An adaptable implementation package targeting evidence-based indicators in primary care: A pragmatic cluster-randomised evaluation
In primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed...
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| Vydané v: | PLoS medicine Ročník 17; číslo 2; s. e1003045 |
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| Hlavní autori: | , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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United States
Public Library of Science
01.02.2020
Public Library of Science (PLoS) |
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| ISSN: | 1549-1676, 1549-1277, 1549-1676 |
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| Abstract | In primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed effects on adherence to four different evidence-based quality indicators.
We undertook two parallel, pragmatic cluster-randomised trials using balanced incomplete block designs in general practices in West Yorkshire, England. We used 'opt-out' recruitment, and we randomly assigned practices that did not opt out to an implementation package targeting either diabetes control or risky prescribing (Trial 1); or blood pressure (BP) control or anticoagulation in atrial fibrillation (AF) (Trial 2). Within trials, each arm acted as the implementation control comparison for the other targeted indicator. For example, practices assigned to the diabetes control package acted as the comparison for practices assigned to the risky prescribing package. The implementation package embedded behaviour change techniques within audit and feedback, educational outreach, and computerised support, with content tailored to each indicator. Respective patient-level primary endpoints at 11 months comprised the following: achievement of all recommended levels of haemoglobin A1c (HbA1c), BP, and cholesterol; risky prescribing levels; achievement of recommended BP; and anticoagulation prescribing. Between February and March 2015, we recruited 144 general practices collectively serving over 1 million patients. We stratified computer-generated randomisation by area, list size, and pre-intervention outcome achievement. In April 2015, we randomised 80 practices to Trial 1 (40 per arm) and 64 to Trial 2 (32 per arm). Practices and trial personnel were not blind to allocation. Two practices were lost to follow-up but provided some outcome data. We analysed the intention-to-treat (ITT) population, adjusted for potential confounders at patient level (sex, age) and practice level (list size, locality, pre-intervention achievement against primary outcomes, total quality scores, and levels of patient co-morbidity), and analysed cost-effectiveness. The implementation package reduced risky prescribing (odds ratio [OR] 0.82; 97.5% confidence interval [CI] 0.67-0.99, p = 0.017) with an incremental cost-effectiveness ratio of £1,359 per quality-adjusted life year (QALY), but there was insufficient evidence of effect on other primary endpoints (diabetes control OR 1.03, 97.5% CI 0.89-1.18, p = 0.693; BP control OR 1.05, 97.5% CI 0.96-1.16, p = 0.215; anticoagulation prescribing OR 0.90, 97.5% CI 0.75-1.09, p = 0.214). No statistically significant effects were observed in any secondary outcome except for reduced co-prescription of aspirin and clopidogrel without gastro-protection in patients aged 65 and over (adjusted OR 0.62; 97.5% CI 0.39-0.99; p = 0.021). Main study limitations concern our inability to make any inferences about the relative effects of individual intervention components, given the multifaceted nature of the implementation package, and that the composite endpoint for diabetes control may have been too challenging to achieve.
In this study, we observed that a multifaceted implementation package was clinically and cost-effective for targeting prescribing behaviours within the control of clinicians but not for more complex behaviours that also required patient engagement.
