Review:

Assessed by:

Date:

Section A: Methods used to identify, include and critically appraise studies

A.1 Were the criteria used for deciding which studies to include in the review reported?

Did the authors specify:

_ Types of studies

_ Participants

_ Intervention(s)

_ Outcome(s)

Coding guide ‐ check the answers above

YES: All four should be yes

_ Yes

_ Can't tell/partially

_ No

Comments (note important limitations or uncertainty)

A.2 Was the search for evidence reasonably comprehensive?

Were the following done:

_ Language bias avoided (no restriction of inclusion based on language)

_ No restriction of inclusion based on publication status

_ Relevant databases searched (including Medline + Cochrane Library)

_ Reference lists in included articles checked

_ Authors/experts contacted

Coding guide ‐ check the answers above:

YES: All five should be yes

PARTIALLY: Relevant databases and reference lists are both ticked off

_ Yes

_ Can't tell/partially

_ No

Comments (note important limitations or uncertainty)

A.3 Is the review reasonably up‐to‐date?

Were the searches done recently enough that more recent research is unlikely to be found or to change the results of the review?

Coding guide – consider how many years since the last search (e.g. if more than 10 years the review is unlikely to be up‐to‐date) and whether there is ongoing research

_ Yes

_ Can't tell/not sure

_ No

Comments (note important limitations or uncertainty)

A.4 Was bias in the selection of articles avoided?

Did the authors specify:

_ Explicit selection criteria

_ Independent screening of full text by at least 2 reviewers

_ List of included studies provided

_ List of excluded studies provided

Coding guide ‐ check the above

YES: All four should be yes

_ Yes

_ Can't tell/partially

_ No

Comments (note important limitations or uncertainty)

A.5 Did the authors use appropriate criteria to assess the risk for bias in analysing the studies that are included?^†( See Appendix for an example of criteria ‐ Assessing Risk of Bias Criteria for EPOC Reviews)

_ The criteria used for assessing the risk of bias were reported

_ A table or summary of the assessment of each included study for each criterion was reported

_ Sensible criteria were used that focus on the risk of bias (and not other qualities of the studies, such as precision or applicability)

Coding guide ‐ check the above

YES: All four should be yes

_ Yes

_ Can't tell/partially

_ No

Comments (note important limitations or uncertainty)

A.6 Overall – how would you rate the methods used to identify, include and critically appraise studies?

Summary assessment score A relates to the 5 questions above.

If the "No" or "Partial" option is used for any of the questions above, the review is likely to have important limitations.

Examples of major limitations might include not reporting explicit selection criteria, not providing a list of included studies or not assessing the risk of bias in included studies.

_ Major limitations (limitations that are important enough that the results of the review are not reliable and they should not be used in the policy brief)

_ Important limitations (limitations that are important enough that it would be worthwhile to search for another systematic review and to interpret the results of this review cautiously, if a better review cannot be found)

_ Reliable (only minor limitations)

Comments (note any major limitations or important limitations).

Section B: Methods used to analyse the findings

B.1 Were the characteristics and results of the included studies reliably reported?

Was there:

_ Independent data extraction by at least 2 reviewers

_ A table or summary of the characteristics of the participants, interventions and outcomes for the included studies

_ A table or summary of the results of the included studies.

Coding guide ‐ check the answers above

YES: All three should be yes

_ Yes

_ Partially

_ No

_ Not applicable (e.g. no included studies)

Comments (note important limitations or uncertainty)

B.2 Were the methods used by the review authors to analyse the findings of the included studies reported?

B.3 Did the review describe the extent of heterogeneity?

_Did the review ensure that included studies were similar enough that it made sense to combine them, sensibly divide the included studies into homogeneous groups, or sensibly conclude that it did not make sense to combine or group the included studies?

_Did the review discuss the extent to which there were important differences in the results of the included studies?

_If a meta‐analysis was done, was the I², chi square test for heterogeneity or other appropriate statistic reported?

_ Yes

_ Partially

_ No

_ Not applicable (e.g. no included studies)

Comments (note important limitations or uncertainty)

B.4 Were the findings of the relevant studies combined (or not combined) appropriately relative to the primary question the review addresses and the available data?

How was the data analysis done?

_Descriptive only

_Vote counting based on direction of effect

_Vote counting based on statistical significance

_Description of range of effect sizes

_Meta‐analysis

_Meta‐regression

_Other: specify

_Not applicable (e.g. no studies or no data)

How were the studies weighted in the analysis?

_Equal weights (this is what is done when vote counting is used)

_By quality or study design (this is rarely done)

_Inverse variance (this is what is typically done in a meta‐analysis)

_Number of participants

_Other, specify:

_Not clear

_Not applicable (e.g. no studies or no data)

Did the review address unit of analysis errors?

_Yes ‐ took clustering into account in the analysis (e.g. used intra‐cluster correlation coefficient)

_No, but acknowledged problem of unit of analysis errors

_No mention of issue

_Not applicable ‐ no clustered trials or studies included

Coding guide ‐ check the answers above

If narrative OR vote counting (where quantitative analyses would have been possible) OR inappropriate table, graph or meta‐analyses OR unit of analyses errors not addressed (and should have been) the answer is likely NO.

If appropriate table, graph or meta‐analysis AND appropriate weights AND the extent of heterogeneity was taken into account, the answer is likely YES.

If no studies/no data: NOT APPLICABLE

If unsure: CAN'T TELL/PARTIALLY

_ Yes

_ Partially

_ No

_ Not applicable (e.g. no included studies)

Comments (note important limitations or uncertainty)

B.5 Did the review examine the extent to which specific factors might explain differences in the results of the included studies?

_Were factors that the review authors considered as likely explanatory factors clearly described?

_Was a sensible method used to explore the extent to which key factors explained heterogeneity?

