34 Chapter 2 described a governance arrangement, in this case; formal reprimands and subject to termination in case of failing to complete training. For all studies, the median number of used strategies was 6 (IQR 4 – 8), with a median of 0 for the EPOC category delivery (IQR 0 – 1), and 0 for the EPOC category financial (IQR 0 – 0), and 0 for the EPOC category government arrangements (IQR 0 – 0), and a median of 6 (IQR 4 – 7) for the EPOC category implementation strategies. The median number of strategies in studies measuring patient-related nursing outcomes was 7.0 (IQR 5-8, n=21) for studies which reported a significant improvement, and was 6.0 (IQR 4.5-8.5, n=9) for studies which reported no change. The median number of strategies in studies measuring adherence was 6.0 (IQR 4.8-8, n=26) for studies that reported a significant improvement, and was 6.0 (IQR 4-7, n=18) for studies that reported no change. Most studies did not apply strategies in the control group, or did not provide a description of usual care. Eight studies [37-40, 48, 49, 61, 72] applied strategies in the control group, in most cases printed study material or availability of products e.g. providing pH-strips. Effects of implementation strategies Fifteen cluster randomized controlled trials studied the effects of specific implementation strategies. The individual strategies and the combinations of strategies applied in these trials varied [25, 26, 31, 32, 36-39, 41, 47-49, 52, 55, 61, 72]. For example, two cluster randomized controlled trials, by De Visschere et al. [47], and van der Putten et al. [78], described a supervised implementation strategy for an oral hygiene guideline. Both found a decrease of denture plaque after a 6-month follow-up (respectively; p<0.01 and p<0.0001). Other randomized controlled trials did not use a supervised implementation strategy, which limited the ability to conclude effectiveness of this specific implementation strategy. Lozano et al. [49] created three groups to implement an asthma treatment guideline. One group received a peer leader intervention, one received a planned care intervention, and one served as a control group, receiving care as usual. They only found an effect on patient-related nursing outcomes in the planned care intervention group; i.e., a decrease in asthma symptom days per year compared to usual care (p=0.02). We could not compare these outcomes with those of another cluster randomized controlled trial, because no similar implementation strategies were used in other randomized controlled trials.
RkJQdWJsaXNoZXIy MTk4NDMw