gms | German Medical Science

Background/research question: Clinical practice guidelines (CPGs) are instruments that aim to assist practitioners’ and patients’ decisions in clinical practice. The successful implementation and adherence of CPGs are however influenced by different factors such as personal beliefs, cultural, economic, ethnical, organisational and local context factors. The aim of this systematic review is to investigate the barriers and facilitators regarding the adherence of CPGs in Germany.

Methods: The study protocol is published in the Open Science Framework [1]). We searched for primary studies (qualitative, quantitative and mixed-methods) that report on barriers or facilitators to CPG adherence in Germany. We searched in PubMed and Embase for studies published between January 2011 and November 2022. Two reviewers independently screened the articles, extracted the data, and assessed the quality of the studies (Mixed Methods Appraisal Tool). Data collected on barriers and facilitators of CPG adherence were mapped and analysed based on the domains of the Theoretical Domains Framework (TDF).

Results: The included studies (n=24) mainly examined national CPGs. The TDF domains of environmental context and resources (e.g. employer support for CPGs' use), beliefs about consequences (e.g. contradiction with their experience), and knowledge (e.g. no knowledge about the CPGs) were among the most frequently reported barriers by health care professionals. Among facilitators, the most frequently cited categories were environmental context and resources (e.g., electronic tools that facilitate decision making), knowledge (e.g. physician education), and reinforcement (e.g. financial support). Barriers and facilitators related to the process of CPG development and dissemination (e.g., layout, length, evidence base, dissemination pathways) were also frequently mentioned as influential factors for adherence to CPGs. Most studies had quality limitations, mainly related to the high risk of nonresponse bias and representativeness of the target population.

Conclusion: Multidimensional factors were identified to contribute to CPG adherence in Germany. The results should lead to a better understanding of the topic and at the same time form a basis for developing strategies to improve implementation of and adherence to CPGs in Germany.

Competing interests: All authors declare that they have no conflicts of interest.