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Table 3 Indirect comparisons of multifaceted to single interventions ( N =23 reviews)

From: Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews

Author

Study characteristics

Review findingsa

Conclusion

Comparison

Findings

Arnold (2005) [31]

N: 40 studies

Single vs. control

14/32 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions have mixed effects when compared to controls

Interventions to Improve Antibiotic Prescribing Practices in Ambulatory Care

Study designs: randomized controlled trials, controlled before-after, interrupted time series

• 2/4 studies favoured audit and feedback vs. control

• 2/10 studies favoured educational meetings vs. control

Populations: physicians, nurses, other

• 3/8 studies favoured educational outreach vs. control

Settings: primary care practices, outpatient clinics, communities, other

• 2/2 studies favoured formulary vs. control

AMSTAR (quality) score: 7

• 2/3 studies favoured reminders vs. control

• 3/5 studies favour patient mediated vs. control

Overall: mixed effects (44%)

Multifaceted vs. control

4/7 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (57%)

Beach (2006)b[20]

N: 27 studies

Single vs. control

8/9 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Improving Health Care Quality for Racial/Ethnic Minorities: A Systematic Review of the Best Evidence Regarding Provider and Organization Interventions

Study designs: randomized controlled trials, clinical trials

• 6/7 studies favoured reminders vs. control

Populations: physicians, nurses, other

• 1/2 studies favoured educational meetings vs. control

Settings: primary care practices, outpatient clinics, communities, other

• 1/1 study favoured local consensus process vs. control

AMSTAR (quality) score: 5

Overall: generally effective (89%)

Multifaceted vs. control

5/7 studies reported a multifaceted intervention was effective over a control intervention

 

Boonacker (2010) [34]

N: 10 studies

Single vs. control

17/19 comparison (across N = 6 studies) reported a single intervention was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

Interventions in Health Care Professionals to Improve Treatment in Children with Upper Respiratory Tract Infections

Study designs: randomized controlled trials, controlled trials, controlled before-after

• 11/13 comparisons favoured reminders vs. control (3 studies)

Populations: physicians, nurses, pharmacists, nurse practitioners

• 4/4 comparisons favoured distribution of educational materials vs. control (2 studies)

Settings: primary care practices, hospitals, communities

• 2/2 comparisons favoured a local consensus process vs. control (1 study)

AMSTAR (quality) score: 4

Overall: generally effective (89%)

Multifaceted vs. control

4/6 comparisons (across N = 4 studies) reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (67%)

Davey (2005) [28]

N: 69 studies

Single vs. control

24/34 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

• 5/6 studies favoured audit and feedback vs. control

• 9/11 studies favoured organizational—other vs. control

• 0/2 studies favoured educational outreach vs. control

• 5/6 studies favoured formulary vs. control

• 1/1 favoured professional—other vs. control

• 1/2 studies favoured revision of roles vs. control

• 3/5 studies favoured reminders vs. control

• 0/1 study favoured distribution of educational materials vs. control

Interventions to Improve Antibiotic Prescribing Practices for Hospital Inpatients

Study designs: controlled trials, controlled before-after, interrupted time series

Overall: generally effective (71%)

Populations: physician, nurses, pharmacists, other

Settings: hospitals

AMSTAR (quality) score: 7

Multifaceted vs. control

18/26 studies reported a multifaceted intervention was effective over a control intervention

Overall: generally effective (69%)

Flodgren (2011) [35]

N: 18 studies (in 19 papers)

Single vs. control

29/40 comparisons (across N = 8 studies) reported a single intervention (local opinion leaders) was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

Local Opinion Leaders: Effects on Professional Practice and Health Care Outcomes

Study designs: randomized controlled trials (cluster)

Populations: physicians, nurses, other

Overall: generally effective (73%)

Settings: primary care practices, hospitals, communities, other

AMSTAR (quality) score: 9

Multifaceted vs. control

16/26 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention

 

Overall: mixed effects (62%)

Forsetlund (2009) [18]

N: 81 studies

Single vs. control

12/16 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes

Study designs: randomized controlled trials

• 12/15 studies favoured educational meetings vs. control

Populations: nurses, pharmacists, physicians, psychiatrists, other

• 0/1 study favoured changes in structure/facilities/equipment vs. control

Settings: communities, hospitals, outpatient clinics, pharmacists, primary care practices

Overall: generally effective (75%)

