Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
Top Cited Papers
- 1 January 2012
- journal article
- review article
- Published by Annals of Family Medicine in Annals of Family Medicine
- Vol. 10 (1), 63-74
- https://doi.org/10.1370/afm.1312
Abstract
PURPOSE This study was a systematic review with a quantitative synthesis of the literature examining the overall effect size of practice facilitation and possible moderating factors. The primary outcome was the change in evidence-based practice behavior calculated as a standardized mean difference. METHODS In this systematic review, we searched 4 electronic databases and the reference lists of published literature reviews to find practice facilitation studies that identified evidence-based guideline implementation within primary care practices as the outcome. We included randomized and nonrandomized controlled trials and prospective cohort studies published from 1966 to December 2010 in English language only peer-reviewed journals. Reviews of each study were conducted and assessed for quality; data were abstracted, and standardized mean difference estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias, influence, subgroup, and meta-regression analyses were also conducted. RESULTS Twenty-three studies contributed to the analysis for a total of 1,398 participating practices: 697 practice facilitation intervention and 701 control group practices. The degree of variability between studies was consistent with what would be expected to occur by chance alone (I-2 = 20%). An overall effect size of 0.56 (95% CI, 0.43-0.68) favored practice facilitation (z = 8.76; P < .001), and publication bias was evident. Primary care practices are 2.76 (95% CI, 2.18-3.43) times more likely to adopt evidence-based guidelines through practice facilitation. Meta-regression analysis indicated that tailoring (P = .05), the intensity of the intervention (P = .03), and the number of intervention practices per facilitator (P = .004) modified evidence-based guideline adoption. CONCLUSION Practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care. Implementation fidelity factors, such as tailoring, the number of practices per facilitator, and the intensity of the intervention, have important resource implications.Keywords
This publication has 99 references indexed in Scilit:
- Primary Care Practice Transformation is Hard WorkMedical Care, 2011
- Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot studyImplementation Science, 2010
- A Method for Estimating Relative Complexity of Ambulatory CareAnnals of Family Medicine, 2010
- Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration ProjectAnnals of Family Medicine, 2010
- Effect of Facilitation on Practice Outcomes in the National Demonstration Project Model of the Patient-Centered Medical HomeAnnals of Family Medicine, 2010
- Integrating Screening and Interventions for Unhealthy Behaviors into Primary Care PracticesAmerican Journal of Preventive Medicine, 2008
- Making research relevant: if it is an evidence-based practice, where's the practice-based evidence?Family Practice, 2008
- Evidence based medicine - The case of the misleading funnel plotBMJ, 2006
- Why Don't Physicians Follow Clinical Practice Guidelines?JAMA, 1999
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986