. 2014 Oct 6;9:152. doi: 10.1186/s13012-014-0152-6

Table 3.

Indirect comparisons of multifaceted to single interventions ( N =23 reviews)

Author	Study characteristics	Review findings ^a		Conclusion
Author	Study characteristics	Comparison	Findings	Conclusion
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
		Multifaceted vs. control	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%)
	AMSTAR (quality) score: 5	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
		Multifaceted vs. control	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
		Multifaceted vs. control	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
		Multifaceted vs. control	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
	AMSTAR (quality) score: 8	Multifaceted vs. control	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)
	Populations: physicians, other		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	Multifaceted vs. control	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
		Multifaceted vs. control	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
		Multifaceted vs. control	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
		Multifaceted vs. control	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	Multifaceted vs. control	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
	AMSTAR (quality) score: 9	Multifaceted vs. control	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
		Multifaceted vs. control	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	Single vs. control	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		Overall: generally effective (70%)
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
		Multifaceted vs. control	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
		Multifaceted vs. control	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
	Populations: physicians, nurses, other		• 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
		Multifaceted vs. control	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	Multifaceted vs. control	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
		Multifaceted vs. control	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
		Multifaceted vs. control	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
	Settings: primary care practices, hospitals, communities		Overall: generally ineffective (25%)
	AMSTAR (quality) score: 5		Overall: generally ineffective (25%)
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
		Multifaceted vs. control	Overall: mixed effects (44%)

^aFindings are reported by the number of studies where available. In a small number of cases, reviews reported findings by the number of comparisons.

^bAlso in Table 2.

^cAlso in Table 1.