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A Framework for Implementing National Respiratory Guidelines in Wales / RHYS JEFFERIES

Swansea University Author: RHYS JEFFERIES

DOI (Published version): 10.23889/SUthesis.65359

Abstract

Introduction: Implementation outcomes are necessary to experience clinical impact of interventions in the real world. Clear synergy exists between evidence-based clinical recommendations in clinical guidelines and the evidence-based process of implementing them, however less than a quarter of clinic...

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Published: Swansea, Wales, UK 2023
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Lewis, K; Williams, S
URI: https://cronfa.swan.ac.uk/Record/cronfa65359
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first_indexed 2023-12-20T15:12:48Z
last_indexed 2023-12-20T15:12:48Z
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spelling v2 65359 2023-12-20 A Framework for Implementing National Respiratory Guidelines in Wales 99199b2980c778440137a1c5c133ac45 RHYS JEFFERIES RHYS JEFFERIES true false 2023-12-20 Introduction: Implementation outcomes are necessary to experience clinical impact of interventions in the real world. Clear synergy exists between evidence-based clinical recommendations in clinical guidelines and the evidence-based process of implementing them, however less than a quarter of clinical guidelines are implemented using a framework. Methods: Critical review and analysis of the published literature provided the basis for developing framework constructs to facilitate the process of implementing national clinical guidelines in Wales. This is an observational assessment using mixed methods to assess the acceptability and adoption of novel national clinical guidelines in Wales. The framework is adapted in preparation for formal validation. Results: A conceptual framework for implementing clinical guidelines at scale was developed from the literature and findings from thematic analysis of potential guideline adopters in Wales. This was deemed relevant to wider strategies and was therefore applied to the implementation of novel asthma/COPD and COVID-19 guidelines. Applying the framework demonstrated widespread acceptance and adoption of the guidelines across all Health Boards in NHS Wales, however evidence of widespread adherence of the guidelines with fidelity remains unproven as this requires longitudinal observation of process and clinical outcome benefits relating to each guideline recommendations. Conclusions: The differentiation of contexts between the two case studies presented here highlights the difference in pace and urgency of implementation to optimise penetration of a guideline 23 implementation strategy across a target population in Wales. It addresses much of the ambiguity of definitions and joins common principles to create a framework that can be recommended for further testing with other clinical specialities and contexts outside of Wales. Whilst the COVID-19 pandemic introduced a major barrier to guideline adoption for asthma and COPD, it also presented a unique scenario that stimulated large-scale use of a novel COVID guideline. Whilst it was too soon to explore the correlation between implementation strategies, guideline adherence, and clinical outcomes – achieving acceptance and adoption of the guidelines lays the foundations for further exploration of social benefits on a national scale. E-Thesis Swansea, Wales, UK Clinical guidelines, implementation, respiratory, Covid, framework 14 12 2023 2023-12-14 10.23889/SUthesis.65359 Part of this thesis has been redacted to protect personal information. COLLEGE NANME COLLEGE CODE Swansea University Lewis, K; Williams, S Doctoral Ph.D 2023-12-20T16:19:01.3002223 2023-12-20T14:36:52.8978177 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science RHYS JEFFERIES 1 65359__29302__7114b9ca9cfd443ab0b558395784c87e.pdf 2023_Jefferies_R.final.65359.pdf 2023-12-20T15:08:19.6118932 Output 10974538 application/pdf E-Thesis – open access true Copyright: The Author, Rhys Jefferies, 2023. true eng
title A Framework for Implementing National Respiratory Guidelines in Wales
spellingShingle A Framework for Implementing National Respiratory Guidelines in Wales
RHYS JEFFERIES
title_short A Framework for Implementing National Respiratory Guidelines in Wales
title_full A Framework for Implementing National Respiratory Guidelines in Wales
title_fullStr A Framework for Implementing National Respiratory Guidelines in Wales
title_full_unstemmed A Framework for Implementing National Respiratory Guidelines in Wales
title_sort A Framework for Implementing National Respiratory Guidelines in Wales
author_id_str_mv 99199b2980c778440137a1c5c133ac45
author_id_fullname_str_mv 99199b2980c778440137a1c5c133ac45_***_RHYS JEFFERIES
author RHYS JEFFERIES
author2 RHYS JEFFERIES
format E-Thesis
publishDate 2023
institution Swansea University
doi_str_mv 10.23889/SUthesis.65359
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description Introduction: Implementation outcomes are necessary to experience clinical impact of interventions in the real world. Clear synergy exists between evidence-based clinical recommendations in clinical guidelines and the evidence-based process of implementing them, however less than a quarter of clinical guidelines are implemented using a framework. Methods: Critical review and analysis of the published literature provided the basis for developing framework constructs to facilitate the process of implementing national clinical guidelines in Wales. This is an observational assessment using mixed methods to assess the acceptability and adoption of novel national clinical guidelines in Wales. The framework is adapted in preparation for formal validation. Results: A conceptual framework for implementing clinical guidelines at scale was developed from the literature and findings from thematic analysis of potential guideline adopters in Wales. This was deemed relevant to wider strategies and was therefore applied to the implementation of novel asthma/COPD and COVID-19 guidelines. Applying the framework demonstrated widespread acceptance and adoption of the guidelines across all Health Boards in NHS Wales, however evidence of widespread adherence of the guidelines with fidelity remains unproven as this requires longitudinal observation of process and clinical outcome benefits relating to each guideline recommendations. Conclusions: The differentiation of contexts between the two case studies presented here highlights the difference in pace and urgency of implementation to optimise penetration of a guideline 23 implementation strategy across a target population in Wales. It addresses much of the ambiguity of definitions and joins common principles to create a framework that can be recommended for further testing with other clinical specialities and contexts outside of Wales. Whilst the COVID-19 pandemic introduced a major barrier to guideline adoption for asthma and COPD, it also presented a unique scenario that stimulated large-scale use of a novel COVID guideline. Whilst it was too soon to explore the correlation between implementation strategies, guideline adherence, and clinical outcomes – achieving acceptance and adoption of the guidelines lays the foundations for further exploration of social benefits on a national scale.
published_date 2023-12-14T16:19:02Z
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score 11.014067

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