_Descriptive/textual

_Graphical

_Meta‐regression

_Other

_ Yes

_ Partially

_ No

_ Not applicable (e.g. too few studies, no important differences in the results of the included studies, or the included studies were so dissimilar that it would not make sense to explore heterogeneity of the results)

Comments (note important limitations or uncertainty)

B.6 Overall ‐ how would you rate the methods used to analyse the findings relative to the primary question addressed in the review?

Summary assessment score B relates to the 5 questions in this section, regarding the analysis.

If the "No" or "Partial" option is used for any of the 5 preceding questions, the review is likely to have important limitations.

Examples of fatal flaws might include not reporting critical characteristics of the included studies or not reporting the results of the included studies.

_ Fatal flaws (limitations that are important enough that the results of the review are not reliable and they should not be used in the policy brief)

_ Important limitations (limitations that are important enough that it would be worthwhile to search for another systematic review and to interpret the results of this review cautiously, if a better review cannot be found)

_ Reliable (only minor limitations)

Use comments to specify if relevant, to flag uncertainty or need for discussion

Section C: Overall assessment of the reliability of the review

C.1 Are there any other aspects of the review not mentioned before which lead you to question the results?

_ Additional methodological concerns

_ Robustness

_ Interpretation

_ Conflicts of interest (of the review authors or for included studies)

_ Other

_ No other quality issues identified

C.2 Based on the above assessments of the methods how would you rate the reliability of the review?

_ Fatal flaws (exclude); briefly (and politely) state the reasons for excluding the review by completing the following sentence: This review was not included in this policy brief for the following reasons:

Comments (briefly summarise any key messages or useful information that can be drawn from the review for policy makers or managers):

_ Important limitations ; briefly (and politely) state the most important limitations by editing the following sentence, if needed, and specifying what the important limitations are: This review has important limitations.

_ Reliable ; briefly note any comments that should be noted regarding the reliability of this review by editing the following sentence, if needed: This is a good quality systematic review with only minor limitations.

Who receives care and when

Queuing strategies

Ballini 2015

Review objective: to assess the effectiveness of interventions aimed at reducing waiting times for elective care, both diagnostic and therapeutic.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, controlled before‐after studies, and interrupted time series studies of any type of regulatory/administrative, economic, clinical or organisational intervention aimed at reducing waiting times for access to elective diagnostic or therapeutic procedures

2 cluster‐randomised trials, 1 randomised trial, and 5 reanalysed interrupted time series studies of interventions: rationing or prioritising demand (1 study), expanding capacity (1 with a co‐intervention), and restructuring the intake assessment/referral process (7 studies)

Participants

Healthcare providers of any discipline/area, and patients referred to any type of elective procedure

7 hospitals, 1 outpatient clinic and 135 general practices/primary care, performing elective procedures for ear‐nose‐throat referrals (1 study), uncomplicated spinal surgery (1 study), dermatology (1 study), elective surgery (1 study), colposcopy for abnormal cervical cytology (1 study), any paediatric clinic conditions treated in an outpatient clinic (1 study), laparoscopic sterilisation (1 study), and urological interventions (1 study)

Settings

Any setting

Studies in UK (5 studies), USA (2 studies), and Australia (1 study)

Outcomes

Number or proportion of participants whose waiting times were above or below a time threshold, mean or median waiting times, safety outcomes (mortality, morbidity, complication rates), and costs

Number and proportion of participants waiting longer (2 studies) or less (2 studies) than a recommended time to be attended or get an appointment, effects on waiting time (5 studies), direct and indirect costs (2 studies)

Date of most recent search: November 2013

Limitations: this is a well‐conducted systematic review with only minor limitations.

Care received by groups vs individual care

Catling 2015

Review objective: to compare the effects of group antenatal care versus one‐to‐one care on outcomes for women and their babies.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised and non‐randomised trials of group antenatal care

4 randomised trials

Participants

Pregnant women accessing antenatal care

Pregnant women receiving antenatal care at public (3 studies) and military clinics (1 study)

Settings

Hospital, clinics or any settings delivering antenatal care worldwide

USA (2 studies), Iran (1 study), Sweden (1 study)

Outcomes

Primary: preterm births, low birthweight, small‐for‐gestational age, perinatal mortality

Secondary: maternal satisfaction, breastfeeding, length of hospital stay, infant Apgar scores, mode of birth, induction of labour, analgesia/anaesthesia use in labour, attendance at antenatal care, care provider satisfaction, cost‐effectiveness

Primary: preterm births (3 studies), low birthweight (3 studies), small for gestational age (3 studies), perinatal mortality (3 studies)

Secondary: admission of baby to neonatal intensive care unit (2 studies), breastfeeding initiation (3 studies), spontaneous vaginal birth (1 study)

Date of most recent search: October 2014

Limitations: this is well‐conducted systematic review with only minor limitations.

Who provides care

Pre‐licensure education

Pariyo 2009

Review objective: to assess the effect of changes in the pre‐licensure education of health professionals on health‐worker supply.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, controlled before‐after studies and interrupted time series studies of interventions that could increase the capacity of health professional training institutions; reduce the loss of students (and increase the likelihood that students will graduate); or increase the recruitment of students from other countries into health professional training institutions

2 controlled before‐after studies of minority academic advising programmes consisting of academic, personal, financial and vocational advice, skills building, mentorships, supplementary training and annual evaluations

Participants

Health professional students prior to licensure

2 studies among minority groups and general health professional students

Settings

No restrictions

2 studies from the USA

Outcomes

Increased numbers of health workers ultimately available for recruitment into the health workforce, improved population‐to‐health professional ratios

2 studies of the numbers of health workers ultimately available for recruitment into the health workforce

Date of most recent search: February 2008

Limitations: this is a well‐conducted systematic review with only minor limitations

Recruitment and retention strategies

Grobler 2015

Review objective: to assess the effectiveness of interventions to increase the proportion of healthcare professionals working in rural and other underserved areas

