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Meta-Analysis
. 2018 Jul;33(7):1142-1154.
doi: 10.1007/s11606-018-4435-5. Epub 2018 May 4.

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

Eva Kovacs  1   2 , Ralf Strobl  3 , Amanda Phillips  3   4 , Anna-Janina Stephan  3   4 , Martin Müller  5 , Jochen Gensichen  6 , Eva Grill  3   4   7
Affiliations
Meta-Analysis

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

Eva Kovacs et al. J Gen Intern Med. 2018 Jul.

Abstract

Background: As clinical practice guidelines represent the most important evidence-based decision support tool, several strategies have been applied to improve their implementation into the primary health care system. This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs).

Methods: The studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results.

Results: The 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categories of knowledge transfer, diagnostic behaviour, prescription, counselling and patient-level results. The forest plot revealed a moderate overall effect size of 0.22 [0.15, 0.29] where single interventions were more effective (0.27 [0.17, 0.38]) than multifaceted interventions (0.13 [0.06, 0.19]).

Discussion: Guideline implementation strategies are heterogeneous. Reducing the complexity of strategies and tailoring to the local conditions and PCPs' needs may improve implementation and clinical practice.

Keywords: evidence-based medicine; general practitioner; harvest plot; implementation; intervention.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of paper selection.
Figure 2
Figure 2
Impact of intervention (harvest plot). Height of the bar: quality of the paper. Colour of the bar: number of PCPs in the intervention (grey < 100, black ≥ 100). Category of the outcome: D: diagnostic behaviour, P: prescription, C: counselling, K: knowledge level, O: outcome of care on patient level, formula image : theory-based intervention.
Figure 3
Figure 3
Impact of intervention (forest plot) separated for outcome categories. The summary measure for each outcome category is shown at the end of each category; the summary measure over all studies at the bottom. Size of box proportional to log of sample size.
See this image and copyright information in PMC

Comment in

References

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