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Meta-Analysis
. 2010 Mar 17:(3):CD005470.
doi: 10.1002/14651858.CD005470.pub2.

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

Richard Baker  1 , Janette Camosso-Stefinovic, Clare Gillies, Elizabeth J Shaw, Francine Cheater, Signe Flottorp, Noelle Robertson
Affiliations
Meta-Analysis

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

Richard Baker et al. Cochrane Database Syst Rev. .

Update in

  • Tailored interventions to address determinants of practice.
    Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N, Wensing M, Fiander M, Eccles MP, Godycki-Cwirko M, van Lieshout J, Jäger C. Baker R, et al. Cochrane Database Syst Rev. 2015 Apr 29;2015(4):CD005470. doi: 10.1002/14651858.CD005470.pub3. Cochrane Database Syst Rev. 2015. PMID: 25923419 Free PMC article.

Abstract

Background: In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain.

Objectives: To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes.

Search strategy: For this update, in addition to the EPOC Register and pending files, we searched the following databases without language restrictions, from inception until August 2007: MEDLINE, EMBASE, CINAHL, BNI and HMIC. We searched the National Research Register to November 2007. We undertook further searches to October 2009 to identify potentially eligible published or ongoing trials.

Selection criteria: Randomised controlled trials (RCTs) of interventions tailored to address prospectively identified barriers to change that reported objectively measured professional practice or healthcare outcomes in which at least one group received an intervention designed to address prospectively identified barriers to change.

Data collection and analysis: Two reviewers independently assessed quality and extracted data. We undertook quantitative and qualitative analyses. The quantitative analyses had two elements.1. We carried out a meta-regression to compare interventions tailored to address identified barriers to change with either no interventions or an intervention(s) not tailored to the barriers.2. We carried out heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, concealment of allocation, rigour of barrier analysis, use of theory, complexity of interventions, and the reported presence of administrative constraints.

Main results: We included 26 studies comparing an intervention tailored to address identified barriers to change to no intervention or an intervention(s) not tailored to the barriers. The effect sizes of these studies varied both across and within studies.Twelve studies provided enough data to be included in the quantitative analysis. A meta-regression model was fitted adjusting for baseline odds by fitting it as a covariate, to obtain the pooled odds ratio of 1.54 (95% CI, 1.16 to 2.01) from Bayesian analysis and 1.52 (95% CI, 1.27 to 1.82, P < 0.001) from classical analysis. The heterogeneity analyses found that no study attributes investigated were significantly associated with effectiveness of the interventions.

Authors' conclusions: Interventions tailored to prospectively identified barriers are more likely to improve professional practice than no intervention or dissemination of guidelines. However, the methods used to identify barriers and tailor interventions to address them need further development. Research is required to determine the effectiveness of tailored interventions in comparison with other interventions.

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Figures

Figure 1
Figure 1
Meta-regression plotThe log odds ratio at follow-up is plotted against the log odds ratio at baseline, with each circle representing one study in the analysis, and the red line indicating the pooled estimated follow-up log odds ratio for each value of the baseline log odds ratio. Circle size is relative to the standard error of the log odds ratio. The result from the classical analysis can be read from the graph in that when the intervention and control groups are equal at baseline (i.e. when the baseline odds ratio=0) then the estimated log odds ratio from the plot is 0.42. When exponentiated this gives the pooled effect size of 1.52.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. *

    2. Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. New England Journal of Medicine. 1983;308(24):1457–63. [MEDLINE: 83219085] - PubMed

    1. *

    2. Avorn J, Soumerai SB, Everitt DE, Ross-Degnan D, Beers MH, Sherman D, et al. A randomized trial of a program to reduce the use of psychotropic drugs in nursing homes. New England Journal of Medicine. 1992;327:168–73. [MEDLINE: 92301485; : 30 RCTC] - PubMed
    3. Beers M, Avorn J, Soumerai SB, Everitt DE, Sherman DS, Salem S. Psychoactive medication use in intermediate-care facility residents. JAMA. 1988;260(20):3016–20. - PubMed

    1. *

    2. Baker R, Reddish S, Robertson N, Hearshaw H, Jones B. Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice. British Journal of General Practice. 2001;51:737–41. - PMC - PubMed

    1. *

    2. Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM. Improving treatment of late life depression in primary care: a randomized clinical trial. Journal of the American Geriatric Society. 1994;42:839–46. - PubMed
    3. Callahan CM, Niennaber NA, Hendrie HC, Tierney WM. Depression in elderly outpatients: primary care physicians’ attitudes and practice patterns. Journal of General Internal Medicine. 1992;7:27–31. - PubMed

