Evaluating the implementation of evidence-based TCM Clinical Practice Guidelines for Cerebral Infarction

IntroductionSeveral clinical practice guidelines for traditional Chinese medicine(TCM) have been established and recently implemented. However, their effectiveness in practice is rarely evaluated. ‘Evidence-based Clinical Practice Guidelines for Cerebral Infarction’ were taken as example guidelines, to evaluate whether the recommended methods of treatment had been adhered to.MethodsAn evaluation index system was devised which included rating scales, questionnaires and interviews with both clinical physicians and patients.ResultsThe guidelines were more successfully implemented if Chinese patent medicine was administered orally or intravenously, compared with acupuncture and tuina treatment. Barriers for implementing the TCM guidelines included factors affecting physicians’ acceptance and application such as the strength of recommendations, their knowledge structure and professional skills. Factors affecting the patients’ acceptance included their socio-economic status, understanding and medical/social insurance. Three strategies that could help the effective implementation of the guidelines were identified: intervention with a reward/penalty policy by administrative departments, explanations of the guidelines by experts, making guideline content more accessible to clinical physicians by adding different modules of guideline-recommendations to doctors’ work stations. Questionnaires and interviews were effective for evaluating implementation barriers. This evaluation index system was a useful and potentially accurate method to identify implementation.ConclusionBarriers in implementing the TCM guidelines were involved at every single step of clinical practice. Feasible strategies can facilitate implementation results.