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies of any intervention to increase the recruitment or retention of health professionals in underserved areas

1 interrupted time series study from Taiwan of the effects of National Health Insurance on the equality of distribution of healthcare professionals

Participants

Qualified healthcare professionals of any cadre or specialty

Physicians, doctors of Chinese medicine and dentists

Settings

All settings

Taiwan

Outcomes

Recruitment of health professionals: the proportion of health professionals who initially choose to work in rural or urban underserved communities as a result of being exposed to the intervention. Retention: the proportion of healthcare professionals who continue to work in rural or urban underserved communities as a consequence of the intervention

Equality of geographic distribution of healthcare professionals measured using the Gini coefficient

Date of most recent search: April 2014

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Lay health workers: hypertension

Brownstein 2007

Review objective: to examine the effectiveness of community health workers (CHWs) for supporting the care of people with hypertension.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Any study design evaluating the effectiveness of CHWs in supporting the care of hypertensive people

8 randomised trials, 3 before‐after studies, 1 non‐randomised trial, 1 interrupted time‐series study, and 1 survey. All studies but one focused exclusively on controlling hypertension. CHWs contacted recipients from weekly to yearly.

Participants

CHWs with no formal professional designation but trained to deliver healthcare to hypertensive people

The CHWs, predominantly women with different experience in community service and training, were recruited from the community, and resembled the participants in race/ethnicity and socioeconomic background.

Settings

Healthcare or community settings

All studies took place in the USA and mainly focused on poor, urban African Americans.

Outcomes

At least 1 outcome among participants

Participant satisfaction, awareness, behaviour, physiologic measures, health outcomes, and healthcare system outcomes

Date of most recent search: May 2006

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Lay health workers: delivery of community‐based neonatal care packages

Lassi 2015

Review objective: to assess the effectiveness of community‐based intervention packages in reducing maternal and neonatal morbidity and mortality.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised or non‐randomised trials evaluating the effectiveness of community‐based intervention packages in reducing maternal and neonatal mortality

24 randomised and 2 non‐randomised trials of intervention packages, including mainly: building community‐support or women's groups (9 studies), community mobilisation and antenatal and postnatal home visitation (7 studies), community mobilisation and home‐based neonatal treatment (1 study), training traditional birth attendants who made antenatal and intrapartum home visits (2 studies), home‐based neonatal care and treatment (2 studies), and education of mothers and antenatal and postnatal visitation (2 studies)

Participants

Women of reproductive age, pregnant women at any period of gestation

Women of reproductive age, newborns and other family members, support groups, traditional birth attendants, community health workers, and midwives

Settings

Communities

Bangladesh (6 studies), India (6 studies), Pakistan (4 studies), Malawi (2 studies), Tanzania (1 study), Ghana (1 study), Nepal (1 study), Zambia (1 study), China (1 study), South Africa (1 study), Vietnam (1 study), and Greece (1 study)

Outcomes

Primary: maternal mortality, neonatal mortality, early neonatal mortality, and late neonatal mortality. Secondary outcomes included: perinatal mortality, stillbirths, measures of morbidity, quality of care, and institutional deliveries

Maternal mortality (11 studies), neonatal mortality (21 studies), early (11 studies) and late (11 studies) neonatal mortality, perinatal mortality (17 studies), stillbirths (15 studies), institutional deliveries (16 studies), and measures of morbidity, and quality of care

Date of most recent search: May 2014

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Lay health workers: MCH and infectious diseases

Lewin 2010

Review objective: to assess the effects of lay health worker interventions in improving maternal and child health and tuberculosis outcomes.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials of lay health worker (paid or voluntary) interventions in maternal and child health and infectious diseases

82 trials were found. 73 trials evaluated interventions in maternal and child health, and 9 trials evaluated interventions related to tuberculosis.

Participants

Lay health workers: any health worker without formal professional certification who was trained in some way in the context of the intervention. No restriction on types of patients

Considerable differences in numbers, recruitment methods and training of lay health workers. Different recipients were targeted

Settings

All primary care and community health settings globally

54 studies took place in 6 high‐income countries: Australia (1 study), Canada (3 studies), Ireland (1 study), New Zealand (1 study), UK (8 studies), and USA (40 studies). 12 studies took place in 8 middle‐income countries: Brazil (2 studies), China (1 study), India (2 studies), Mexico (1 study), Philippines (1 study), Thailand (1 study), Turkey (1 study), South Africa (3 studies). 16 trials were from 10 low‐income countries: Bangladesh (4 studies), Burkina Faso (1 study), Ecuador (1 study), Ethiopia (1 study), Ghana (1 study), Iraq (1 study), Jamaica (1 study), Nepal (1 study), Pakistan (2 studies), Tanzania (2 studies), Vietnam (1 study)

Outcomes

Primary outcomes: health behaviours and healthcare outcomes, including harms

Secondary outcomes: utilisation of lay health worker services, consultation processes, satisfaction with care, costs, social development measures

Most studies reported multiple effect measures and many did not specify a primary outcome

Date of most recent search: February 2009

Limitations: this is a well‐conducted systematic review with only minor limitations, but studies were only included up to February 2009.

Role expansion or task shifting

Midlevel health professionals: non‐doctor providers for abortion care

Ngo 2013

Review objective: to compare the effectiveness and safety of abortion procedures administered by midlevel providers versus procedures administered by doctors

Types of

What the review author searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials and comparison studies exploring effectiveness or safety of abortion procedures (surgical or medical) provided by midlevel providers and doctors

5 studies: randomised trials (2 studies) ‐ 1 exploring surgical aspiration procedures and the other medical abortion procedures

Prospective cohort studies (3 studies) ‐ all exploring surgical aspiration abortion procedures

Participants

Women seeking termination of pregnancy

Total of 8539 women seeking termination of pregnancy; women aged from < 20 to > 40 years. In the 4 studies of surgical abortion procedures, maximum gestational ages ranged from 10 to 16+ weeks. In the trial of medical abortion, women with gestational ages of up to 9 weeks were included.

