Background
Methods
Inclusion criteria
Search strategy
Screening
Data extraction and analysis
Results
Characteristics of interventions
Lead author | Year | Setting | Healthcare professional group | Target behavior | Target behavior (category) | Intervention | Participants randomised | Control group | Significant effectafound? | Outcomes | Cohens d | Size |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Armstrong [56] | 2013 | Not reported | Nurse practitioners, physician’s assistant, physician | Initiation of a recommended therapeutic alternative within 90 days of the fax alert for the 13 PDDIs | Prescribing Behaviors | Faxed alerts | N | N | N | Therapy change | nad | |
Avery [40] | 2012 | Primary Care | Doctors | Prescribing errors | Prescribing Behaviors | Computer-generated feedback | Y | Y | Y | Prescription problems | 0.09b | S |
Prescribed B Blocker | 0.08b | S | ||||||||||
Prescribed an NSAID | 0.17b | S | ||||||||||
Bahrami [9] | 2004 | Dentist | Dental practitioners | Guideline implementation for the management of impacted and un-erupted third molars in primary dental care | Adherence to clinical patient management guidelines | Computer-based training | Y | Y | N | Guideline implemented | -0.10b | S |
Beidas [50] | 2012 | Community Care | Mental health community therapists | Therapist adherence to CBT for child anxiety, skill in CBT for child anxiety, knowledge about CBT for child anxiety, and satisfaction with training. | Adherence to clinical patient management guidelines | Computer-based training | Y | Y | N | Guideline adherence | -0.15b | S |
Beeckman [57] | 2013 | Nursing Home | Nurses, nursing assistants, physiotherapists, occupational therapists | Adherence to recommendations to pressure ulcer prevention | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | Y | Guideline adherence | 1.26b | L |
Buising [10] | 2008 | Tertiary Care | Doctors (senior and junior) | Antibiotic prescribing | Prescribing Behaviors | Healthcare professional decision supports | N | N | Y | Concordant therapy | 0.76b | M |
Carton [58] | 2002 | Hospital | Junior and senior practitioners | Effects of computer-based guidelines on unnecessary medical imaging | Adherence to clinical patient management guidelines | Reminders/ alerts | N | N | Y | Test requests not confirming to guidelines | 0.17b | S |
Cosgrove [59] | 2007 | Tertiary Care | Clinicians | Inappropriate antimicrobial therapy | Adherence to clinical patient management guidelines | Text message | N | N | N | Guideline adherence | 0.19b | S |
Curtis [60] | 2007 | Primary Care & Secondary Care | Physicians | To increase bone mineral density (BMD) testing and osteoporosis medication prescribing among patients receiving long term glucocorticoid therapy | Adherence to clinical patient management guidelines & Prescribing Behaviors | Hyperlinks | Y | Y | N | nad | ||
Dimeff [61] | 2009 | Secondary Care | Mental health treatment providers | Increasing knowledge and self-efficacy and application of course content performance-based role plays | Increasing knowledge, or self-efficacy/confidence | Computer-based training | Y | Y | Y | Knowledge | 0.52c | M |
Dykes [62] | 2005 | Hospital | Nurses, resident physicians, physical therapists, pharmacist, and dieticians | Adherence to practice guidelines for heart failure | Adherence to clinical patient management guidelines | Healthcare professional decision supports | N | Y | Y | nad | ||
Eccles [63] | 2002 | Primary Care | GPs and practice nurses | Adherence to the guidelines | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | N | Blood pressure recorded | 0.00b | S |
Exercise recorded or advised | -0.16b | S | ||||||||||
Weight recorded or advised | -0.11b | S | ||||||||||
Smoking status known | -0.28b | S | ||||||||||
Smoking education given | 0.00b | S | ||||||||||
electrocardiogram recorded | 0.00b | S | ||||||||||
