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Interventions to improve adherence to cardiovascular disease guidelines: a systematic review

BACKGROUND: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and...

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Autores principales: Jeffery, Rebecca A., To, Matthew J., Hayduk-Costa, Gabrielle, Cameron, Adam, Taylor, Cameron, Van Zoost, Colin, Hayden, Jill A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619086/
https://www.ncbi.nlm.nih.gov/pubmed/26494597
http://dx.doi.org/10.1186/s12875-015-0341-7
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author Jeffery, Rebecca A.
To, Matthew J.
Hayduk-Costa, Gabrielle
Cameron, Adam
Taylor, Cameron
Van Zoost, Colin
Hayden, Jill A.
author_facet Jeffery, Rebecca A.
To, Matthew J.
Hayduk-Costa, Gabrielle
Cameron, Adam
Taylor, Cameron
Van Zoost, Colin
Hayden, Jill A.
author_sort Jeffery, Rebecca A.
collection PubMed
description BACKGROUND: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes. METHODS: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. RESULTS AND DISCUSSION: We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]). CONCLUSIONS: Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-015-0341-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-46190862015-10-25 Interventions to improve adherence to cardiovascular disease guidelines: a systematic review Jeffery, Rebecca A. To, Matthew J. Hayduk-Costa, Gabrielle Cameron, Adam Taylor, Cameron Van Zoost, Colin Hayden, Jill A. BMC Fam Pract Research Article BACKGROUND: Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes. METHODS: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. RESULTS AND DISCUSSION: We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]). CONCLUSIONS: Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-015-0341-7) contains supplementary material, which is available to authorized users. BioMed Central 2015-10-22 /pmc/articles/PMC4619086/ /pubmed/26494597 http://dx.doi.org/10.1186/s12875-015-0341-7 Text en © Jeffery et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Jeffery, Rebecca A.
To, Matthew J.
Hayduk-Costa, Gabrielle
Cameron, Adam
Taylor, Cameron
Van Zoost, Colin
Hayden, Jill A.
Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title_full Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title_fullStr Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title_full_unstemmed Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title_short Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
title_sort interventions to improve adherence to cardiovascular disease guidelines: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619086/
https://www.ncbi.nlm.nih.gov/pubmed/26494597
http://dx.doi.org/10.1186/s12875-015-0341-7
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