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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