Introduction

The analytic framework presented in the Introduction guided the literature search, abstraction and analysis for Key Question (KQ) 2. KQ2 concerns dissemination to clinicians or patients. As discussed in the Methods section, we included dissemination strategies that met two main criteria. First, they attempted to increase reach, ability, or motivation or used multicomponent approaches addressing one or more of these strategies. We categorized specific dissemination tactics as comprising reach, ability, motivation or multicomponent approaches as described previously. Second, they attempted to address health-related decisions and behaviors, clinical outcomes, or knowledge. We included only randomized controlled trials (RCTs) or cluster RCTs (cRCTs)—hereafter referred to as trials.

This section presents the results that compare the dissemination strategies noted above. Some trials compared strategies directly with each other (e.g., ability strategies vs. motivation strategies) and can be regarded as head-to-head trials for comparative effectiveness analyses. Some trials compared strategies to a usual care or no-treatment control group, but we included them in our analysis if they had at least two trial arms that addressed our inclusion criteria and if we believed that we might glean information about the relative effectiveness of one strategy versus another. In many cases where there was not a direct comparison significant tests or confidence intervals were likely also not reported, and we note this in the summary tables.

We divided the trials by dissemination strategies and by outcomes for clinicians and patients. The included studies were very heterogeneous with regard to the specific health-related decisions and behaviors, clinical outcomes or knowledge studied. They were also very heterogeneous with regard to specific dissemination strategies reflecting the reach, ability, motivation, and multicomponent approaches. Because of this heterogeneity, we chose to present summary tables in this section that describe trial results in words rather than numerically. Information reflects the comparisons as presented by the original investigators, which in some cases do not reflect precisely the constructs or directionality of our conceptual framework and definitions of strategies. Detailed evidence tables containing additional statistical results presenting numerical findings for abstracted trials appear in Appendix E.

Figure 1 in the previous section presents the flow diagram that accounts for all titles/abstracts and full-text articles reviewed and the final set of articles for all three KQs. In all, 163 articles were relevant to KQ 2. After full-text review, we retained 42 articles that met inclusion criteria; they report on 38 unique trials (including one trial that reported on different outcomes in multiple articles) about dissemination strategies.

In this section, we do not present summary tables that classify studies by the mode of delivery, agent, and communication goal. However, we examined this alternate presentation of results to ensure we were not missing any major conclusions about dissemination conceived in this alternate manner. This alternative organization did not reveal any different conclusions. This is likely due to the non-significant findings across studies and the fact that in almost all cases there was confounding among the various variables we used to classify dissemination strategies.

Description of Included Studies

Two team members independently assessed study quality for 163 articles related to KQ 2. When there were disagreements they were adjudicated by 2–3 team members. We used 38 trials in the KQ 2 analysis. Of these, we assessed 15 as low risk of bias^83–100 and 23 as moderate risk of bias.^{72,78,101–122} Those assessed as high risk of bias were not abstracted or used for analysis.

These 38 trials reported a wide variety of primary and secondary outcomes that spanned a range of health-related or clinical problems; these are documented in the outcome column in Tables 14–30. Even though some trials examined similar outcomes, e.g., guideline-concordant care, they may have used different dissemination strategies or focused on different problems or clinical issues. Because of this heterogeneity, we were not able to combine trials to conduct a quantitative analysis of the effect of dissemination to clinicians or patients.

We graded the SOE for trials at the level of dissemination strategy (increasing reach, ability, motivation, or multicomponent) and outcome category (health-related decision or behavior, clinical outcome or knowledge). In some cases, only one trial was relevant to the analysis (i.e., a single study for which SOE could be graded); in other cases we had as many as six trials on a strategy-outcome topic, but they were different enough to preclude any meta-analysis.

The trials were conducted in the United States, Canada, England, Germany, Finland, the Netherlands, Scotland, and Spain. Sample sizes ranged from 114 participants to 3,293 participants. For the cRCTs, cluster sizes ranged from 9 to 249.

