Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.
German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
J Gen Intern Med. 2018 Jul;33(7):1142-1154. doi: 10.1007/s11606-018-4435-5. Epub 2018 May 4.
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).
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.
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]).
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.
临床实践指南作为最重要的循证决策支持工具，已经应用了多种策略来将其纳入基层医疗系统。本研究旨在评估干预方法对基层医疗提供者（PCP）遵循指南的影响。
通过在 Medline 和 Embase 中进行系统搜索选择的研究根据干预方案和结果指标类别进行了分类。应用收获图和森林图来整合结果。
36 项研究涵盖了六个干预方案，其中单一干预措施最为有效，而材料分发的效果最差。收获图显示在知识转移、诊断行为、处方、咨询和患者层面结果等类别中，有 27 组无效果，14 组中度效果，21 组强效果。森林图显示出中等总体效应量为 0.22 [0.15, 0.29]，其中单一干预措施（0.27 [0.17, 0.38]）比多方面干预措施（0.13 [0.06, 0.19]）更有效。
指南实施策略具有异质性。减少策略的复杂性，并针对当地情况和 PCP 的需求进行调整，可能会提高实施效果和临床实践。
