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

Lau, Rosa and Stevenson, Fiona and Ong, Bie Nio and Dziedzic, Krysia and Treweek, Shaun and Eldridge, Sandra and Everitt, Hazel and Kennedy, Anne and Qureshi, Nadeem and Rogers, Anne and Peacock, Richard and Murray, Elizabeth [Biomed Central] . (2016) Achieving change in primary care - causes of the evidence to practice gap: systematic reviews of reviews. BioMed Central. Implementation Science, 11 (40) doi: 10.1186/s13012-016-0396-4

URL: https://implementationscience.biomedcentral.com/ar...

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.


Item Type:Evidence resource
Publication Type:Review
Drug Type:Alcohol or other drugs in general
Intervention Type:AOD disorder, AOD disorder treatment method, Education and training
Source:Biomed Central
Date:22 March 2016
Page Range:p. 40
Publisher:BioMed Central
Volume:11
Number:40
EndNote:View
Subjects:HJ Treatment method > Treatment outcome
J Health care, prevention and rehabilitation > Health services, substance use research
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Provider / worker / staff attitude toward treatment
J Health care, prevention and rehabilitation > Health care programme or facility > Community-based treatment (primary care)
J Health care, prevention and rehabilitation > Health care administration > Health care quality control
MP-MR Policy, planning, economics, work and social services > Organisational development
MP-MR Policy, planning, economics, work and social services > Organisational development > Workforce / staff skills and training
N Communication, information and education > Information transfer > Information transfer from research to practice
R Research > Research outcome > Policy implications of research
R Research > Research dissemination
R Research > Type of research study > Review
T Demographic characteristics > Substance or health care worker
T Demographic characteristics > Doctor
T Demographic characteristics > Nurse
T Demographic characteristics > Social worker

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