Barriers to implementation of guidelines by healthcare professionals include lack of awareness and lack of familiarity with the guideline and its recommendations. Attitudes of healthcare professionals and lack of agreement with recommendations can also act as barriers to implementation (Fischer et al. 2016). Patients and patient organisations can play a key role in addressing this problem by becoming involved with implementation strategies (SIGN 2019). Structured implementation can improve adherence to guideline recommendations.
Implementation of guidelines includes developing additional tools, documents or campaigns to encourage awareness and use of the guidelines. These can be designed either for patients and the public, or for professionals. Patients and public members of guideline development groups can be involved in both the design, testing and promotion of such implementation strategies.
After implementation tools have been developed, patient and public members and organisations can help promote and distribute these tools. This is usually alongside the dissemination of the guideline itself, using dissemination strategies such as those described in this chapter.
Implementation tools can include web-based resources for health and social care professionals or patients to help implement the guideline recommendations, for example, podcasts and video presentations. They can also include the development of more- or less-extensive public awareness campaigns and strategies. Case studies 6, 7, 8, 9, 10 and 11 demonstrate the various strategies and tools that can support implementation of guideline recommendations.
Case study 6
|As part of implementation of the SIGN glaucoma guideline a poster was created highlighting key recommendations for use with community optometrists. A patient representative on the guideline group was involved with the design of these and dissemination. |
Case study 7
|Patient organisations can promote guidelines in their training for patients and professionals to encourage a change in practice. To help with implementing SIGN’s guideline on children and young people exposed prenatally to alcohol (SIGN156), Adoption UK Scotland highlights recommendations from the guideline in training they provide for professionals to help support families.|
Information from guidelines for patients and the public
Information for patients and the public, such as patient versions of guidelines and plain language summaries, give patients, carers and members of the public access to recommendations in guidelines. This can help with implementation (see the chapter on how to develop information from guidelines for patients and the public). Patient information about conditions or procedures can help people to understand the care and treatment choices available to them based on the evidence and can support shared decision making about their own health (Bradley et al. 2019). Information from guidelines can help patients to evaluate their own care because they can monitor whether their own care is in line with options recommended in guidelines. It allows patients to discuss recommended treatment options with healthcare professionals and to find out why they are not being offered recommended treatments. Providing patients with this information can help to change the behaviour of the healthcare professionals caring for them. Case study 8 demonstrates this.
Case study 8
|The National competence service for simultaneous substance misuse and mental illness in Norway has produced a wide range of resources for patients and professionals, which they publish on their website. These resources include a ‘recommendation card’ for patients that highlights the 10 most important recommendations so that patients and relatives have increased knowledge of what kind of assessment, treatment and follow-up to expect from their healthcare professionals. |
The Norwegian guideline for assessment, treatment and follow-up of people with substance abuse and mental illness was developed by the Norwegian National Directorate of Health, medical associations, the Knowledge center for dual diagnosis and 10 user organisations. A user version of the guideline was developed by the Knowledge center for dual diagnosis in collaboration with several user and relatives organisations. They have also developed and published several other resources:
– Video collection of examples on how assessment tools and motivational interviews can be used in clinical work, as well as videos with representatives from user organisations that address several important topics.
– Web page with an introduction to motivational interview (MI), with clinical examples of how the various MI techniques can be used, as well as videos that show how the method can be used in clinical work. Care givers and patients can order free cards on assessment of drug use and MIs.
– Dual-diagnosis TV consisting of continuous lectures, interviews and other short snippets.
– Contact information for the Expert Council, a group where the National knowledge center for dual diagnosis, user organisations, social entrepreneurs, and professional organisations share experiences and discuss key topics within the drug or substance misuse and mental health field.
A web resource for users with:
– information about follow-up and treatment
– guideline and guidance documents from the authorities
– links to all user organisations, foundations, and social entrepreneurs in the area of substance abuse and mental health
– user rights
– digital self-help programmes or guidance
– helplines and humanitarian organisations to contact for practical help.
