• Vivian Jiang, E Marshall Brooks, Sebastian T Tong, John Heintzman, and Alex H Krist.
• From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (VJ, EMB, AHK); Department of Family Medicine, Oregon Health Sciences University, Portland, OR (JH); Oregon Community Health Information Network (OCHIN), Portland OR (JH). Vivian.Jiang@cuanschutz.edu.
• J Am Board Fam Med. 2020 Mar 1; 33 (2): 271-278.

BackgroundDespite widespread recognition that adherence to clinical preventive guidelines improves patient outcomes, clinicians struggle to implement guideline changes in a timely manner. Multiple factors influence guideline adoption and effective implementation. However, few studies evaluate their collective and inter-related effects. This qualitative study provides a comprehensive picture of the interplay between multiple factors on uptake of new or changed preventive guidelines.MethodsSemistructured interviews conducted in 2018 with a diverse sample of clinicians and practice leaders sought to understand patient, clinician, practice, health system, environment, and guideline factors of influence. An immersion-crystallization approach was used to identify emergent themes.ResultsInterviewees expressed motivation to adhere to guidelines but also valued sharing decisions with patients. Personal biases and fears affected both clinician and patient guideline adoption. Practices facilitated implementation through workflow optimization and encouraging a culture of evidence-based practice while a key health system function was to maintain electronic health record alerts. More traditional environmental factors, such as insurance coverage or transportation, were less of a barrier to guideline adoption and implementation than the influence of media and specialists. Various specific guideline characteristics also affected ease of adoption and implementation. Different settings expressed greater health system, practice, or clinician-centric approaches to guideline implementation.ConclusionsGuideline uptake is influenced by a complex interplay of multiple levels of factors including the patient, clinician, practice, health system, environment, and guideline levels. Comprehensively understanding all levels of influence for each specific clinical setting may help to determine the optimal intervention(s) for improving uptake of evidence-based guidelines.© Copyright 2020 by the American Board of Family Medicine.

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