Background
Methods
Design
Data source
Inclusion criteria
Selection of studies and data extraction
Data synthesis
Sensitivity analyses
Results
Description of reviews
Sensitivity analyses
Effectiveness of multifaceted interventions
Effect size/dose-response statistical analyses (N = 3)
First author (year) and title | Review characteristics | Review findings | Conclusion |
---|---|---|---|
French (2010) [8] |
N: 28 studies | Analysis based on studies with multiple intervention components as follows: | The effectiveness of multifaceted interventions did not increase incrementally with the number of components |
Interventions for Improving the Appropriate Use of Imaging in People with Musculoskeletal Conditions | Study designs: randomized controlled trials, controlled trials, interrupted time series | • 1 (N = 11) | |
• 2 (N = 7) | |||
• 3 (N = 7) | |||
• 4 (N = 1) | |||
Populations: physicians, other | There was no relationship between the effect size and the number of intervention components as evidenced by | ||
Settings: primary care practices, hospitals | • No statistical evidence of a relationship between the number of interventions used in the study group and the effect size (Kruskal-Wallis test, p = 0.48) | ||
AMSTAR (quality) score: 9 | • No statistical evidence of an increased effect size by increasing the number of components (quantile regression, coefficient -2.51, 95% CI: -11.58 to +6.56, p = 0.57) | ||
Grimshaw (2004) [7] |
N: 235 (283 papers) | Analysis based on studies with multiple intervention components as follows: | The effectiveness of multifaceted interventions did not increase incrementally with the number of components |
Effectiveness and Efficiency of Guideline Dissemination and Implementation Strategies | 208 studies were involved in this analysis | • 1 (N = 56) | |
Study designs: randomized controlled trials, controlled trials, controlled before-after, interrupted time series | • 2 (N = 63) | ||
• 3 (N = 46) | |||
• 4 (N = 28) | |||
• 5 (N = 12) | |||
Populations: physicians, nurses, pharmacists, other | • 6 (N = 2) | ||
• 7 (N = 1) | |||
Settings: primary care practices, hospitals, outpatient clinics, communities, nursing homes, other | There was no relationship between the effect size and the number of intervention components as evidenced by | ||
AMSTAR (quality) score: 7 | • For studies with no-intervention control groups, there was no statistical evidence of a relationship between the number of interventions used in the study group and the effect size (Kruskal-Wallis test, p = 0.18) | ||
• There was no statistical evidence of a difference between studies that used multiple intervention control groups and studies with multiple intervention study groups (Kruskal-Wallis test, p = 0.69) | |||
Shojania (2009) [26] |
N: 32 studies | Analysis based on studies with 1 intervention component (N = 18 studies) and 1 or more intervention components (N = 14 studies) | Single interventions were more effective than multifaceted interventions |
The Effects of On-Screen, Point of Care Computer Reminders on Processes and Outcomes of Care | Study designs: controlled clinical trials, randomized controlled trials | There was statistical evidence of a relationship between 1 and >1 interventions used in the study group and the effect size | |
Populations: physicians | • There was a significant difference in the effect size improvement between comparisons involving single (computer reminders alone) vs. usual care (no co-interventions) and multifaceted (computer reminders plus one or more co-interventions) vs. the other interventions alone (Kruskal-Wallis test, p = 0.04) | ||
Settings: ambulatory care settings, hospitals, nursing homes, outpatient clinics, primary care practices | • The median improvement for single vs. usual care was 5.7% (IQR: 2.0% to 24.0%) | ||
AMSTAR (quality) score: 8 | • The median improvement for multifaceted interventions (that is computer reminders plus additional interventions versus those additional interventions alone) was 1.9% (IQR: 0.0% to 6.2%) |
Direct comparisons (N = 8)
First author (year) and title | Review characteristics | Review findingsa
| Conclusionb
|
---|---|---|---|
Beach 2006 [20] |
N: 27 studies | 3/4 studies reported multifaceted interventions to be more effective than a single intervention | Generally effective (75%) |
Improving Health Care Quality for Racial/Ethnic Minorities: A Systematic Review of the Best Evidence Regarding Provider and Organization Interventions | Study designs: randomized controlled trials, clinical trials | • 1/1 study favoured multifaceted vs. reminders | |
Populations: physicians, nurses, other | • 1/1 study favoured multifaceted vs. distribution of educational materials | ||
Settings: primary care practices, outpatient clinics, communities, other | • 1/2 studies favoured multifaceted vs. educational meetings | ||
AMSTAR (quality) score: 5 | |||
Hulscher (2001) [21] |
