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

Rosa Lau (Corresponding Author), Fiona Stevenson, Bie Nio Ong, Krysia Dziedzic, Shaun Treweek, Sandra Eldridge, Hazel Everitt, Anne Kennedy, Nadeem Qureshi, Anne Rogers, Richard Peacock, Elizabeth Murray

Research output: Contribution to journalArticle

104 Citations (Scopus)
4 Downloads (Pure)

Abstract

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.
Original languageEnglish
Article number40
JournalImplementation Science
Volume11
DOIs
Publication statusPublished - 22 Mar 2016

Fingerprint

Primary Health Care
Guidelines
Technology
Professional Role
Preventive Medicine
Developed Countries
Libraries
Public Health
Organizations
Delivery of Health Care
Professional Practice Gaps

Keywords

  • barriers
  • complex interventions
  • evidence-based practice
  • facilitators
  • health services research
  • implementation research
  • primary care
  • systematic review

Cite this

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews. / Lau, Rosa (Corresponding Author); Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Treweek, Shaun; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Qureshi, Nadeem; Rogers, Anne; Peacock, Richard; Murray, Elizabeth.

In: Implementation Science, Vol. 11, 40, 22.03.2016.

Research output: Contribution to journalArticle

Lau, R, Stevenson, F, Ong, BN, Dziedzic, K, Treweek, S, Eldridge, S, Everitt, H, Kennedy, A, Qureshi, N, Rogers, A, Peacock, R & Murray, E 2016, 'Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews', Implementation Science, vol. 11, 40. https://doi.org/10.1186/s13012-016-0396-4
Lau, Rosa ; Stevenson, Fiona ; Ong, Bie Nio ; Dziedzic, Krysia ; Treweek, Shaun ; Eldridge, Sandra ; Everitt, Hazel ; Kennedy, Anne ; Qureshi, Nadeem ; Rogers, Anne ; Peacock, Richard ; Murray, Elizabeth. / Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews. In: Implementation Science. 2016 ; Vol. 11.
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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.",
keywords = "barriers , complex interventions, evidence-based practice, facilitators, health services research , implementation research, primary care, systematic review",
author = "Rosa Lau and Fiona Stevenson and Ong, {Bie Nio} and Krysia Dziedzic and Shaun Treweek and Sandra Eldridge and Hazel Everitt and Anne Kennedy and Nadeem Qureshi and Anne Rogers and Richard Peacock and Elizabeth Murray",
note = "Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).",
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T1 - Achieving change in primary care—causes of the evidence to practice gap

T2 - systematic reviews of reviews

AU - Lau, Rosa

AU - Stevenson, Fiona

AU - Ong, Bie Nio

AU - Dziedzic, Krysia

AU - Treweek, Shaun

AU - Eldridge, Sandra

AU - Everitt, Hazel

AU - Kennedy, Anne

AU - Qureshi, Nadeem

AU - Rogers, Anne

AU - Peacock, Richard

AU - Murray, Elizabeth

N1 - Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).

PY - 2016/3/22

Y1 - 2016/3/22

N2 - 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.

AB - 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.

KW - barriers

KW - complex interventions

KW - evidence-based practice

KW - facilitators

KW - health services research

KW - implementation research

KW - primary care

KW - systematic review

U2 - 10.1186/s13012-016-0396-4

DO - 10.1186/s13012-016-0396-4

M3 - Article

VL - 11

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

M1 - 40

ER -