IMPLEMENTING GUIDELINES AND INNOVATIONS IN GENERAL-PRACTICE - WHICH INTERVENTIONS ARE EFFECTIVE

Background. It is crucial that research findings are implemented in ge neral practice if high-quality care is to be achieved. Multifaceted in terventions are usually assumed to be more effective than single inter ventions, but this hypothesis has yet to be tested for general practic e care. This review evaluates the effectiveness of interventions in in fluencing the implementation of guidelines and adoption of innovations in general practice. A systematic literature study was carried out us ing MEDLINE searches for the period from January 1980 until June 1994, and 21 medical journals were searched manually. Randomized controlled trials and controlled before and after studies (with pre-and post-int ervention measurements in all groups) were selected for the analysis. Clinical area, interventions used, methodological characteristics and effects on clinical behaviour were noted independently by two research ers using a standardized scoring form. Of 143 studies found, 61 were s elected for the analysis, covering 86 intervention groups that could b e compared with a control group without the intervention. Information transfer alone was effective in two out of 18 groups, whereas combinat ions of information transfer and learning through social influence or management support were effective in four out of eight and three out o f seven groups respectively. Information linked to performance was eff ective in 10 out of 15 groups, but the combination of information tran sfer and information linked to performance was effective in only three out of 20 groups, Some, but not all, multifaceted interventions are e ffective in inducing change in general practice, Social influence and management support can improve the effectiveness of information transf er, but information linked to performance does nor necessarily do so, The variation in the effectiveness of interventions needs further anal ysis.