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Overcoming barriers to guideline implementation: the case of cardiac rehabilitation
  1. R S Fernandez1,2,
  2. P Davidson3,
  3. R Griffiths1,2,
  4. Y Salamonson1
  1. 1University of Western Sydney, Sydney, Australia
  2. 2New South Wales Centre for Evidence Based Health Care (a collaborating centre of the Joanna Briggs Institute), Sydney, Australia
  3. 3Curtin University of Technology, Sydney, New South Wales, Australia
  1. Correspondence to Dr Ritin S Fernandez, Family and Community Health, College of Health and Science, University of Western Sydney, Locked Bag 1797, Penrith South DC 1797, New South Wales, Australia; r.fernandez{at}


Aims This study explored the strategies used by cardiac rehabilitation (CR) coordinators to overcome the obstacles to implementation of the evidence-based Reducing Risk in Heart Disease guidelines.

Methods The study design used qualitative, semistructured in-depth interviews with 20 CR coordinators from New South Wales, Australia, to explore the strategies used to facilitate guideline implementation. Non-probability sampling was used to recruit CR coordinators to obtain a broad understanding of the issues. Interviews were transcribed and thematic content analysis was undertaken to identify common themes.

Results Coordinators addressed the barriers to implementing guidelines through their commitment to best practice and striving to overcome the odds through providing opportunistic health education, alternate methods of secondary prevention, and partnering and engaging with local communities.

Conclusions Although CR coordinators face multiple barriers to implementing evidence-based guidelines for patients with coronary heart disease, they use strategies such as harnessing community capacity and using available resources creatively. The development of a more integrated, multifactorial and coordinated approach to improving use of guidelines in clinical practice to improve the treatment and secondary prevention of coronary heart disease is urgently needed.

  • Chronic disease
  • cardiac rehabilitation
  • guideline implementation
  • quality improvement
  • leadership
  • qualitative research
  • clinical practice guidelines

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Sydney South West Area Health Service.

  • Provenance and peer review Not commissioned; externally peer reviewed.