AMSTAR (quality) score: 8

Multifaceted vs. control

10/14 studies reported a multifaceted intervention was effective over a control intervention

Overall: generally effective (71%)

French (2010)c[8]

N: 28 studies

Single vs. control

12/14 comparisons (across N = 11 studies) reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Interventions for Improving the Appropriate Use of Imaging in People with Musculoskeletal Conditions

Study designs: randomized controlled trials, controlled trials, interrupted time series

• 5/6 comparisons favoured distribution of educational materials vs. control (5 studies)

• 5/5 comparisons favoured reminders vs.

control (4 studies)

Populations: physicians, other

• 2/3 comparisons favoured audit and feedback vs. control (2 studies)

Overall: generally effective (86%)

Settings: primary care practices, hospitals

Multifaceted vs. control

14/20 comparisons (across N = 16 studies) reported a multifaceted intervention was effective over a control intervention

AMSTAR (quality) score: 9

Overall: generally effective (70%)

Grimshaw (2004)c[7]

N: 235 studies (in 283 papers)

Single vs. control

53/62 comparisons (across N = 60 studies) reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

• 7/11 comparisons favoured distribution of educational materials vs. control (11 studies)

• 1/1 comparison favoured educational meetings vs. control (1 study)

• 7/7 comparisons favoured audit and feedback vs. control (6 studies)

• 30/33 comparisons favoured reminders vs. control (32 studies)

• 1/2 comparisons favoured professional—other vs. control (2 studies)

• 0/1 comparisons favoured revisions of roles vs. control (1 study)

• 1/1 comparisons favoured continuity of care vs. control (1 study)

Overall: generally effective (85%)

Effectiveness and Efficiency of Guideline Dissemination and Implementation Strategies

Study designs: randomized controlled trials, controlled trials, controlled before-after, interrupted time series

Populations: physicians, nurses, pharmacists, other

Settings: primary care practices, hospitals, outpatient clinics, communities, nursing homes, other

AMSTAR (quality) score: 7

Multifaceted vs. control

74/92 comparisons (across N = 78 studies) reported a multifaceted intervention was effective over a control intervention

Overall: generally effective (80%)

Hakkennes (2008) [36]

N: 14 studies (in 27 papers)

Single vs. control

6/8 reported a single intervention was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

Guideline Implementation in Allied Health Professions: A Systematic Review of the Literature

Study designs: randomized controlled trials, controlled trials, controlled before-after

• 3/3 studies favoured educational meetings vs. control

Populations: pharmacists, other

• 1/2 studies favoured distribution of educational materials vs. control

Settings: hospitals, pharmacies, primary care practices, outpatient clinics, communities

• 1/1 study favoured educational outreach vs. control

AMSTAR (quality) score: 5

• 1/1 study favoured revision of roles vs. control

• 0/1 study favoured reminders vs. control

Overall: generally effective (75%)

Multifaceted vs. control

3/5 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (60%)

Hulscher (2001)b[21]

N: 55 studies

Single vs. control

13/18 comparisons (across N = 15 studies) reported a single intervention was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

Interventions to Implement Prevention in Primary Care

Study designs: randomized controlled trials, controlled before-after

• 6/6 comparisons favoured audit and feedback vs. control (5 studies)

Populations: physicians, nurses, other

• 3/5 comparisons favoured educational meetings vs. control (4 studies)

Settings: primary care practices, outpatient clinics, medical centres

• 1/3 comparisons favoured distribution of educational materials vs. control (3 studies)

AMSTAR (quality) score: 5

• 2/3 comparisons favoured educational outreach vs. control (2 studies)

• 1/1 comparison favoured local consensus proves vs. control (1 study)

Overall: generally effective (72%)

Multifaceted vs. control

4/6 comparisons (across N = 6 studies) reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (67%)

Jamtvedt (2006)b[22]

N: 118 studies

Single vs. control

28/38 studies reported a single intervention (audit and feedback) was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Audit and Feedback: Effects on Professional Practice and Health Care Outcomes

Study designs: randomized controlled trials

Population: any kind of health-care professional

Overall: generally effective (74%)

Setting: Any kind of organization

Multifaceted vs. control

61/74 studies reported a multifaceted intervention was effective over a control intervention

AMSTAR (quality) score: 8

Overall: generally effective (82%)

Laliberte (2011) [37]

N: 13 studies (in 16 papers)

Single vs. control

13/13 (100%) comparisons (across N = 6 studies) reported a single intervention was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

