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. 2015 Oct 22:16:147.
doi: 10.1186/s12875-015-0341-7.

Interventions to improve adherence to cardiovascular disease guidelines: a systematic review

Rebecca A Jeffery  1 , Matthew J To  2 , Gabrielle Hayduk-Costa  3 , Adam Cameron  4 , Cameron Taylor  5 , Colin Van Zoost  6   7 , Jill A Hayden  8
Affiliations

Interventions to improve adherence to cardiovascular disease guidelines: a systematic review

Rebecca A Jeffery et al. BMC Fam Pract. .

Abstract

Background: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes.

Methods: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome.

Results and discussion: We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]).

Conclusions: Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions.

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Figures

Fig. 1
Fig. 1
PRISMA flow chart of study inclusions
Fig. 2
Fig. 2
Risk of bias summary table for each study. Green indicates a low risk of bias, yellow indicates unclear risk of bias and red indicates high risk of bias, as assessed by reviewers using the Cochrane risk of bias tool
Fig. 3
Fig. 3
Risk of bias summary graph, summarized for each domain. Green indicates a low risk of bias, yellow indicates unclear risk of bias and red indicates high risk of bias, as assessed by reviewers using the Cochrane risk of bias tool
Fig. 4
Fig. 4
Forest plot of education intervention comparison for continuous adherence outcome at a short term time point (<6 months)
Fig. 5
Fig. 5
Summary disease target outcome forest plot for three comparisons measured by standardized mean difference, with point estimate and 95 % CIs
Fig. 6
Fig. 6
Summary adherence outcome forest plot for five comparisons measured by odds ratio, with point estimates and 95 % CIs
See this image and copyright information in PMC

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