Interventions to improve adherence to cardiovascular disease guidelines: a systematic review.
BACKGROUND
Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes.


METHODS
We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome.


CONCLUSIONS
We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]).


CONCLUSIONS
Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions.
Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2. rjeffer@dal.caAQ3.
Rebecca A
RA
Jeffery
Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2. mt303402@dal.ca.
Matthew J
MJ
To
Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2. gb980142@dal.ca.
Gabrielle
G
Hayduk-Costa
Department of Medicine, Dalhousie University, Halifax, Canada. adam.cameron@live.ca.
Adam
A
Cameron
Department of Science, St. Mary's University, Halifax, Canada. camtaylor85@eastlink.ca.
Cameron
C
Taylor
Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2. colin.vanzoost@cdha.nshealth.ca.|Department of Medicine, Dalhousie University, Halifax, Canada. colin.vanzoost@cdha.nshealth.ca.
Colin
C
Van Zoost
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada. jhayden@dal.ca.
Jill A
JA
Hayden
D002318:Cardiovascular Diseases / Q000628:therapy*; D004501:Education, Medical; D019983:Guideline Adherence; D006801:Humans; D016896:Treatment Outcome