Settings

Any setting

South Africa and Vietnam (1 study); Nepal (1 study); USA (2 studies) and India (1 study). All studies took place in either a hospital or specialist health clinic, such as a women's health centre or sexual and reproductive health clinic.

Outcomes

Effectiveness or efficacy of abortion procedures, provided by midlevel providers versus doctors, measured as incomplete or failed abortion.

Safety of abortion procedures administered by midlevel providers versus doctors, measured as adverse events and complications.

Both randomised trials and 2 of the cohort studies examined effectiveness, measured as incomplete or failed abortion.

The trial of surgical abortion and the 3 cohort studies examined safety, measured as complications (immediate and delayed).

Date of most recent search: February 2012

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Healthcare providers giving additional social support to pregnant women vs usual care

Hodnett 2010

Review objective: to assess the effects of programmes offering additional social support compared with routine care for pregnant women who are believed to be at high risk for giving birth to babies that are either preterm, weigh less than 2500 grams, or both, at birth.

Types of

What the review authors
searched for

What the review authors found

Study designs and Interventions

Randomised trials of standardised or individualised programmes of additional social support, provided either during home visits, regular antenatal clinic visits, or by telephone on several occasions during pregnancy

17 randomised trials. 14 of the studies involved one‐to‐one support and the rest involved both one‐to‐one and group sessions

Participants

Pregnant women judged to be at risk of having babies who are preterm, growth‐restricted, or both

12,264 pregnant women

Settings

Not pre‐specified

Australia, Great Britain, France, Latin America, South Africa, and the USA

Outcomes

Caesarean section, gestational age < 37 weeks, birth weight < 2500 g, stillbirth/neonatal death

Caesarean section (9 studies), gestational age <37 weeks (11 studies), birth weight < 2500 g (11 studies), stillbirth/neonatal death (11 studies), antenatal hospital admission (3 studies)

Date of search: January 2010

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Midlevel health professionals: midwife‐led care in pregnancy

Sandall 2013

Review objective: to compare midwife‐led care with other models of care for childbearing women and their infants.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials comparing midwife‐led care to other models of care

15 randomised trials

Participants

Pregnant women

17,674 pregnant women recruited from both community and hospital settings. All studies included low risk pregnancies, and 5 studies also included high‐risk pregnancies.

Settings

Community or hospital

Australia (7 studies), UK (5 studies), Ireland (2 studies) and Canada (1 study)

Outcomes

Primary outcomes: Birth and immediate postpartum ‐ regional analgesia, caesarean birth, instrumental/spontaneous vaginal birth, intact perineum; Neonatal ‐ preterm birth, overall foetal loss and neonatal death

Secondary outcomes: complications, procedures or medication use

All primary outcomes and secondary outcomes, such as antenatal hospitalisation, antepartum haemorrhage, induction of labour, amniotomy, augmentation/artificial oxytocin during labour, no intrapartum analgesia/anaesthesia, opiate analgesia, attendance at birth by known midwife and episiotomy

Date of most recent search: January 2016

Limitations: this is well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Clinical officers/non‐physician clinicians/associate clinicians vs physician for caesarean section

Wilson 2011

Review objective: to determine whether key outcomes of caesarean section differ between non‐physician clinicians and medical doctors.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Controlled studies that compared non‐physician clinicians and medically trained doctors for caesarean section

6 non‐randomised studies comparing the outcomes of caesarean section performed by non‐physicians versus caesarean section performed by physicians

Participants

Women having a caesarean section

The 6 studies included adults only

Settings

Low‐income countries

The studies took place in 5 African countries: Burkina Faso, Malawi (2 studies), Mozambique, Tanzania, and Zaire

Outcomes

Any clinically relevant maternal or perinatal outcomes

All 6 studies reported maternal mortality. Other reported outcomes included perinatal mortality (5 studies), wound dehiscence (3 studies), and wound infection (2 studies).

Date of most recent search: 2010 (month not specified)

Limitations: This is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Non‐specialist vs specialist providers for mental health

Van Ginneken 2013

Review objective: to assess the effectiveness of the delivery of mental, neurological and substance abuse (MNS) interventions by non‐specialist health workers (NSHWs) and other professionals with health roles (OPHRs) in low‐and middle‐income countries

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series studies of NSHW interventions aimed at treating patients with MNS disorders or supporting their caregivers

38 studies, including randomised trials (27), controlled before‐after studies (9 studies) and non‐randomised trials (2 studies)

Participants

Adults or children with any MNS disorder seeking primary or community care

Adults (27 studies) and children (11 studies) with depression, anxiety or both (18 studies), post‐traumatic stress disorder (12 studies), dementia (2 studies), alcohol abuse (2 studies), schizophrenia (1 study), substance abuse (1 study), epilepsy (1 study), child developmental disorders (1 study)

Settings

Rural or urban settings in low‐ and middle‐income countries

15 studies from 7 low‐income countries and 23 from 15 middle‐income countries. 16 studies in rural settings, 23 in urban settings, and 5 in refugee camps

Outcomes

Primary outcomes: improvement in symptoms, psychosocial functioning, or quality of life

Secondary outcomes: patient satisfaction/behaviour, adverse clinical outcomes, caregiver outcomes, health service/provider delivery‐related outcomes

Patient health and psychosocial functioning indicators, caregiver outcomes

Date of most recent search: June 2012

Limitations: this is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

Specialist nursing post added to hospital nurse staffing

Butler 2011

Review objective: to determine the effect of hospital nurse staffing models on patient and staff‐related outcomes.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐ after studies, and interrupted time series studies of interventions relating to hospital nurse staffing models

15 studies (8 randomised trials, 2 non‐randomised trials, and 5 controlled before‐ after studies). 4 studies assessed primary nursing, self‐scheduling, and team midwifery; and 11 studies related to nursing skill‐mix (9 examining the addition of specialist nurses to usual staffing; 2 examining increases in the proportion of support staff versus usual nursing staff).

