Baker Richard, Camosso-Stefinovic Janette, Gillies Clare, Shaw Elizabeth J, Cheater Francine, Flottorp Signe, Robertson Noelle
Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester, Leicestershire, UK, LE1 6TP.
Cochrane Database Syst Rev. 2010 Mar 17(3):CD005470. doi: 10.1002/14651858.CD005470.pub2.
In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain.
To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes.
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.
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.
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.
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.
在本综述的上一版本中，针对变革障碍量身定制的干预措施的有效性尚不确定。
评估针对已识别的变革障碍量身定制的干预措施对专业实践或患者结局的有效性。
对于本次更新，除了EPOC注册库和待处理文件外，我们检索了以下数据库，无语言限制，从建库至2007年8月：MEDLINE、EMBASE、CINAHL、BNI和HMIC。我们检索了截至2007年11月的国家研究注册库。我们进一步检索至2009年10月，以识别潜在符合条件的已发表或正在进行的试验。
针对前瞻性识别的变革障碍量身定制的干预措施的随机对照试验（RCT），这些试验报告了客观测量的专业实践或医疗保健结局，其中至少有一组接受了旨在解决前瞻性识别的变革障碍的干预措施。
两名评审员独立评估质量并提取数据。我们进行了定量和定性分析。定量分析有两个部分。1. 我们进行了meta回归，以比较针对已识别的变革障碍量身定制的干预措施与无干预措施或未针对这些障碍量身定制的干预措施。2. 我们进行了异质性分析，以调查干预措施有效性差异的来源。这些包括以下因素的影响：偏倚风险、分配隐藏、障碍分析的严谨性、理论的使用、干预措施的复杂性以及报告的行政限制的存在。
我们纳入了26项研究，比较了针对已识别的变革障碍量身定制的干预措施与无干预措施或未针对这些障碍量身定制的干预措施。这些研究的效应大小在不同研究之间以及同一研究内部都有所不同。12项研究提供了足够的数据可纳入定量分析。通过将基线比值作为协变量进行拟合，建立了一个meta回归模型，以获得贝叶斯分析的合并比值比为1.54（95%CI，1.16至2.01），经典分析的合并比值比为1.52（95%CI，1.27至1.82，P<0.001）。异质性分析发现，所研究的任何研究属性均与干预措施的有效性无显著关联。
与无干预措施或指南传播相比，针对前瞻性识别的障碍量身定制的干预措施更有可能改善专业实践。然而，用于识别障碍和量身定制干预措施以解决这些障碍的方法需要进一步改进。需要开展研究以确定量身定制的干预措施与其他干预措施相比的有效性。
