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Table 1 Characteristics of included studies

From: Interventions to improve adherence to cardiovascular disease guidelines: a systematic review

Study ID

Topic of trial

Study Design

Population description

Setting

Intervention Description; Intervention 2 description (if applicable)

Type

Duration of treatment period

Comparison intervention

Outcomes measured

Risk of bias ratinga

Ansari, 2003

Use of beta-blockers in congestive heart failure

cRCT

Specialist doctors and nurse practitioners, patients with CHF

USA, urban medical centre

Nurse facilitator plus healthcare provider educational sessions; provider and patient reminder letters

Other type: Nurse facilitator; notifications

1 year

Educational sessions, no nurse facilitator

Mortality, hospitalization, adherence (prescription review, chart review)

High risk of bias

Baker, 2003

Guidelines in prioritised review criteria

cRCT

Family doctors, patients with angina

England, general practices

Review criteria; criteria plus feedback

Other type: review criteria

12 months

Guideline dissemination alone

Disease target (cholesterol), adherence (prescription review, chart review)

Low risk of bias

Bertoni, 2009

Physician adherence to ATP III guidelines

cRCT

Family doctors

USA, primary care practices

CDSS, educational sessions, academic detailing, CME sessions

Education + audit and feedback + academic detailing + CME session

2 years

educational sessions, CME sessions, guideline mailed to participants

Disease target (cholesterol), adherence (prescription review, chart review)

High risk of bias

Berwanger, 2012

Multifaceted quality improvement intervention in ACS patients

cRCT

Patients with ACS at general public hospitals

Brazil, public hospitals

Training, reminders, checklists, case management, educational sessions

Education

8 months

Routine care

Mortality, major adverse cardiac events, adherence (prescription review)

Low risk of bias

Bonds, 2009

Compliance to JNC 7 guidelines to improve blood pressure

cRCT

Family doctors

USA, primary care practices

Educational sessions, dissemination of guidelines, academic detailing for physicians, feedback on blood pressure control

Education + audit and feedback + academic detailing + CME sessions

2 years

Similar to intervention but focused on ATPIII guidelines

Disease target (BP), adherence (prescription review, chart review)

Low risk of bias

Browner, 1994

CME and follow up to improve detection and treatment of high cholesterol

cRCT

Family and internal medicine doctors

USA, general practices

CME seminar; Intensive CME (office visits and educational materials)

Education + CME sessions

18 months

Educational sessions

Disease target (cholesterol), adherence (chart review)

High risk of bias

Carter, 2009

Physician and pharmacist collaborative model to improve blood pressure

cRCT

Family doctors, patients with hypertension

USA, community based family medicine

Collaborative model, team building exercises, training sessions, educational sessions

Education + other (collaborative model)

6 months

Collaborative model

Disease target (BP), guideline adherence tool

High risk of bias

De Lusignan, 2013

Audit based education to reduce blood pressure

cRCT

Mixed health care professionals

United Kingdom, primary care

Audit based education consisting of workshops; academic detailing plus workshops

Education + audit and feedback; academic detailing

2 years

Usual care

Mortality, major adverse cardiac events, disease target (BP), adherence (prescription review)

Low risk of bias

Deales, 2014

Team based approach to disease and care management

cRCT

Mixed health care professionals

Italy, primary care groups

Recommendations as textbooks and decision algorithms, education sessions

Education

12 months

Usual care

Disease target (HbA1c), adherence (chart review)

High risk of bias

Dijkstra, 2006

Implementation strategies for diabetes guidelines

cRCT

T1D and T2D patients

The Netherlands, hospitals

Educational meetings, feedback, reminder card; diabetes passport, education

Education + audit and feedback

1 year

Usual care

Disease target (HbA1c), adherence (chart review)

High risk of bias

Eaton, 2011

Multimodal intervention to improve screening and management of hyperlipidemic patients

cRCT

Family doctors

USA, primary care practices

PDA with decision support and education toolkit and academic detailing

Academic detailing

12 months

PDA with decision support but minimal follow up

Disease target (cholesterol), adherence (chart review)

Low risk of bias

Eccles, 2002

Computerised decision support system to implement angina guidelines

cRCT

Family doctors

England, general practices

Computer decision support that provided access to guidelines

Other: CDSS

12 months

Same intervention but asthma guideline provided

Quality of life, adherence (chart review)