Participants

Patients and nursing staff

Nursing staff: midwives; surgical, medical and gynaecological ward nurses; nurse case managers; clinical nurse specialists; nursing assistants; advance practice nurses

Patients: pregnant women; women scheduled for surgery; women admitted with hip fractures; people with breast cancer, diabetes, mental health problems, multiple sclerosis, myocardial infarctions

Settings

Hospital settings worldwide

USA (7 studies), UK (4 studies), Australia (1 study), the Netherlands (2 studies), and Canada (1 study)

Outcomes

Any objective measure of patient or staff‐related outcome

Staff‐related outcomes: absenteeism, staff retention and staff turnover; Patient outcomes: patient falls, medication errors and adverse incidents, length of stay, patient mortality, re‐admission and attendance at the emergency department post‐discharge

Costs

Date of most recent search: May 2009

Limitations: This is a well‐conducted systematic review with only minor limitations.

Role expansion or task shifting

‐ Physician‐nurse substitution

Martínez‐González 2014

Review objective: to assess the impact of physician‐nurse substitution in primary care on clinical parameters

Types of

What the review authors searched for

What the review authors found

Study designs andInterventions

Randomised trials that examined physician‐nurse substitution

11 randomised trials. Nurses had full clinical autonomy to manage patients' disease (1 trial); Nurses made independent decisions for several tasks, but still needed minor support or short communication with the physicians (10 trials). In all trials, the physicians performed standard care.

Participants

Patients of all ages seeking first contact or undergoing care for all conditions including mental health and addiction restricted to primary care

32,247 participants with mean age raging between 11.2 to 67.1 years. 35% of the population were males (10 trials) and females only (1 trial).

Patients showed up with a range of complex conditions including cerebrovascular disease, hypertension, heart failure, diabetes mellitus, asthma, incontinence, Parkinson's disease and HIV.

Settings

General practices, community or

ambulatory care settings with n

o geographical limitation

The studies took place in the UK (2 studies), the Netherlands (4 studies), USA (2 studies), South Africa (2 studies) and Russia (1 study)

Outcomes

Clinical parameters that detected changes in the clinical status or physiological capability of patients in relation to various forms of disease

Measures of quality of life, satisfaction, mortality, hospital admissions, progression of disease, and process of care were excluded

Changes in blood pressure (5 studies), cholesterol and triglycerides concentration (4 studies), glycosylated haemoglobin level (4 studies), lung and kidney function (1 study), various parameters of cardiac function (1 study), frequency of incontinent episodes (1 study), mobility stand‐up test and bone sustaining fracture in patients with Parkinson's disease (1 study), and CD4 cell counts in HIV/AIDS patients (1 study)

Date of most recent search: August 2012

Limitations: this is a well‐conducted systematic review with only minor limitations, restricted to English language and published studies.

Role expansion or task shifting

Pharmacists delivering non‐dispensing services to patients

Pande 2013

Review objective: to examine the effectiveness of services provided by pharmacists on patient outcomes and health service utilisation and costs in low‐ and middle‐income countries.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Any health or medicine‐related, patient‐targeted service delivered by pharmacists (other than medicine compounding and dispensing, and excluding other services such as the selling of cosmetics or other non‐pharmaceutical products) evaluated in a randomised trial, non‐randomised trial, controlled before‐after study, or interrupted time series study.

12 randomised trials in middle‐income countries were included. 11 examined pharmacist interventions targeted at patients, and 1 evaluated a pharmacist intervention targeted at healthcare professionals. All the included studies compared pharmacist‐provided services with usual care.

Participants

Pharmacists (or pharmacies) delivering services in outpatient settings other than, or in addition to, medicine compounding and dispensing

Practising pharmacists and research pharmacists

Settings

Outpatient settings

Sudan (1 study), India (2 studies), Egypt (1 study), Paraguay (1 study), Thailand (2 studies), Chile (2 studies), Bulgaria (2 studies), and South Africa (1 study)

Outcomes

Objective measurement of patient outcomes and process outcomes such as health service utilisation and costs

Process outcomes (4 studies), rate of hospitalisation (2 studies), number of visits to private clinics or outpatient clinics and emergency rooms in hospitals (1 study), medication costs of patients with chronic obstructive pulmonary disease and asthma (1 study), the number of visits to general practitioners (2 studies), clinical and humanistic outcomes (11 studies), patient outcomes (7 studies), asthma score (1 study)

Date of most recent search: March 2010

Limitations: this is a well‐conducted systematic review with minor limitations. There were few evaluations of impact that allowed robust conclusions to be drawn, particularly as many of the studies did not take all the costs involved into account.

Role expansion or task shifting

Skilled birth attendants

Yakoob 2011

Review objective: to determine the effect of provision of skilled birth attendance as well as basic and emergency obstetric care on stillbirths

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised and non‐randomised trials; and observational studies evaluating the provision of skilled birth attendance and emergency obstetric care

21 studies: 13 for skilled birth attendance (10 before‐after or non‐randomised studies and 3 observational studies) and 9 historical or ecological studies for emergency obstetric care

Participants

Pregnant women and newborns

Most women were from rural areas, but some were also from suburbs and mixed areas.

Settings

Community‐based settings in any country

Most skilled birth attendance studies were from low‐ and middle‐income countries (Bangladesh, Bolivia, China, Guatemala, Indonesia, Malawi, Mexico, Mozambique, Nigeria, Papua New Guinea, Sudan, and Tanzania). 3 studies were from high‐income countries (Netherlands, Norway and Sweden).