Exercise electrocardiogra m recorded | 0.00b | S | ||||||||||
Haemoglobin concentration recorded | 0.00b | S | ||||||||||
Thyroid function recorded | -0.10b | S | ||||||||||
Cholesterol or other lipid concentrations recorded | -0.09b | S | ||||||||||
Blood glucose or HBA1c concentrations recorded | 0.00b | S | ||||||||||
Edelman [34] | 2014 | Primary Care | Physicians | Confidence and knowledge | Increasing knowledge, or self-efficacy/confidence | Healthcare professional decision supports | N | N | Y | Confidence discussing sickle cell disease Confidence conducting follow-up | nad | |
Fein [41] | 2010 | Hospital | Clinical staff | Identification of psychiatric problems/ hospital assessments | Increasing screening/testing rates | Healthcare professional decision supports | N | N | Y | Identification of adolescents with psychiatric problems | 0.29b | S |
ED assessments | 0.22b | S | ||||||||||
Fifield [64] | 2010 | Hospital | Primary care physicians | Improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines (NAEPP) | Adherence to clinical patient management guidelines | Reminders/ alerts Computer-generated feedback | N | Y | Y | Guideline appropriate prescribing | nad | |
Filippi [65] | 2003 | Primary Care | GPs | Increasing the use of antiplatelet drugs for diabetic patients at high-risk to develop future CVD | Prescribing Behaviors | Healthcare professional decision supports | Y | Y | Y | Patients treated | 0.36b | S |
Fortuna [37] | 2009 | Hospital | Physicians, nurse practitioners and physician assistants | Reducing prescribing of heavily marketed hypnotic medications in ambulatory care settings | Prescribing Behaviors | Reminders/ alerts | Y | Y | Y | nad | ||
Gerber [66] | 2013 | Primary Care | Paediatricians | Decrease inappropriate antibiotic prescribing for common ARTIs over time by primary care paediatricians | Prescribing Behaviors | Email Feedback | Y | Y | Y | nad | ||
Goetz [4] | 2013 | Primary Care | Primary care clinicians | Increasing the rate of risk-based and routine HIV diagnostic tests | Increasing screening/testing rates | Reminders/ alerts | Y | Y | Y | nad | ||
Goetz [47] | 2008 | Primary Care & Secondary Care | Academic and non-academic staff physicians, postgraduate medical trainees and mid-level providers | Increasing the rate of HIV diagnostic testing | Increasing screening/testing rates | Reminders/ alerts Email Feedback | N | Y | Y | nad | ||
Gonzales [67] | 2013 | Primary Care | Clinicians | Antibiotic treatment of uncomplicated acute bronchitis | Prescribing Behaviors | Healthcare professional decision supports | Y | Y | Y | Unnecessary use of antibiotics | 0.46b | S |
Guldberg [68] | 2011 | Primary Care | GPs | Initiation of treatment | Clinical intervention/ management | Electronic Feedback System | Y | Y | Y | Oral antidiabetic treatment initiated (1) | 0.71b | M |
Oral antidiabetic treatment initiated (2) | 0.71b | M | ||||||||||
Insulin treatment initiated (1) | 0.55b | M | ||||||||||
Insulin treatment initiated (2) | 0.37b | S | ||||||||||
Lipid lowering treatment initiated | 0.71b | M | ||||||||||
Blood-pressure reducing treatment initiated | 0.90b | L | ||||||||||
Gupta [38] | 2014 | Hospital | Physicians | Appropriate head CT use in patients with mild traumatic brain injury guideline adherence | Adherence to clinical patient management guidelines | Healthcare professional decision supports | N | N | Y | nad | ||
Hibbs [69] | 2014 | Hospital | Clinicians | Blood transfusion practice of clinicians | Increasing screening/testing rates | Healthcare professional decision supports | N | Y | Y | Transfusion compliance | 0.46b | S |
Hobbs [70] | 1996 | Primary Care | Primary care practitioners | Prescribing of lipid lowering agents, use of lab tests, and referrals to secondary care for the investigation of hyperlipidaemia | Prescribing Behaviors & Increasing appropriate referrals | Healthcare professional decision supports | Y | Y | N | nad | ||
