title: Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews.
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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  PROSPERO CRD42014009410.
authors.affiliation: eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. r.lau@ucl.ac.uk.
authors.forename: Rosa
authors.identifier: http://orcid.org/0000-0003-0625-2228
authors.initials: R
authors.lastname: Lau
authors.affiliation: eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, 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, Staffordshire, 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, Staffordshire, UK.
authors.forename: Krysia
authors.initials: K
authors.lastname: Dziedzic
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, 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, Nottingham, 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, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D055317:Evidence-Based Practice; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care; D057170:Translational Research, Biomedical
keywords: Barriers; Complex interventions; Evidence-based practice; Facilitators; Health services research; Implementation research; Primary care; Systematic review