Outcomes

Stillbirths and perinatal mortality

2 (uncontrolled) before‐after studies reported stillbirths and 4 reported perinatal mortality and were included in the primary analysis.

Date of most recent search: March 2010

Limitations: this is reasonably well‐conducted systematic review with only minor limitations such as the incomplete reporting of included studies' characteristics.

Role expansion or task shifting

Dental care by dental therapists

Wright 2013

Review objective: to determine the effect of a model of provision of dental care that utilises midlevel providers compared to no care or care by dentists

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Experimental, observational and descriptive studies evaluating the provision of irreversible and surgical procedures by midlevel providers

18 retrospective or cross‐sectional studies

Participants

People of any age

School children (15 studies), Indian communities (2 studies), military servicemen (1 study)

Settings

Urban or rural

The studies took place in Australia (6 studies), Canada (3 studies), Hong Kong (3 studies), New Zealand (5 studies) and the USA (3 studies).

Outcomes

Dental disease incidence, prevalence, or severity; untreated disease; and cost‐effectiveness

Caries, diagnostic procedures, treatment planning, irreversible or surgical procedures

Date of most recent search: February 2012

Limitations: this is a well‐conducted systematic review with only minor limitations.

Coordination of care

Care pathways

Improved pre‐hospital trauma systems vs no systems

Henry 2012

Review objective: to assess the effectiveness of pre‐hospital trauma systems in developing countries.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies, uncontrolled before‐after studies and cohort studies assessing the effectiveness of pre‐hospital trauma systems.

14 included studies of which 8 were included in a meta‐analysis (3 non‐randomised trials, 4 before‐after studies and 1 retrospective cohort study)

Participants

Community members and professionals delivering pre‐hospital trauma care for communities

Communities of rural areas (4 studies) and urban areas (4 studies)

Settings

Developing countries (International Monetary Fund's World Economic Outlook Report 2010).

Mexico (2 studies), Iran (2 studies) and 1 each from Afghanistan, Brazil, Cambodia, Iraq, and Trinidad and Tobago.

Outcomes

Mortality (primary outcome), injury severity, physiologic severity, and pre‐hospital time

Mortality and pre‐hospital time analysed by injury severity

Date of most recent search: December 2010

Limitations: this is a well‐conducted systematic review with only minor limitations.

Care pathways

Rapid response systems in hospitals vs no systems

Maharaj 2015

Review objective: to assess the effect of the rapid response system on hospital mortality and cardiopulmonary arrest outside the intensive care unit.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Comparisons between a control cohort and intervention (rapid response system) cohort that provided quantitative data about mortality rates or cardiopulmonary arrests

29 studies met the inclusion criteria: cluster‐randomised trials (2 studies), interrupted time series studies (2 studies), controlled before‐after study (1 study), and before‐after studies with no contemporaneous control group (24 studies)

Participants

Hospitalised patients

Hospitalised adults (21 studies) and children (8 studies)

Settings

Hospitals

Academic teaching hospitals (22 studies) and community hospitals (6 studies) in the USA (11 studies), Australia (7 studies), Canada (3 studies), the UK (2 studies), Pakistan, Portugal, Saudi Arabia, South Korea, Sweden, the Netherlands (1 each)

Outcomes

Hospital mortality (primary outcome); non‐intensive care unit cardiopulmonary arrest, and intensive care unit admissions (secondary outcomes)

Hospital mortality (27 studies), cardiopulmonary arrests (26 studies), intensive care unit admissions (10 studies)

Date of most recent search: December 2013

Limitations: this is a well‐conducted systematic review with only minor limitations.

Care pathways

Hospital clinical pathways vs usual care

Rotter 2010

Review objective: to assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies evaluating clinical pathways

19 randomised trials, 4 controlled before‐after studies and 2 interrupted time series studies. 20 studies compared a stand‐alone clinical pathway to usual care and 7 compared a multifaceted intervention that included a clinical pathway to usual care.

Participants

Health professionals in a hospital setting, hospitalised patients, and hospitals

Health professionals, hospitalised patients and hospitals

Settings

Hospitals

General acute ward (15 studies), extended stay facility (4 studies), intensive care unit (4 studies), emergency department (3 studies) and mental health outpatient clinic (1 study). Only 1 study was conducted in a middle‐income country (Thailand). All the other studies took place in high income economies: USA (13 studies), Australia (4 studies), Japan (3 studies), UK (2 studies), Canada (2 studies), (1 study), Taiwan (1 study) and Norway (1 study).

Outcomes

Patient outcomes, professional practice, length of stay and hospital costs

Complications (6 studies), readmission to hospital (8 studies), length of stay (17 studies), in‐hospital mortality (5 studies), and hospital costs (11 studies)

Date of most recent search: April 2008

Limitations: this is a well‐conducted systematic review with only minor limitations.

Case management

Children with pneumonia/community‐based with antibiotics/hospital‐based with oxygen or vitamins

Theodoratou 2010

Review objective: to assess the effectiveness of pneumonia case management on mortality and morbidity from childhood pneumonia.