N: 55 studies | 7/8 comparisons (across N = 6 studies) state multifaceted interventions are more effective than single interventions | Generally effective (88%) |
Interventions to Implement Prevention in Primary Care | Study designs: randomized controlled trials, controlled before-after | • 5/6 comparisons favoured multifaceted vs. group education (5 studies) | |
Populations: physicians, nurses, other | • 2/2 comparisons favoured multifaceted vs. reminders (2 studies) | ||
Settings: primary care practices, outpatient clinics, medical centres | |||
AMSTAR (quality) score: 5 | |||
Jamtvedt (2006) [22] |
N: 118 studies | 6/19 studies state multifaceted interventions are more effective than single interventions (audit and feedback alone). | Generally ineffective (32%) |
Audit and Feedback: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials | ||
Population: any kind of health-care professional | |||
Setting: any kind of organization | |||
AMSTAR (quality) score: 8 | |||
Legare (2012) [27] |
N: 21 | 2/3 studies state multifaceted interventions are more effective than single interventions | Mixed effects (67%) |
Patients' Perceptions of Sharing in Decisions: A Systematic Review of Interventions to Enhance Shared Decision Making in Routine Clinical Practice | Study designs: randomized controlled trials, cluster randomized controlled trials | • 2/2 studies favoured multifaceted vs. patient mediated | |
Populations: physicians | • 0/1 study favoured multifaceted vs. educational meeting | ||
Settings: primary care practices, outpatient clinics, hospitals, pharmacies, communities | |||
AMSTAR (quality) score: 7 | |||
Marinopoulos (2007) [23] |
N: 136 studies | 6/8 studies state multifaceted interventions (use of multiple media) are more effective than single interventions | Generally effective (75%) |
Effectiveness of Continuing Medical Education | Study designs: randomized controlled trials, before-after, observational | • 3/5 studies favoured multifaceted over distribution of educational materials | |
Populations: physicians, pharmacists, nurses, other | • 2/2 studies favoured multifaceted over educational meetings | ||
Settings: primary care practices, hospitals, long-term care facilities | • 1/1 study favoured multifaceted over audit and feedback | ||
AMSTAR (quality) score: 7 | |||
O'Brien (2007) [24] |
N: 69 studies | 12/12 studies state multifaceted interventions are more effective than single interventions | Generally effective (100%) |
Educational Outreach Visits: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials | • 3/3 studies favoured multifaceted vs. audit and feedback | |
Populations: any kind of health-care professional | • 7/7 studies favoured multifaceted vs. distribution of educational materials | ||
Settings: primary care practices, outpatient clinics, nursing homes, hospitals, pharmacies, communities | • 1/1 study favoured multifaceted vs. educational meetings | ||
• 1/1 study favoured multifaceted vs. reminders | |||
AMSTAR (quality) score: 8 | |||
Weinmann (2007) [25] |
N: 18 studies (in 17 papers) | 2/5 studies state multifaceted interventions are more effective than single interventions (distribution of educational materials) | Mixed effects (40%) |
Effects of Implementation of Psychiatric Guidelines on Provider Performance and Patient Outcome: Systematic Review | Study designs: randomized controlled trials, controlled trials, before-after | ||
Populations: physicians, nurses, pharmacists, mental health clinicians, medical assistants | |||
Settings: primary care practices, hospitals, communities | |||
AMSTAR (quality) score: 5 | |||
Wensing (1994) [6] |
N: 75 studies | 1/3 studies state multifaceted interventions more effective than single interventions | Mixed effects (33%) |
Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review | Study designs: randomized controlled trials, controlled trials, before-after, cohort | • 0/1 study favoured multifaceted over distribution of educational materials | |
Populations: physicians | • 0/1 study favoured multifaceted over reminders | ||
Settings: primary care practices | • 1/1 study favoured multifaceted over audit and feedback | ||
AMSTAR (quality) score: 4 |
Indirect comparisons (N = 23)
Author | Study characteristics | Review findingsa
| Conclusion | |
---|---|---|---|---|
Comparison | Findings | |||
Arnold (2005) [31] |
N: 40 studies | Single vs. control | 14/32 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions have mixed effects when compared to controls |
Interventions to Improve Antibiotic Prescribing Practices in Ambulatory Care | Study designs: randomized controlled trials, controlled before-after, interrupted time series | • 2/4 studies favoured audit and feedback vs. control | ||
• 2/10 studies favoured educational meetings vs. control | ||||
Populations: physicians, nurses, other | • 3/8 studies favoured educational outreach vs. control | |||
