Health professionals' adherence to stroke clinical guidelines: a review of the literature.

BACKGROUND: The process of implementation of clinical guidelines i.e. getting guidelines into practice has been extensively reviewed and meta-reviewed from a generic perspective. However, in relation to stroke care, there has been no review of these studies to date, although implementing stroke clinical guidelines is a topic of great interest within the stroke literature. This review aims to identify stroke studies that have addressed adherence to generic and specific stroke care clinical guidelines.
METHOD: A computer search was conducted using PubMed, CINAHL, PsychINFO, Web of Science and the Cochrane Systematic Reviews databases. Search terms included those relevant to the implementation of stroke clinical guidelines. We assessed all studies retrieved against specific inclusion criteria and collated only those studies that emphasized adherence to stroke clinical guidelines.
RESULTS: Eighty-eight articles were selected for further review from 153 articles retrieved. Of those, 27 were studies on adherence to stroke clinical guidelines and were included in this review - 16 were categorized as generic stroke guidelines and 11 were on specific aspects of stroke care. Each category was further divided into studies that assessed adherence to stroke guidelines only and those that intervened to improve adherence. Adherence was generally greater for studies that included an intervention. Specific stroke care guidelines were poorly adhered to compared to generic stroke guidelines but these studies were better at identifying organizational and team barriers to implementation. Most studies conducted audits of patient medical records and a limited number assessed health professionals' views or used a behavioural framework to assess adherence. DISCUSSION: Adherence to stroke guidelines varied in the studies reviewed. Given the evidence that implementation of clinical guidelines in stroke care leads to better quality of care and improved health outcomes for patients, there is a need to increase adherence behaviours of health professionals towards recommended guidelines, in particular for long term stroke care.