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Primary care
Guidelines do not self-implement: time for a research paradigm shift from massive creation to effective implementation in evidence-based medicine research in China
  1. Junqiang Zhao1,2,
  2. Melissa Demery Varin1,2,
  3. Ian D Graham3,4
  1. 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
  3. 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Junqiang Zhao, School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada; jzhao126{at}

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Evidence-based medicine should be complemented by evidence-based implementation.

—Grol, R. and Grimshaw, J. (1999)

In 2018, the BMJ opened a special collection, analysing the evolution of medical research in China, with a paper entitled ‘Clinical practice guidelines in China’.1 Chen et al’s paper1 described the publication growth, low methodological quality, potential conflict of interest and poor implementation status of clinical practice guidelines (CPGs) in China, and offered five recommendations for Chinese CPG development and implementation.

As researchers working in the field of implementation science, we feel that the paper’s aim was not fully realised due to the lack of discussion on guideline implementation. We argue that although high-quality guideline development is essential, researchers need to simultaneously focus on how to improve guideline implementation, especially when high-quality guidelines already exist and can be adopted as it is or can be adapted for the local context. It is time for Chinese evidence-based medicine (EBM) researchers and stakeholders to embrace and advance implementation science, answering questions on how guideline implementation can be optimised in varying contexts.

Without implementation, guideline creation fails to realise benefit and wastes resources

Chen et al’s paper, taken as a whole, seems to imply that the mere existence of high-quality CPGs leads to …

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  • Contributors JZ conceptualized and wrotethe initial draft of the article. MDV and IDG provided critical review andcontributions to the paper. All authors reviewed and approved the final versionof the paper.

  • Competing interests None declared.

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

  • Patient consent for publication Not required.