Professional Intervention: Multifaceted

Definition: Any combination of two or more professional, organisational, financial, structural or regulatory interventions designed to improve prescribing practices or other health provider behaviour.

Effectiveness: Twelve high quality reviews (Beney, Faulkner, Forsetlund, Harvey, Jamtvedt, Lemmens, Lewin, O'Brien, Pirkis, Reeves, Smith, Thomas) and two key reviews (Arnold, Davey) were identified. Four high quality reviews (Jamtvedt, O'Brien, Smith, Pirkis) and one key review (Davey) found multifaceted interventions to be generally effective for appropriate care outcomes. One high quality review (Forsetlund) found multifaceted interventions that included educational meetings to be generally effective at improving appropriate care outcomes. Two high quality reviews (Jamtvedt, O'Brien) found multifaceted interventions to be generally effective for prescribing-related outcomes. Two key reviews (Arnold, Davey) and one high quality review (Lemmens) reported mixed results for the effectiveness of multifaceted interventions on prescribing related outcomes. One high quality review (Lewin) found multifaceted intervetions to be generally ineffective for appropriate care outcomes. There was insufficient evidence in five high quality reviews (Beney, Faulkner, Harvey, Reeves, Thomas) to draw any conclusions about the effects of multifaceted interventions on appropriate care outcomes. There was insufficient evidence in four high quality reviews (Beney, Forsetlund, Lewin, Smith) to draw any conclusions about the effects of multifaceted interventions on prescribing outcomes.

Summary of Overall Findings from Reviews: 6/9 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective.

Summary of Findings Related to Prescribing: 2/5 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective for improving prescribing outcomes.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health service utilisation, costs, and patient outcomes. Cochrane Database of Systematic Reviews 2000 (3):CD000336. 9 (High)
Harvey EL, Glenny A-M, Kirk SFL, Summerbell CD. Improving health professionals' management and the organisation of care for overweight and obese people (Cochrane Review). The Cochrane Database of Systematic Reviews 2001 (2):1-60. 9 (High)
Faulkner A, Mills N, Baxter K, Kinnersley P, Peters TJ, Sharp D. A systematic review of the effect of primary care-based service innovations on quality and patterns of referral to specialist secondary care. British Journal of General Practice 2003 53 (496):878-884. 8 (High)
Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009 15 (2):CD003030. 8 (High)
Jamtvedt G, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2006 (2):CD000259. 8 (High)
Lemmens KMM, Nieboer AP, Huijsman R. A systematic review of integrated use of disease-management interventions in asthma and COPD. Respiratory Medicine 2009 103 (5):670-691. 8 (High)
Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centered approach in clinical consultations. The Cochrane Database of Systematic Reviews 2001 (4):CD003267. 8 (High)
O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007 (4):CD000409. 8 (High)
Pirkis JE, Jolley D, Dunt DR. Recruitment of women by GPs for pap tests: a meta-analysis. British Journal of General Practice 1998 48 (434):1603-1607. 8 (High)
Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008 (1) 8 (High)
Smith SM, Allwright S, O'Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database of Systematic Reviews 2007 (3):CD004910. 8 (High)
Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database of Systematic Reviews 2000 (1):CD000349. 8 (High)
Akbari A, Mayhew A, Al-Alawi MA, Grimshaw J, Winkens R, Glidewell E, Pritchard C, Thomas R, Fraser C. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews 2008 8 (4):CD005471. 7 (Medium)
Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews 2005 (4):CD003539. 7 (Medium)
Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2005 (4):CD003543. 7 (Medium)
de Belvis AG, Pelone F, Biasco A, Ricciardi W, Volpe M. Can primary care professionals' adherence to Evidence Based Medicine tools improve quality of care in Type 2 diabetes mellitus? A systematic review. Diabetes Research and Clinical Practice 2009 85 (2):119-131. 7 (Medium)
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. 2004 8 (6):iii-72. 7 (Medium)
Kastner M, Straus SE. Clinical decision support tools for osteoporosis disease management: A systematic review of randomized controlled trials. Journal of General Internal Medicine 2008 23 (12):2095-2105. 7 (Medium)
Lancaster T, Silagy C, Fowler G. Training health professionals in smoking cessation. The Cochrane Database of Systematic Reviews 2000 (3):CD000214. 7 (Medium)
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB. Effectiveness of continuing medical education. Evidence Report — Technology Assessment (Full Rep) 2007 (149):1-69. 7 (Medium)
McGowan JL, Grad R, Pluye P, Hannes K, Deane K, Labrecque M, Welch V, Tugwell P. Electronic retrieval of health information by healthcare providers to improve practice and patient care. Cochrane Database of Systematic Reviews 2009 (3):CD004749. 7 (Medium)
Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. American Journal of Geriatric Psychiatry 2008 16 (8):621-632. 7 (Medium)
Qureshi N, Allen J, Hapgood R. A systematic review of educational outreach visits for non-prescribing interventions in general practice. European Journal of General Practice 2002 8 (1):31-36. 7 (Medium)
Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. The Cochrane Database of Systematic Reviews 2000 (4):CD001481. 7 (Medium)
Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2009 (3):CD000072. 7 (Medium)
Bravata DM, Gienger AL, Holty JE, Sundaram V, Khazeni N, Wise PH, McDonald KM, Owens DK. Quality improvement strategies for children with asthma: a systematic review. Archives of Pediatrics and Adolescent Medicine 2009 163 (6):572-581. 6 (Medium)
Fahey T, Schroeder K, Ebrahim S. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2006 (4):CD005182. 6 (Medium)
Flores-Mateo G, Argimon JM. Evidence based practice in postgraduate healthcare education: a systematic review. BMC Health Services Research 2007 7 (119):1-8. 6 (Medium)
Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organisational interventions to improve the management of depression in primary care. A systematic review. Journal of the American Medical Informatics Association 2003 289 (23):3145-3151. 6 (Medium)
Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people: a systematic review and meta-analysis. British Journal of Clinical Pharmacology 2008 65 (3):303-316. 6 (Medium)
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