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Review ArticleSystematic Reviews

Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings

N. Bruce Baskerville, Clare Liddy and William Hogg
The Annals of Family Medicine January 2012, 10 (1) 63-74; DOI: https://doi.org/10.1370/afm.1312
N. Bruce Baskerville
MHA, PhD
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  • For correspondence: nbbaskerville@uwaterloo.ca
Clare Liddy
MD, MSc, CCFP, FCFP
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William Hogg
MSc, MClSc, MDCM, CCFP, FCFP
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  • Figure 1
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    Figure 1

    Flowchart of identification of relevant studies.

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    Figure 2

    Effect of practice facilitation vs control in random-effects meta-analysis sorted from low to high methodological performance and effect size (N = 23).

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    Figure 3

    Publication bias funnel plot with observed (N = 23) and imputed studies.

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    Figure 4

    Number of practices per facilitator and effect size (n = 21).

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    Figure 5

    Intensity of intervention and effect size (N = 23).

Tables

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    Table 1

    Research Design Characteristics of Studies with High Methodological Performance Scores (N = 23)

    Author, YearScoreaTrial CharacteristicsOutcome MeasureMonths Follow-up (% Retention)Effect Size SMD (SE) 95% CI
    Kottke et al,63 19926Design: CCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: Y
    Mean percentage of patients advised to quit19 (83)1.01 (0.52) 0.00 to 2.02c
    McBride et al,67 20006Design: RCT
    Allocation concealed: N
    Blindedb: N
    Intent to treat: N
    Percentage of records with CVD screening18 (100)0.82 (0.46) –0.08 to 1.72
    Stange et al,48 20036Design: RCT
    Allocation concealed: N
    Blindedb: N
    Intent to treat: N
    Mean rate of preventive service24 (NR)0.59 (0.23) 0.13- to 1.05c
    Lobo et al,57 20046Design: RCT
    Allocation concealed: Y
    Blindedb: N
    Intent to treat: N
    Mean health-related quality of life21 (57)0.44 (0.18) 0.09 to 0.79c
    Roetzhiem et al,34 20056Design: C-RCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: N
    Mean number of CA-screening tests24 (100)0.84 (0.29) 0.27 to 1.41c
    Hogg et al,78 20086Design: CCT
    Allocation concealed: N
    Blindedb: N
    Intent to treat: Y
    Mean preventive performance index6 (87)0.73 (0.29) 0.16 to 1.30c
    Aspy et al,82 20086Design: CCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: N
    Percent given physical inactivity brief intervention18 (89)1.12 (0.36) 0.42 to 1.82c
    Jaén et al,85 20106Design: RCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: N
    Mean prevention service score26 (86)0.04 (0.37) –0.69 to 0.77
    Cockburn et al,70 19927Design: RCT
    Allocation concealed: N
    Blindedb: N
    Intent to treat: N
    Mean number of cessation cards used3 (79)0.24 (0.15) –0.06 to 0.54
    Modell et al,55 19987Design: RCT
    Allocation concealed: N
    Blindedb: N
    Intent to treat: N
    Median number of hemoglobin tests12 (100)0.32 (0.40) –0.45 to 1.09
    Engels et al,80 20067Design: RCT
    Allocation concealed: Y
    Blindedb: N
    Intent to treat: Y
    Mean number of projects initiated12 (92)1.04 (0.32) 0.41 to 1.67c
    Aspy et al,83 20087Design: RCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: N
    Mean percent with MMG9 (100)1.31 (0.57) 0.20 to 2.42c
    Deitrich et al,59 199218Design: RCT
    Allocation concealed: N
    Blindedb: Y
    Intent to treat: N
    Mean rate of prevention service12 (96)0.59 (0.29) 0.02 to 1.16c
    Lobo et al,57 20028Design: RCT
    Allocation concealed: Y
    Blindedb: N
    Intent to treat: Y
    Mean number of adherence items21 (100)0.66 (0.19) 0.30 to 1.02c
    Bryce et al,47 19959Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Percentage of consults initiated for asthma12 (93.3)0.62 (0.31) 0.02 to 1.22c
    Kinsinger et al,56 19989Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: N
    Percentage of patients with CBE and MMG18 (94)0.47 (0.27) –0.05 to 0.99
    Solberg et al,69 19989Design: RCT
    Allocation concealed: Y
    Blindedb: N
    Intent to treat: Y
    Mean number of preventive systems processes22 (100)1.08 (0.32) 0.45 to 1.71c
    Lemelin et al17 20019Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: N
    Mean preventive performance index18 (98)0.98 (0.32) 0.36 to 1.60c
    Frijling et al,35 20029Design: C-RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Percentage giving eye examination21 (95)0.26 (0.18) –0.09 to 0.61
    Frijling et al,65 20039Design: C-RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Percentage assessing hypertension risk21 (95)0.39 (0.18) 0.04 to 0.74c
    Margolis et al,58 200410Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Mean percentage given preventive service30 (100)0.60 (0.31) 0.00 to 1.20c
    Mold et al,81 200810Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Percentage implementing processes6 (100)0.94 (0.53) –0.10 to 1.98
    Hogg et al,79 200812Design: RCT
    Allocation concealed: Y
    Blindedb: Y
    Intent to treat: Y
    Mean preventive performance index13 (100)0.11 (0.27) –0.42 to 0.64
    • CA = cancer; CBE = clinical breast examination; CCT = controlled clinical trial; C-RCT = cluster randomized-controlled trial; CVD = cardiovascular disease; MMG = mammography; N = no (not reported); RCT = randomized controlled trial; SE = standard error; SMD = standardized mean difference; Y = yes (reported).

