Barriers and Facilitators of Healthcare Provider Uptake of Clinical Practice Guideline Recommendations for the Management of Common Mental Health Concerns: A Qualitative Evidence Synthesis

Clinical practice guidelines synthesize the best available evidence and recommend treatments with the intention of enhancing client outcomes. Despite evidence for effectiveness, guideline-recommended treatments are often under-utilized. We conducted a systematic review of six bibliographic databases published prior to May 6, 2020. Qualitative studies that reported on mental healthcare provider perceived barriers and facilitators to the delivery of evidence-based treatments (EBTs) recommended by practice guidelines for the management of depression, anxiety-related disorders, and posttraumatic stress disorder (PTSD) within usual care were eligible. A meta-synthesis approach was used to synthesize barriers and facilitators that were coded in accordance with the Theoretical Domains Framework. Confidence in evidence was graded with the Grading of Recommendation, Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Eighteen studies that reported on 705 mental healthcare providers (primarily psychologists and social workers) met inclusion criteria. Evidence synthesized pertained primarily to the delivery of (a) cognitive processing therapy (CPT) and prolonged exposure (PE) for the management of PTSD among veterans; and (b) cognitive behavioral therapy (CBT) for the management of depression and anxiety-related disorders. Factors that reliably influenced the delivery of EBTs included the following: (a) knowledge and self-efficacy; (b) anticipation of client outcomes in the presence of complex comorbidity; (c) client preference and readiness to engage in treatment; (d) available time, presence of trained staff, and institutional policies; and (e) availability of professional supports. Findings could influence the delivery of EBTs but must be taken in context with the tripartite model of evidence-based practice. Les lignes directrices cliniques constituent la synthèse des meilleures données probantes disponibles et recommandent des traitements qui amélioreront l'état de santé des patients. Or, même si des éléments probants en démontrent l'efficacité, les traitements recommandés par les lignes directrices sont souvent sous-utilisés. Nous avons donc mené une analyse systématique de six bases de données bibliographiques publiées avant le 6 mai 2020. Les études qualitatives portant sur les obstacles perçus par les professionnels de la santé mentale et sur les éléments facilitateurs de la prestat