The study is registered with the ISRCTN registry (ISRCTN91989345). |
|---|---|
| AbstractList | In primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed effects on adherence to four different evidence-based quality indicators.BACKGROUNDIn primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed effects on adherence to four different evidence-based quality indicators.We undertook two parallel, pragmatic cluster-randomised trials using balanced incomplete block designs in general practices in West Yorkshire, England. We used 'opt-out' recruitment, and we randomly assigned practices that did not opt out to an implementation package targeting either diabetes control or risky prescribing (Trial 1); or blood pressure (BP) control or anticoagulation in atrial fibrillation (AF) (Trial 2). Within trials, each arm acted as the implementation control comparison for the other targeted indicator. For example, practices assigned to the diabetes control package acted as the comparison for practices assigned to the risky prescribing package. The implementation package embedded behaviour change techniques within audit and feedback, educational outreach, and computerised support, with content tailored to each indicator. Respective patient-level primary endpoints at 11 months comprised the following: achievement of all recommended levels of haemoglobin A1c (HbA1c), BP, and cholesterol; risky prescribing levels; achievement of recommended BP; and anticoagulation prescribing. Between February and March 2015, we recruited 144 general practices collectively serving over 1 million patients. We stratified computer-generated randomisation by area, list size, and pre-intervention outcome achievement. In April 2015, we randomised 80 practices to Trial 1 (40 per arm) and 64 to Trial 2 (32 per arm). Practices and trial personnel were not blind to allocation. Two practices were lost to follow-up but provided some outcome data. We analysed the intention-to-treat (ITT) population, adjusted for potential confounders at patient level (sex, age) and practice level (list size, locality, pre-intervention achievement against primary outcomes, total quality scores, and levels of patient co-morbidity), and analysed cost-effectiveness. The implementation package reduced risky prescribing (odds ratio [OR] 0.82; 97.5% confidence interval [CI] 0.67-0.99, p = 0.017) with an incremental cost-effectiveness ratio of £1,359 per quality-adjusted life year (QALY), but there was insufficient evidence of effect on other primary endpoints (diabetes control OR 1.03, 97.5% CI 0.89-1.18, p = 0.693; BP control OR 1.05, 97.5% CI 0.96-1.16, p = 0.215; anticoagulation prescribing OR 0.90, 97.5% CI 0.75-1.09, p = 0.214). No statistically significant effects were observed in any secondary outcome except for reduced co-prescription of aspirin and clopidogrel without gastro-protection in patients aged 65 and over (adjusted OR 0.62; 97.5% CI 0.39-0.99; p = 0.021). Main study limitations concern our inability to make any inferences about the relative effects of individual intervention components, given the multifaceted nature of the implementation package, and that the composite endpoint for diabetes control may have been too challenging to achieve.METHODS AND FINDINGSWe undertook two parallel, pragmatic cluster-randomised trials using balanced incomplete block designs in general practices in West Yorkshire, England. We used 'opt-out' recruitment, and we randomly assigned practices that did not opt out to an implementation package targeting either diabetes control or risky prescribing (Trial 1); or blood pressure (BP) control or anticoagulation in atrial fibrillation (AF) (Trial 2). Within trials, each arm acted as the implementation control comparison for the other targeted indicator. For example, practices assigned to the diabetes control package acted as the comparison for practices assigned to the risky prescribing package. The implementation package embedded behaviour change techniques within audit and feedback, educational outreach, and computerised support, with content tailored to each indicator. Respective patient-level primary endpoints at 11 months comprised the following: achievement of all recommended levels of haemoglobin A1c (HbA1c), BP, and cholesterol; risky prescribing levels; achievement of recommended BP; and anticoagulation prescribing. Between February and March 2015, we recruited 144 general practices collectively serving over 1 million patients. We stratified computer-generated randomisation by area, list size, and pre-intervention outcome achievement. In April 2015, we randomised 80 practices to Trial 1 (40 per arm) and 64 to Trial 2 (32 per arm). Practices and trial personnel were not blind to allocation. Two