Data from: Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review

Objectives: To evaluate (1) the state of the art in sustainability
research and (2) the outcomes of professionals’ adherence to guideline
recommendations in medical practice. Design: Systematic review. Data
sources: Searches were conducted until August 2015 in MEDLINE, CINAHL,
EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the
Guidelines International Network (GIN) library. A snowball strategy, in
which reference sections of other reviews and of included papers were
searched, was used to identify additional papers. Eligibility criteria:
Studies needed to be focused on sustainability and on professionals’
adherence to clinical practice guidelines in medical care. Studies had to
include at least 2 measurements: 1 before (PRE) or immediately after
implementation (EARLY POST) and 1 measurement longer than 1 year after
active implementation (LATE POST). Results: The search retrieved 4219
items, of which 14 studies met the inclusion criteria, involving 18
sustainability evaluations. The mean timeframe between the end of active
implementation and the sustainability evaluation was 2.6 years (minimum
1.5–maximum 7.0). The studies were heterogeneous with respect to their
methodology. Sustainability was considered to be successful if performance
in terms of professionals’ adherence was fully maintained in the late
postimplementation phase. Long-term sustainability of professionals’
adherence was reported in 7 out of 18 evaluations, adherence was not
sustained in 6 evaluations, 4 evaluations showed mixed sustainability
results and in 1 evaluation it was unclear whether the professional
adherence was sustained. Conclusions: (2) Professionals’ adherence to a
clinical practice guideline in medical care decreased after more than
1 year after implementation in about half of the cases. (1) Owing to the
limited number of studies, the absence of a uniform definition, the high
risk of bias, and the mixed results of studies, no firm conclusion about
the sustainability of professionals’ adherence to guidelines in medical
practice can be drawn.