Charif AB, Zomahoun HTV, LeBlanc L, et al. (2017). Effective strategies for scaling up evidence-based practices in primary care: A systematic review. Implementation Science. 12(139). doi: 10.1186/s13012-017-0672-y
Researchers conducted a systematic review of 14 studies evaluating strategies for scaling up evidence-based practices (EBP) in primary care. Researchers reviewed studies for 5 categories of strategies targeting: health care infrastructure (e.g., increasing equipment availability, changing connections within a health care system), policy and regulation (e.g. changing hospital policies affecting use of EBP), financing (e.g. changing payment mechanisms), human resources (e.g., training and deploying providers, changing roles of administrators), and patients (e.g. involving patients in recruitment or promotion). Researchers considered outcomes related to scale-up process (e.g., coverage, cost), health systems (e.g. site performance), patients, and providers. EBP coverage was defined as proportion of total targeted participants that received EBP; 80% coverage was considered successful scale up. Most studies reviewed were conducted in low- (n=5) and middle-income (n=6) countries, and targeted scale-up within clinical sites (n=11). The most common scale-up strategies targeted human resources (n=12), followed by healthcare infrastructure (n=6), policy and regulation (n=5), and financing (n=2). Five studies reported outcomes of scaling-up: coverage (3), cost (1), other outcomes (2). One study objectively reported successful scale-up (80% coverage), 9 studies subjectively declared successful scale-up, and 2 reported unsuccessful scale-up. Thirteen studies reported patient and/or provider outcomes; 6 reported a statistically significant positive impact on patient or provider outcomes, 3 reported no statistical impact, and 4 studies descriptively reported a positive impact. None of the reviewed studies achieved both 80% coverage and positive impact on patient or provider outcomes.