    1. *

    2. Cheater FM, Baker R, Reddish S, Spiers N, Wailoo A, Gillies C, et al. Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes. Medical Care. 2006;44:542–51. - PubMed

References to studies excluded from this review

    1. Allison JJ, Kiefe CI, Wall T, Casebeer L, Ray MN, Spettell CM, et al. Multicomponent Internet continuing medical education to promote chlamydia screening. American Journal of Preventive Medicine. 2005 Apr;28(3):285–90. - PubMed

    1. *

    2. Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz HH, et al. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. Journal of Antimicrobial Chemotherapy. 2007;60(3):638–44. - PubMed
    1. Azocar F, Cuffel B, Goldman W, McCarter L. The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization. Journal of Behavioral Health Services & Research. 2003 Jan-Feb;30(1):109–18. - PubMed
    1. Baer JS, Wells EA, Rosengren DB, Hartzler B, Beadnell B, Dunn C. Agency context and tailored training in technology transfer: A pilot evaluation of motivational interviewing training for community counsellors. Journal of Substance Abuse Treatment. 2009 Sep;37(2):191–202. - PMC - PubMed
    1. Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K, et al. Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance. International Journal of Pharmacy Practice. 2003 Jun;11(2):71–80. - PubMed

References to studies awaiting assessment

    1. Althabe F, Buekens P, Bergel E, Belizán JM, Campbell MK, Moss N, et al. Guidelines Trial Group. A behavioral intervention to improve obstetrical care. New England Journal of Medicine. 2008 May 1;358(18):1929–40. - PubMed
    1. Benner JS, Cherry SB, Erhardt L, Fernandes M, Flammer M, Gaciong Z, et al. Rationale, design, and methods for the risk evaluation and communication health outcomes and utilization trial (REACH OUT) Contemporary Clinical Trials. 2007;28(5):662–673. - PubMed
    1. Cupples ME, Byrne MC, Smith SM, Leathem CS, Murphy AW. Secondary prevention of cardiovascular disease in different primary healthcare systems with and without payfor-performance. Heart. 2008;94:1594–600. - PubMed
    1. Herdeiro MT, Polónia J, Gestal-Otero JJ, Figueiras A. Improving the reporting of adverse drug reactions: a cluster-randomized trial among pharmacists in Portugal. Drug Safety. 2008;31(4):335–44. - PubMed
    1. Lafata JE, Gunter MJ, Hsu J, Kaatz S, Krajenta R, Platt R, et al. Academic detailing to improve laboratory testing among outpatient medication users. Medical Care. 2007 Oct;45(10):966–72. - PubMed

References to ongoing studies

    1. Barkun A. The Dissemination of Consensus Recommendations on Upper Gastrointestinal Bleeding (REASON-II) http://clinicaltrials.gov/ct2/show/NCT00840008.
    1. Dykes PC. Falls - Tailoring Interventions for Patient Safety (Falls TIPS) http://clinicaltrials.gov/ct2/show/NCT00675935. - PubMed
    1. Engelman K. Use of Novel Tailored Reminders in Rural Primary Care. http://clinicaltrials.gov/ct2/show/NCT00593073.
    1. Gjelstad S, Fetveit A, Straand J, Dalen I, Rognstad S, Lindbaek M. Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155] BMC Health Services Research. 2006 Jun 15;6:75. - PMC - PubMed
    1. Jansen YJFM, de Bont A, Foets M, Bruijnzeels M, Bal R. Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation. BMC Health Services Research. 2007;7:125. - PMC - PubMed

Additional references

    1. Ashford J, Eccles M, Bond S, Hall LA, Bond J. Improving health care through professional behaviour change: introducing a framework for identifying behaviour change strategies. British Journal of Clinical Governance. 1999;4(1):14–23.
    1. Bosch M, van der Weijden T, Wensing M, Grol R. Tailoring quality improvement interventions to identified barriers: a multiple case analysis. Journal of Evaluation in Clinical Practice. 2007;13:161–8. - PubMed
    1. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abbound PC, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65. - PubMed
    1. Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser W, et al. Evidence-based strategies for implementing guidelines in obstetrics. Obstetrics and Gynecology. 2006;108:1234–45. - PubMed
    1. [last accessed: 24 November 2009];TSC User Guide to Managing Specialized Registers and Handsearch Records. (Version 1.1). 2008 http://www.cochrane.org/tsc/TSC%20User%20Guide%20for%20SRs&HS.Version%20....

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