Effectiveness of strategies to facilitate uptake or implementation of complex interventions: a systematic review of reviews
Effectiveness of strategies to facilitate uptake or implementation of complex interventions: a systematic review of reviews
Introduction
Research has consistently shown that many effective complex interventions are not taken up in practice. Getting evidence or complex interventions implemented into routine practice is often a challenge, particularly in primary care. Complex interventions are defined as interventions with several interacting components, e.g. prescribing decision support to aid guideline implementation, web-based self-management programme for people with type 2 diabetes. To bridge this evidence-to-practice gap, it is important to use effective methods/strategies to optimize implementation.
Aim/objectives
Assess the effectiveness of different strategies (single or multifaceted) for optimizing implementation of complex interventions; Assess the effects of strategies in different clinical areas (e.g. prevention, guideline, prescribing); Identify active components that contribute towards effective implementation; Describe cost-effectiveness evidence of these strategies.
Method
Five electronic databases were searched until December 2013. Citations and full-text papers were independently screened by two reviewers against pre-defined selection criteria [population: primary care in developed countries; intervention: implementation of complex interventions, by using single/multifaceted implementation strategies; comparison(s): usual care, no strategy, another strategy (single/multifaceted); outcomes: degree of implementation, e.g. process, professionals' behaviour or performance; study design: reviews]. Data were extracted using standardized data abstraction forms. A multi-step systematic process was developed; results were described narratively and the synthesis was guided by the pre-defined research questions.
Findings
91 reviews were included. For dichotomous outcomes, effects of educational outreach visits, audit & feedback, educational meetings and computerized reminders were small-moderate (some more variable than others). Multifaceted strategies were not necessarily better than single strategies. However, multifaceted strategies including organizational interventions (redefined role, enhanced multidisciplinary team work) appeared to be more effective in changing practice. Active (and inactive) components that contributed towards the effectiveness of implementation were identified. There was limited evidence on the cost-effectiveness of using these implementation strategies.
How the research advances dissemination and implementation
research
This work will provide a comprehensive overview of the topic by providing a deeper understanding of how to implement evidence-based approaches to improve service delivery and quality of patient care; and inspire individuals to think differently when planning and implementing a complex intervention in primary care. Implications for practice and future research were drawn from the findings of this review.
Funding
This Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
1-2
Lau, Rosa
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Stevenson, Fiona
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Ong, Bie Nio
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Dziedzic, Krysia
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Treweek, Shaun
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Eldridge, Sandra
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Everitt, Hazel
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Kennedy, Anne
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Qureshi, Nadeem
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Rogers, Anne
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Peacock, Richard
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Murray, Elizabeth
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14 August 2015
Lau, Rosa
03fb9ae0-3810-4805-99a8-060a89e1761d
Stevenson, Fiona
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Ong, Bie Nio
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Dziedzic, Krysia
b2fe3d66-6300-4bb8-8a9f-e895fa102603
Treweek, Shaun
2e309a54-c618-4a59-b0fd-2b878034cb98
Eldridge, Sandra
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Everitt, Hazel
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Kennedy, Anne
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Qureshi, Nadeem
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Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Peacock, Richard
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Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Lau, Rosa, Stevenson, Fiona, Ong, Bie Nio, Dziedzic, Krysia, Treweek, Shaun, Eldridge, Sandra, Everitt, Hazel, Kennedy, Anne, Qureshi, Nadeem, Rogers, Anne, Peacock, Richard and Murray, Elizabeth
(2015)
Effectiveness of strategies to facilitate uptake or implementation of complex interventions: a systematic review of reviews.
[in special issue: 7th Annual Conference on the Science of Dissemination and Implementation in Health]
Implementation Science, 10 (S1), supplement 1, , [A67].
(doi:10.1186/1748-5908-10-S1-A67).
Abstract
Introduction
Research has consistently shown that many effective complex interventions are not taken up in practice. Getting evidence or complex interventions implemented into routine practice is often a challenge, particularly in primary care. Complex interventions are defined as interventions with several interacting components, e.g. prescribing decision support to aid guideline implementation, web-based self-management programme for people with type 2 diabetes. To bridge this evidence-to-practice gap, it is important to use effective methods/strategies to optimize implementation.
Aim/objectives
Assess the effectiveness of different strategies (single or multifaceted) for optimizing implementation of complex interventions; Assess the effects of strategies in different clinical areas (e.g. prevention, guideline, prescribing); Identify active components that contribute towards effective implementation; Describe cost-effectiveness evidence of these strategies.
Method
Five electronic databases were searched until December 2013. Citations and full-text papers were independently screened by two reviewers against pre-defined selection criteria [population: primary care in developed countries; intervention: implementation of complex interventions, by using single/multifaceted implementation strategies; comparison(s): usual care, no strategy, another strategy (single/multifaceted); outcomes: degree of implementation, e.g. process, professionals' behaviour or performance; study design: reviews]. Data were extracted using standardized data abstraction forms. A multi-step systematic process was developed; results were described narratively and the synthesis was guided by the pre-defined research questions.
Findings
91 reviews were included. For dichotomous outcomes, effects of educational outreach visits, audit & feedback, educational meetings and computerized reminders were small-moderate (some more variable than others). Multifaceted strategies were not necessarily better than single strategies. However, multifaceted strategies including organizational interventions (redefined role, enhanced multidisciplinary team work) appeared to be more effective in changing practice. Active (and inactive) components that contributed towards the effectiveness of implementation were identified. There was limited evidence on the cost-effectiveness of using these implementation strategies.
How the research advances dissemination and implementation
research
This work will provide a comprehensive overview of the topic by providing a deeper understanding of how to implement evidence-based approaches to improve service delivery and quality of patient care; and inspire individuals to think differently when planning and implementing a complex intervention in primary care. Implications for practice and future research were drawn from the findings of this review.
Funding
This Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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Effectiveness of strategies to facilitate uptake or imlementation of complex interventions - a systematic review of reviews.pdf
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e-pub ahead of print date: 14 August 2015
Published date: 14 August 2015
Organisations:
Faculty of Health Sciences
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Local EPrints ID: 384339
URI: http://eprints.soton.ac.uk/id/eprint/384339
PURE UUID: ff0ed146-cd8c-492c-bca7-416bb121c29e
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Date deposited: 18 Dec 2015 11:49
Last modified: 15 Mar 2024 03:04
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Contributors
Author:
Rosa Lau
Author:
Fiona Stevenson
Author:
Bie Nio Ong
Author:
Krysia Dziedzic
Author:
Shaun Treweek
Author:
Sandra Eldridge
Author:
Anne Kennedy
Author:
Nadeem Qureshi
Author:
Richard Peacock
Author:
Elizabeth Murray
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