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

Kovács, Éva; Strobl, Ralf; Phillips, Amanda; Stephan, Anna-Janina; Müller, Martin; Gensichen, Jochen; Grill, Eva

doi:10.1007/s11606-018-4435-5

Cited by 41 publications

(39 citation statements)

References 73 publications

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“…8,9 Interventions targeting these barriers, such as clinician and patient education or system-level changes like alerts or team-based care, have been shown effective in increasing guideline uptake. 10 However, few studies provide a comprehensive evaluation of how different levels of factors collectively affect guideline uptake. 11 Examining these factors as a whole and how they interact may better inform interventions.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Uptake of Changes to Clinical Preventive Guidelines

et al. 2020

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Background: Despite widespread recognition that adherence to clinical preventive guidelines improves patient outcomes, clinicians struggle to implement guideline changes in a timely manner. Multiple factors influence guideline adoption and effective implementation. However, few studies evaluate their collective and interrelated effects. This qualitative study provides a comprehensive picture of the interplay between multiple factors on uptake of new or changed preventive guidelines. Methods: Semistructured interviews conducted in 2018 with a diverse sample of clinicians and practice leaders sought to understand patient, clinician, practice, health system, environment, and guideline factors of influence. An immersion-crystallization approach was used to identify emergent themes. Results: Interviewees expressed motivation to adhere to guidelines but also valued sharing decisions with patients. Personal biases and fears affected both clinician and patient guideline adoption. Practices facilitated implementation through workflow optimization and encouraging a culture of evidence-based practice while a key health system function was to maintain electronic health record alerts. More traditional environmental factors, such as insurance coverage or transportation, were less of a barrier to guideline adoption and implementation than the influence of media and specialists. Various specific guideline characteristics also affected ease of adoption and implementation. Different settings expressed greater health system, practice, or clinician-centric approaches to guideline implementation. Conclusions: Guideline uptake is influenced by a complex interplay of multiple levels of factors including the patient, clinician, practice, health system, environment, and guideline levels. Comprehensively understanding all levels of influence for each specific clinical setting may help to determine the optimal intervention(s) for improving uptake of evidence-based guidelines.

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Section: Introductionmentioning

confidence: 99%

Factors Influencing Uptake of Changes to Clinical Preventive Guidelines

et al. 2020

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“…Factors, such as perceptions of illness by clinicians and unawareness of the published gout treatment recommendations play a vital role in these problems [18,19]. Moreover, the promotion of clinical guidelines through printed material was minimally effective for clinicians [39,40]. The results of our study showed suboptimal management of GF in EDs based on the 2012 TRA-GMG.…”

Section: Discussionmentioning

confidence: 79%

Quality of gout care in the emergency departments: a multicentre study

et al. 2020

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Background: To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. Methods: A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. Results: Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). Conclusions: Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.

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“…Findings from another feasibility study suggested that additional material such as small portable cards with inclusion criteria, telephone numbers and listed referral options are helpful [52]. A meta-analysis of the effectiveness of implementation strategies for non-communicable disease guidelines in primary health care concluded that the simple provision of educational materials without training is ineffective [53]. In line with our ndings, a review on secondary care found that providing information about successful examples can lower implementation barriers and enhance adherence [50].…”

Section: Discussionmentioning

confidence: 79%

Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

Seckler

Regauer

Rotter

et al. 2020

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Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. Trial registration : PROSPERO 2018 CRD42018087689

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

Abstract: 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.

Cited by 41 publications

References 73 publications

Factors Influencing Uptake of Changes to Clinical Preventive Guidelines

Factors Influencing Uptake of Changes to Clinical Preventive Guidelines

Quality of gout care in the emergency departments: a multicentre study

Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

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