Received: JAccepted: SeptemPublished: October 24, 2014Ĭopyright: © 2014 Unverzagt et al. PLoS ONE 9(10):Įditor: Harald Mischak, University of Glasgow, United Kingdom 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.Ĭitation: Unverzagt S, Peinemann F, Oemler M, Braun K, Klement A (2014) Meta-Regression Analyses to Explain Statistical Heterogeneity in a Systematic Review of Strategies for Guideline Implementation in Primary Health Care. This study aimed to identify effect modifiers of implementation strategies on physician adherence. 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. 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. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. 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. 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. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. 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.
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