gms | German Medical Science

Background: Guidelines are important decision resources. However, the extent of (Dutch) guideline-adherence, what influential factors are and if better adherence leads to better outcomes are unclear.

Objectives: To investigate the adherence rate to Dutch guidelines, influential factors to and effects of it.

Methods: A systematic review was performed in 6 literature-databases (2000-2011) for empirical studies on the adherence to Dutch guidelines. Included studies were categorized according to research design, professional group, healthcare setting and guideline subject. Methodological study quality was assessed with EPOC-instruments.

Results: 8677 unique references were obtained, of which 100 documents (91 studies) were included. Studies concerned guidelines for physicians (76), nurses (19) and physiotherapists (13), working in hospital (51), primary (43) or residential (6) care. The majority (76) were observational studies, and 5 were RCTs. Adherence rate was operationalized in many ways. Consequently, a large variation in adherence was found, making an overarching statement impossible. A moderate indication was found that adherence is positively related with a positive attitude of professionals towards guidelines, practical usefulness of the guideline, level of evidence of guideline recommendations, a form of automated support in using the guideline and combined methods of implementing the guideline. Effects of adherence were found in a few studies and tended to show better patient outcomes, but were inconclusive about cost (effectiveness).

Discussion: Adherence to Dutch guidelines varies widely. Due to measuring differences, we cannot provide a general statement about guideline adherence.

Implications for guideline developers/users: A more uniform system to measure adherence is needed.