Table 1.
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)