Barriers and strategies associated with the implementation of mental health clinical guidelines

The presentation will discuss findings from a review of 231 articles examining the most recent evidence on barriers to, and strategies for, dissemination and implementation of clinical guidelines and clinical support tools, with a focus on the military mental health environment. To be accepted for the review, studies must have assessed either barriers to the use of clinical practice guidelines or support tools or strategies to improve the use of guidelines or tools. Randomized controlled trials, observational studies and individual case studies were included. Significant barriers to dissemination and implementation of guidelines and tools were found to exist at the provider, consumer, and health system/organizational levels. Most evaluations of dissemination and implementation strategies have concluded that multifaceted interventions tend to be more successful than single interventions, and that tailored strategies are necessary to address highly variable and influential local conditions. Barriers – The prevalence and influence of barriers to guideline and tool implementation were found to be affected by certain characteristics of mental health and military care settings and care processes, as well as by the demographics and preferences of both providers and individuals with mental illness. Strategies – Dissemination and implementation strategies were identified across five themes: fostering ownership and enthusiasm, improving convenience, educating stakeholders, leveraging human capital and measuring and rewarding improvement. Wide variability in the implementation of these strategies, when combined with similar variability in individual, provider, care setting and illness characteristics, has typically resulted in inconsistent findings regarding their effects on both adherence to guideline and tool recommendations and outcomes. In addition, the effectiveness of certain strategies may vary by professional discipline, provider demographics or targeted illness. Studies reported generally poor sustainability of improvements. Additional research is necessary to assess the comparative effectiveness and economic efficiency of dissemination and implementation strategies in promoting successful, sustained guideline and tool adoption and fostering improved outcomes.