gms | German Medical Science

Background: Many factors affect uptake of clinical practice guidelines. In 2010, we presented a systematic review concluding there was very limited evidence on how format/presentation of guidelines influenced implementation. This also included an opinion-based framework of influencing characteristics.

Objectives: To develop an evidence based framework of guideline characteristics reported as influencing implementation.

Methods: Previous searches were updated. Thematic analysis was used. Studies included if they reported the views/perceptions of users on format/presentation of clinical guidelines.

Results: We developed a conceptual framework, resulting in refinement of categories and assessment of the direction of association. For example, several studies reported that users liked electronic guidelines that could be retrieved rapidly. They preferred guidelines to be short and concise, in plain language with algorithms, decision trees, tables, checklists and summaries. Another example on evidence synthesis, found that practitioners reported:

• Presentation of the evidence base underpinning recommendations was important in influencing use.
• Reliability considered to be based on scientific evidence.
• Short literature synthesis assisted decision making but might lack key elements for decision making.

Discussion: The framework is based on what users think about format/presentation of guidelines; there are inconsistencies and areas of uncertainty. However, some consistent messages have emerged which may aid in guideline development and presentation.

Implications for guideline developers/users: Understanding what users think and how this influences use of guidelines may help in developing guidelines and determining presentation. However, further research is needed to evaluate the impact of format/presentation on implementation rates, and ultimately patient outcomes.