Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings
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PURPOSE: This study was a systematic review with a quantitative synthesis of the literature examining the overall effect size of practice facilitation and possible moderating factors. The primary outcome was the change in evidence-based practice behavior calculated as a standardized mean difference. METHODS: In this systematic review, we searched 4 electronic databases and the reference lists of published literature reviews to find practice facilitation studies that identified evidence-based guideline implementation within primary care practices as the outcome. We included randomized and nonrandomized controlled trials and prospective cohort studies published from 1966 to December 2010 in English language only peer-reviewed journals. Reviews of each study were conducted and assessed for quality; data were abstracted, and standardized mean difference estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias, influence, subgroup, and meta-regression analyses were also conducted. RESULTS: Twenty-three studies contributed to the analysis for a total of 1,398 participating practices: 697 practice facilitation intervention and 701 control group practices. The degree of variability between studies was consistent with what would be expected to occur by chance alone (I2 = 20%). An overall effect size of 0.56 (95% CI, 0.43-0.68) favored practice facilitation (z = 8.76; P <.001), and publication bias was evident. Primary care practices are 2.76 (95% CI, 2.18-3.43) times more likely to adopt evidence-based guidelines through practice facilitation. Meta-regression analysis indicated that tailoring (P = .05), the intensity of the intervention (P = .03), and the number of intervention practices per facilitator (P = .004) modified evidence-based guideline adoption. CONCLUSION: Practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care. Implementation fidelity factors, such as tailoring, the number of practices per facilitator, and the intensity of the intervention, have important resource implications.
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Within the 23 studies reviewed, facilitators employed a number of different facilitation strategies, in particular audit and feedback (used in 100 per cent of studies) and interactive consensus building and goal setting (91 per cent use), alongside reminders, tailoring to context and quality improvement tools such as Plan-Do-Study-Act (PDSA) cycles.
“Within the 23 studies reviewed, facilitators employed a number of different facilitation strategies, in particular audit and feedback (used in 100 per cent of studies) and interactive consensus building and goal setting (91 per cent use), alongside reminders, tailoring to context and quality improvement tools such as Plan-Do-Study-Act (PDSA) cycles.”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [52]
A 2012 systematic review of practice facilitation in primary care concluded that practices supported by a facilitator were 2.76 times more likely to adopt evidence-based clinical guidelines.
“A 2012 systematic review of practice facilitation in primary care concluded that practices supported by a facilitator were 2.76 times more likely to adopt evidence-based clinical guidelines [52].”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [52]
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Flagged first, then by citations
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Cited by
Sorted by citations
Harvey, G., & Kitson, A. (2015) · Implementation Science · doi:10.1186/s13012-016-0398-2 · Cited by 1,271 · see citing works
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., Laraque, D., GLAD-PC STEERING GROUP, Levitt, A., Birmaher, B., Campo, J., Clarke, G., et al. (2018) · Pediatrics · doi:10.1542/peds.2017-4081 · Cited by 446 · see citing works
Why (we think) facilitation works: insights from organizational learning theory
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Lau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., Everitt, H., Kennedy, A., Qureshi, N., Rogers, A., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009993 · Cited by 254 · see citing works
“43) times more likely to adopt evidence-based guidelines through practice facilitation.(82) Similar significant effects were observed in other reviews.”
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Personalized Implementation of Video Telehealth
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Aifah, A. A., Hade, E. M., Colvin, C., Henry, D., Mishra, S., Rakhra, A., Onakomaiya, D., Ekanem, A., Shedul, G., Bansal, G. P., et al. (2023) · Implementation Science · doi:10.1186/s13012-023-01272-5 · Cited by 11 · see citing works
Ready for the Challenge of Depression Care in the Medical Home
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- Authors
- Baskerville, N. B., Liddy, C., & Hogg, W.
- Affiliations
- University of Waterloo (CA)
- University of Ottawa (CA)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2012-01-01
- Volume
- 10
- Issue
- 1
- Pages
- 63-74
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC3262473
- OpenAlex
- W2098408559
- Cited by
- 571
- References
- 107
- Citations by year
- 2026: 26 · 2025: 34 · 2024: 57 · 2023: 48 · 2022: 51 · 2021: 74 · 2020: 51 · 2019: 40 · 2018: 43 · 2017: 30 · 2016: 25 · 2015: 34 · 2014: 26 · 2013: 24 · 2012: 8
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- practice facilitation, evidence-based practice, guideline implementation, primary care, implementation fidelity, intervention tailoring, intervention intensity, publication bias
- MeSH terms
- Clinical Trials as Topic, Health Facility Administrators, Humans, Primary Health Care, Regression Analysis, Evidence-Based Practice, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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