Effectiveness of Interventions to Improve the Detection and Treatment of Osteoporosis in Primary Care Settings: A Systematic Review and Meta-Analysis

Study designs: RCT, CT, other (cluster RCT)

• 12/12 comparisons favoured reminders vs. control (5 studies)

Population: physicians, pharmacists, other (orthopaedic surgeons)

• 1/1 comparison (1 study) favoured continuity of care vs. control

Setting: primary care practices, pharmacies, communities

Overall: generally effective (100%)

AMSTAR (quality) score: 9

Multifaceted vs. control

4/7 comparisons (across N = 3 studies) reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (57%)

Lemmens (2009) [38]

N: 40 studies

Single vs. control

2/7 studies reported a single intervention was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally ineffective when compared to controls

A Systematic Review of Integrated Use of Disease-Management Interventions in Asthma and COPD

Study designs: randomized controlled trials, controlled before-after

• 0/3 studies favoured revision roles—nursing vs. control

Populations: nurses, physicians and pharmacists

• 2/3 studies favoured revision roles—pharmacy vs. control

• 0/1 study favoured continuity of care vs. control

Overall: generally ineffective (29%)

Settings: communities, hospitals, nursing homes, outpatient clinics, pharmacies, primary care practices

AMSTAR (quality) score: 8

Multifaceted vs. control

3/7 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (43%)

Lloyd-Evans (2011) [29]

N: 11 studies

Single vs. control

3/4 comparisons (across N = 2 studies) reported a single intervention (educational meetings) was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Initiatives to Shorten Duration of Untreated Psychosis: Systematic Review

Study designs: randomized controlled trials, controlled trials, observational

Overall: generally effective (75%)

Populations: physicians, youth workers, counsellors

Multifaceted vs. control

7/10 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention

Settings: primary care practices, schools

Overall: generally effective (70%)

AMSTAR (quality) score: 6

Lugtenberg (2009) [32]

N: 20 studies (in 30 papers)

Single vs. control

2/4 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions have mixed effects when compared to controls

Effects of Evidence-Based Clinical Practice Guidelines on Quality of Care: A Systematic Review

Study designs: randomized controlled trials, controlled before-after, interrupted time series

• 0/1 study favoured audit and feedback vs. control

• 1/1 study favoured distribution of educational materials vs. control

Populations: physicians, other

Settings: primary care practices, hospitals

AMSTAR (quality) score: 5

• 1/1 study favoured educational meetings vs. control

• 0/1 study favoured educational outreach vs. control

Overall: mixed effects (50%)

Multifaceted vs. control

10/18 comparisons(across N = 16 studies) reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (56%)

Marinopoulos (2007)b[23]

N: 136 studies

Single vs. control

14/22 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions have mixed effects when compared to controls

Effectiveness of Continuing Medical Education

Study designs: randomized controlled trials, before-after, observational

• 3/6 studies favoured distribution of educational materials vs. control

Populations: physicians, pharmacists, nurses, other

8/13 studies favoured educational meetings vs. control

Settings: primary care practices, hospitals, long-term care facilities

2/2 studies favoured educational outreach vs. control

AMSTAR (quality) score: 7

• 1/1 study favoured audit and feedback vs. control

Overall: mixed effects (64%)

Multifaceted vs. control

24/39 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (62%)

Naikoba (2001) [39]

N: 21 studies

Single vs. control

6/9 studies reported a single intervention was effective over a control intervention

Multifaceted interventions are generally effective when compared to controls, while single interventions have mixed effects when compared to controls

The Effectiveness of Interventions Aimed at Increasing Handwashing in Healthcare Workers - A systematic Review

Study designs: randomized controlled trials, controlled trials, observational

• 2/4 studies favoured audit and feedback vs. control

Populations: physicians, nurses, other

• 2/2 studies favoured reminders vs. control

• 1/2 studies favoured educational meetings vs. control

Settings: hospitals, nursing homes

• 1/1 study favoured distribution of educational materials vs. control

AMSTAR (quality) score: 4

Overall: mixed effects (67%)

Multifaceted vs. control

6/7 studies reported a multifaceted intervention was effective over a control intervention

Overall: generally effective (86%)

O'Brien (2007)b[24]

N: 69 studies

Single vs. control

26/28 studies reported a single intervention (educational outreach) was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Educational Outreach Visits: Effects on Professional Practice and Health Care Outcomes