practices were lost to follow-up but provided some outcome data. We analysed the intention-to-treat (ITT) population, adjusted for potential confounders at patient level (sex, age) and practice level (list size, locality, pre-intervention achievement against primary outcomes, total quality scores, and levels of patient co-morbidity), and analysed cost-effectiveness. The implementation package reduced risky prescribing (odds ratio [OR] 0.82; 97.5% confidence interval [CI] 0.67-0.99, p = 0.017) with an incremental cost-effectiveness ratio of £1,359 per quality-adjusted life year (QALY), but there was insufficient evidence of effect on other primary endpoints (diabetes control OR 1.03, 97.5% CI 0.89-1.18, p = 0.693; BP control OR 1.05, 97.5% CI 0.96-1.16, p = 0.215; anticoagulation prescribing OR 0.90, 97.5% CI 0.75-1.09, p = 0.214). No statistically significant effects were observed in any secondary outcome except for reduced co-prescription of aspirin and clopidogrel without gastro-protection in patients aged 65 and over (adjusted OR 0.62; 97.5% CI 0.39-0.99; p = 0.021). Main study limitations concern our inability to make any inferences about the relative effects of individual intervention components, given the multifaceted nature of the implementation package, and that the composite endpoint for diabetes control may have been too challenging to achieve.In this study, we observed that a multifaceted implementation package was clinically and cost-effective for targeting prescribing behaviours within the control of clinicians but not for more complex behaviours that also required patient engagement.CONCLUSIONSIn this study, we observed that a multifaceted implementation package was clinically and cost-effective for targeting prescribing behaviours within the control of clinicians but not for more complex behaviours that also required patient engagement.The study is registered with the ISRCTN registry (ISRCTN91989345).TRIAL REGISTRATIONThe study is registered with the ISRCTN registry (ISRCTN91989345). In a pragmatic cluster-randomized evaluation, Thomas Willis and colleagues investigate the clinical and cost-effectiveness of an adaptable implementation package to improve evidence-based indicators of patient health in primary care practices in the UK. In primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed effects on adherence to four different evidence-based quality indicators. We undertook two parallel, pragmatic cluster-randomised trials using balanced incomplete block designs in general practices in West Yorkshire, England. We used 'opt-out' recruitment, and we randomly assigned practices that did not opt out to an implementation package targeting either diabetes control or risky prescribing (Trial 1); or blood pressure (BP) control or anticoagulation in atrial fibrillation (AF) (Trial 2). Within trials, each arm acted as the implementation control comparison for the other targeted indicator. For example, practices assigned to the diabetes control package acted as the comparison for practices assigned to the risky prescribing package. The implementation package embedded behaviour change techniques within audit and feedback, educational outreach, and computerised support, with content tailored to each indicator. Respective patient-level primary endpoints at 11 months comprised the following: achievement of all recommended levels of haemoglobin A1c (HbA1c), BP, and cholesterol; risky prescribing levels; achievement of recommended BP; and anticoagulation prescribing. Between February and March 2015, we recruited 144 general practices collectively serving over 1 million patients. We stratified computer-generated randomisation by area, list size, and pre-intervention outcome achievement. In April 2015, we randomised 80 practices to Trial 1 (40 per arm) and 64 to Trial 2 (32 per arm). Practices and trial personnel were not blind to allocation. Two practices were lost to follow-up but provided some outcome data. We analysed the intention-to-treat (ITT) population, adjusted for potential confounders at patient level (sex, age) and practice level (list size, locality, pre-intervention achievement against primary outcomes, total quality scores, and levels of patient co-morbidity), and analysed cost-effectiveness. The implementation package reduced risky prescribing (odds ratio [OR] 0.82; 97.5% confidence interval [CI] 0.67-0.99, p = 0.017) with an incremental cost-effectiveness ratio of £1,359 per quality-adjusted life year (QALY), but there was insufficient evidence of effect on other primary endpoints (diabetes control OR 1.03, 97.5% CI 0.89-1.18, p = 0.693; BP control OR 1.05, 97.5% CI 0.96-1.16, p = 0.215; anticoagulation prescribing OR 0.90, 97.5% CI 0.75-1.09, p = 0.214). No statistically significant effects were observed in any secondary outcome except for reduced co-prescription of aspirin and clopidogrel without gastro-protection in patients aged 65 and over (adjusted OR 0.62; 97.5% CI 0.39-0.99; p = 0.021). Main study limitations concern our inability to make any inferences about the relative effects of individual intervention components, given the multifaceted nature of the implementation package, and that the composite endpoint for diabetes control may have been too challenging to achieve. In this study, we observed that a multifaceted implementation package was clinically and cost-effective for targeting prescribing behaviours within the control of clinicians but not for more complex behaviours that also required patient engagement. The study is registered with the ISRCTN registry (ISRCTN91989345). BACKGROUND:In primary care, multiple priorities and system pressures make closing the gap between evidence and practice challenging. Most implementation studies focus on single conditions, limiting generalisability. We compared an adaptable implementation package against an implementation control and assessed effects on adherence to four different evidence-based quality indicators. METHODS AND FINDINGS:We undertook two parallel, pragmatic cluster-randomised trials using balanced incomplete block designs in general practices in West Yorkshire, England. We used 'opt-out' recruitment, and we randomly assigned practices that did not opt out to an implementation package targeting either diabetes control or risky prescribing (Trial 1); or blood pressure (BP) control or anticoagulation in atrial fibrillation (AF) (Trial 2). Within trials, each arm acted as the implementation control comparison for the other targeted indicator. For example, practices assigned to the diabetes control package acted as the comparison for practices assigned to the risky prescribing package. The implementation package embedded behaviour change techniques within audit and feedback, educational outreach, and computerised support, with content tailored to each indicator. Respective patient-level primary endpoints at 11 months comprised the following: achievement of all recommended levels of haemoglobin A1c (HbA1c), BP, and cholesterol; risky prescribing levels; achievement of recommended BP; and anticoagulation prescribing. Between February and March 2015, we recruited 144 general practices collectively serving over 1 million patients. We stratified computer-generated randomisation by area, list size, and pre-intervention outcome achievement. In April 2015, we randomised 80 practices to Trial 1 (40 per arm) and 64 to Trial 2 (32 per arm). Practices and trial personnel were not blind to allocation. Two practices were lost to follow-up but provided some outcome data. We analysed the intention-to-treat (ITT) population, adjusted for potential confounders at patient level (sex, age) and practice level (list size, locality, pre-intervention achievement against primary outcomes, total quality scores, and levels of patient co-morbidity), and analysed cost-effectiveness. The implementation package reduced risky prescribing (odds ratio [OR] 0.82; 97.5% confidence interval [CI] 0.67-0.99, p = 0.017) with an incremental cost-effectiveness ratio of £1,359 per quality-adjusted life year (QALY), but there was insufficient evidence of effect on other primary endpoints (diabetes control OR 1.03, 97.5% CI 0.89-1.18, p = 0.693; BP control OR 1.05, 97.5% CI 0.96-1.16, p = 0.215; anticoagulation prescribing OR 0.90, 97.5% CI 0.75-1.09, p = 0.214). No statistically significant effects were observed in any secondary outcome except for reduced co-prescription of aspirin and clopidogrel without gastro-protection in patients aged 65 and over (adjusted OR 0.62; 97.5% CI 0.39-0.99; p = 0.021). Main study limitations concern our inability to make any inferences about the relative effects of individual intervention components, given the multifaceted nature of the implementation package, and that the composite endpoint for diabetes control may have been too challenging to achieve. CONCLUSIONS:In this study, we observed that a multifaceted implementation package was clinically and cost-effective for targeting prescribing behaviours within the control of clinicians but not for more complex behaviours that also required patient engagement. TRIAL REGISTRATION:The study is registered with the ISRCTN registry (ISRCTN91989345). |
| Author | Carder, Paul Hartley, Suzanne Johnson, Stella Alderson, Sarah Meads, David Foy, Robbie Glidewell, Liz Hulme, Claire Vargas-Palacios, Armando Farrin, Amanda J. Petty, Duncan Collinson, Michelle Holland, Michael Willis, Thomas A. |
