Evidence map›Paper›PMID 27001107›Full record

SynthesisImplementation science : IS2016

Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.

Rosa Lau, Fiona Stevenson, Bie Nio Ong, Krysia Dziedzic, Shaun Treweek, Sandra Eldridge, Hazel Everitt, Anne Kennedy, Nadeem Qureshi, Anne Rogers and 2 more

2 registry-linked trialsAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Implementation science : IS, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 277 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
277citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05466656 naunknown statusnot on this mapstarted 2021, after this paper: background citation

SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Second Edition)

TypeinterventionalSponsorTeresa Moreno CasbasRan2021 to 2024Enrolled115ConditionsPain, Incontinence, Urinary, Obesity, Childhood, BreastfeedingArmsContinuous quality improvement cycle model
NCT06522529 naunknown statusnot on this mapstarted 2024, after this paper: background citation

SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Thrid Edition)

TypeinterventionalSponsorInstituto de Salud Carlos IIIRan2024 to 2026Enrolled400ConditionsPain, Obesity, Childhood, Breast Feeding, Incontinence, UrinaryArmsMultifaceted implementation strategy
3 · Its place in the literature

Who cites it

277 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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217 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Rosa LaueHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. r.lau@ucl.ac.uk.ORCID http://orcid.org/0000-0003-0625-2228
Fiona StevensoneHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
Bie Nio OngArthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, Staffordshire, UK.
Krysia DziedzicArthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, Staffordshire, UK.
Shaun TreweekHealth Services Research Unit, University of Aberdeen, Aberdeen, UK.
Sandra EldridgeCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Hazel EverittPrimary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Anne KennedyFaculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
Nadeem QureshiDivision of Primary Care, University of Nottingham, Nottingham, UK.
Anne RogersFaculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
Richard PeacockArchway Healthcare Library, London, UK.
Elizabeth MurrayeHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.

Funding

Chief Scientist Office HSRU1Department of Health CAT CDRF 10-018Department of Health KMRF-2014-03-002
6 · The paper itself

Abstract

backgroundThis study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care.

designThis study is a systematic review of reviews.

methodsMEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from inception to December 2013. Eligible reviews addressed causes of the evidence to practice gap in primary care in developed countries. Data from included reviews were extracted and synthesised using guidelines for meta-synthesis.

resultsSeventy reviews fulfilled the inclusion criteria and encompassed a wide range of topics, e.g. guideline implementation, integration of new roles, technology implementation, public health and preventative medicine. None of the included papers used the term "cause" or stated an intention to investigate causes at all. A descriptive approach was often used, and the included papers expressed "causes" in terms of "barriers and facilitators" to implementation. We developed a four-level framework covering external context, organisation, professionals and intervention. External contextual factors included policies, incentivisation structures, dominant paradigms, stakeholders' buy-in, infrastructure and advances in technology. Organisation-related factors included culture, available resources, integration with existing processes, relationships, skill mix and staff involvement. At the level of individual professionals, professional role, underlying philosophy of care and competencies were important. Characteristics of the intervention that impacted on implementation included evidence of benefit, ease of use and adaptability to local circumstances. We postulate that the "fit" between the intervention and the context is critical in determining the success of implementation.

conclusionsThis comprehensive review of reviews summarises current knowledge on the barriers and facilitators to implementation of diverse complex interventions in primary care. To maximise the uptake of complex interventions in primary care, health care professionals and commissioning organisations should consider the range of contextual factors, remaining aware of the dynamic nature of context. Future studies should place an emphasis on describing context and articulating the relationships between the factors identified here. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014009410.

Indexed as

Evidence-Based PracticeHealth Services ResearchPrimary Health CareTranslational Research, BiomedicalHumansBarriersComplex interventionsEvidence-based practiceFacilitatorsHealth services researchImplementation researchPrimary careSystematic review

Identifiers

PMID27001107
PMCPMC4802575

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.