Settings: primary care practices, outpatient clinics, communities, other | • 2/2 studies favoured formulary vs. control | |||
AMSTAR (quality) score: 7 | • 2/3 studies favoured reminders vs. control | |||
• 3/5 studies favour patient mediated vs. control | ||||
Overall: mixed effects (44%) | ||||
Multifaceted vs. control | 4/7 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (57%) | ||||
Beach (2006)b[20] |
N: 27 studies | Single vs. control | 8/9 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Improving Health Care Quality for Racial/Ethnic Minorities: A Systematic Review of the Best Evidence Regarding Provider and Organization Interventions | Study designs: randomized controlled trials, clinical trials | • 6/7 studies favoured reminders vs. control | ||
Populations: physicians, nurses, other | • 1/2 studies favoured educational meetings vs. control | |||
Settings: primary care practices, outpatient clinics, communities, other | • 1/1 study favoured local consensus process vs. control | |||
AMSTAR (quality) score: 5 | Overall: generally effective (89%) | |||
Multifaceted vs. control | 5/7 studies reported a multifaceted intervention was effective over a control intervention | |||
Boonacker (2010) [34] |
N: 10 studies | Single vs. control | 17/19 comparison (across N = 6 studies) reported a single intervention was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
Interventions in Health Care Professionals to Improve Treatment in Children with Upper Respiratory Tract Infections | Study designs: randomized controlled trials, controlled trials, controlled before-after | • 11/13 comparisons favoured reminders vs. control (3 studies) | ||
Populations: physicians, nurses, pharmacists, nurse practitioners | • 4/4 comparisons favoured distribution of educational materials vs. control (2 studies) | |||
Settings: primary care practices, hospitals, communities | • 2/2 comparisons favoured a local consensus process vs. control (1 study) | |||
AMSTAR (quality) score: 4 | Overall: generally effective (89%) | |||
Multifaceted vs. control | 4/6 comparisons (across N = 4 studies) reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (67%) | ||||
Davey (2005) [28] |
N: 69 studies | Single vs. control | 24/34 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
• 5/6 studies favoured audit and feedback vs. control | ||||
• 9/11 studies favoured organizational—other vs. control | ||||
• 0/2 studies favoured educational outreach vs. control | ||||
• 5/6 studies favoured formulary vs. control | ||||
• 1/1 favoured professional—other vs. control | ||||
• 1/2 studies favoured revision of roles vs. control | ||||
• 3/5 studies favoured reminders vs. control | ||||
• 0/1 study favoured distribution of educational materials vs. control | ||||
Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients | Study designs: controlled trials, controlled before-after, interrupted time series | Overall: generally effective (71%) | ||
Populations: physician, nurses, pharmacists, other | ||||
Settings: hospitals | ||||
AMSTAR (quality) score: 7 | ||||
Multifaceted vs. control | 18/26 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: generally effective (69%) | ||||
Flodgren (2011) [35] |
N: 18 studies (in 19 papers) | Single vs. control | 29/40 comparisons (across N = 8 studies) reported a single intervention (local opinion leaders) was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
Local Opinion Leaders: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials (cluster) | |||
Populations: physicians, nurses, other | Overall: generally effective (73%) | |||
Settings: primary care practices, hospitals, communities, other | ||||
AMSTAR (quality) score: 9 | ||||
Multifaceted vs. control | 16/26 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (62%) | ||||
Forsetlund (2009) [18] |
N: 81 studies | Single vs. control | 12/16 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials | • 12/15 studies favoured educational meetings vs. control | ||
Populations: nurses, pharmacists, physicians, psychiatrists, other | • 0/1 study favoured changes in structure/facilities/equipment vs. control | |||
Settings: communities, hospitals, outpatient clinics, pharmacists, primary care practices | Overall: generally effective (75%) | |||
AMSTAR (quality) score: 8 | Multifaceted vs. control | 10/14 studies reported a multifaceted intervention was effective over a control intervention | ||
Overall: generally effective (71%) | ||||
French (2010)c[8] |
N: 28 studies | Single vs. control | 12/14 comparisons (across N = 11 studies) reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Interventions for Improving the Appropriate Use of Imaging in People with Musculoskeletal Conditions | Study designs: randomized controlled trials, controlled trials, interrupted time series | • 5/6 comparisons favoured distribution of educational materials vs. control (5 studies) | ||
• 5/5 comparisons favoured reminders vs. | ||||
control (4 studies) | ||||
