10.6084/M9.FIGSHARE.C.6227504
Aleksi J. Raudasoja
Aleksi J.
Raudasoja
0000-0002-9117-8861
Finnish Medical Society Duodecim
University of Helsinki
Petra Falkenbach
Petra
Falkenbach
University of Oulu
Oulu University Hospital
Robin W. M. Vernooij
Robin W. M.
Vernooij
0000-0001-5734-4566
Utrecht University
University Medical Center Utrecht
Jussi M. J. Mustonen
Jussi M. J.
Mustonen
Arnav Agarwal
Arnav
Agarwal
University of Toronto
McMaster University
Yoshitaka Aoki
Yoshitaka
Aoki
0000-0002-4365-443X
University of Fukui
Marco H. Blanker
Marco H.
Blanker
0000-0002-1086-8730
University of Groningen
Rufus Cartwright
Rufus
Cartwright
0000-0001-5501-319X
Chelsea and Westminster Hospital NHS Foundation Trust
London North West Healthcare NHS Trust
Imperial College London
Herney A. Garcia-Perdomo
Herney A.
Garcia-Perdomo
University of Valle
Tuomas P. Kilpeläinen
Tuomas P.
Kilpeläinen
0000-0002-7697-0148
University of Helsinki
Olli Lainiala
Olli
Lainiala
0000-0002-5665-229X
Tampere University
Tiina Lamberg
Tiina
Lamberg
Finnish Medical Society Duodecim
Olli P. O. Nevalainen
Olli P. O.
Nevalainen
Tampere University
University of Helsinki
Eero Raittio
Eero
Raittio
0000-0002-9258-9355
Patrick O. Richard
Patrick O.
Richard
Centre Hospitalier Universitaire de Sherbrooke
Université de Sherbrooke
Philippe D. Violette
Philippe D.
Violette
0000-0002-6116-5496
McMaster University
Jorma Komulainen
Jorma
Komulainen
0000-0001-8884-2867
Finnish Medical Society Duodecim
Raija Sipilä
Raija
Sipilä
0000-0002-5071-8681
Finnish Medical Society Duodecim
Kari A. O. Tikkinen
Kari A. O.
Tikkinen
University of Helsinki
Randomized controlled trials in de-implementation research: a systematic scoping review
Abstract Background Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration OSF Open Science Framework hk4b2
Medicine
Neuroscience
Cancer
Science Policy
110309 Infectious Diseases
figshare
2022
2022-10-02
2022-10-02
Collection
10.1186/s13012-022-01238-z
CC BY 4.0