Types of

What the review authors searched for

What the review authors found

Study designs and interventions

Randomised trials, cluster‐randomised trials, quasi‐experimental studies, and observational studies investigating the effect of community and hospital case management (including antibiotics, oxygen, zinc and vitamin A supplements)

14 studies were included for community case management: quasi‐experimental (1 study), before‐after study (2 studies), concurrent cohort studies (8 studies), other observational studies (3 studies). 10 studies were included for hospital case management with antibiotics: before‐after studies (2 studies), case series (mostly arms of randomised trials) (8 studies). 1 before‐after study of oxygen treatment and 11 randomised trials of supplements

Participants

Under 5‐year‐old children with pneumonia

Children from rural and urban areas

Settings

Community and hospital

India (8 studies), Pakistan (4 studies), Papua New Guinea (3 studies), Bangladesh (2 studies), Nepal (2 studies), Tanzania (2 studies). 1 each from: Malaysia, Philippines, South Africa, Mozambique, Yemen, Brazil, Ecuador, Guatemala, Peru, Uruguay and Vietnam. 3 multi‐country: Colombia; Ghana; India; Mexico; Pakistan; South Africa; Vietnam; Zambia; India; Bangladesh; Ecuador; Mexico; Yemen, Fiji and China

Outcomes

Mortality, morbidity and healthcare utilisation

All‐cause mortality of children with pneumonia; treatment failure rates; length of hospitalisation, time to resolution of severe illness, lethargy, inability to eat, low oxygen saturation, chest indrawing and tachypnoea

Date of most recent search: August 2008

Limitations: this is a well‐conducted systematic review with only minor limitations,but the search was done in 2008.

Case management

People living with HIV/AIDS

Handford 2006

Review objective: to determine the effects of the setting of care and the organisation of care on medical, immunological/virological, psychosocial and/or economic outcomes for persons living with HIV/AIDS.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, cohort studies, case control studies, cross‐sectional studies, and controlled before‐after studies that evaluated the settings and organisation of care

1 randomised trial, 1 non‐randomised trial, 5 prospective cohort studies, and 21 retrospective cohort studies

Participants

People (men, women and children) known to be infected with HIV/AIDS

39,776 HIV‐positive participants

Settings

All settings

Clinical trial settings; hospitals and clinics in high‐income country settings

Outcomes

Medical outcomes, immunological or virological outcomes, psychosocial outcomes, economic outcomes

Mortality (12 studies), receipt of antiretrovirals or indicated prophylaxis as an outcome (10 studies), hospitalisation (5 studies), functional status (1 study), healthcare utilisation outcomes (16 studies)

Date of most recent search: December 2002

Limitations: this is a well‐conducted systematic review with only minor limitations. However, it has not been updated since the last search in December 2002.

Communication between providers

Interactive communication between primary care doctors and specialists vs usual care

Foy 2010

Review objective: to assess the effects of interactive communication between collaborating primary care physicians and key specialists on outcomes for patients receiving ambulatory care.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Intervention studies with concurrent comparison groups (randomised and non‐randomised trials and controlled before‐after studies) and without concurrent comparison groups (time‐series analyses), as well as uncontrolled before‐after designs

11 randomised trials (6 cluster and 5 patient‐level), 1 non‐randomised trial, 3 controlled before‐after studies, and 8 uncontrolled before‐after studies

Participants

Primary care physicians and specialists who work collaboratively as individuals or within clinical teams in psychiatry, endocrinology, and oncology

18 studies of primary care collaborations with mental health services and 5 with primary care collaborations with endocrinology (all of which addressed diabetes). No studies of primary care collaborations with oncology

Settings

Outpatient and community primary care in countries where the main attributes of the healthcare system were broadly known and generalisable to the context of the USA (for example, countries in Western Europe, or Australia and Canada)

Integrated healthcare systems such as the US Veterans Health Administration or the UK's National Health Service (12 studies), and other non‐integrated healthcare systems (11 studies)

Outcomes

Patient, process, and economic outcomes

Patient outcome data, e.g. depression outcomes and improvement in HbA1c haemoglobin test results (23 studies)

Date of most recent search: June 2008

Limitations: this is a well‐conducted systematic review with only minor limitations.

Coordination of care to reduce rehospitalisation

Pre‐/postdischarge interventions vs usual care/transition interventions vs usual care

Hansen 2011

Review objective: to estimate the effectiveness of interventions to reduce 30‐day rehospitalisation.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, cohort studies, or uncontrolled before–after studies assessing interventions delivered around the time of discharge and applicable to general medical adult populations (rather than disease‐specific approaches)

43 included studies: 16 randomised trials, 14 non‐randomised trials, and 13 uncontrolled before‐after studies. Most studies (56%) tested a single‐component intervention.

Participants

General medical adult acute inpatient populations. Studies of paediatric, obstetric, and psychiatric populations were excluded.

Most studies focused on people admitted to general medicine wards or people with heart failure or chronic obstructive pulmonary disease.

Settings

Hospital, ambulatory care and patients' homes

USA (28 studies), UK (2 studies), Canada (2 studies), Hong Kong (2 studies), and 1 study in each of the following countries: Australia, Belgium, Denmark, Ireland, Israel, Netherlands, New Zealand, Portugal, and Taiwan

Outcomes

30‐day rehospitalisation

30‐day rehospitalisation

Date of most recent search: January 2011

Limitations: this is well‐conducted systematic review with only minor limitations.

Discharge planning

Hospital discharge planning vs usual care

Gonçalves‐Bradley 2016

Review objective: to determine the effectiveness of planning the discharge of patients from hospital to home compared to usual care.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials of planned discharge that included: pre‐admission assessment, case finding on admission, inpatient assessment and preparation of a discharge plan based on the individual needs of a patient, implementation of the discharge plan consistent with the assessment and documentation of the discharge planning process, and monitoring

30 randomised trials that evaluated broadly similar interventions that included all 5 components, although 7 of the trials did not describe a monitoring phase

Participants

All patients in hospital irrespective of age, sex or condition

21 trials recruited patients with a medical condition (6 of them heart failure patients), 5 trials with a mix of medical and surgical conditions, 2 trials recruited older people (> 65 years), and 2 from an acute psychiatric ward. The average age of patients recruited to 10 of the trials was > 75 years; between 70 and 75 years in 7 trials, and < 70 years in the remaining trials. They were < 50 years in the 2 trials recruiting participants for a psychiatric hospital.