Low risk of bias

Feldman, 2009

Simplified algorithm for treatment of hypertension

cRCT

Family practices, patients with hypertension

Canada, family practices

Algorithm, aids, one follow up meeting, educational materials and sessions

Education + Other (algorithms)

6 months

Educational sessions and guidelines

Mortality, disease target (BP), adherence (chart review)

Low risk of bias

Fihn, 2011

Collaborative care model based intervention to improve angina management

cRCT

Family doctors, patients with angina

USA, academic primary care clinics

Expert advice, progress evaluations, education

Education

12 months

Usual care

Mortality, disease target, adherence (chart review)

Low risk of bias

Fretheim, 2006

Tailored intervention to support implementation of CVD guidelines

cRCT

Family practices, hypertensive or hypercholesterolemic patients

Norway, general practices

Tailored intervention including reminders, audit and feedback and education

Education + audit and feedback

12 months

Passive dissemination

Disease target (cholesterol, BP), adherence (prescription review, chart review)

Low risk of bias

Gill, 2009

EMR-based intervention for lipid management

cRCT

Family doctors, general internists

USA, academic family practice

EMR disease management tool

Other (integration into EMR)

12 months

Usual care

Disease target (cholesterol), adherence (chart review)

High risk of bias

Goldstein, 2005

Intervention on drug choice for hypertension

cRCT

Family doctors, nurse practitioners

USA, multiple sites

Education, individual drug profiles, follow up

Education

9 months

Education on guidelines

Disease target (BP), adherence (prescription and chart review)

Low risk of bias

Harris, 2005

Teleconferenced educational detailing for diabetes

cRCT

Family doctors

Canada, family practices

Eight one hour small group educational sessions with opinion leaders

Education

3 months

CME session after intervention period

Disease target (HbA1c), adherence (chart review)

High risk of bias

Hayes, 2002

Quality improvement and written feedback for CHF management

cRCT

Hospitals, CHF patients

USA, hospitals

Education, quality improvement tools from liaisons, chart reminders

Education + audit and feedback

6 months

Mailed quality improvement tools

Disease target (ventricular fxn), adherence (chart review)

High risk of bias

Headrick, 1992

Education and feedback strategies to improve compliance with NCEP-PCEP guidelines

RCT

Resident doctors

USA. Academic hospital

Lecture, chart reminders; Lecture, patient specific feedback and chart reminder

Education + Other (reminders)

20 weeks

Lecture alone

Disease targets (cholesterol), adherence (chart review)

Low risk of bias

Hendriks, 2012

Nurse led guideline based software supported ICCP

RCT

Family doctors, specialists, patients with atrial fibrillation

Netherlands, academic center

Nurse specialist educated patients and CDSS

Other (nurse specialist)

12 months

Usual care

Mortality, hospitalizations, quality of life, adherence (chart review)

Low risk of bias

Kiessling, 2011

Case based training to optimize hyperlipidemia care

RCT

Family doctors, patients with CHD

Sweden, primary health care centres

Case based training seminars and guideline provided

Education

2 years

Usual care

Mortality, disease target (cholesterol), adherence (prescription review)

High risk of bias

Leonardis, 2012

Multimodal intervention to improve adherence to targets

cRCT

Specialists, CKD patients

Italy, renal clinics

Education session, follow up and audits

Education + audit and feedback

3 years

Education and standard care

Mortality, hospitalizations, quality of life, disease target (cholesterol), adherence (prescription/ chart review)

Low risk of bias

Levine, 2011

Multicomponent internet delivered intervention improve CHD guideline adherence

cRCT

Family doctors, MI patients

Virgin Islands and Puerto Rico, community primary care clinics

Educational cases, guidelines, monthly update, reminders

Education + Other (reminders)

27 months

Passive dissemination

Disease target (cholesterol), adherence (chart review)

High risk of bias

Ornstein, 2004

Multimethod quality improvement intervention for adherence to quality indicators in CVD and stroke

cRCT

Practice based research network of practices

USA, primary care practices

Education, performance reports quarterly, practice site visits and network meetings (6–7 1–2 day visits) with pharmacist (academic detailing)

Education + academic detailing

2 years

Education, performance reports quarterly

Disease target (BP), adherence (prescription, chart review)

High risk of bias

Petersen, 2013

Effect of financial incentives to reward guideline based hypertension care

cRCT

Family doctors

USA, primary care clinics

Physician level incentives; practice levels incetives; combined (both) incentives

Other (incentives)

20 months

Usual care

Disease target (BP), adherence (prescription, chart review)

