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

  • 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.

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Author:E. Kovacs, R. Strobl, A. Phillips, A.-J. Stephan, Martin Müller, J. Gensichen, E. Grill
Parent Title (English):Journal of General Internal Medicine
Document Type:Article (peer reviewed)
Publication Year:2018
Year of first Publication:2018
Tag:Evidence- based medicine; General practitioner; Harvest plot; Implementation; Intervention
First Page:1142
Last Page:1154
Peer reviewed:Ja
faculties / departments:Fakultät für Angewandte Gesundheits- und Sozialwissenschaften
Dewey Decimal Classification:3 Sozialwissenschaften / 30 Sozialwissenschaften, Soziologie