Using evidence briefs to support future implementation planning: the case of early fibrinolysis for myocardial infarction and rehabilitation for the amputee patient in Colombia.

BACKGROUND

Despite the relevance of clinical practice guidelines for health policy development, planning, evaluation and quality improvement, implementation of the Colombian national guidelines is still in early stages. The objective of this study was to develop two evidence briefs supporting future development of implementation plans.

METHODS

We involved Colombian Ministry of Health representatives in dialogues about prioritizing recommendations for implementation. Two groups of recommendations were selected, and we developed two evidence briefs using the SUPPORT methodology's systematic process of searching and synthesizing evidence. One brief focused on providing early fibrinolysis when invasive therapy is not available promptly for patients with ST-elevation myocardial infarction (STEMI); and the second brief focused on providing rehabilitation services for individuals with amputations.

RESULTS

For the evidence brief on early fibrinolysis (EF) for individuals with a STEMI, 33 articles were included. Overall, 21 studies addressed barriers, 10 addressed facilitators, and 25 focused on strategies for implementation. For the brief on rehabilitation services for persons with amputations, 45 articles were included. A total of 23 studies addressed strategies for adherence to policy recommendations in low- and middle-income countries. Moreover, 23 studies included comprehensive care and continuity of rehabilitation services for persons with amputations or patients currently experiencing or likely to experience a disability. In both briefs, we identified common facilitators and barriers for implementing recommendations. Common barriers related to patient characteristics include living in rural areas or low socioeconomic status communities. Other barriers include the lack of clinicians' training to provide EF for individuals with a STEMI and rehabilitation services for individuals with amputations. A common implementation strategy was establishing networks integrating community facilities and hospitals, with clear healthcare pathways that facilitate navigating the health system and understanding the functions of each stakeholder.

CONCLUSIONS

Both evidence briefs showed that in Colombia, to implement key recommendations, it is essential to improve timely access and continuity of services for populations living in rural areas and low-income settings. Evidence suggests that establishing networks integrating community facilities and hospitals might positively and significantly impact health outcomes and healthcare experience for patients with STEMI and patients with amputations who need rehabilitation services. The education sector is essential in improving the knowledge and skills of patients and healthcare providers of both conditions.