Article Text

Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews
  1. Rosa Lau1,
  2. Fiona Stevenson1,
  3. Bie Nio Ong2,
  4. Krysia Dziedzic2,
  5. Shaun Treweek3,
  6. Sandra Eldridge4,
  7. Hazel Everitt5,
  8. Anne Kennedy6,
  9. Nadeem Qureshi7,
  10. Anne Rogers6,
  11. Richard Peacock8,
  12. Elizabeth Murray1
  1. 1eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
  2. 2Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, UK
  3. 3Health Services Research Unit, University of Aberdeen, Scotland, UK
  4. 4Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  5. 5Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton,UK
  6. 6Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
  7. 7Division of Primary Care, University of Nottingham, Derby, UK
  8. 8Archway Healthcare Library, London, UK
  1. Correspondence to Rosa Lau; r.lau{at}


Objective To identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care.

Design Systematic review of reviews.

Data sources MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from first publication until December 2013; the bibliographies of relevant articles were screened for additional reports.

Eligibility criteria for selecting studies Eligible reviews had to (1) examine effectiveness of single or multifaceted implementation strategies, (2) measure health professional practice or process outcomes and (3) include studies from predominantly primary care in developed countries. Two reviewers independently screened titles/abstracts and full-text articles of potentially eligible reviews for inclusion.

Data synthesis Extracted data were synthesised using a narrative approach.

Results 91 reviews were included. The most commonly evaluated strategies were those targeted at the level of individual professionals, rather than those targeting organisations or context. These strategies (eg, audit and feedback, educational meetings, educational outreach, reminders) on their own demonstrated a small to modest improvement (2–9%) in professional practice or behaviour with considerable variability in the observed effects. The effects of multifaceted strategies targeted at professionals were mixed and not necessarily more effective than single strategies alone. There was relatively little review evidence on implementation strategies at the levels of organisation and wider context. Evidence on cost-effectiveness was limited and data on costs of different strategies were scarce and/or of low quality.

Conclusions There is a substantial literature on implementation strategies aimed at changing professional practices or behaviour. It remains unclear which implementation strategies are more likely to be effective than others and under what conditions. Future research should focus on identifying and assessing the effectiveness of strategies targeted at the wider context and organisational levels and examining the costs and cost-effectiveness of implementation strategies.

PROSPERO registration number CRD42014009410.

  • Implementation
  • Systematic review

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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