Populations: physicians, other | • 2/3 comparisons favoured audit and feedback vs. control (2 studies) | |||
Overall: generally effective (86%) | ||||
Settings: primary care practices, hospitals | Multifaceted vs. control | 14/20 comparisons (across N = 16 studies) reported a multifaceted intervention was effective over a control intervention | ||
AMSTAR (quality) score: 9 | Overall: generally effective (70%) | |||
Grimshaw (2004)c[7] |
N: 235 studies (in 283 papers) | Single vs. control | 53/62 comparisons (across N = 60 studies) reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
• 7/11 comparisons favoured distribution of educational materials vs. control (11 studies) | ||||
• 1/1 comparison favoured educational meetings vs. control (1 study) | ||||
• 7/7 comparisons favoured audit and feedback vs. control (6 studies) | ||||
• 30/33 comparisons favoured reminders vs. control (32 studies) | ||||
• 1/2 comparisons favoured professional—other vs. control (2 studies) | ||||
• 0/1 comparisons favoured revisions of roles vs. control (1 study) | ||||
• 1/1 comparisons favoured continuity of care vs. control (1 study) | ||||
Overall: generally effective (85%) | ||||
Effectiveness and Efficiency of Guideline Dissemination and Implementation Strategies | Study designs: randomized controlled trials, controlled trials, controlled before-after, interrupted time series | |||
Populations: physicians, nurses, pharmacists, other | ||||
Settings: primary care practices, hospitals, outpatient clinics, communities, nursing homes, other | ||||
AMSTAR (quality) score: 7 | ||||
Multifaceted vs. control | 74/92 comparisons (across N = 78 studies) reported a multifaceted intervention was effective over a control intervention | |||
Overall: generally effective (80%) | ||||
Hakkennes (2008) [36] |
N: 14 studies (in 27 papers) | Single vs. control | 6/8 reported a single intervention was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
Guideline Implementation in Allied Health Professions: A Systematic Review of the Literature | Study designs: randomized controlled trials, controlled trials, controlled before-after | • 3/3 studies favoured educational meetings vs. control | ||
Populations: pharmacists, other | • 1/2 studies favoured distribution of educational materials vs. control | |||
Settings: hospitals, pharmacies, primary care practices, outpatient clinics, communities | • 1/1 study favoured educational outreach vs. control | |||
AMSTAR (quality) score: 5 | • 1/1 study favoured revision of roles vs. control | |||
• 0/1 study favoured reminders vs. control | ||||
Overall: generally effective (75%) | ||||
Multifaceted vs. control | 3/5 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (60%) | ||||
Hulscher (2001)b[21] |
N: 55 studies | Single vs. control | 13/18 comparisons (across N = 15 studies) reported a single intervention was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
Interventions to Implement Prevention in Primary Care | Study designs: randomized controlled trials, controlled before-after | • 6/6 comparisons favoured audit and feedback vs. control (5 studies) | ||
Populations: physicians, nurses, other | • 3/5 comparisons favoured educational meetings vs. control (4 studies) | |||
Settings: primary care practices, outpatient clinics, medical centres | • 1/3 comparisons favoured distribution of educational materials vs. control (3 studies) | |||
AMSTAR (quality) score: 5 | • 2/3 comparisons favoured educational outreach vs. control (2 studies) | |||
• 1/1 comparison favoured local consensus proves vs. control (1 study) | ||||
Overall: generally effective (72%) | ||||
Multifaceted vs. control | 4/6 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (67%) | ||||
Jamtvedt (2006)b[22] |
N: 118 studies | Single vs. control | 28/38 studies reported a single intervention (audit and feedback) was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Audit and Feedback: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials | |||
Population: any kind of health-care professional | Overall: generally effective (74%) | |||
Setting: Any kind of organization | Multifaceted vs. control | 61/74 studies reported a multifaceted intervention was effective over a control intervention | ||
AMSTAR (quality) score: 8 | Overall: generally effective (82%) | |||
Laliberte (2011) [37] |
N: 13 studies (in 16 papers) | Single vs. control | 13/13 (100%) comparisons (across N = 6 studies) reported a single intervention was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
Effectiveness of Interventions to Improve the Detection and Treatment of Osteoporosis in Primary Care Settings: A Systematic Review and Meta-Analysis | Study designs: RCT, CT, other (cluster RCT) | • 12/12 comparisons favoured reminders vs. control (5 studies) | ||
Population: physicians, pharmacists, other (orthopaedic surgeons) | • 1/1 comparison (1 study) favoured continuity of care vs. control | |||