In the tables below (Tables 14–30), we summarize the intervention comparisons that the authors had used along with our classification of specific strategies attempting to affect reach, ability, motivation or a combination of these aims. The summary tables show the following: author, year of publication, study design (RCT or cRCT), number of study participants (N) and/or number of clusters (N_c) randomized (if reported), study duration, quality rating for the trial; setting and sample characteristics; study intervention groups (e.g., G1,…GX); and the outcomes as defined by the authors; and a summary of the trial’s results.

We described summary results in several ways. If one group (e.g., G1) had a stronger effect than another group (e.g., G2) we denoted this as G1>G2. If significance tests or confidence intervals were reported for the direct comparison, and they indicated statistical significance, we described these in the table as significant differences. In some cases there were no significance tests or confidence intervals reported for the comparisons of interest; instead, the active arms were compared to a control group and we note this in the tables as no significance tests or confidence intervals reported for the comparison of interest.

If groups did not differ we noted this in summary tables as G1=G2. Here again, if statistical significance tests or confidence intervals were reported for the direct comparison we described these as no significant differences. As previously mentioned, in some cases there were no significance tests or confidence intervals reported. In these cases we noted this in the tables no significance tests or confidence intervals reported for the comparison of interest.

In the next three sections we review the evidence for dissemination strategies focused on clinicians and patients. In the first section we focus on clinicians, in the second section on patients, and in the third section on studies that targeted both clinicians and patients. In each section summarize key points, present the strength of evidence table for each comparison category and summarize the evidence in tables and the narrative. The summary tables describe the study and key findings. The narrative describes additional details, including the specific dissemination tactics a trial used.

Key Question 2. Disseminating Evidence to Clinicians

Detailed Synthesis: Dissemination Strategies for Clinicians and Health-Related Decisions or Behaviors

Table 16 documents the strength of evidence grading for each of the dissemination comparisons focused on clinicians for health-related decisions and behaviors and gives the overall SOE grade.

Table 16

Strength of evidence: Dissemination to clinicians for health-related decisions and behavior outcomes.

Table 15 describes the clinician-focused trials and summarizes their results for decision or behavioral outcomes. The text accompanying the table describes trials that compare (a) reach and ability strategies, (b) reach and motivation strategies, (c) reach versus multicomponent strategies, (d) ability versus multicomponent strategies, (e) motivation versus multicomponent strategies, and (f) ability, or motivation and multicomponent strategies.

Strategies To Increase Reach Versus Strategies To Increase Ability

Four trials tested dissemination strategies to affect clinician health-related decisions and behaviors by increasing reach or increasing ability (Table 17). Three were cRCTs,^83,90,96 and one was a RCT.¹¹⁹ Reach strategies included delivering guidelines by mail or computer; increasing ability strategies included computer assisted learning, textbooks, and individual or group academic detailing. The followup periods ranged from 1 month to 2 years after the intervention. All trials examined guideline-concordant care, but for different behaviors and conditions. Across these trials, intervention groups did not differ significantly for any of the primary outcomes reported.

Table 17

Summary of trials examining dissemination to clinicians for health-related decisions and behavior outcomes.

Strategies To Increase Reach Versus Strategies To Increase Motivation

One trial tested dissemination strategies to affect clinician behavior by increasing reach versus increasing motivation (Table 17).¹⁰⁹ This trial compared conventional guideline delivery with a scheme that contained vignettes involving patient-specific ratings from an expert panel as part of the guideline message. For example “the expert panels recommend exercise testing (rating 7),” where the rating corresponded to the appropriateness of that test for a specific patient portrayed in a vignette (e.g., patient specific ratings). The outcome measure was the agreement between the physician’s test ordering and recommendations of two independent expert panels. Immediate posttest measures after the intervention showed providing this vignette-driven, patient-specific information about the appropriateness of applying a guideline was significantly more effective than simply providing traditional guidelines.