Hoch [71] | 2003 | Primary Care | Physicians | Imitating potassium testing | Increasing screening/testing rates | Reminders/ alerts | N | N | Y | nad | ||
Kortteisto [72] | 2014 | Primary Care | Physicians nurses physiotherapists ward nurses a psychologist | Reminders for best practice guidelines/recommendations | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | N | nad | ||
Litvin [73] | 2013 | Primary Care | Physicians, nurse practitioners, physician’s assistants | Prescribing behavior - antibiotic prescribing for acute respiratory infections | Prescribing Behaviors | Healthcare professional decision supports | N | N | Y | nad | ||
Lobach [74] | 1997 | Primary Care | Primary care clinicians: family physicians, general internist, nurse practitioners, physician’s assistants, and family medicine residents | Rate of compliance with guideline recommendations for diabetes patient care | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | Y | Foot examination | 0.62b | M |
Complete physical examination | 1.07b | L | ||||||||||
Chronic glycemia monitoring | 0.10b | S | ||||||||||
Urine protein determination | 2.36b | L | ||||||||||
Cholesterol level | 0.89b | L | ||||||||||
Ophthalmologic examination | 1.09b | L | ||||||||||
Influenza vaccination | 0.18b | S | ||||||||||
Maiburg [39] | 2003 | Primary Care | GP trainees | Improving knowledge and practice behavior | Increasing knowledge, or self-efficacy/confidence & Clinical intervention/ management | Computer-based training | N | Y | Y | knowledge test | 0.44c | S |
correct performance in visit | 1.59c | L | ||||||||||
Malone [75] | 2012 | Pharmacy | Prescribers | Prevention of serious drug-drug interactions (DDI) prescribing patterns of 25 previously identified clinically important potential DDIs | Prescribing Behaviors | Personal Digital Assistant | N | Y | N | Prescribing at least one DDI | 0.20b | S |
Mayne [76] | 2014 | Hospital | Physician Nurse practitioner | Captured opportunities for HPV vaccination | Increasing screening/testing rates | Reminder within patient electronic health records | Y | Y | Y | nad | ||
Nilasena [77] | 1995 | Secondary Care | Physicians | Physician compliance with diabetes preventive care guidelines | Adherence to clinical patient management guidelines | Reminders/ alerts | Y | Y | N | nad | ||
Patkar [78] | 2006 | Hospital | Breast clinicians (surgeons) | Adherence to guideline recommendations | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | Y | adherence to guidelines | 1.03b | L |
Piening [79] | 2013 | Hospital | Ophthalmologists and hospital pharmacists | Uptake of drug safety information | Adherence to clinical patient management guidelines | Email Feedback | Y | Y | Y | correctly indicated that a serious increase in intra-ocular pressure could be caused by pegaptanib injections | 0.86b | L |
Reeve [80] | 2008 | Pharmacy | Pharmacists | Frequency of clinical interventions recorded by community pharmacists/to discuss the suitability of aspirin therapy in eligible patients with diabetes | Clinical intervention/ management & Prescribing Behaviors | Healthcare professional decision supports | Y | Y | Y | nad | ||
Ribeiro-Vaz [81] | 2012 | Hospital | Doctor, nurse, pharmacist | To promote spontaneous adverse drug reaction reporting by healthcare professionals | Prescribing Behaviors | Hyperlinks | N | N | Y | nad | ||
Rocha [82] | 2001 | Tertiary care | Clinicians - staff physicians, physician assistants, nurse practitioners | Practice patterns and consequently improve the detection and management of nosocomial infections. | Clinical intervention/ management | Reminders/ alerts | N | N | N | Patient management recommendations followed | ||
Ruland [83] | 2002 | Hospital | Nurses | Clinicians eliciting and integrating patients’ preferences into patient care | Clinical intervention/ management | Diagnostic/ risk assessment tool | N | Y | Y | congruence between patient preferences and nurse care priorities | 0.67c | M |
