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. 2018 May 4;33(7):1142–1154. doi: 10.1007/s11606-018-4435-5

Table 1.

Characteristics of Selected Papers

First author, year, country Targeted guideline Study design Included in forest plot (reasoning) Number of PCPs in the intervention arm Applied intervention scheme (theoretical basis) Outcome category (number of indicators) Quality score
Aakhus 201624; Norway Depression CT Yes (main outcome) 51 outreach visit, distribution nested in a complex community intervention Diagnostic behaviour (5)
Outcome on patient level (4)
2.5
Anderson 201425; USA Chronic opioid therapy BA No (lack of control group) Not reported (community health centre) audit (a dashboard to serve as a central, actionable data repository to show prescribing and adherence rates) Diagnostic behaviour (2)
Prescription (1)
Counselling (1)
1.5
Arts 201726; the Netherlands Atrial fibrillation CT Yes 13 reminder: clinical decision support systems integrated in electronic health record Prescription (1) 1.75
Bermejo et al. 200927; Germany Depression CBA No (PCP results not clearly distinguishable) 18 educational meeting as continuous medical education and interdisciplinary quality circles (6 times 3 h); audit based on weak point analysis Diagnostic behaviour (1)
Counselling (1)
1.5
Bonds et al. 200928; USA Hypertension CT Yes (main outcomes) 32 educational meeting, followed by outreach visits in every 6 months, extended by distribution of written education material and of patients tools; audit provided by external auditor firm Prescription (3)
Counselling (1)
Outcome on patient level (4)
2.75
Braun et al. 201129; Germany Chronic heart failure guidelines BA No (lack of control group) 23 educational meeting as introductory seminar, followed by installing a reminder on the praxis computer with pop-up window of the guideline essentials Prescription (4) 1.5
Chen 201630; USA Chronic opioid therapy BA No (lack of control group) Not reported educational meeting, dissemination, networking Diagnostic behaviour (4)
Prescription (2)
1.5
Dormuth et al. 201231; Canada Statin prescription CT Yes 1394 audit: feedback provided on prescription Prescription (2) 2.25
Ennis, 201532; USA Chronic kidney disease CT Yes Not reported reminder: automated laboratory-based clinical decision support system Diagnostic behaviour (10)
Outcome on patient level (9)
1.5
Franx et al. 201433; Netherlands Depression CBA Yes 20 2 days educational meeting and additional conference days; followed by virtual networking of multidisciplinary teams for online discussions exchanging of best practices, supported by a toolkit of instruments as treatment protocols or links to relevant sites Prescription (1)
Diagnostic behaviour (1)
2
French et al. 201334; Australia Acute low back pain CT Yes (excluding simulated diagnostic behaviour) 45 educational meeting combining didactic lectures and small group discussions; supported by providing the educational material on DVD
(Theoretical Domains Framework and the Theory of Planned Behaviour)
Knowledge transfer (4)
Diagnostic behaviour (3)
2.5
Grunfeld et al. 201335; Canada Chronic disease prevention and screening CBA Yes (main outcome) 4 outreach visit extended by practice facilitation and audit (the patient-targeted arm of intervention was skipped in our analysis) Diagnostic behaviour (28) 2.75
Harris 201536; Australia Prevention of cardiovascular disease and type 2 diabetes CT Yes 42 educational meeting, audit and feedback, outreach visit (the patient-targeted education and referral information was skipped in our analysis) Diagnostic behaviour (8) 2.25
Heppe et al. 201237; USA Cardiovascular risk assessment BA No (lack of control group) 234 distribution of guideline via mail Knowledge transfer (1) 1.5
Hunt et al. 200938; USA Diabetes BA No (lack of control group) 71 educational meeting providing guided tours of system navigation and functionality; integrated point-of-care reminder and web-based tools; monthly audit Diagnostic behaviour (6)
Prescription (4)
Outcome on patient level (5)
1.5
Ioannidis et el 200939; Canada Osteoporosis BA No (lack of control group) 340 multifaceted scheme of educational meeting, reminder, audit, opinion leaders, financial reimbursement, patient-medicated interventions and distribution of educational material Prescription (3) 1.5
Kiessling et al. 201140; Sweden Lipid lowering in patients with coronary heart disease CT Yes 26 educational meeting for case discussion in small groups Outcome on patient level (1) 2.75
Licskai et al. 201241; Canada Asthma BA No (lack of control group) 60 patient-mediated intervention involving an asthma educator (knowledge translation framework by the Canadian Institutes of Health Research) Prescription (4)