Strategies To Increase Reach Versus Multicomponent Strategies

Seven trials tested dissemination strategies to affect clinician behavior by increasing reach against multicomponent strategy (Table 17).^{85,95,97,102,113,121,122} Four trials were cRCTs. Each trial compared multicomponent approaches that involved some type of educational component and written or in-person reminders or decisions support materials with reach strategies that entailed postal or emailed guidelines. One study used an opinion leader delivering guidelines as the reach strategy.⁹⁵ The followup periods ranged from 45 days to 1 year after the intervention. Across these six trials, five of the seven found that multicomponent strategies were more effective at changing outcomes compared to reach strategies. In one trial¹⁰² statistical significance tests were not reported for this comparison.

Strategies To Increase Ability Versus Multicomponent Strategies

Three trials tested dissemination strategies to affect clinician behavior by increasing ability against a multicomponent approach (Table 17).^110,116 One was a cRCT with a followup period of up to 136 days after the intervention assessing whether a workshop that provided education about evidence-based medicine and decision support via a decision tree (multicomponent) was better than either the workshop alone (ability) or decision tree alone (ability) in promoting appropriate prescriptions for patients with osteoarthritis.¹¹⁶ The authors reported only significant comparisons of each of these intervention arms with a no-treatment control group and did not compare the intervention arms to each other. The authors suggested that the multicomponent approach they used may confer a weak advantage compared with either of the ability strategies alone, but they presented no specific statistical analyses supporting this statement. The second cRCT with a 6-month followup period tested whether continuing medical education (CME) (ability strategy) that also provided practice enablers and reinforcers (motivation strategy) was better than CME alone in promoting guideline adherence.¹¹⁰ Enablers and reinforcers took the form of a nurse providing prompts to reevaluate care for patients who might have undermanaged, high-risk cardiovascular disease and a checklist of the most recent and relevant clinical practice guidelines. The arm with the CME plus these reinforcing intervention elements was significantly better than CME alone. The RCT in this category was large (N=2,624). They compared an ability strategy (training sessions) with a multicomponent strategy (training sessions plus provision of portable spirometry) to improve diagnosis and severity classification of chronic obstructive pulmonary disease.¹¹⁸ The authors compared both arms with a no-treatment control group, but not to each other, and did not report confidence intervals or significance tests for our comparisons of interest.

Strategies To Increase Motivation Versus Multicomponent Strategies

One trial tested a dissemination strategy to affect clinician behavior by increasing motivation against a multicomponent strategy (Table 17);⁹⁸ it used a cRCT design with a 360-day followup. The primary outcome was guideline adherence related to lymph node assessment and biopsy. The authors compared a motivation strategy involving an expert opinion leader with a multicomponent strategy that involved the expert opinion leader plus academic detailing and a toolkit. The multicomponent arm was more effective for one of the outcomes, i.e., lymph node assessment; the groups did not differ significantly, however, for lymph node removal.

Strategies To Increase Reach and Ability Versus Multicomponent Strategies

One four-arm cRCT study compared a reach strategy (guidelines by mail), two different ability strategies (one educational session with guidelines and a continuing professional education session with guidelines), and a multicomponent strategy that involved all these steps to affect the dispensing of antifungal medications for vulvovaginal candidiasis in community-based pharmacies (Table 17).¹²⁰ This trial assessed the primary outcome by having trained actors visit pharmacies presenting with particular clinical symptoms that might or might not require anti-fungal medication. The groups did not differ significantly immediately after the intervention.

Detailed Synthesis: Dissemination Strategies for Clinicians and Clinical Outcomes

Table 18 documents the strength of evidence grading for six trials that examined dissemination strategies focused on clinicians and assessed clinical outcomes and gives the overall SOE grade.

Table 18

Strength of evidence: Studies examining dissemination to clinicians for clinical outcomes.