Schwarz [84] | 2012 | Primary Care | Primary care providers | Provision of family planning services when prescribing potentially teratogenic medications | Clinical intervention/ management | Healthcare professional decision supports | Y | Y | Y | discussion of risk of medication use | 0.70c | M |
Sharifi [85] | 2014 | Primary Care | Physicians | Tobacco smoke exposure management and quit-line referrals | Increasing appropriate referrals | Reminder within patient electronic health records | N | N | Y | counselling for positive screen | 1.36b | L |
Strayer [86] | 2013 | Primary Care | Physicians | Smoking cessation counselling behaviors, knowledge and comfort/self-efficacy | Increasing knowledge, or self-efficacy/confidence & Clinical intervention/ management | Personal Digital Assistant | N | N | Y | nad | ||
Strom [87] | 2010 | Hospital | Resident physicians and nurse practitioners | Changing prescribing reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, | Prescribing Behaviors | Reminders/ alerts | Y | Y | N | nae | ||
Tang [88] | 1999 | Secondary Care | Clinicians | Influenza vaccination by clinicians Compliance with the guideline: was defined as documentation that a clinician ordered the vaccine, counselled the patient about the vaccine, offered the vaccine to a patient who declined it, or verified that the patient had received the vaccine elsewhere | Adherence to clinical patient management guidelines | Healthcare professional decision supports | N | N | Y | compliance with guidelines | 0.88b | L |
Tierney [48] | 2003 | Primary Care | Physicians and pharmacists | Management of heart disease adherence with care suggestions | Adherence to clinical patient management guidelines | Healthcare professional decision supports | Y | Y | N | Compliance with guidelines | 0.04b | S |
Vagholkar [89] | 2014 | Primary Care | Family physicians | Prescribing - prescription of antihypertensive and lipid-lowering medication. | Prescribing Behaviors | Diagnostic/ risk assessment tool | Y | Y | N | Prescribing of antihypertensive Prescribing of lipid-lowering medication | -0.21b | S |
van Wyk [8] | 2008 | Primary Care | GPs | Screening and treatment for dyslipidaemia | Increasing screening/testing rates | Reminders/ alerts | Y | Y | Y | patients screened | 0.93b | L |
patient treated | 0.68b | M | ||||||||||
Walker [90] | 2010 | Primary Care | GPs | Increasing opportunistic chlamydia testing | Increasing screening/testing rates | Reminders/ alerts | Y | Y | N | Testing rates | -0.09b | S |
Types of intervention
Domain | Number of interventions in each category | Number of effective interventionsa | (%) of effective studies |
---|---|---|---|
Intervention type | |||
Computer-generated feedback | 1 | 1 | 100 |
Email feedback | 3 | 3 | 100 |
Electronic feedback system | 1 | 1 | 100 |
Computer-based training | 4 | 2 | 50 |
Reminder system within patient electronic health records | 2 | 2 | 100 |
Healthcare professional decision support | 19 | 15 | 79 |
Hyperlinks | 2 | 1 | 50 |
Reminders/alerts | 11 | 7 | 64 |
Personal digital assistant | 2 | 1 | 50 |
Diagnostic/risk assessment tool | 2 | 1 | 33 |
Faxed alerts | 1 | 0 | 0 |
Text message | 1 | 0 | 0 |
Target behavior | |||
Adherence to clinical patient management guidelines | 17 | 10 | 59 |
Prescribing behaviors | 15 | 9 | 60 |
Increasing screening/testing rates | 8 | 7 | 88 |
Clinical intervention/management | 6 | 5 | 83 |
Increasing knowledge, or self-efficacy/confidence | 4 | 4 | 100 |
Increasing appropriate referrals | 2 | 1 | 50 |
Setting of intervention
Target healthcare professional for intervention
Target behavior of intervention
Coding interventions for specific BCTs
Thematic analysis
Lead author | Year | Country | Data collection method |
---|---|---|---|
Ackerman [43] | 2013 | USA | Qualitative structured telephone surveys |
