Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33513
Title: Interventions for the uptake of evidence-based recommendations in acute stroke settings.
Austin Authors: Lynch, Elizabeth A;Bulto, Lemma N;Cheng, Heilok;Craig, Louise;Luker, Julie A;Bagot, Kathleen L;Thayabaranathan, Tharshanah;Janssen, Heidi;McInnes, Elizabeth;Middleton, Sandy;Cadilhac, Dominique A
Affiliation: Caring Futures Institute, Flinders University, Adelaide, Australia.
Nursing Research Institute, St Vincent's Health Australia, Sydney, Australia.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
The Florey Institute of Neuroscience and Mental Health
Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Australia.
School of Health Sciences, The University of Newcastle, Callaghan, Australia.
NSW School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Australia.
Issue Date: 11-Aug-2023
Date: 2023
Publication information: The Cochrane Database of Systematic Reviews 2023-08-11; 8(8)
Abstract: There is a growing body of research evidence to guide acute stroke care. Receiving care in a stroke unit improves access to recommended evidence-based therapies and patient outcomes. However, even in stroke units, evidence-based recommendations are inconsistently delivered by healthcare workers to patients with stroke. Implementation interventions are strategies designed to improve the delivery of evidence-based care. To assess the effects of implementation interventions (compared to no intervention or another implementation intervention) on adherence to evidence-based recommendations by health professionals working in acute stroke units. Secondary objectives were to assess factors that may modify the effect of these interventions, and to determine if single or multifaceted strategies are more effective in increasing adherence with evidence-based recommendations. We searched CENTRAL, MEDLINE, Embase, CINAHL, Joanna Briggs Institute and ProQuest databases to 13 April 2022. We searched the grey literature and trial registries and reviewed reference lists of all included studies, relevant systematic reviews and primary studies; contacted corresponding authors of relevant studies and conducted forward citation searching of the included studies. There were no restrictions on language and publication date. We included randomised trials and cluster-randomised trials. Participants were health professionals providing care to patients in acute stroke units; implementation interventions (i.e. strategies to improve delivery of evidence-based care) were compared to no intervention or another implementation intervention. We included studies only if they reported on our primary outcome which was quality of care, as measured by adherence to evidence-based recommendations, in order to address the review aim. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias and certainty of evidence using GRADE. We compared single implementation interventions to no intervention, multifaceted implementation interventions to no intervention, multifaceted implementation interventions compared to single implementation interventions and multifaceted implementation interventions to another multifaceted intervention. Our primary outcome was adherence to evidence-based recommendations. We included seven cluster-randomised trials with 42,489 patient participants from 129 hospitals, conducted in Australia, the UK, China, and the Netherlands. Health professional participants (numbers not specified) included nursing, medical and allied health professionals. Interventions in all studies included implementation strategies targeting healthcare workers; three studies included delivery arrangements, no studies used financial arrangements or governance arrangements. Five trials compared a multifaceted implementation intervention to no intervention, two trials compared one multifaceted implementation intervention to another multifaceted implementation intervention. No included studies compared a single implementation intervention to no intervention or to a multifaceted implementation intervention. Quality of care outcomes (proportions of patients receiving evidence-based care) were included in all included studies. All studies had low risks of selection bias and reporting bias, but high risk of performance bias. Three studies had high risks of bias from non-blinding of outcome assessors or due to analyses used. We are uncertain whether a multifaceted implementation intervention leads to any change in adherence to evidence-based recommendations compared with no intervention (risk ratio (RR) 1.73; 95% confidence interval (CI) 0.83 to 3.61; 4 trials; 76 clusters; 2144 participants, I2 =92%, very low-certainty evidence). Looking at two specific processes of care, multifaceted implementation interventions compared to no intervention probably lead to little or no difference in the proportion of patients with ischaemic stroke who received thrombolysis (RR 1.14, 95% CI 0.94 to 1.37, 2 trials; 32 clusters; 1228 participants, moderate-certainty evidence), but probably do increase the proportion of patients who receive a swallow screen within 24 hours of admission (RR 6.76, 95% CI 4.44 to 10.76; 1 trial; 19 clusters; 1,804 participants; moderate-certainty evidence). Multifaceted implementation interventions probably make little or no difference in reducing the risk of death, disability or dependency compared to no intervention (RR 0.93, 95% CI 0.85 to 1.02; 3 trials; 51 clusters ; 1228 participants; moderate-certainty evidence), and probably make little or no difference to hospital length of stay compared with no intervention (difference in absolute change 1.5 days; 95% CI -0.5 to 3.5; 1 trial; 19 clusters; 1804 participants; moderate-certainty evidence). We do not know if a multifaceted implementation intervention compared to no intervention result in changes to resource use or health professionals' knowledge because no included studies collected these outcomes. We are uncertain whether a multifaceted implementation intervention compared to no intervention improves adherence to evidence-based recommendations in acute stroke settings, because the certainty of evidence is very low.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33513
DOI: 10.1002/14651858.CD012520.pub2
ORCID: 
Journal: The Cochrane Database of Systematic Reviews
Start page: CD012520
PubMed URL: 37565934
ISSN: 1469-493X
Type: Journal Article
Subjects: Stroke/therapy
Appears in Collections:Journal articles

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