title: Achieving change in primary care--effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews.
abstract: OBJECTIVE
  To identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care.
  
  
  METHODS
  Systematic review of reviews.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from first publication until December 2013; the bibliographies of relevant articles were screened for additional reports.
  
  
  METHODS
  Eligible reviews had to (1) examine effectiveness of single or multifaceted implementation strategies, (2) measure health professional practice or process outcomes and (3) include studies from predominantly primary care in developed countries. Two reviewers independently screened titles/abstracts and full-text articles of potentially eligible reviews for inclusion.
  
  
  RESULTS
  Extracted data were synthesised using a narrative approach.
  
  
  RESULTS
  91 reviews were included. The most commonly evaluated strategies were those targeted at the level of individual professionals, rather than those targeting organisations or context. These strategies (eg, audit and feedback, educational meetings, educational outreach, reminders) on their own demonstrated a small to modest improvement (2-9%) in professional practice or behaviour with considerable variability in the observed effects. The effects of multifaceted strategies targeted at professionals were mixed and not necessarily more effective than single strategies alone. There was relatively little review evidence on implementation strategies at the levels of organisation and wider context. Evidence on cost-effectiveness was limited and data on costs of different strategies were scarce and/or of low quality.
  
  
  CONCLUSIONS
  There is a substantial literature on implementation strategies aimed at changing professional practices or behaviour. It remains unclear which implementation strategies are more likely to be effective than others and under what conditions. Future research should focus on identifying and assessing the effectiveness of strategies targeted at the wider context and organisational levels and examining the costs and cost-effectiveness of implementation strategies.
  CRD42014009410.
authors.affiliation: eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Rosa
authors.initials: R
authors.lastname: Lau
authors.affiliation: eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stevenson
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, UK.
authors.forename: Bie Nio
authors.initials: BN
authors.lastname: Ong
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, UK.
authors.forename: Krysia
authors.initials: K
authors.lastname: Dziedzic
authors.affiliation: Health Services Research Unit, University of Aberdeen, Scotland, UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton,UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Everitt
authors.affiliation: Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Division of Primary Care, University of Nottingham, Derby, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
authors.affiliation: Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Archway Healthcare Library, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Peacock
authors.affiliation: eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D019049:Developed Countries; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*
keywords: Implementation; PRIMARY CARE; Systematic review