Barnett [92] | 2015 | UK | Think-aloud and semi-structured interviews |
Bokhour [93] | 2015 | USA | Qualitative semi-structured interviews |
Burns [94] | 2007 | Australia | Semi-structured interviews |
Doerr [95] | 2014 | USA | Semi-structured interviews |
Dowding [96] | 2009 | UK | In-depth semi-structured interviews |
Dryden [97] | 2012 | USA | Qualitative, in-depth semi-structured telephone interviews |
Edelman [34] | 2014 | USA | Semi-structured interviews and quantitative survey data |
Guldberg [98] | 2010 | Denmark | Group and individual semi-structured interviews |
Hains [99] | 2009 | Australia | Semi-structured interviews |
Litvin [100] | 2012 | USA | Semi-structured group interviews |
Maguire [101] | 2008 | UK | Questionnaires and semi-structured interviews |
Mandt [102] | 2010 | Norway | Focus groups |
Patterson [42] | 2004 | USA | Semi-structured interviews |
Power [103] | 2014 | Canada | Surveys |
Randell [104] | 2010 | UK | In-depth semi-structured interviews |
Rousseau [105] | 2003 | UK | Semi-structured interviews |
Saleem [106] | 2005 | USA | Qualitative field observations |
Vishwanath [107] | 2009 | USA | Surveys |
Weir [108] | 2011 | USA | Formative interviews |
Zhu [109] | 2015 | USA | Qualitative Survey |
Discussion
Construct | Topic | Specific features / recommendations | References | Barrier / facilitator |
---|---|---|---|---|
What works | Type of intervention | Healthcare professional decision support | ||
Reminders and alerts | ||||
BCTs | Instruction on how to perform the behaviour (BCTTv1 4.1) | |||
For whom interventions work for | Target healthcare professional behaviour | Adherence to clinical guidelines for patient management | ||
Prescribing behaviours | ||||
Increasing knowledge or self-efficacy / confidence | ||||
Increasing screening / testing rates | ||||
Clinical intervention / management | ||||
Target healthcare professional | GPs | |||
Multiple healthcare professionals (more than two different types of healthcare professional) | ||||
Under what circumstances | Role of the healthcare professional | Increases confidence in decision making | Facilitator | |
Attitudes and perceptions towards technology important in terms of uptake and usage | Facilitator | |||
Importance of endorsement from senior peers | Facilitator | |||
Engagement important factor for implementation | Facilitator | |||
Assigning responsibility to using the system | Facilitator | |||
Facilitator | ||||
Design, content and technical issues | Pilot testing - iterative modification to meet staff needs | Facilitator | ||
Insufficient access to IT resources | Barrier | |||
Physical location of computer | Barrier | |||
Technical issues such as computer performance and software updates | Barrier | |||
Links to external patient information resources important | Facilitator | |||
Links to patient guidelines must be readily available, consistent and relevant | Facilitator | |||
Usability and benefit for patient care | Provides access to important information relevant to the clinical encounter | Facilitator | ||
Technology / interface must not be difficult to use | Barrier | |||
Technical training for staff | Facilitator | |||
Importance of a learning period / time for familiarisation of the technology | Facilitator | |||
Considers complexities of individual patients (for example patients with specific conditions, or comorbidities) | Facilitator | |||
Helps facilitate discussions with patients | Facilitator | |||
Practice and workload issues | Use of technology increases workload and may cause disruption | Barrier | ||
Time taken to use the system / requirement of additional staff members | Barrier | |||
Improves communication between healthcare professionals | Facilitator | |||
Must be easily integrated into day-to-day workload | Facilitator | |||
Technology aligns with current practice initiatives, and wider organisational context | Facilitator |