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促进辅助医疗循证干预实施策略的有效性:系统评价。

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review.

机构信息

Department of Public Health and Primary Care, Environment and Health, KU Leuven, Leuven, Belgium.

International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, Australia.

出版信息

BMC Health Serv Res. 2021 Mar 18;21(1):241. doi: 10.1186/s12913-021-06190-0.

Abstract

BACKGROUND

Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group.

METHODS

Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation.

RESULTS

A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies.

CONCLUSION

Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.

摘要

背景

在过去几十年中,循证医疗实践在医疗保健领域变得越来越流行。许多指南已经制定出来,以提高医疗保健组织中基于证据的决策制定水平,但人们常常忽略了这些指南的实际实施策略与指南本身同样重要。这些策略的有效性很少针对辅助医疗治疗组进行专门测试。

方法

从 2000 年到 2019 年 10 月,我们在 Cochrane、Medline、Embase 和 Scopus 数据库中进行了搜索。如果在辅助医疗人员中测试了基于证据的实施策略,则纳入了 I 级和 II 级研究。使用 SIGN 方法评估偏倚风险。使用叙述性综合方法对证据进行综合。应用国家卫生和医学研究委员会 (NHMRC) 模型来评估推荐的等级。

结果

总共确定了 490 篇独特的文章,其中有 6 项主要研究符合纳入标准。描述了三种不同的实施策略和三种多方面的组件策略。我们发现教育会议、当地意见领袖和患者介导干预具有中等证据。我们发现多方面组件策略的证据更强。

结论

很少有研究描述辅助医疗实施策略的有效性,但在辅助医疗治疗组人群中实施研究的多方面组件策略方面发现了证据。在考虑在辅助医疗中实施基于证据的干预措施时,多管齐下的方法似乎更成功。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7189/7977260/73284f5c0000/12913_2021_6190_Fig1_HTML.jpg

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