Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Department of Marketing, University of Lausanne, Quartier UNIL-Chamberonne, Lausanne, Quartier, CH-1015, Switzerland.
BMC Med. 2024 Sep 27;22(1):412. doi: 10.1186/s12916-024-03588-5.
Action on smoking, obesity, excess alcohol, and physical inactivity in primary care is effective and cost-effective, but implementation is low. The aim was to examine the effectiveness of strategies to increase the implementation of preventive healthcare in primary care.
CINAHL, CENTRAL, The Cochrane Database of Systematic Reviews, Dissertations & Theses - Global, Embase, Europe PMC, MEDLINE and PsycINFO were searched from inception through 5 October 2023 with no date of publication or language limits. Randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies comparing implementation strategies (team changes; changes to the electronic patient registry; facilitated relay of information; continuous quality improvement; clinician education; clinical reminders; financial incentives or multicomponent interventions) to usual care were included. Two reviewers screened studies, extracted data, and assessed bias with an adapted Cochrane risk of bias tool for Effective Practice and Organisation of Care reviews. Meta-analysis was conducted with random-effects models. Narrative synthesis was conducted where meta-analysis was not possible. Outcome measures included process and behavioural outcomes at the closest point to 12 months for each implementation strategy.
Eighty-five studies were included comprising of 4,210,946 participants from 3713 clusters in 71 cluster trials, 6748 participants in 5 randomised trials, 5,966,552 participants in 8 interrupted time series, and 176,061 participants in 1 controlled before after study. There was evidence that clinical reminders (OR 3.46; 95% CI 1.72-6.96; I = 89.4%), clinician education (OR 1.89; 95% CI 1.46-2.46; I = 80.6%), facilitated relay of information (OR 1.95, 95% CI 1.10-3.46, I = 88.2%), and multicomponent interventions (OR 3.10; 95% CI 1.60-5.99, I = 96.1%) increased processes of care. Multicomponent intervention results were robust to sensitivity analysis. There was no evidence that other implementation strategies affected processes of care or that any of the implementation strategies improved behavioural outcomes. No studies reported on interventions specifically designed for remote consultations. Limitations included high statistical heterogeneity and many studies did not account for clustering.
Multicomponent interventions may be the most effective implementation strategy. There was no evidence that implementation interventions improved behavioural outcomes.
PROSPERO CRD42022350912.
在初级保健中采取行动应对吸烟、肥胖、过量饮酒和缺乏身体活动是有效且具有成本效益的，但实施率较低。本研究旨在探讨增加初级保健中预防保健实施的策略的有效性。
从建库到 2023 年 10 月 5 日，我们在 CINAHL、CENTRAL、The Cochrane Database of Systematic Reviews、Dissertations & Theses - Global、Embase、Europe PMC、MEDLINE 和 PsycINFO 数据库中进行了检索，未设定发表日期或语言限制。我们纳入了比较实施策略（团队变革；电子患者登记册变更；信息传递促进；持续质量改进；临床医生教育；临床提醒；经济激励或多组分干预）与常规护理的随机试验、非随机试验、对照前后研究和中断时间序列研究。两名审查员筛选研究、提取数据，并使用经过改编的 Cochrane 有效实践和组织保健评价工具评估偏倚。使用随机效应模型进行荟萃分析。无法进行荟萃分析时，采用叙述性综合法。每个实施策略的最近 12 个月的过程和行为结果为结局指标。
共纳入 85 项研究，包括 71 项聚类试验中的 4210946 名参与者、5 项随机试验中的 6748 名参与者、8 项中断时间序列中的 5966552 名参与者和 1 项对照前后研究中的 176061 名参与者。有证据表明临床提醒（OR 3.46；95%CI 1.72-6.96；I=89.4%）、临床医生教育（OR 1.89；95%CI 1.46-2.46；I=80.6%）、信息传递促进（OR 1.95，95%CI 1.10-3.46，I=88.2%）和多组分干预（OR 3.10；95%CI 1.60-5.99，I=96.1%）增加了护理过程。多组分干预结果在敏感性分析中是稳健的。没有证据表明其他实施策略会影响护理过程，也没有证据表明任何实施策略会改善行为结果。没有研究报告专门针对远程咨询设计的干预措施。局限性包括高统计学异质性和许多研究没有考虑到聚类。
多组分干预可能是最有效的实施策略。没有证据表明实施干预措施改善了行为结果。
PROSPERO CRD42022350912。