Study designs: randomized controlled trials

Populations: any kind of health-care professional

Overall: generally effective (93%)

Settings: primary care practices, outpatient clinics, nursing homes, hospitals, pharmacies, communities

Multifaceted vs. control

40/45 studies reported a multifaceted intervention was effective over a control intervention

AMSTAR (quality) score: 8

Overall: generally effective (89%)

Robertson (2010) [40]

N: 21 studies

Single vs. control

10/11 comparisons (across N = 10 studies) reported a single intervention (reminders) was effective over a control intervention

Multifaceted interventions have mixed effects when compared to controls, while single interventions are generally effective when compared to controls

The Impact of Pharmacy Computerised Clinical Decision Support on Prescribing, Clinical and Patient Outcomes: A Systematic Review of the Literature

Study designs: randomized controlled trials, controlled trials, interrupted time series, controlled before-after, cohort

Populations: physicians, nurses, pharmacists, nurse practitioners

Overall: generally effective (91%)

Multifaceted vs. control

3/9 comparisons (across N = 8 studies) reported a multifaceted intervention was effective over a control intervention

Settings: primary care practices, outpatient clinics, hospitals, pharmacies, communities

AMSTAR (quality) score: 4

Overall: mixed effects (33%)

Solomon (1998) [33]

N: 49 studies

Single vs. control

18/34 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions have mixed effects when compared to controls

Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework

Study designs: randomized controlled trials, controlled trials

• 8/15 studies favoured audit and feedback vs. control

Populations: physicians, nurses, medical and surgical residents

• 5/7 studies favoured distribution of educational materials vs. control

Settings: hospitals, outpatient clinics, communities, other

• 3/5 studies favoured reminders—general vs. control

AMSTAR (quality) score: 5

• 0/1 study favoured reminders—CPOE vs. control

• 0/4 studies favoured educational meetings vs. control

• 2/2 studies favoured local consensus process vs. control

Overall: mixed effects (53%)

Multifaceted vs. control

10/18 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (56%)

Steinman (2006) [30]

N: 26 studies

Single vs. control

10/10 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally effective when compared to controls

Improving Antibiotic Selection: A Systematic Review and Quantitative Analysis of Quality Improvement Strategies

Study designs: randomized controlled trials, controlled before-after, interrupted time series

• 7/7 studies favoured educational outreach vs. control

Populations: not specified

• 1/1 study favoured educational meetings vs. control

Settings: primary care practices, outpatient clinics

• 1/1 study favoured audit and feedback vs. control

AMSTAR (quality) score: 5

• 1/1 study favoured distribution of educational materials

Overall: generally effective (100%)

Multifaceted vs. control

21/23 studies reported a multifaceted intervention was effective over a control intervention

Overall: generally effective (91%)

Weinmann (2007)b[25]

N: 18 studies (in 17 papers)

Single vs. control

1/4 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions are generally ineffective when compared to controls

Effects of Implementation of Psychiatric Guidelines on Provider Performance and Patient Outcome: Systematic Review

Study designs: randomized controlled trials, controlled trials, before-after

• 1/3 favoured education vs. control

Populations: physicians, nurses, pharmacists, mental health clinicians, medical assistants

• 0/1 favoured audit and feedback vs. control

Multifaceted vs. control

Overall: generally ineffective (25%)

Settings: primary care practices, hospitals, communities

2/8 studies reported a multifaceted intervention was effective over a control intervention

Overall: generally ineffective (25%)

AMSTAR (quality) score: 5

Wensing (1994)b[6]

N: 75 studies

Single vs. control

18/30 studies reported a single intervention was effective over a control intervention

Both multifaceted and single-component interventions have mixed effects when compared to controls

Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review

Study designs: randomized controlled trials, controlled trials, before-after, cohort

• 1/4 favoured distribution of educational materials vs. control

Populations: physicians

• 2/3 favoured educational outreach vs. control

Settings: primary care practices

• 7/10 favoured audit and feedback vs. control

AMSTAR (quality) score: 4

• 6/8 favoured reminders vs. control

• 2/5 favoured educational meetings vs. control

Overall: mixed effects (60%)

Multifaceted vs. control

7/16 studies reported a multifaceted intervention was effective over a control intervention

Overall: mixed effects (44%)

  1. aFindings are reported by the number of studies where available. In a small number of cases, reviews reported findings by the number of comparisons.
  2. bAlso in Table 2.
  3. cAlso in Table 1.