    • ↵a Scored on a scale from 0 to 12, in which the higher the score, the higher the quality of the study methods.

    • ↵b Single- or double-blind study.

    • ↵c P <.05; z statistic.

Additional Files

  • Figures
  • Tables
  • Supplemental Tables

    Supplemental Table 1. Excluded Studies With Low Methodological Performance Scores (n = 21); Supplemental Table 2. Intervention Characteristics of Studies With High Methodological Performance Scores (N = 23)

    Files in this Data Supplement:

    • Supplemental data: Table - PDF file, 3 pages, 135 KB
    • Supplemental data: Table - PDF file, 3 pages, 127 KB
  • The Article in Brief

    Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings

    N. Bruce Baskerville , and colleagues

    Background Practice facilitation is a multifaceted approach in which skilled individuals help others address the challenges in implementing evidence-based care guidelines in the primary care setting. As the United States attempts to redesign medical practice, practice facilitation increasingly is used to assist with needed practice changes. This study, a systematic review of the existing literature, examines the overall effect of practice facilitation.

    What This Study Found Practice facilitation has a robust effect on the adoption of evidence-based guidelines in primary care. The systematic review, which includes 23 studies representing nearly 1,400 primary care practices, finds that practices are 2.76 times more likely to adopt evidence-based guidelines with practice facilitation than without. Tailoring the intensity of the intervention to the needs of the practice and the number of practices per facilitator has an impact on the effectiveness of the facilitation.

    Implications

    • The authors call for large-scale collaborative, practice-based evaluation research to understand the impact of facilitation on the adoption of guidelines, the relationship between context and the components of facilitation, sustainability, and costs to the health system.
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The Annals of Family Medicine: 10 (1)
The Annals of Family Medicine: 10 (1)
Vol. 10, Issue 1
January/February 2012
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Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
N. Bruce Baskerville, Clare Liddy, William Hogg
The Annals of Family Medicine Jan 2012, 10 (1) 63-74; DOI: 10.1370/afm.1312

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Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
N. Bruce Baskerville, Clare Liddy, William Hogg
The Annals of Family Medicine Jan 2012, 10 (1) 63-74; DOI: 10.1370/afm.1312
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