| AuthorAffiliation | 4 College of Medicine and Health, University of Exeter, Exeter, United Kingdom 1 Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom 2 Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom 6 West Yorkshire Research and Development, NHS Bradford Districts CCG, Bradford, United Kingdom Harvard Medical School, UNITED STATES 3 Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom 5 School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom |
| AuthorAffiliation_xml | – name: 4 College of Medicine and Health, University of Exeter, Exeter, United Kingdom – name: 1 Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom – name: 6 West Yorkshire Research and Development, NHS Bradford Districts CCG, Bradford, United Kingdom – name: 5 School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom – name: 2 Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom – name: 3 Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom – name: Harvard Medical School, UNITED STATES |
| Author_xml | – sequence: 1 givenname: Thomas A. orcidid: 0000-0002-0252-9923 surname: Willis fullname: Willis, Thomas A. – sequence: 2 givenname: Michelle orcidid: 0000-0003-3568-6455 surname: Collinson fullname: Collinson, Michelle – sequence: 3 givenname: Liz orcidid: 0000-0003-2519-2654 surname: Glidewell fullname: Glidewell, Liz – sequence: 4 givenname: Amanda J. orcidid: 0000-0002-2876-0584 surname: Farrin fullname: Farrin, Amanda J. – sequence: 5 givenname: Michael orcidid: 0000-0002-6331-5398 surname: Holland fullname: Holland, Michael – sequence: 6 givenname: David orcidid: 0000-0003-1369-2483 surname: Meads fullname: Meads, David – sequence: 7 givenname: Claire orcidid: 0000-0003-2077-0419 surname: Hulme fullname: Hulme, Claire – sequence: 8 givenname: Duncan orcidid: 0000-0003-2763-0726 surname: Petty fullname: Petty, Duncan – sequence: 9 givenname: Sarah orcidid: 0000-0002-5418-0495 surname: Alderson fullname: Alderson, Sarah – sequence: 10 givenname: Suzanne surname: Hartley fullname: Hartley, Suzanne – sequence: 11 givenname: Armando orcidid: 0000-0002-6503-0134 surname: Vargas-Palacios fullname: Vargas-Palacios, Armando – sequence: 12 givenname: Paul orcidid: 0000-0002-7940-6016 surname: Carder fullname: Carder, Paul – sequence: 13 givenname: Stella orcidid: 0000-0002-2832-052X surname: Johnson fullname: Johnson, Stella – sequence: 14 givenname: Robbie surname: Foy fullname: Foy, Robbie |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32109257$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1007/s00125-013-2940-y 10.1016/S0140-6736(16)00620-6 10.1016/S0140-6736(14)61212-5 10.1016/j.jclinepi.2013.08.015 10.1371/journal.pone.0177949 10.1016/S0140-6736(12)60480-2 10.1136/bmj.h2147 10.1136/qhc.12.1.47 10.1111/j.1365-2125.2006.02698.x 10.1056/NEJMsa055505 10.1093/fampra/cmw003 10.1136/bmj.a1655 10.1161/STROKEAHA.116.015468 10.1136/bmj.i4079 10.1056/NEJMsa1508955 10.1001/jama.299.10.1182 10.1136/bmjopen-2015-010276 10.3310/hta8060 10.1001/jamainternmed.2016.6217 10.1016/S0140-6736(16)00215-4 10.1016/S0140-6736(11)61817-5 10.1016/S0140-6736(11)61184-7 10.1186/s12875-015-0350-6 10.1136/bmj.317.7162.858 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Membership of the ASPIRE programme team is provided in the Acknowledgements. I have read the journal’s policy and the authors of this manuscript have the following competing interests: PC and SJ are employed by NHS Bradford Districts CCG, which commissioned and funded Prescribing Support Services Ltd. (PSS; DP’s practice pharmacy company) to conduct the educational outreach visits as part of the implementation package. The commission followed established NHS commissioning guidelines. DP was responsible for the recruitment and training of pharmacist-facilitators to deliver the educational outreach visits. Neither he nor the facilitators were involved in the analysis. PC and SJ were not involved in the implementation or analysis of the study. SA was funded by an NIHR academic clinical lectureship (2014-2019). RF received grant funding from NIHR Programme Grants for Applied Research during the conduct of this study. There are no other relationships or activities that could appear to have influenced the submitted work. All authors have completed the ICMJE uniform disclosure form at www.icjme.org/coi_disclosure.pdf. |