In addition to equipping patients with information about treatment options, raising awareness of guideline recommendations can promote their involvement in other areas, such as implementation of recommendations in relation to healthcare-associated infections. Raising patient’s self-awareness on the risks and transmission of infections is one method to promote their involvement in infection prevention and control interventions. Involving patients as partners can promote conversations with professionals about infection control, for example, the patient can remind healthcare professionals to wash their hands (Fernandes Agreli et al. 2019).
Self-management is an important component of care for patients with chronic conditions. Research shows that patients view guidelines as potential sources of self-management support (DECIDE patients and the public, Vernooij et al. 2016). It is therefore crucial that every effort is made to develop implementation strategies in which patients can play an active role. One example is online education tools that promote shared decision making. Brosseau et al. 2012 found that an online evidence-based educational programme delivered through Facebook could improve the knowledge, skills, and self-efficacy of patients with arthritis in relation to evidence-based self-management rehabilitation interventions. Facebook offers a way for healthcare professionals to interact with their patients and share guideline recommendations to promote shared decision making.
Involvement of patients in innovative implementation strategies for self-management recommendations can increase their feeling of having control over their life. For example, self-monitoring, the use of short message services (SMS), diaries, reminders and action plans can serve as tools to support self-management for patients with conditions, such as cancer pain, asthma and diabetes. In patients with cancer pain, SMS alerts and interactive voice response (through a mobile phone) can be used to report and assess pain, allowing patients to be more involved with their pain management. In patients with asthma, action plans can encourage patients to be in more control of their asthma. The use of such tools may be a way to encourage patient empowerment because the patient’s role in managing their condition becomes more active, thus aiding the implementation of self-management recommendations (te Boveldt et al. 2012, Vernooij et al. 2016). Case study 9 provides an example of how patient organisations can support implementation of self-management recommendations.
Case study 9
|A UK patient organisation, the National Rheumatoid Arthritis Society, developed a framework of supported self-management for people with newly diagnosed rheumatoid arthritis with the aim of improving patient outcomes. The Right Start service and resources supports the implementation of recommendations on self-management in the NICE guideline on rheumatoid arthritis in adults: management ( NG100 2018) and related quality standard (QS33 2013). Right Start outcomes are being independently evaluated as part of a quality improvement programme and national audit.|
Development of apps and web-based resources
Often apps and web-based resources are developed for health and social care professionals and patients to help with implementing guideline recommendations. Examples of patients and public members being involved in developing such implementation materials are highlighted in case studies 10 and 11.
Case study 10
Case study 11
|To help with implementing the guideline developed by SIGN, NICE and Royal College of GPs on managing the long-term effects of COVID-19 (2020), an app is in development for patients and the public. A patient who was involved in developing the guideline was involved with this at both the planning stage and early user testing stage of the app development. Interactive content is being developed to support self-management. Further user testing with patients and the public is planned.|
Public awareness-raising campaigns
Patient organisations and charities can be involved in using a guideline to develop education programmes for patients or people at high risk of a condition. Informing patients and the public about a condition and how best to prevent, diagnose and treat it can support the implementation of a guideline by encouraging patients to seek care in accordance with the guideline. It also ensures that professionals treat conditions in patients in accordance with the new, updated or existing guidelines. In addition to being organised or co-developed by patient organisations or charities, patients can be involved in delivering such education programmes.
Individual patients and members of the public can be involved in raising awareness of public health messages, based on evidence. Case study12 provides an example of this.
Case study 12
|World Antibiotic Awareness Week (WAAW) is a global campaign held each year in mid-November. The Scottish Antimicrobial Prescribing Group (SAGP) and Health Scotland lead activities in Scotland to support WAAW and work closely with colleagues in Public Health England and professional groups to coordinate activities and share feedback. The aim is to raise awareness among health and social care staff, patients and the public about the need to use antibiotics more wisely to stop antimicrobial resistance. Since 2019, the campaign slogan has been ‘Keep Antibiotics Working’ and SAPG has promoted key messages using social media, the SAPG website, and radio adverts. Health Scotland has supported the campaign using posters in community pharmacies, GP practices and other community settings. Antimicrobial Management Teams in Scotland lead their Health Board campaign and local activities are supported by SAPG communications and resources. Public partners (volunteers) play an important role in these local activities through promoting the key messages and engaging healthcare staff and members of the public in discussions about the campaign.|