Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.
Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.
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DOI：
10.1186/s13012-016-0396-4
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发表时间：
2016-03-22
期刊：
影响因子：
--
通讯作者：
Murray, Elizabeth
中科院分区：
文献类型：
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作者：
Lau, Rosa;Stevenson, Fiona;Murray, Elizabeth
背景技术背景：本研究旨在识别、总结和综合有关初级保健中复杂干预措施实践差距的证据的原因的文献。设计：本研究是对综述的系统性综述。方法：从开始到2013年12月，检索MEDLINE、EMBASE、CINAHL、科克伦图书馆和PsychINFO。合格的综述涉及发达国家初级保健中证据与实践差距的原因。从纳入审查的数据进行提取和综合使用指南为meta-synthesis.RESULTS：70评论满足纳入标准，涵盖了广泛的主题，如指南的实施，整合新的角色，技术的实施，公共卫生和预防医学。纳入的文献均未使用“原因”一词，也未说明打算调查原因。经常采用描述性方法，所纳入的文件用执行的“障碍和促进因素”来表述“原因”。我们制定了一个四个层次的框架，包括外部环境，组织，专业人员和干预。外部环境因素包括政策、激励结构、主导模式、利益攸关方的支持、基础设施和技术进步。与组织相关的因素包括文化、可用资源、与现有流程的整合、关系、技能组合和员工参与。在专业人员个人一级，专业角色、基本的护理理念和能力都很重要。影响实施的干预措施的特点包括效益证据、易用性和对当地情况的适应性。我们假设，“适合”之间的干预和上下文是至关重要的，在确定成功的implementation.CONCLUSIONS：这一全面的审查审查总结了目前的知识，在初级保健的障碍和促进者，以实施多样化的复杂干预措施。为了最大限度地提高初级保健中复杂干预措施的利用率，卫生保健专业人员和委托组织应考虑一系列背景因素，同时保持对背景动态性质的认识。未来的研究应该强调描述背景和阐明这里确定的因素之间的关系。
BACKGROUND: This study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care.DESIGN: This study is a systematic review of reviews.METHODS: MEDLINE, 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.RESULTS: Seventy 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.CONCLUSIONS: This 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.