Life In The Slower Lane

Here is the structured PICO analysis for the twenty-fifth article you uploaded:

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Full Title (verbatim and exact):

“Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis”

McArthur C, Bai Y, Hewston P, Giangregorio L, Straus S, Papaioannou A

Implementation Science (2021); 16:70

DOI: https://doi.org/10.1186/s13012-021-01140-0

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Type of Article:

Systematic review (qualitative evidence synthesis)

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PICO Analysis:

Population:

• Staff working in long-term care (LTC) homes globally, including:
  • Registered nurses, personal support workers, physicians, pharmacists, administrators, allied health professionals
• Settings included homes where 24-hour nursing care is provided, with ≥50% of residents over age 65
• Multiple countries represented, primarily Canada, Australia, the UK, Netherlands, South Korea, and the USA 

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Intervention:

• Implementation of evidence-based clinical guidelines across various health topics in LTC (e.g., pain management, dementia care, pressure injury prevention, medication safety, infection control, oral health)
• Study focus: understanding the barriers and facilitators to implementation from the perspective of LTC staff

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Comparator:

• Not applicable – this is a qualitative synthesis without an intervention vs. control comparison
• Studies compared experiences before vs. after guideline implementation or between different LTC settings

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Outcome:

1. Person-centred outcomes:

• Indirectly addressed – many studies aimed to improve resident outcomes such as:
  • Reduced use of antipsychotics
  • Improved oral and palliative care
  • Safer medication administration
  • Enhanced symptom management (e.g., pain, pressure ulcers)

2. Process outcomes:

• Commonly identified barriers (high confidence):
  • Time constraints and inadequate staffing
  • Knowledge gaps in guideline content or procedures
  • Cost and lack of physical resources
  • Poor communication and inconsistent team practices
  • Organisational resistance and limited leadership engagement
• Commonly identified facilitators (high confidence):
  • Presence of local champions and leaders
  • Well-designed tools and protocols tailored to the LTC context
  • Sufficient time, staffing, and education resources
  • Collaboration across disciplines and with families 

3. Health system outcomes:

• Analysis mapped barriers and facilitators to the COM-B model (Capability, Opportunity, Motivation – Behaviour)
• Suggested implementation strategies included:
  • Training and education
  • Environmental restructuring
  • Modelling and enablement
  • Persuasion and incentivisation
• Recommendations for policymakers included:
  • Investing in resident-centred models of care
  • Standardising training for all LTC roles
  • Enhancing team communication structures

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Summary Conclusion:

This qualitative systematic review synthesised insights from 33 studies across 12 countries, identifying common barriers and enablers to implementing evidence-based guidelines in LTC. It found that workforce constraints, lack of organisational support, and insufficient training are pervasive challenges. However, local leadership, interdisciplinary coordination, and tailored implementation tools can significantly improve uptake. The authors mapped these findings to the Behaviour Change Wheel to propose theory-informed strategies such as training, enablement, and environmental restructuring. These insights can guide design of future interventions to improve the quality and consistency of care for older people in LTC homes.

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