SynthesisPostgraduate medical journal2011
Patterns of 'leakage' in the utilisation of clinical guidelines: a systematic review.
Synthesis in Postgraduate medical journal, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 92 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Second Edition)
SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Thrid Edition)
Who cites it
92 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review.Clinical rehabilitation · 2023Pooled it
- Semantic Web in Healthcare: A Systematic Literature Review of Application, Research Gap, and Future Research Avenues.International journal of clinical practice · 2022Pooled it
- Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis.Implementation science : IS · 2021Pooled it
- Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews.Implementation science : IS · 2020Pooled it
- Pooled it
- The quantity and quality of complementary and alternative medicine clinical practice guidelines on herbal medicines, acupuncture and spinal manipulation: systematic review and assessment using AGREE II.BMC complementary and alternative medicine · 2016Pooled it
- Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.Implementation science : IS · 2016Pooled it
- Do guidelines offer implementation advice to target users? A systematic review of guideline applicability.BMJ open · 2015Pooled it
- Planning a Clinical Practice Guideline Revision for a Core Set of Outcome Measures in Adults Undergoing Neurologic Physical Therapy, Part 2: Determining Stakeholders' Uptake and Recommendations.Clinical and public health guidelines · 2026Article
- Facilitators of Clinical Guideline Implementation in Tertiary Care: A Systematic Literature Review.Health care analysis : HCA : journal of health philosophy and policy · 2026Article
- Article
- Use of ESGE clinical practice guidelines in daily endoscopy: Results of a national survey of Spanish endoscopists.Endoscopy international open · 2026Article
- Dissemination and implementation science for global ophthalmology: closing the last-mile translational gap.Frontiers in public health · 2026Review
- Peripheral Intravenous Catheter Care at Australian Emergency Departments: A Cross-Sectional Observational Study.Journal of advanced nursing · 2025Observational
- Quality improvement report: Investigating barriers in HIV testing oncology patients to optimize HIV testing practice.HIV medicine · 2025Article
- Peripheral intravenous catheter clinical care standard adherence in emergency departments: A qualitative study underpinned by the behaviour change wheel.Journal of advanced nursing · 2025Article
- Exploration of Potential Determinants of Implementation of a Clinical Practice Guide to Enhance Physical Activity Participation of Children With Developmental Coordination Disorder.Physiotherapy Canada. Physiotherapie Canada · 2025Article
- Patient and contextual factors influence clinicians' decision making regarding universal screening for gestational diabetes: results of a factorial survey set in rural and remote Western Australia.BMC pregnancy and childbirth · 2025Article
- Impact of National Society Guidelines and National Comprehensive Cancer Network (NCCN) Guidelines on Genetic Testing Use Among Patients with Breast Cancer.Annals of surgical oncology · 2025Article
- Challenges using electronic health records to support unhealthy alcohol use screening and intervention in primary care practices in the Pacific Northwest.Journal of the American Medical Informatics Association : JAMIA · 2025Article
32 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundResearch evidence is insufficient to change physicians' behaviour. In 1996, Pathman developed a four step model: that physicians need to be aware of, agree with, adopt, and adhere to guidelines.
objectiveTo review evidence in different settings on the patterns of 'leakage' in the utilisation of clinical guidelines using Pathman's awareness-to-adherence model.
methodsA systematic review was conducted in June 2010. Primary studies were included if they reported on rates of awareness and agreement and adoption and/or adherence.
results11 primary studies were identified, reporting on 29 recommendations. Descriptive analyses of patterns and causes of leakage were tabulated and graphed. Leakage was progressive across all four steps. Median adherence from all recommendations was 34%, suggesting that potential benefits for patients from health research may be lost. There was considerable variation across different types of guidelines. Recommendations for drug interventions, vaccination and health promotion activities showed high rates of awareness. Leakage was most pronounced between adoption and adherence for drug recommendations and between awareness and agreement for medical management recommendations. Barriers were reported differentially for all steps of the model.
conclusionLeakage from research publication to guideline utilisation occurs in a wide variety of clinical settings and at all steps of the awareness-to-adherence pathway. This review confirms that clinical guidelines are insufficient to implement research and suggests there may be different factors influencing clinicians at each step of this pathway. Recommendations to improve guideline adherence need to be tailored to each step.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.