Universität zu Köln

Unverzagt, Susanne, Peinemann, Frank ORCID: 0000-0002-4727-1313, Oemler, Matthias, Braun, Kristin and Klement, Andreas (2014). Meta-Regression Analyses to Explain Statistical Heterogeneity in a Systematic Review of Strategies for Guideline Implementation in Primary Health Care. PLoS One, 9 (10). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

This study is an in-depth-analysis to explain statistical heterogeneity in a systematic review of implementation strategies to improve guideline adherence of primary care physicians in the treatment of patients with cardiovascular diseases. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Effect modifiers included the staff responsible for implementation, level of prevention and definition pf the primary outcome, unit of randomization, duration of follow-up and risk of bias. Six clinical and methodological factors were investigated as potential effect modifiers of the efficacy of different implementation strategies on guideline adherence in primary care practices on the basis of information from 75 eligible trials. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. Physician adherence was improved by 62% (95% confidence interval (95% CI) 29 to 104%) or 29% (95% CI 5 to 60%) in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of cardiovascular diseases by around 30% (30%; 95% CI -2 to 71% and 31%; 95% CI 9 to 57%, respectively) compared to tertiary prevention. This study aimed to identify effect modifiers of implementation strategies on physician adherence. Especially the cooperation of different health professionals in primary care practices might increase efficacy and guideline implementation seems to be more difficult in tertiary prevention of cardiovascular diseases.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Unverzagt, Susanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Peinemann, Frank UNSPECIFIED orcid.org/0000-0002-4727-1313 UNSPECIFIED Oemler, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Braun, Kristin UNSPECIFIED UNSPECIFIED UNSPECIFIED Klement, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-425547
DOI:	10.1371/journal.pone.0110619
Journal or Publication Title:	PLoS One
Volume:	9
Number:	10
Date:	2014
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RANDOMIZED CONTROLLED-TRIAL; BLOOD-PRESSURE CONTROL; CORONARY-ARTERY DISEASE; DECISION-SUPPORT-SYSTEM; CHRONIC HEART-FAILURE; QUALITY-OF-CARE; SECONDARY PREVENTION; GENERAL-PRACTICE; MYOCARDIAL-INFARCTION; CLINICAL REMINDERS Multiple languages Multidisciplinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42554