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| References | AJ Hayes (pmed.1003045.ref022) 2013; 56 T Doran (pmed.1003045.ref021) 2006; 355 R Baker (pmed.1003045.ref025) 2015 National Institute for Health and Care Excellence (pmed.1003045.ref008) 2015 AC Tricco (pmed.1003045.ref029) 2012; 379 KG Shojania (pmed.1003045.ref014) 2009 FDR Hobbs (pmed.1003045.ref004) 2016; 387 DM Levine (pmed.1003045.ref001) 2016; 176 DM Berwick (pmed.1003045.ref031) 2008; 299 M Hallsworth (pmed.1003045.ref034) 2016; 387 TA Holt (pmed.1003045.ref036) 2017; 48 B Rushforth (pmed.1003045.ref005) 2015; 16 N Ivers (pmed.1003045.ref012) 2012 L Glidewell (pmed.1003045.ref016) 2018; 13 National Institute for Health and Care Excellence (pmed.1003045.ref011) 2014 B Baird (pmed.1003045.ref003) 2016 T Dreischulte (pmed.1003045.ref027) 2016; 374 TA Willis (pmed.1003045.ref020) 2016; 11 RL Howard (pmed.1003045.ref009) 2007; 63 JM Grimshaw (pmed.1003045.ref006) 2004; 8 B Guthrie (pmed.1003045.ref028) 2016; 354 The Blood Pressure Lowering Treatment Trialists’ Collaboration (pmed.1003045.ref010) 2014; 384 R Foy (pmed.1003045.ref035) 2016; 6 AJ Avery (pmed.1003045.ref026) 2012; 379 P Craig (pmed.1003045.ref032) 2008; 337 J McCambridge (pmed.1003045.ref030) 2014; 67 K Loudon (pmed.1003045.ref018) 2015; 350 pmed.1003045.ref024 R Grol (pmed.1003045.ref033) 1998; 317 PA Lord (pmed.1003045.ref019) 2016; 33 R Cooksey (pmed.1003045.ref002) 2006 K Lovibond (pmed.1003045.ref023) 2011; 378 MA O’Brien (pmed.1003045.ref013) 2007 M Eccles (pmed.1003045.ref017) 2003; 12 R Lawton (pmed.1003045.ref015) 2016; 11 TA Willis (pmed.1003045.ref007) 2017; 12 |
| References_xml | – volume-title: Atrial fibrillation: the management of atrial fibrillation year: 2014 ident: pmed.1003045.ref011 – volume: 56 start-page: 1925 issue: 9 year: 2013 ident: pmed.1003045.ref022 article-title: UKPDS Outcomes Model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30 year United Kingdom Prospective Diabetes Study: UKPDS 82 publication-title: Diabetologia doi: 10.1007/s00125-013-2940-y – volume: 387 start-page: 2323 issue: 10035 year: 2016 ident: pmed.1003045.ref004 article-title: Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14 publication-title: Lancet doi: 10.1016/S0140-6736(16)00620-6 – start-page: CD001096 issue: 3 year: 2009 ident: pmed.1003045.ref014 article-title: The effects of on-screen, point of care computer reminders on processes and outcomes of care publication-title: Cochrane Database Syst Rev – start-page: CD000409 issue: 4 year: 2007 ident: pmed.1003045.ref013 article-title: Educational outreach visits: effects on professional practice and health care outcomes publication-title: Cochrane Database Syst Rev – volume: 384 start-page: 591 issue: 9943 year: 2014 ident: pmed.1003045.ref010 article-title: Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data publication-title: Lancet doi: 10.1016/S0140-6736(14)61212-5 – volume: 67 start-page: 267 issue: 3 year: 2014 ident: pmed.1003045.ref030 article-title: Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects publication-title: J Clin Epidemiol doi: 10.1016/j.jclinepi.2013.08.015 – volume-title: Understanding pressures in general practice year: 2016 ident: pmed.1003045.ref003 – volume: 12 start-page: e0177949 issue: 7 year: 2017 ident: pmed.1003045.ref007 article-title: Variations in achievement of evidence-based, high-impact quality indicators in general practice: an observational study publication-title: PLoS ONE doi: 10.1371/journal.pone.0177949 – volume: 379 start-page: 2252 issue: 9833 year: 2012 ident: pmed.1003045.ref029 article-title: Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis publication-title: Lancet doi: 10.1016/S0140-6736(12)60480-2 – volume: 350 start-page: h2147 year: 2015 ident: pmed.1003045.ref018 article-title: The PRECIS-2 tool: designing trials that are fit for purpose publication-title: BMJ doi: 10.1136/bmj.h2147 – start-page: CD000259 issue: 6 year: 2012 ident: pmed.1003045.ref012 article-title: Audit and feedback: effects on professional practice and patient outcomes publication-title: Cochrane Database Syst Rev – volume: 12 start-page: 47 issue: 1 year: 2003 ident: pmed.1003045.ref017 article-title: Research designs for studies evaluating the effectiveness of change and improvement strategies publication-title: Qual Saf Health Care doi: 10.1136/qhc.12.1.47 – volume: 63 start-page: 136 issue: 2 year: 2007 ident: pmed.1003045.ref009 article-title: Which drugs cause preventable admissions to hospital? A systematic review publication-title: Brit J Clin Pharmacol doi: 10.1111/j.1365-2125.2006.02698.x – volume: 355 start-page: 375 issue: 4 year: 2006 ident: pmed.1003045.ref021 article-title: Pay-for-performance programs in family practices in the United Kingdom publication-title: N Engl J Med doi: 10.1056/NEJMsa055505 – volume: 13 issue: 32 year: 2018 ident: pmed.1003045.ref016 article-title: To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis publication-title: Implement Sci – start-page: CD005470 issue: 4 year: 2015 ident: pmed.1003045.ref025 article-title: Tailored interventions to address determinants of practice publication-title: Cochrane Database Syst Rev – volume: 33 start-page: 200 issue: 2 year: 2016 ident: pmed.1003045.ref019 article-title: Optimizing primary care research participation: a comparison of three recruitment methods in data-sharing studies publication-title: Fam Pract doi: 10.1093/fampra/cmw003 – ident: pmed.1003045.ref024 – volume: 337 start-page: a1655 year: 2008 ident: pmed.1003045.ref032 article-title: Developing and evaluating complex interventions: the new Medical Research Council guidance publication-title: BMJ doi: 10.1136/bmj.a1655 – volume: 48 start-page: 787 issue: 3 year: 2017 ident: pmed.1003045.ref036 article-title: Automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial publication-title: Stroke doi: 10.1161/STROKEAHA.116.015468 – volume-title: A review of UK health research funding year: 2006 ident: pmed.1003045.ref002 – volume: 11 issue: 113 year: 2016 ident: pmed.1003045.ref015 article-title: Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study publication-title: Implement Sci – volume: 354 start-page: i4079 year: 2016 ident: pmed.1003045.ref028 article-title: Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial publication-title: BMJ doi: 10.1136/bmj.i4079 – volume-title: Type 2 diabetes in adults: management year: 2015 ident: pmed.1003045.ref008 – volume: 11 start-page: 1 issue: 1 year: 2016 ident: pmed.1003045.ref020 article-title: Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting ‘high impact’ clinical practice recommendations in general practice publication-title: Implement Sci – volume: 374 start-page: 1053 issue: 11 year: 2016 ident: pmed.1003045.ref027 article-title: Safer prescribing—a trial of education, informatics, and financial incentives publication-title: N Engl J Med doi: 10.1056/NEJMsa1508955 – volume: 299 start-page: 1182 issue: 10 year: 2008 ident: pmed.1003045.ref031 article-title: The science of improvement publication-title: JAMA doi: 10.1001/jama.299.10.1182 – volume: 6 start-page: e010276 issue: 5 year: 2016 ident: pmed.1003045.ref035 article-title: Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics publication-title: BMJ Open doi: 10.1136/bmjopen-2015-010276 – volume: 8 start-page: iii1 issue: 6 year: 2004 ident: pmed.1003045.ref006 article-title: Effectiveness and efficiency of guideline dissemination and implementation strategies publication-title: Health Technol Assess doi: 10.3310/hta8060 – volume: 176 start-page: 1778 issue: 12 year: 2016 ident: pmed.1003045.ref001 article-title: The quality of outpatient care delivered to adults in the United States, 2002 to 2013 publication-title: JAMA Intern Med doi: 10.1001/jamainternmed.2016.6217 – volume: 387 start-page: 1743 issue: 10029 year: 2016 ident: pmed.1003045.ref034 article-title: Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial publication-title: Lancet doi: 10.1016/S0140-6736(16)00215-4 – volume: 379 start-page: 1310 issue: 9823 year: 2012 ident: pmed.1003045.ref026 article-title: A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis publication-title: Lancet doi: 10.1016/S0140-6736(11)61817-5 – volume: 378 start-page: 1219 issue: 9798 year: 2011 ident: pmed.1003045.ref023 article-title: Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study publication-title: Lancet doi: 10.1016/S0140-6736(11)61184-7 – volume: 16 start-page: 156 issue: 1 year: 2015 ident: pmed.1003045.ref005 article-title: Developing ‘high impact’ guideline-based quality indicators for UK primary care: a multi-stage consensus process publication-title: BMC Fam Pract doi: 10.1186/s12875-015-0350-6 – volume: 317 start-page: 858 issue: 7162 year: 1998 ident: pmed.1003045.ref033 article-title: Attributes of clinical guidelines that influence use of guidelines in general practice: observational study publication-title: BMJ doi: 10.1136/bmj.317.7162.858 |
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| SubjectTerms | Adult Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anticoagulants - therapeutic use Antihypertensive Agents - therapeutic use Atrial Fibrillation - drug therapy Biology and life sciences Clinical Audit Cost-Benefit Analysis Decision Support Systems, Clinical Diabetes Mellitus - drug therapy Drug Interactions Evidence-Based Medicine - methods Female Formative Feedback Glycated Hemoglobin - metabolism Humans Hypertension - drug therapy Hypoglycemic Agents - therapeutic use Implementation Science Male Medicine and Health Sciences Middle Aged Platelet Aggregation Inhibitors - adverse effects Primary Health Care - methods Quality-Adjusted Life Years Social Sciences United Kingdom Young Adult |
| Title | An adaptable implementation package targeting evidence-based indicators in primary care: A pragmatic cluster-randomised evaluation |
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