Table 19 describes clinician-focused trials and summarizes their results for clinical outcomes. Text accompanying the table describes trials that compare (a) reach and ability strategies, (b) reach and multicomponent strategies, and (c) reach, ability, or multicomponent strategies.

Table 19

Summary of trials examining dissemination to clinicians for clinical outcomes.

Strategies To Increase Reach Versus Strategies To Increase Ability

One cRCT compared a reach strategy with two ability strategies.⁹⁶ The reach strategy involved mailed information. The ability strategies involved group academic detailing in one group and individual academic detailing in the other group. Over a two year followup period there were no significant differences among groups for guideline adherence related to treatment of hypertension patients.

Strategies To Increase Reach Versus Multicomponent Strategies

Four studies compared reach strategies with multicomponent strategies.^{86,95,100,106} Three were cRCTs that had 1-year followup assessing patient outcomes such as physical functioning and pain,⁸⁶ nutrition support,¹⁰⁰ or quality of life.¹⁰⁶ One study was a cRCT with followup at 1.5, 3, 6, and 12 months.⁹⁵ Three studies used mailed guidelines as the reach strategy; multicomponent approaches involved educational training, use of supportive decision aids, opinion leaders, or a nurse specialist for consultation.^86,95,106 Jain et al. compared giving written materials with an extensive multicomponent intervention providing education, web-based tools, and interpersonal support to dieticians providing nutritional support to critically ill adults on mechanical ventilation in an intensive care unit.¹⁰⁰ The reach and multicomponent approaches did not differ significantly for any of these studies at followup assessment.

Strategies To Increase Reach, Ability, and Multicomponent Strategies

One trial tested the effect of dissemination strategies to improve clinical outcomes by increasing reach versus increasing ability versus a multicomponent approach.¹⁰⁸ Reach strategy included dissemination of a guideline regarding childhood asthma treatment, ability strategy included the addition of education, and the multicomponent approach added individualized treatment advice. Study groups did not differ significantly in in airway responsiveness at 12-month followup.

Detailed Synthesis: Dissemination Strategies for Clinicians and Knowledge Outcomes

Table 20 documents the strength of evidence grading for each of the dissemination comparisons focused on clinicians for clinical outcomes and gives the overall SOE grade.

Table 20

Strength of evidence: Trials examining dissemination to clinicians for knowledge outcomes.

Table 21 describes clinician-focused trials and summarizes their results for knowledge outcomes. Text accompanying the table describes trials that compare (a) reach and ability strategies, (b) reach and multicomponent strategies, and (c) reach, ability, or multicomponent strategies.

Table 21

Summary of studies examining dissemination to clinicians for knowledge outcomes.

Strategies To Increase Reach Versus Strategies To Increase Ability

One trial compared a reach strategy (dissemination of guidelines via email) with an ability strategy (guidelines and a web-based education program) and measured enhancement of residents’ knowledge of the use of opioids for managing pain.¹¹⁹ At the end of a 60-day followup period, residents receiving the ability strategy had significantly higher scores on a knowledge and competence measure.

Strategies To Increase Reach Versus Multicomponent Strategies

One study compared a reach strategy (dissemination of guidelines via mail) with a multicomponent strategy that involved a one-day workshop led by opinion leaders. During the workshop materials supporting guideline practice for whiplash were provided to participants. The workshop was followed by a two-hour outreach visit six months later. The multicomponent approach was significantly better at increasing knowledge about how to treat whiplash.

Strategies To Increase Reach, Strategies To Increase Ability, and Multicomponent Strategies

This four-arm cRCT study (previously described in Table 16) also assessed clinician knowledge as a primary outcome.¹²⁰ They compared a reach strategy (guidelines by mail), two ability strategies (educational session with guidelines and CME with guidelines), and a multicomponent strategy that involved all these combined strategies. The outcome measure appropriate dispensing of antifungal medications for vulvovaginal candidiasis in community-based pharmacies. The groups did not differ significantly in knowledge scores assessed with self-report prepost intervention questionnaires

Key Question 2. Disseminating Evidence to Patients

Detailed Synthesis: Dissemination Strategies for Patients and Health-Related Decisions or Behaviors

Table 22 documents the strength of evidence grading for each of the dissemination comparisons focused on patients for health-related decisions and behavior outcomes and gives the overall SOE grade.

