STRENGTH OF EVIDENCE FOR STRATEGIES USED TO DISSEMINATE MEDICAL EVIDENCE TO CLINICIANS AND PATIENTS

Purpose: This systematic review (SR) examined the comparative effectiveness of approaches to disseminate clinical evidence for medical decision making among patients and clinicians. The dissemination strategies examined included those to 1) increase the reach of evidence, 2) increase motivation to adopt and use evidence; or 3) increase ability to use evidence or 4) a multicomponent approach combining some of these approaches.

Method: We used rigorous systematic review procedures outlined by the Evidence-based Practice Centers.  This process involved outlining key questions to guide the SR; obtaining peer review and input on proposed questions and search methods; searching MEDLINE®, the Cochrane Library, and Cochrane Central Trials Registry for studies published from 2000 to 2013; reviewing all abstracts obtained from the search; grading the quality of relevant articles retained for the SR via two independent reviewers; and a qualitative synthesis and analysis of the retained articles retained to determine the strength of evidence supporting each dissemination approach.

Result: Of the 142 articles specific to this topic, we retained 42 articles covering 38 randomized controlled trials (RCT) after quality rating. The trials investigated a range of primary and secondary clinical outcomes and behaviors across a wide range of clinical problems, thereby precluding meta-analysis. Sample sizes for non-cluster RCTs ranged from 114 participants to 3,293 participants and cluster RCT sizes ranged from 9 to 249. Our analysis revealed that, compared to single dissemination strategies, the strength of evidence supporting multi-component strategies was stronger and these approaches are more effective at enhancing clinician behavior, particularly guideline adherence for clinical outcomes. The strength of evidence was low or insufficient for many comparisons for dissemination approaches to clinicians. Evidence was insufficient for determining the benefit of dissemination approaches for patients, as well as the benefit of approaches that target both clinicians and patients. 

Conclusion: The finding that multi-component dissemination approaches are more effective than single component approaches is consistent with prior reviews. This review contributes to previous research by investigating whether effects were dependent on the type of dissemination strategy used and by including studies that used strategies to disseminate evidence to patients as well as clinicians. This review provides a foundation for addressing gaps in the dissemination literature. The gaps and opportunities for future work will be discussed.