand how adaptation was performed. Interventions always included some form of dissemination, such as educational meetings or workshops.
Conclusions
Only a small number of locally adapted guidelines have been investigated in RCTs. There is a huge variety of settings and diseases. Remarkably, no new evidence has been published since 2010. This may explain shortcomings in reporting.
Clinical practice guidelines (CPGs) often fail to be fully implemented in practice. One barrier to CPG implementation is inconsistency between recommendations and existing practice patterns. This can include patients, personnel, structure, availability of resources, and cultural and ethical values. To account for this, it is feasible to tailor national CPGs to a regional or local context (eg, hospital). Local ownership can be beneficial and help to implement the guideline without affecting guideline validity. This process is also known as guideline adaptation.
Objectives
To identify randomized controlled trials (RCTs) investigating the effectiveness of locally adapted CPGs.
Methods
We performed a scoping review, following the JBI guidance. The scoping review was registered with the Open Science Framework (https://osf.io/3ed2w). The intervention had to be a locally adapted guideline (locally meaning adapted to any delineated area and/or entity at a subnational and/or transnational level). Cointerventions were accepted. We did not restrict the control group. As we considered locally adapted guidelines as an intervention, and it seems feasible to test locally adapted guidelines in trials, we only considered RCTs, including cluster RCTs. MEDLINE and Embase were searched in October 2023. Two reviewers independently screened titles and abstracts, full-text articles, and charted data. Conflicts were resolved by involving a third reviewer. Data were summarized descriptively.
Results
Five cluster RCTs reported in 6 publications and published between 2000 and 2010 were included. The trials originated from the UK (n = 2), Australia, the US, and the Netherlands. The adapted CPGs focused on diabetes, asthma, smoking cessation, mental disorders, and menorrhagia and urinary incontinence. The number of sites (eg, practices) ranged from 4 to 30. Reporting was mostly insufficient to understand how adaptation was performed. Interventions always included some form of dissemination, such as educational meetings or workshops.
Conclusions
Only a small number of locally adapted guidelines have been investigated in RCTs. There is a huge variety of settings and diseases. Remarkably, no new evidence has been published since 2010. This may explain shortcomings in reporting.