| Printed educational materials (PEM) |
Purpose (eg, increase or decrease in, modification of behaviour)
*Based on very limited evidence and box plots presented only | ▸ Mode,
*Due to the lack of variability, not able to assess the importance of these characteristics to determine PEM effectiveness |
| Educational strategies |
Mixed interactive and didactic formats High attendance at educational meetings Low complexity of the targeted behaviour Tailoring Relevance or identify needs with a facilitator Interaction/active participation Facilitate and (small) team based Training support Management support Clear goals Led by senior colleagues/superior Intensity and frequency Programmes directed at trainee physicians Focus on serious outcomes
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Didactic sessions/lectures alone Seminar-based sessions High complexity of the targeted behaviour Minimal interaction/discussion Passive strategies (eg, mailed educational materials) Programmes directed at established physicians
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| Educational outreach visits |
| No data reported |
| Audit and feedback (A&F) |
Source—(p<0.001) supervisor/senior colleague Format—(p=0.02) feedback provided both verbally and written Measurable targets and action plan (p<0.001) Timing—concurrent feedback, presented close to the time of decision-making Active Tailoring Part of an overall strategy Low/ non-existent baseline
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Effect size was not influenced by the number of implementation strategies in addition to A&F. A&F alone vs A&F in a multifaceted intervention: not significant; Dichotomous: estimated absolute difference in adjusted RD=3.3%, p=0.27)
|
| Practice facilitation |
Tailoring to the context and needs of the practice (SMD=0.62, 95% CI 0.48 to 0.75; p=0.05) Higher intensity of the intervention (average number of contacts by the average meeting time in hours; p=0.03) Smaller number of practices per facilitator (p=0.004)
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No tailoring (SMD=0.37, 95% CI 0.16 to 0.58) Lower intensity of the intervention Larger number of practices per facilitator
|
| Financial strategies |
Larger size of payment Clear goal Low complexity of task Concurrent or intermittent payment Sustainability of new behaviour—incentives may only buy temporary priority Positive effect was greater for initially low performers (low baseline performance, more room for improvement) compared with already high performers Involvement of stakeholders in target selection and incentive programme development Context (national level gave more uniform results than fragmented programmes) Design choices (process indicators gave higher improvement than outcome measures) High awareness of the existence of an incentive programme Incentives based on financial rewards only showed more positive effects
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Size of payment—small rewards may not motivate doctors to change their behaviour or practices High complexity of task End of year payment (infrequent performance feedback) Continuing adding additional funding or payment in the long term is not effective. Low awareness of the existence of an incentive programme Incentives based on a competitive approach (reward for high performers, as well as penalty for low performers)
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| Local opinion leaders |
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