Table 22

Strength of evidence: Trials examining dissemination to patients for health-related decisions and behavior outcomes.

Table 23 describes patient-focused trials and summarizes their results for health-related decisions and behavior outcomes. Text accompanying the table describes trials that (a) compare reach strategies of various types, (b) reach and motivation strategies, (c) reach and multicomponent strategies, and (d) motivation and multicomponent strategies.

Table 23

Summary of trials examining dissemination to patients for health-related decisions and behavior outcomes.

Strategies To Increase Reach

Three trials compared reach strategies with other reach strategies with respect to patient health-related decisions and behaviors including intention to get a PSA screening,^107,115 self-efficacy for infant care, health care utilization,¹¹⁴ and evidence discussions.¹¹⁵ These RCTs had samples sizes ranging from 137 to 1,152, took place in community-based, academic health care, and outpatient clinical settings. Followup assessment ranged from 1 week to 2 months after the interventions. Results across the trials were inconsistent, but generally did not find any significant differences between the reach strategies compared. The two studies that compared printed materials with electronic methods—i.e., a DVD¹¹⁴ or a video¹¹⁵ found no significant differences between groups on outcomes, except that the DVD was significantly more effective at reducing two measures of health care utilization¹¹⁴ among parents caring for infants.

Strategies To Increase Reach Versus Strategies To Increase Motivation

Four trials (N ranging from 218 to 894) compared strategies to enhance reach with strategies to enhance motivation. Two trials examined findings over a 6- and 12-month followup periods, and two used 24- or 27-month followup periods. One aimed to encourage adherence to mammography screening guidelines;¹⁰⁴ two encouraged physical activity among older adults in community settings,^101,111 and the other examined treatment preferences and treatments undertaken for menorrhagia.⁹¹ Interpersonal telephone counseling, categorized as a motivational strategy, produced inconsistent effects. In one trial, telephone counseling was significantly better than a reach strategy involving mailed information, at prompting recipients to get mammography screening.¹⁰⁴ In another trial, interpersonal telephone counseling and automated telephone counseling did not differ in encouraging physical activity over 1 year;¹⁰¹ in a third trial, print-based feedback was more effective than telephone-based counseling in promoting physical activity over 1 year at at the 12-, but not 6-month, followup.¹¹¹ In the trial that compared provision of an information packet (reach) to a preference elicitation interview with a nurse (motivation) found no differences for the outcomes studied.⁹¹

Strategies To Increase Reach Versus Multicomponent Strategies

Four trials (N ranging from 297 to 1,127) compared reach strategies with multicomponent approaches. Two took place in community settings and focused on enhancing Latino health, with one focused on changing nutrition intake^72,78 and one focused on smoking cessation.⁹⁹ Both trials had a 12-week followup. Another trial also focused on increasing dietary and fitness goals.⁹² Both trials had a 12-week followup and one of these subsquently reported as 12-month followup.⁷² The other trial, in a clinical setting, focused on improving adherence to mammography screening.¹¹⁷ Two of these trials compared reach strategies (print materials) with a multicomponent strategy (print materials plus interpersonal counseling via telephone or in person); groups did not differ significantly in the primary outcomes studied, percent calories from fat or number of daily grams of fiber,^78,117 and of the nine secondary outcomes related to dietary intake only three were significantly increased in the group that received tailored print materials plus an interpersonal counselor at the 12-week followup.⁷⁸ These findings were not replicated at the 12 month followup.⁷² The trial that compared single-session telephone counseling (motivation strategy) with more intensive telephone counseling plus supporting materials (multicomponent) and found the multicomponent strategy to be more effective than the motivation strategy at the 12-week followup.⁹⁹ The trial that compared the provision of advice and information to two differenent behavioral counseling approaches that differed by the type of dietary recommendations provided found inconsistent results.⁹² Both multicomponent strategies involving behahavioral counseling were more effective than just the provision of individual advise at a six month followup. However, at an 18-month followup the multicomponent strategy involving the DASH dietary recommendations was signficantly more effective than the other groups.