Outcome on patient level (6): in the harvest plot only
1.75
Liddy 201542; Canada Secondary prevention of heart disease, stroke, peripheral vascular disease, renal disease and diabetes Stepped wedge cluster randomized trial No (data presentation) 182 outreach visit, audit and feedback, networking Diagnostic behaviour (1) 2.75
Mahlknecht, 201643; Austria Several chronic disease guidelines BA No (lack of control group) 20 audit: benchmarking of 43 consensual quality indicators, networking in quality circles Diagnostic behaviour (43) 2
Mallen 201744; UK Osteoarthritis CT Yes 20 educational meeting Outcome on patient level (1) 2.5
Mold 201445; USA Kidney disease BA No (lack of control group) 58 audit, outreach visit in wave II Diagnostic behaviour (2)
Prescription (2)
Outcome on patient level (4)
1.5
Peters-Klimm et al. 200946; Germany Chronic systolic heart failure CT Yes (main outcome) 18 educational meeting with multifaceted approaches including structured case discussions on real patients, communication training and practice organisation; audit Diagnostic behaviour (2)
Prescription (4)
Outcome on patient level (6)
2
Redaèlli 201547; Germany Asthma CBA No (data presentation) Not reported educational meeting Knowledge transfer (1) 1.25
Romera et al. 201348; Spain Screening for depression CT Yes 30 1 day educational meeting by a psychiatrist in small group; monthly reminders by email and feedback from the PCP on adherence and feasibility Diagnostic behaviour (1)
Prescription (1)
2.25
Secher et al. 201249; Denmark Resuscitation CT Yes 216 distribution of guideline in direct mail, the cover letter outlining changes; supported by a poster Knowledge transfer (9) 2
Shah et al. 201450; Canada Cardiovascular disease CT Yes (main outcome) 40 distribution of a toolbox: an introductory letter; a synopsis of the key guideline elements pertaining to cardiovascular disease risk; a laminated card with an algorithm for risk assessment and screening for cardiovascular disease; and a pad of tear-off sheets for patients with risk self-assessment tool and a list of risk reduction strategies Outcome on patient level (15): in the harvest plot only
Diagnostic behaviour (5): in the harvest plot only
Prescription (10): in the harvest plot only
2.5
Sinnema 201551; the Netherlands Anxiety and depression CT Yes (main outcome) 12 educational meetings in both arms;
intervention only: motivational interview, networking targeted to identified barriers
Diagnostic behaviour (2)
Prescription (1)
Counselling (1)
2
Sipilä et al. 201152; Finland Hypertension CBA Yes (main outcomes) 25 16 educational meetings (lectures, workshops, patient cases and role modelling) and 12 distance learning tasks in 2 years; audit Prescription (16) 1.5
Skoglund et al. 201353; Sweden Hypertension CBA No (number of patient not provided) 408 Providing evidence-based drug information with motivational interview technique Prescription (1) 2.25
Soler et al. 201054; Spain Chronic obstructive pulmonary disease CBA Yes (main outcomes) 301 educational meeting by pulmonologists and training on spirometry Diagnostic behaviour (6)
Prescription (9)
2.5
Tahvonen 201655; Finland Spine radiography BA No (lack of control group) educational meeting, distribution Diagnostic behaviour (1) 1.5
Valles-Fernandez et el 201256; Spain Hypertension CT Yes 430 8 educational meetings in 2 years, supported by posters and leaflets, audit in every 6 months Diagnostic behaviour (1)
Outcome on patient level (1)
2
Verbiest 201457; the Netherlands Smoking cessation CT Yes (main outcome) 25 educational meeting, action planning Counselling (1) 1.75
Vidal Pardo et al. 201358; Spain Diabetes CBA Yes 58 educational meeting as 3 90-min workshops; supported by providing the educational material and by other online teaching resources as forum, tutorial and case resolution Diagnostic behaviour (10) 2.5
Wentworth et al. 201159; USA Kidney disease BA No (lack of control group) 3 distribution of educational material (1-page quick reference and patient guide); outreach visit as academic detailing and practice enhancement assistants implementing a computer-guided, point-of-care decision-support system, providing reminder during 1 year (RE-AIM framework) Diagnostic behaviour (8)
Prescription (4)
Outcome on patient level (4)
2

CT controlled trial; (C)BA (controlled) before-after study

Mean of the rating of four criteria (random allocation to the interventions, blinding the outcome assessors, completeness of the outcome data, avoiding selective reporting, each rated as no problem (3 points); probably no problem (2 points); and no info or a reported problem (1 point)

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