P212 Review of Systematic Reviews Related to Clinical Guidelines Implementation. (15th August 2013) - Geba, D
Abstract : Background: Clinical guidelines should be implemented using evidence-based implementation strategies. However, guideline development programmes rarely allocate resources to perform evidence-based reviews of implementation strategies required to implement their guidelines. A streamlined approach to obtain such summaries of evidence in preparation for development of cardiovascular risk reduction guidelines sponsored by a national-level organisation was a review of systematic reviews (SRs) of implementation strategies. Objectives: To explore whether SRs of implementation strategies provide support for the effectiveness of these strategies. Methods Rx for Change database of the Canadian Agency for Drugs and Technologies in Health (CADTH) was selected a priori as data source for this review of systematic reviews. The review was limited to high quality SRs of interventions targeting clinicians. Results: A total of 12 SRs met study inclusion criteria. These SRs suggest that implementation strategies, such as audit and feedback, academic detailing, and educational meetings, are generally effective in improving providers' behaviours, with small to moderate effect sizes. Discussion: This review of SRs provides support for the overall efficacy of guideline implementation strategies, while highlighting the need for further comparative and cost effectiveness research to address gaps in the knowledge identified (e.g., limited information on head-to-head comparisons between strategies, clinical context, and cost of interventions). Implications for Guideline Developers/Users: Guideline developers should include recommendations for guideline implementation in their future guidelines. Making specific recommendations on choosing one implementation strategy over the others should be avoided until further head-to-head comparisons are available.