Strategies To Increase Motivation Versus Multicomponent Strategies

One trial compared an interpersonal motivation strategy (lay health advisors [LHA]) with two different multicomponent approaches─one that involved tailored and targeted print and video materials (TPV), and another that involved LHAs plus the print and video materials (LHA+TPV).¹⁰³ TPV was significantly better than control, and a LHA or a multicomponent approach that involved both TPV and LHA for fruit and vegetable intake and physical activity; the more intense multicomponent approach (LHA+TPV) was not significantly better than control or other active comparators for any outcome. There were no significant differences among groups related to fat intake or CRC screening.

Detailed Synthesis: Dissemination Strategies to Patients for Clinical Outcomes

Table 24 documents the strength of evidence grading for each of the dissemination comparisons focused on patients and assessing clinical outcomes and gives the overall SOE grade.

Table 24

Strength of evidence: Trials examining dissemination to patients for clinical outcomes.

Table 25 describes patient-focused trials and summarizes their results for clinical outcomes. Text accompanying the table describes trials that compare (a) reach and motivation strategies, and (b) reach and multicomponent strategies.

Table 25

Summary of trials examining dissemination to patients for clinical outcomes.

Strategies To Increase Reach Versus Strategies To Increase Motivation

One trial compared a reach strategy that involved providing written and video-based information with a preference elicitation interview for 894 women with menorrhagia in outpatient clinics.⁹¹ Followup measures at 6, 12, and 24 months showed no differences between groups on a health status measure.

Strategies To Increase Reach Versus Multicomponent Strategies

One trial compared a reach strategy involving providing advice in an in-person meeting with registered dietitian with two different multicomponent strategies that entailed lifestyle behavioral counseling with slightly different informational content.^92–94 Participants were adults with or at risk for hypertension. The two multicomponent groups did not differ significantly at 6-month followup, but both were superior to advice only in affecting blood pressure at 6-month followup.

Detailed Synthesis: Dissemination Strategies for Patients and Knowledge Outcomes

Table 26 documents the strength of evidence grading for each of the dissemination comparisons focused on patients for knowledge outcomes and gives the overall SOE grade.

Table 26

Strength of evidence: Trials examining dissemination to patients for knowledge outcomes.

Table 27 describes patient-focused trials and summarizes their results for knowledge outcomes. Text accompanying the table describes trials that compare (a) various reach strategies, (b) reach and motivation strategies, and (c) reach and multicomponent strategies.

Table 27

Summary of trials examining dissemination to patients for knowledge outcomes.

Strategies To Increase Reach

Three trials compared reach strategies with other reach strategies with respect to patient knowledge. These RCTs had samples sizes ranging from 137 to 1,152, took place in community-based, academic health care, and outpatient clinical settings. Followup assessment ranged from 1 week to 2 months after the interventions. Two studies related to prostate cancer screening knowledge; the other focused on parental knowledge of infant development. Results across the trials were inconsistent. The two studies that compared printed materials with electronic methods—i.e., a DVD¹¹⁴ or a video¹¹⁵ found no significant differences between groups on knowledge outcomes. The two studies that examined prostate cancer screening knowledge showed inconsistent results.^107,115 In one, a decision aid in the form a booklet was significantly more effective in increasing knowledge than either a video or leaflets;¹⁰⁷ by contrast, groups receiving written materials or a video did not differ significantly (although these were not designed as decision aids).¹¹⁵