High risk of bias

Peters-Klimm, 2009

Educational model for GPs for the management of CHF

cRCT

Family doctors, CHF patients

Germany, general practitioner clinics

“Train the trainer” = multidisciplinary andragogic and didactic educational sessions

Education + Other (feedback)

7 months

Single educational session by cardiologist

Mortality, hospitalizations, quality of life, disease target (course), adherence (prescription review)

Low risk of bias

Reutens, 2012

Education of GPs on the IDF-WPR guidelines to improve metabolic control

cRCT

Family doctors, T2D patients

Asia-Pacfic, general practitioner clinics

Education meetings (two 3 months apart), reminder letters and cards, flowsheet on patient notes, patient diabetes passport

Education + Other (reminders, diabetes passport)

12 months

Instructed on assessments in study but no information on guidelines

Disease target (BP), adherence (chart review)

High risk of bias

Rood, 2005

Computer based guidelines to improve nurse measurement of patient glucose

RCT

ICU patients

The Netherlands, teaching hospital

Guideline based advice via computer decision support software

Other (decision support tool)

10 weeks

Paper based guideline flowchart

Disease target (glucose), adherence (chart review)

High risk of bias

Rossi, 1997

Guideline reminders to improve prescribing based on JNC V guideline

cRCT

Nurse practitioners, hypertension patients

USA, GIM clinic

Guideline reminder for prescription and alternatives

Other (reminder)

5 months

Usual care

Disease target (BP), adherence (prescription review)

High risk of bias

Roumie, 2006

Multifactorial intervention to improve quality of care of hypertension patients

cRCT

Physicians and nurse practitioners, hypertension patients

USA, community and hospital clinics

Alert on medical record; Educational sessions and alert on medical record

Education + other (alerts)

6 months

Providers received email with guideline

Mortality, hospitalizations, disease target (BP), adherence (prescription review)

High risk of bias

Simon, 2005

Academic detailing individually or group to increase diuretic use in hypertension patients

cRCT

Family doctors, hypertension patients

USA, community health plan

Academic detailing meeting one-on-one; small group academic detailing session

Academic detailing

3 months

Passive dissemination

Hospitalizations, disease target(BP), adherence (chart review)

High risk of bias

Steyn, 2013

Structured clinical record and training health care providers to control diabetes and hypertension

cRCT

Nurses, patients with diabetes and hypertension

South Africa, community health centres

Structured record with guideline embedded added to patient folders, educational package

Education

1 year

Passive dissemination

Disease target (HbA1c), adherence (chart review)

High risk of bias

Svetkey, 2009

Intervention to increase physician adherence to BP guideline

cRCT

Physicians, hypertension patients

USA, community practice

CME courses, treatment algorithm, quarterly feedback on adherence

Education + CME session + other (feedback)

18 months

Usual care

Disease target (BP), adherence (chart review)

Low risk of bias

Tierney, 2003

Decision support system with guideline for managing ischemic heart disease and CHF patients

RCT

Pharmacists, CHF patients

USA, academic primary care practice

Physicians received patient specific feedback; pharmacist system to send feedback to physicians; both

Education + audit and feedback + other (decision support system)

1 year

Usual care

Mortality, hospitalizations, quality of life, adherence (chart review)

High risk of bias

Van Bruggen, 2008

Facilitator enhanced multifaceted intervention for T2D guideline implementation

cRCT

Family doctors and nurses and practice assistants, T2D patients

The Netherlands, primary care practices

Facilitators visited twice a month to train staff on guidelines, performance feedback,

Education + audit and feedback

1 year

Usual care

Disease target (HbA1c), adherence (prescription and chart review)

Low risk of bias

Van Steenkiste, 2007

Decision support tool for risk management improving CVD guideline performance

cRCT

Family doctors, patients without CVD

The Netherlands, hospital

Education, decision support tool,

Other (decision support tool)

8 months

Educational materials on guideline

Disease target (lifestyle), adherence (chart review)

High risk of bias

Verweij, 2013

Effectiveness of guideline based care on weight, CVD risk

cRCT

Occupational physicians

The Netherlands, occupational medicine

Environment scan, patient counselling training, patient toolkit

Other (environment scan, toolkit)

18 months

Usual care

Quality of life, disease target (BP), adherence (chart review)

High risk of bias

  1. Footnote: a Risk of bias rated as high or low risk of bias based on overall domains, where high risk of bias designated if greater than 3 domains rated as high risk of bias