Table 1.
Study design, participants | Toolkit and intervention | Evidence informing toolkit development | Outcomes measured | Results | Quality | |
---|---|---|---|---|---|---|
Cavanaugh et al26 | Two RCTs at 2 academic medical centres N=198 adult patients with diabetes n=99 (control) n=99 (intervention) Country: USA |
Intervention components: enhanced diabetes care programme; training sessions; DLNET Control components: enhanced diabetes care programme Toolkit target: health professionals Toolkit contents: customisable 24 instructive modules about diabetes self-management activities, including blood glucose monitoring, nutrition management, foot care, administration of medications |
Incorporated communication principles |
|
Significant improvements in A1c levels in intervention and control groups at 3 months (adjusted analyses showed greater improvement in the intervention group (p=0.03)) Significant improvement in self-efficacy from baseline in both groups (p=0.01,0.02) (but NS differences between groups in adjusted analyses) NS differences between intervention and control for self-management behaviour or treatment satisfaction NS differences between intervention and control groups at 6 months Implementation outcomes: sustainability of outcomes measured at 3 and 6 months Toolkit effectiveness: partially effective |
M |
Dykes et al 30 | Cluster RCT N=8 units in 4 urban US hospitals, N=10 264 patients n=5160 (intervention) n=5104 (control) Country: USA |
Intervention components: FPTK; local champions Control components: usual care Toolkit target: health professionals Toolkit contents: Morse Falls Scale to assess fall risk; interventions tailored to patient-specific areas of risk; bed poster, patient/family education handout, fall prevention plan (tailored for each patient) |
Literature review, focus groups with nurses+nursing assistants, assessment of barriers and facilitators to optimal practice |
|
Significantly fewer patients with falls in intervention versus control units (p=0.02) Significantly lower adjusted fall rates in intervention versus control units per 1000 patient-days (p=0.04) NS difference in fall-related injuries Implementation outcomes: protocol adherence >89% Toolkit effectiveness: mostly effective |
M |
Majumdar et al42 | Controlled clinical trial N=14 managed care practices Country: USA |
Low-intensity intervention components: evidence-based guideline on Helicobacter pylori; Toolkit High-intensity intervention components: evidence-based guideline on H. pylori; Toolkit; academic detailing of guideline dissemination by a PCP champion using persuasive educational session; 1 month reinforcement of guideline message; and reminder about eligible patients by a pharmacist Control components: usual care Toolkit target: health professionals Toolkit contents: customised list of eligible patients from participating practice; educational materials for patients; patient letters used to arrange for test or follow-up appointment; pre-printed materials including: (A) H. pylori serology test requisitions, (B) preapproved prescriptions, (C) progress notes for patient charts |
Not specified |
|
Significant increase in H. pylori test-ordering in high-intensity intervention versus usual care at 12 months (p=0.02)Significant decrease in proton pump inhibitor use by 9% per year in high-intensity intervention versus usual care (p=0.028) Implementation outcomes: sustainability of outcomes measured at 12 months Toolkit effectiveness: mostly effective |
M |
Menchetti et al44 | Cluster RCT N=15 primary care groups with 223 PCPs n=8 intervention (128 patients) n=7 control (99 patients) Country: Italy |
Intervention components: 2-day intensive training for PCPs; implementation of a stepped care protocol; dedicated consultant psychiatrist; Depression Management Toolkit Control components: usual care Toolkit target: PCPs Toolkit contents: issues discussed during training with PCPs; diagnostic procedure based on the PHQ-9; treatment algorithm |
Based on training program developed by project steering committee |
|
NS differences between groups in remission of depression at 3, 6, 12 months; however in patients with minor/major depression, intervention was more effective than usual care at 3 months (p=0.015). Intervention group showed significantly higher treatment response rates at 3 (p=0.016) and 6 months (p=0.049). PCP increased use of appropriate antidepressants and decreased use of sedatives, hypnotics at 3 months. Implementation outcomes: sustainability of outcomes measured at 3, 6, 12 months Toolkit effectiveness: partially effective |
