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Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews

Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews
Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews
BACKGROUND: This study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care.

DESIGN: This study is a systematic review of reviews.

METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from inception to December 2013. Eligible reviews addressed causes of the evidence to practice gap in primary care in developed countries. Data from included reviews were extracted and synthesised using guidelines for meta-synthesis.

RESULTS: Seventy reviews fulfilled the inclusion criteria and encompassed a wide range of topics, e.g. guideline implementation, integration of new roles, technology implementation, public health and preventative medicine. None of the included papers used the term "cause" or stated an intention to investigate causes at all. A descriptive approach was often used, and the included papers expressed "causes" in terms of "barriers and facilitators" to implementation. We developed a four-level framework covering external context, organisation, professionals and intervention. External contextual factors included policies, incentivisation structures, dominant paradigms, stakeholders' buy-in, infrastructure and advances in technology. Organisation-related factors included culture, available resources, integration with existing processes, relationships, skill mix and staff involvement. At the level of individual professionals, professional role, underlying philosophy of care and competencies were important. Characteristics of the intervention that impacted on implementation included evidence of benefit, ease of use and adaptability to local circumstances. We postulate that the "fit" between the intervention and the context is critical in determining the success of implementation.

CONCLUSIONS: This comprehensive review of reviews summarises current knowledge on the barriers and facilitators to implementation of diverse complex interventions in primary care. To maximise the uptake of complex interventions in primary care, health care professionals and commissioning organisations should consider the range of contextual factors, remaining aware of the dynamic nature of context. Future studies should place an emphasis on describing context and articulating the relationships between the factors identified here.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014009410.
barriers, complex interventions, evidence-based practice, facilitators, health services reseach, implementation research, primary care, systematic review
1-39
Lau, Rosa
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Stevenson, Fiona
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Ong, Bie Nio
f967326a-f5e0-4571-821e-57f44e726d02
Dziedzic, Krysia
b2fe3d66-6300-4bb8-8a9f-e895fa102603
Treweek, Shaun
2e309a54-c618-4a59-b0fd-2b878034cb98
Eldridge, Sandra
0df61b1d-95f5-4108-a6a8-91a81afddbe9
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Qureshi, Nadeem
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Rogers, Anne
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Peacock, Richard
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Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Lau, Rosa
03fb9ae0-3810-4805-99a8-060a89e1761d
Stevenson, Fiona
881eb2a9-d7a8-449d-be50-ead6fda5cd3e
Ong, Bie Nio
f967326a-f5e0-4571-821e-57f44e726d02
Dziedzic, Krysia
b2fe3d66-6300-4bb8-8a9f-e895fa102603
Treweek, Shaun
2e309a54-c618-4a59-b0fd-2b878034cb98
Eldridge, Sandra
0df61b1d-95f5-4108-a6a8-91a81afddbe9
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Qureshi, Nadeem
48c1e15a-f152-4532-b657-ed2877dc0b6b
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Peacock, Richard
ddabbfb1-4edb-41ba-95cc-2b9053d9ce1a
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 (2016) Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews. Implementation Science, 11 (40), 1-39. (doi:10.1186/s13012-016-0396-4). (PMID:27001107)

Record type: Article

Abstract

BACKGROUND: This study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care.

DESIGN: This study is a systematic review of reviews.

METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from inception to December 2013. Eligible reviews addressed causes of the evidence to practice gap in primary care in developed countries. Data from included reviews were extracted and synthesised using guidelines for meta-synthesis.

RESULTS: Seventy reviews fulfilled the inclusion criteria and encompassed a wide range of topics, e.g. guideline implementation, integration of new roles, technology implementation, public health and preventative medicine. None of the included papers used the term "cause" or stated an intention to investigate causes at all. A descriptive approach was often used, and the included papers expressed "causes" in terms of "barriers and facilitators" to implementation. We developed a four-level framework covering external context, organisation, professionals and intervention. External contextual factors included policies, incentivisation structures, dominant paradigms, stakeholders' buy-in, infrastructure and advances in technology. Organisation-related factors included culture, available resources, integration with existing processes, relationships, skill mix and staff involvement. At the level of individual professionals, professional role, underlying philosophy of care and competencies were important. Characteristics of the intervention that impacted on implementation included evidence of benefit, ease of use and adaptability to local circumstances. We postulate that the "fit" between the intervention and the context is critical in determining the success of implementation.

CONCLUSIONS: This comprehensive review of reviews summarises current knowledge on the barriers and facilitators to implementation of diverse complex interventions in primary care. To maximise the uptake of complex interventions in primary care, health care professionals and commissioning organisations should consider the range of contextual factors, remaining aware of the dynamic nature of context. Future studies should place an emphasis on describing context and articulating the relationships between the factors identified here.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014009410.

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Accepted/In Press date: 28 February 2016
Published date: 22 March 2016
Keywords: barriers, complex interventions, evidence-based practice, facilitators, health services reseach, implementation research, primary care, systematic review
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 390343
URI: http://eprints.soton.ac.uk/id/eprint/390343
PURE UUID: c4b51201-92b6-433c-9a16-016df751158c
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Anne Kennedy: ORCID iD orcid.org/0000-0003-4570-9104

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Date deposited: 24 Mar 2016 11:52
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: Hazel Everitt ORCID iD
Author: Anne Kennedy ORCID iD
Author: Nadeem Qureshi
Author: Anne Rogers
Author: Richard Peacock
Author: Elizabeth Murray

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