Setting: primary care practices, pharmacies, communities | Overall: generally effective (100%) | |||
AMSTAR (quality) score: 9 | Multifaceted vs. control | 4/7 comparisons (across N = 3 studies) reported a multifaceted intervention was effective over a control intervention | ||
Overall: mixed effects (57%) | ||||
Lemmens (2009) [38] |
N: 40 studies | Single vs. control | 2/7 studies reported a single intervention was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally ineffective when compared to controls |
A Systematic Review of Integrated Use of Disease-Management Interventions in Asthma and COPD | Study designs: randomized controlled trials, controlled before-after | • 0/3 studies favoured revision roles—nursing vs. control | ||
Populations: nurses, physicians and pharmacists | • 2/3 studies favoured revision roles—pharmacy vs. control | |||
• 0/1 study favoured continuity of care vs. control | ||||
Overall: generally ineffective (29%) | ||||
Settings: communities, hospitals, nursing homes, outpatient clinics, pharmacies, primary care practices | ||||
AMSTAR (quality) score: 8 | ||||
Multifaceted vs. control | 3/7 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (43%) | ||||
Lloyd-Evans (2011) [29] |
N: 11 studies | Single vs. control | 3/4 comparisons (across N = 2 studies) reported a single intervention (educational meetings) was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Initiatives to Shorten Duration of Untreated Psychosis: Systematic Review | Study designs: randomized controlled trials, controlled trials, observational | Overall: generally effective (75%) | ||
Populations: physicians, youth workers, counsellors | Multifaceted vs. control | 7/10 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention | ||
Settings: primary care practices, schools | Overall: generally effective (70%) | |||
AMSTAR (quality) score: 6 | ||||
Lugtenberg (2009) [32] |
N: 20 studies (in 30 papers) | Single vs. control | 2/4 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions have mixed effects when compared to controls |
Effects of Evidence-Based Clinical Practice Guidelines on Quality of Care: A Systematic Review | Study designs: randomized controlled trials, controlled before-after, interrupted time series | • 0/1 study favoured audit and feedback vs. control | ||
• 1/1 study favoured distribution of educational materials vs. control | ||||
Populations: physicians, other | ||||
Settings: primary care practices, hospitals | ||||
AMSTAR (quality) score: 5 | ||||
• 1/1 study favoured educational meetings vs. control | ||||
• 0/1 study favoured educational outreach vs. control | ||||
Overall: mixed effects (50%) | ||||
Multifaceted vs. control | 10/18 comparisons(across N = 16 studies) reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (56%) | ||||
Marinopoulos (2007)b[23] |
N: 136 studies | Single vs. control | 14/22 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions have mixed effects when compared to controls |
Effectiveness of Continuing Medical Education | Study designs: randomized controlled trials, before-after, observational | • 3/6 studies favoured distribution of educational materials vs. control | ||
Populations: physicians, pharmacists, nurses, other | 8/13 studies favoured educational meetings vs. control | |||
Settings: primary care practices, hospitals, long-term care facilities | 2/2 studies favoured educational outreach vs. control | |||
AMSTAR (quality) score: 7 | • 1/1 study favoured audit and feedback vs. control | |||
Overall: mixed effects (64%) | ||||
Multifaceted vs. control | 24/39 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (62%) | ||||
Naikoba (2001) [39] |
N: 21 studies | Single vs. control | 6/9 studies reported a single intervention was effective over a control intervention | Multifaceted interventions are generally effective when compared to controls, while single interventions have mixed effects when compared to controls |
The Effectiveness of Interventions Aimed at Increasing Handwashing in Healthcare Workers - A systematic Review | Study designs: randomized controlled trials, controlled trials, observational | • 2/4 studies favoured audit and feedback vs. control | ||
Populations: physicians, nurses, other | • 2/2 studies favoured reminders vs. control | |||
• 1/2 studies favoured educational meetings vs. control | ||||
Settings: hospitals, nursing homes | • 1/1 study favoured distribution of educational materials vs. control | |||
AMSTAR (quality) score: 4 | Overall: mixed effects (67%) | |||
Multifaceted vs. control | 6/7 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: generally effective (86%) | ||||
O'Brien (2007)b[24] |
N: 69 studies | Single vs. control | 26/28 studies reported a single intervention (educational outreach) was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Educational Outreach Visits: Effects on Professional Practice and Health Care Outcomes | Study designs: randomized controlled trials | |||