M |
Shah et al51 | Pragmatic Cluster RCT n=933 789 adult patients with diabetes (administrative data study) n=1592 patients with diabetes at high risk for cardiovascular disease (clinical data study) Country: Canada |
Intervention components: toolkit Control components: usual care Toolkit target: family physicians Toolkit contents: introductory letter; tailored 8-page summary of practice guidelines; 4-page synopsis of key guideline elements pertaining to cardiovascular disease risk; small laminated card with simplified algorithm for cardiovascular risk assessment, vascular protection strategies+screening for cardiovascular disease; tear-off sheets for patients with a cardiovascular self-assessment tool; list of recommended risk reduction strategies. Toolkit was packaged in a brightly coloured box with Canadian Diabetic Association branding) |
Clinical experts (family physicians, endocrinologists), clinicians with KT expertise |
|
NS difference between groups in death or non-fatal MI (p=0.07) and use of a statin (p=0.26). Decreased use of ECG (p=0.02) and cardiac stress tests (p=0.04) in intervention group Implementation outcomes: not specified Toolkit effectiveness: not effective |
M |
Wright et al57 | Cluster RCT N=42 Ontario hospitals (616 patients with stage II colon cancer) Country: Canada |
Intervention components: standardised lecture from expert opinion leader; toolkit; academic detailing of local opinion leader; 6-month follow-up reminder package Control components: standardised lecture from expert opinion leader Toolkit target: physicians Toolkit contents: pathology template; poster and pocket cards emphasising 12 LNs to be assessed in colon cancer |
Not specified |
|
Significant increase in mean number of LNs assessed and the proportion of cases with 12 or more LNs retrieved for both groups after standardised lecture (p<0.001). No additional increase noted with academic detailing and toolkit. Implementation outcomes: not specified Toolkit effectiveness: not effective |
S |
Goeppinger et al33 | 4 months RCT and 9 months longitudinal study N=921 adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or chronic joint symptoms n=463 (control), n=458 (intervention) Country: USA |
Intervention components: Arthritis Self-Management Toolkit Control components: no intervention Toolkit target: patients with arthritic conditions Toolkits contents (available in English and Spanish): ‘self-test’ to self-tailor the toolkit; information sheets on arthritic-related health issues and on key process components of the Arthritis Self-Management Program (eg, decision-making); Arthritis Help Book; audio relaxation and exercise CDs; audio CD of all material from information sheets |
Not specified |
|
Statistically significant improvement in 6/7 health status measures, all health-related behaviours and self-efficacy but not in medical care utilisation variables at 4 months postintervention (p<0.01) in intervention versus control groups Results maintained at 9 months compared with baseline Implementation outcomes: sustainability of outcomes measured at 9 months 97% of participants reported use of the toolkit and found it useful. The Book was rated the most useful part Toolkit effectiveness: mostly effective |
S |
Horvath et al36 | RCT N=108 dyads of patients with progressive dementia of Alzheimer's type/caregiver n=48(control) n=60 (intervention) Country: USA |
Intervention components: Home Safety Toolkit Control components: 1 page standard patient education sheet Toolkit target: caregivers of patients with Alzheimer's Toolkit contents: ‘Keep the Home Safe for a Person with Memory Loss’ booklet; low-cost sample items to reduce risky behaviours and accidents |
Principles of health literacy, patient-centred care and self-efficacy |
|
Significantly higher caregiver self-efficacy (p=0.002), significantly lower caregiver strain (p≤0.001), significant improvement in home safety (p≤0.001), significantly fewer risky behaviours and accidents (p≤0.001) in intervention versus control Implementation outcomes: fidelity to protocol achieved Cost of toolkit included but not a cost/benefit analysis Toolkit effectiveness: mostly effective |
S |
DLNET, Diabetes Literacy Numeracy Education Toolkit; FPTK, Fall Prevention Toolkit; LN, lymph node; M, moderate; NS, non significant; PCP, primary care physician; PHQ-9, Patient Health Questionnaire-9; RCT, randomised controlled trial; S, strong.