Strategies To Increase Reach Versus Strategies To Increase Motivation

One trial (N=894) compared a strategy to enhance reach with a strategy to enhance motivation using a 6-, 12-, and 24-month followup period. This trial did not report significance tests or confidence intervals for the group comparisons examining knowledge of treatment options for menorrhagia.⁹¹

Strategies To Increase Reach Versus Multicomponent Strategies

One trial (described in Table 22 for behavioral outcomes) also compared a reach strategy that used print materials with a multicomponent strategy that used print materials plus interpersonal counseling by telephone to increase two types of knowledge─accuracy of risk perceptions and mammography effectiveness.¹¹⁷ For knowledge outcomes, results were inconsistent. The multicomponent approach was more effective than the reach strategy for accuracy of risk perceptions but not for mammography effectiveness.

Key Question 2. Disseminating Information to Clinicians and Patients

Detailed Synthesis: Dissemination Strategies for Clinicians and Patients for Health-Related Decisions and Behavior Outcomes

Table 28 documents the strength of evidence grading for each of the dissemination comparisons focused on clinicians and patients for health-related decisions and behavior outcomes and gives the overall SOE grade.

Table 28

Strength of evidence: Trials examining dissemination to clinicians and patients for health-related decisions and behavior outcomes.

Table 29 describes clinician and patient-focused trials and summarizes their results for health-related decisions and behavior outcomes. Text accompanying the table describes trials that compare (a) reach and multicomponent strategies, (b) ability and multicomponent strategies, and (c) various multicomponent strategies.

Table 29

Summary of studies examining dissemination to clinicians and patients for health-related decisions and behavior outcomes.

Strategies To Increase Reach Versus Multicomponent Strategies

Three RCTs and one cRCT compared reach strategies with multicomponent strategies to affect health-related decisions and behavior outcomes. Sample sizes ranged from 327 to 1387; and followup periods ranged from 12 weeks to 1 year. Reach strategies included dissemination to either a patient¹⁰⁵ or clinicians.^84,87,89 The multicomponents strategies involved dissemination to both patients and physicians. Across these four trials there was either no significant difference between groups or significance test or confidence intervals were not reported for comparisons between active comparators.

Strategies To Increase Ability Versus Multicomponent Strategies

One cRCT study compared an academic detailing session (increase clinician ability) with a multicomponent strategy that included academic detailing and tools and resources for both patients and providers.⁸⁸ Patient resources included a patient education toolkit (with a companion Web site) and a computer kiosk with patient activation software. Physicians received with a decision support tool based on a personal digital assistant, which included four booster academic detailing sessions. The clinician only and multicomponent group focused on both clinicians and patients did not differ significantly.

Comparisons of Multicomponent Strategies

One cRCT compared two multicomponent arms to a control condition in an effort to enhance self-reported CRC screening in a community-based setting.¹¹² In each arm patients received educational information about CRC and a letter was also sent to the patient’s physician. In one of the arms patients also received additional materials in the form of a fecal occult blood test (FOBT) kit. The authors did not make a direct comparison of the multicomponent arms to each other, although both were significantly better than the control group.

Detailed Synthesis: Dissemination Strategies for Clinicians and Patients for Clinical Outcomes

Table 30 documents the strength of evidence grading for the dissemination comparison focused on clinicians and patients for clinical outcomes and gives the overall SOE grade. Table 31 describes the single trial in this category.

Table 30

Strength of evidence: Trial examining dissemination to clinicians and patients for clinical outcomes.

Table 31

Summary of studies examining dissemination to clinicians and patients for clinical outcomes.

One trial compared a reach strategy (mailed guidelines) with two multicomponent strategies that involved providing either education and academic detailing or education, academic detailing, and motivational counseling for patients.⁸⁴ This cRCT examined functional capacity among patients with low back pain using 6- and 12-month followup assessments. The groups did not differ significantly on functional capacity at either followup.