Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews
BackgroundThe underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. ObjectiveThis study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary ca...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-07-01
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| Series: | Interactive Journal of Medical Research |
| Online Access: | https://www.i-jmr.org/2022/2/e38419 |
| _version_ | 1797734943642615808 |
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| author | Claude Bernard Uwizeye Hervé Tchala Vignon Zomahoun André Bussières Aliki Thomas Dahlia Kairy José Massougbodji Nathalie Rheault Sébastien Tchoubi Leonel Philibert Serigne Abib Gaye Lobna Khadraoui Ali Ben Charif Ella Diendéré Léa Langlois Michèle Dugas France Légaré |
| author_facet | Claude Bernard Uwizeye Hervé Tchala Vignon Zomahoun André Bussières Aliki Thomas Dahlia Kairy José Massougbodji Nathalie Rheault Sébastien Tchoubi Leonel Philibert Serigne Abib Gaye Lobna Khadraoui Ali Ben Charif Ella Diendéré Léa Langlois Michèle Dugas France Légaré |
| author_sort | Claude Bernard Uwizeye |
| collection | DOAJ |
| description |
BackgroundThe underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception.
ObjectiveThis study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured.
MethodsWe performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis.
ResultsOf the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level.
ConclusionsClinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes. |
| first_indexed | 2024-03-12T12:51:22Z |
| format | Article |
| id | doaj.art-a618d11064f249c7ac6b526bc18a6f99 |
| institution | Directory Open Access Journal |
| issn | 1929-073X |
| language | English |
| last_indexed | 2024-03-12T12:51:22Z |
| publishDate | 2022-07-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Interactive Journal of Medical Research |
| spelling | doaj.art-a618d11064f249c7ac6b526bc18a6f992023-08-28T22:43:06ZengJMIR PublicationsInteractive Journal of Medical Research1929-073X2022-07-01112e3841910.2196/38419Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic ReviewsClaude Bernard Uwizeyehttps://orcid.org/0000-0002-3858-6567Hervé Tchala Vignon Zomahounhttps://orcid.org/0000-0001-6328-5451André Bussièreshttps://orcid.org/0000-0002-2818-6949Aliki Thomashttps://orcid.org/0000-0001-9807-6609Dahlia Kairyhttps://orcid.org/0000-0001-6872-6607José Massougbodjihttps://orcid.org/0000-0002-0355-0118Nathalie Rheaulthttps://orcid.org/0000-0003-1207-1335Sébastien Tchoubihttps://orcid.org/0000-0003-1363-3600Leonel Philiberthttps://orcid.org/0000-0002-9795-872XSerigne Abib Gayehttps://orcid.org/0000-0001-6983-0801Lobna Khadraouihttps://orcid.org/0000-0002-4792-9197Ali Ben Charifhttps://orcid.org/0000-0003-2893-2910Ella Diendéréhttps://orcid.org/0000-0003-3590-5128Léa Langloishttps://orcid.org/0000-0001-7461-6105Michèle Dugashttps://orcid.org/0000-0002-5112-6231France Légaréhttps://orcid.org/0000-0002-2296-6696 BackgroundThe underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. ObjectiveThis study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. MethodsWe performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. ResultsOf the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. ConclusionsClinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.https://www.i-jmr.org/2022/2/e38419 |
| spellingShingle | Claude Bernard Uwizeye Hervé Tchala Vignon Zomahoun André Bussières Aliki Thomas Dahlia Kairy José Massougbodji Nathalie Rheault Sébastien Tchoubi Leonel Philibert Serigne Abib Gaye Lobna Khadraoui Ali Ben Charif Ella Diendéré Léa Langlois Michèle Dugas France Légaré Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews Interactive Journal of Medical Research |
| title | Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews |
| title_full | Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews |
| title_fullStr | Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews |
| title_full_unstemmed | Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews |
| title_short | Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews |
| title_sort | implementation strategies for knowledge products in primary health care systematic review of systematic reviews |
| url | https://www.i-jmr.org/2022/2/e38419 |
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