چکیده (انگلیسی):

Background:Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical
practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions
that target healthcare providers to improve adherence to CVD guidelines and patient outcomes.
Methods:We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from
inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited
to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a
patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were
conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out
where possible. GRADE summary of findings tables were created for each comparison and outcome.
Results and Discussion:We included 38 RCTs in our review. Interventions included guideline dissemination,
education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by
intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the
education intervention showed statistically significant improvement compared to usual care (standardized mean
difference = 0.58 [95 % confidence interval 0.35 to 0.8]).
Conclusions:Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of
evidence and number of trials limited our ability to draw conclusions.