Populations: any kind of health-care professional | Overall: generally effective (93%) | |||
Settings: primary care practices, outpatient clinics, nursing homes, hospitals, pharmacies, communities | Multifaceted vs. control | 40/45 studies reported a multifaceted intervention was effective over a control intervention | ||
AMSTAR (quality) score: 8 | Overall: generally effective (89%) | |||
Robertson (2010) [40] |
N: 21 studies | Single vs. control | 10/11 comparisons (across N = 10 studies) reported a single intervention (reminders) was effective over a control intervention | Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls |
The Impact of Pharmacy Computerised Clinical Decision Support on Prescribing, Clinical and Patient Outcomes: A Systematic Review of the Literature | Study designs: randomized controlled trials, controlled trials, interrupted time series, controlled before-after, cohort | |||
Populations: physicians, nurses, pharmacists, nurse practitioners | Overall: generally effective (91%) | |||
Multifaceted vs. control | 3/9 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention | |||
Settings: primary care practices, outpatient clinics, hospitals, pharmacies, communities | ||||
AMSTAR (quality) score: 4 | Overall: mixed effects (33%) | |||
Solomon (1998) [33] |
N: 49 studies | Single vs. control | 18/34 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions have mixed effects when compared to controls |
Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework | Study designs: randomized controlled trials, controlled trials | • 8/15 studies favoured audit and feedback vs. control | ||
Populations: physicians, nurses, medical and surgical residents | • 5/7 studies favoured distribution of educational materials vs. control | |||
Settings: hospitals, outpatient clinics, communities, other | • 3/5 studies favoured reminders—general vs. control | |||
AMSTAR (quality) score: 5 | • 0/1 study favoured reminders—CPOE vs. control | |||
• 0/4 studies favoured educational meetings vs. control | ||||
• 2/2 studies favoured local consensus process vs. control | ||||
Overall: mixed effects (53%) | ||||
Multifaceted vs. control | 10/18 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (56%) | ||||
Steinman (2006) [30] |
N: 26 studies | Single vs. control | 10/10 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally effective when compared to controls |
Improving Antibiotic Selection: A Systematic Review and Quantitative Analysis of Quality Improvement Strategies | Study designs: randomized controlled trials, controlled before-after, interrupted time series | • 7/7 studies favoured educational outreach vs. control | ||
Populations: not specified | • 1/1 study favoured educational meetings vs. control | |||
Settings: primary care practices, outpatient clinics | • 1/1 study favoured audit and feedback vs. control | |||
AMSTAR (quality) score: 5 | • 1/1 study favoured distribution of educational materials | |||
Overall: generally effective (100%) | ||||
Multifaceted vs. control | 21/23 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: generally effective (91%) | ||||
Weinmann (2007)b[25] |
N: 18 studies (in 17 papers) | Single vs. control | 1/4 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions are generally ineffective when compared to controls |
Effects of Implementation of Psychiatric Guidelines on Provider Performance and Patient Outcome: Systematic Review | Study designs: randomized controlled trials, controlled trials, before-after | • 1/3 favoured education vs. control | ||
Populations: physicians, nurses, pharmacists, mental health clinicians, medical assistants | • 0/1 favoured audit and feedback vs. control | |||
Multifaceted vs. control | Overall: generally ineffective (25%) | |||
Settings: primary care practices, hospitals, communities | 2/8 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: generally ineffective (25%) | ||||
AMSTAR (quality) score: 5 | ||||
Wensing (1994)b[6] |
N: 75 studies | Single vs. control | 18/30 studies reported a single intervention was effective over a control intervention | Both multifaceted and single-component interventions have mixed effects when compared to controls |
Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review | Study designs: randomized controlled trials, controlled trials, before-after, cohort | • 1/4 favoured distribution of educational materials vs. control | ||
Populations: physicians | • 2/3 favoured educational outreach vs. control | |||
Settings: primary care practices | • 7/10 favoured audit and feedback vs. control | |||
AMSTAR (quality) score: 4 | • 6/8 favoured reminders vs. control | |||
• 2/5 favoured educational meetings vs. control | ||||
Overall: mixed effects (60%) | ||||
Multifaceted vs. control | 7/16 studies reported a multifaceted intervention was effective over a control intervention | |||
Overall: mixed effects (44%) |