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Table 2 Summary of the characteristics and results of the included studies

From: Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

Source, year

Design/method of data collection

Primary aim

Setting, country

Included participants: n (intervention group (IG)/ control group (CG))

Age in years: mean (range)

Groups in the intervention, provider

Results of the main project reports

Source of the barrier and facilitator data extraction

Azad et al., 2008 [30]

RCT

Effectiveness of the intervention

Primary care, Canada

Female patients with heart failure and their family caregivers

91 (45/46)

IG: 74.2

CG: 75.7

Caregivers: n.a.

IG: multi-disciplinary care pathway for heart failure

- 12 visits

- assessment and evidence-based

  treatment by various disciplines

- group sessions/workshops: heart

  failure management and education

CG: usual care

Provider: medicine, pharmacy, nursing, occupational therapy, physical therapy,

social work

No significant difference in primary outcome

 

Byszewski et al., 2010 [31]

with an additional publication focusing the intervention arm

Variance, adherence

 

All patients from the IG (n = 45)

IG: 74.2

  

Barrier and facilitator typology derived from data

Bleijenberg et al., 2016a [32]

cRCT

Effectiveness of the intervention

Primary care, Netherlands

Community-dwelling elderly people

3092 (790IGa/ 1446IGb/856CG)

IGa: 73.5

IGb: 74.0

CG: 74.6

IGa: frailty screening followed by routine care from a general practitioner

IGb: Proactive Primary Care Program on Preserving Daily Functioning of Older

People:

frailty assessment followed by personalized nurse-led care

- geriatric assessment

- tailored care planning

- care coordination

- follow-up

- educational training for providers

CG: usual care

Provider: practice nurses, general

practitioners

Significant differences in primary outcome in both IGs

 

Bleijenberg et al., 2013b [33]

with a nested mixed-methods study:

- quantitative: pre-and post-

  questionnaires

- qualitative: focus groups with health professionals

Barriers, needs, expectations

 

32 general practitioners

21 practice nurses

General

practitioners: 55.0

Practice nurses: 46.5

  

Barrier and facilitator themes

Respondents’ agreement with pre-defined barrier statements

Bleijenberg et al., 2015 [34]

with a nested qualitative study: interviews with patients

Perceptions, experiences

 

11 patients from IGb (subsample)

79

  

Barrier and facilitator themes

Bleijenberg et al., 2016b [35]

with a nested mixed-methods study:

- quantitative:

  descriptive data

- qualitative: focus

  group with nurses

Intervention delivery

 

835 patients (identified as frail) from IGb

Subsample of practice nurses from IGb (n = n.a.)

Patients: 75.4

Practice nurses: n.a.

  

Barrier and facilitator themes

Harris et al., 2015 [36]

cRCT

Effectiveness of the intervention

Primary care, UK

Community-dwelling aged people

298 (150/148)

(60–75)

IG: Pedometer accelerometer consultation evaluation (PACE)-Lift intervention

- individually tailored consultations

- patient handbook

- individual physical walking/activity plan

- physical activity diary

- pedometer, accelerometer

- educational training for providers

CG: usual care

Provider: practice nurse

Positive effect on primary outcome (significant differences at 3 months but not at 12 months), with no

effect on adverse events

 
 

with nested qualitative studies:

interviews with patients, group interview with health professionals

Acceptability,

Barriers, facilitators

 

30 patients

4 practice nurses

   

Barrier and facilitator themes

Melis et al., 2008 [37]

cRCT

Effectiveness of the intervention

Primary care,

Netherlands

Community-dwelling

independently living elderly people and their family caregivers

151 (85/66)

IG: 81.7

CG: 82.8

Caregivers: n.a.

IG: Dutch Geriatric Intervention Program (DGIP)

- multi-professional assessment

- individualized, integrated treatment plan

- regular evaluation and follow-up visits

CG: regular medical care

Provider: primary care physician, geriatric specialist nurse (and geriatricians)

The intervention had a positive

effect on primary outcomes

(significant differences at 3 months but not at 6 months)

 

Melis et al., 2010 [38]

with a nested process evaluation

Content, adherence

 

All patients from the IG (n = 85)

81.7

  

Barrier and facilitator typology derived from data

Metzelthin et al., 2013b [39]

cRCT

Effectiveness of the intervention

Primary care, Netherlands

Community-dwelling frail elderly people

346 (193/153)

IG: 77.5

CG: 76.8

IG: Prevention of Care (PoC) approach- multi-dimensional assessment

- interdisciplinary care

- tailored treatment plan

- evaluation and follow-up

- educational training for providers

CG: usual care

Provider: practice nurses, general

practitioners, occupational therapists,

physical therapists

No significant differences in primary outcomes

 

Metzelthin et al., 2013a [40]

with additional mixed-method components:

- quantitative:   logbooks, evaluation forms

- qualitative:

  interviews with

  patients and health

  professionals, focus

  groups with health

  professionals

Extent to which the implementation

occurred as planned,

experiences

regarding benefits,

burden, barriers and facilitators

 

7 practice

nurses

12 general

practitioners

6 occupational therapists

20 physical

therapists

194 patients

Patients: 77.7

Health

professionals: n.a.

  

Barrier and facilitator themes

van Bruggen et al., 2008 [41]

cRCT

Effectiveness of the intervention

Primary care,

Netherlands

People with type 2 diabetes

1640 (822/818)

IG: 67.1

CG: 67.2

IG: - locally adapted shared care guidelines

- educational training for providers

CG: usual care (national guidelines)

Provider: general practitioners, nurses, practice assistance

No significant differences in outcomes, but improvement in the process of diabetes care

 
 

with nested qualitative studies:

interviews with health professionals

Barriers,

facilitators

     

Barrier and facilitator themes

Weldam et al., 2017a [42]

cRCT

Effectiveness of the intervention

Primary care,

Netherlands

People with mild to severe COPD

204 (103/101)

IG: 68.0

CG: 66.0

IG: nurse-led Chronic Obstructive

Pulmonary Disease – Guidance, Research on Illness Perception (COPD-GRIP) intervention

- three extra face-to-face consultations with individualized content, based on the

  patient’s responses and the needs

- assessment

- individualized care plan

- evaluation

- educational training for providers

CG: usual care

Provider: practice/respiratory nurse

No significant difference in outcomes

 

Weldam et al., 2017b [43]

with nested mixed-method components:

- quantitative:

  pre- and post-

  questionnaires

- qualitative: focus

  groups with health

  professionals

Facilitators, barriers, expectations

 

24 nurses

Questionnaires: 45.5

Focus group: 47.4

  

Barrier and facilitator themes

Respondents’

agreement with

pre-defined barrier statements

  1. IG intervention group; CG control group; COPD-GRIP Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception; DGIP Dutch Geriatric Intervention Program; PACE Pedometer accelerometer consultationevaluation; PoC Prevention of Care