Settings

Acute, rehabilitation or community hospitals

USA (13 trials), UK (5 studies), Canada (3 studies), France (2 studies), Australia (1 study), Denmark (1 study), the Netherlands (1 study), Slovenia (1 study), Sweden (1 study), Switzerland (1 study), and Taiwan (1 study)

Outcomes

Length of stay in hospital, readmission rate to hospital, complication rate, place of discharge, mortality rate, patient health/psychological status, patient/caregiver satisfaction, psychological health of caregivers, cost of community care/healthcare, use of medications

Length of stay in hospital (15 trials), readmission rate to hospital (18 studies), place of discharge (3 studies), mortality rate (9 studies), patient health/psychological status (14 studies), patient/caregiver satisfaction (4 studies), cost of community care/healthcare (7 studies), use of medications (2 studies). Follow‐up times varied between 2 weeks and 9 months.

Date of most recent search: October 2015

Limitations: this is a well‐conducted systematic review with only minor limitations.

Integration

Adding a service to an existing service vs services with no addition ‐ integrated vs vertical delivery models

Dudley 2011

Review objective: to determine whether strategies that aim to integrate primary health services or strengthen linkages at the point of delivery in low‐ and middle‐income countries produce a more coherent product and improve healthcare delivery and/or health outcomes

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Any management or organisational change strategy applied to existing systems that aimed to increase integration at the service delivery level in primary health. The review included randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series studies.

5 randomised trials and 4 controlled before‐after studies.

‐ Adding a family planning clinic to: an expanded programme of immunisation (1 study), a maternal and child health service (2 studies), and a voluntary HIV counselling and testing service (1 study)

‐ Different forms of integration of nutrition and infectious disease control (1 study)

‐ Integrating sexually transmitted infection, HIV/AIDS and TB health services with routine services (4 studies)

Participants

Users and providers in primary healthcare facilities in low‐ and middle‐income countries

Individual patients, couples, households, and communities using primary healthcare services; and providers of primary healthcare services.

Settings

Primary healthcare facilities in low‐ and middle‐income countries

India (2 studies), South Africa (2 studies), Nepal, Tanzania, Togo, Zambia, Zimbabwe

Outcomes

Healthcare delivery, healthcare received, and health behaviour and status outcomes

Processes and outputs of healthcare delivery (9 studies)

Health status (5 studies)

Knowledge and behaviours of service users (3 studies)

Users' perceptions of the service (1 study)

Date of most recent search: September 2010

Limitations: this is a well‐conducted systematic review with only minor limitations.

Referral Systems

Healthcare delivery of organisational interventions vs no intervention for referral from primary to secondary care

Akbari 2008

Review objective: to assess the effects of interventions to change primary care outpatient referral rates or improve outpatient referral appropriateness.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series studies of interventions to change outpatient referral rates or improve outpatient referral appropriateness.

17 studies were found, of which 9 evaluated professional educational interventions, 4 evaluated organisational interventions, and 4 evaluated financial interventions. Of the 17 studies identified, 10 were randomised trials, 1 was a non‐randomised trial, 5 were controlled before‐after studies, and 1 was an interrupted time series study.

Participants

Primary care physicians, including general practitioners, family doctors, family physicians, family practitioners, and other physicians working in primary healthcare settings, who fulfil primary healthcare tasks

Specialist physicians working in hospitals or community outpatient settings

Primary care physicians and specialist physicians

Settings

Primary care and hospitals

Studies conducted in the UK (12 studies), the USA (2 studies), and 1 each in the Netherlands, Palestine, and Finland

Outcomes

Objectively measured provider performance in a healthcare setting (for example, referral rates or appropriateness of referral) or health outcomes.

Number of primary care visits, referral rates, appropriateness of referrals, case mix of referrals, appropriateness of specialist investigations, costs of prescriptions

Date of most recent search: October 2007

Limitations: this is a well‐conducted systematic review with only minor limitations.

Referral Systems

Nurse vs physician triage systems in emergency departments

Rowe 2011.

Review objective: to estimate the effectiveness of triage systems in reducing emergency department (ED) overcrowding.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Parallel or cluster‐randomised trials, non‐randomised trials, cohort studies, interrupted time series studies, case‐control studies, and before‐after studies assessing the effect of physician‐led triage systems

28 included studies: 2 randomised trials, 7 non‐randomised trials, 1 interrupted time series study, 16 before‐after studies, and 2 prospective cohort studies. The studies compared nurse‐led triage with triage teams (20 studies) or emergency physicians (8 studies).

Participants

Adult or mixed (children and adult) patients seeking healthcare

All studies took place in single emergency departments

Settings

Emergency departments

USA (17 studies), UK (4 studies), Australia (2 studies), Canada (2 studies), Hong Kong (2 studies), Singapore (1 study)

Outcomes

ED length of stay, time from patient arrival/triage to physically leaving the ED, physician initial assessment time from patient arrival, proportion of patients leaving the ED without being seen and leaving the ED against medical advice

ED length of stay (19 studies), physician initial assessment time from patient arrival (9 studies), proportion of patients leaving the ED without being seen (12 studies) and leaving the ED against medical advice (2 studies)

Date of most recent search: May 2009

Limitations: this is well‐conducted systematic review with only minor limitations, but the last search was conducted in 2009.

Teams

Team midwifery vs standard care

Butler 2011.

See under "Who provides care/role expansion or task shifting/specialst nursing post added to hospital nurse staffing"

Teams

Multidisplinary team care for people living with HIV/AIDS vs no team

Young 2010

Review objective: to assess the effectiveness of home‐based care to reduce morbidity and mortality in people with HIV/AIDS.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised and non‐randomised trials of home‐based care, provided by family, lay and/or professional people, including all forms of treatment, care and support

11 randomised trials: home‐based nursing compared with usual care (3 studies); multi‐professional team compared with an independent primary nurse (2 studies); computer‐based information compared with brochures or usual care (2 studies); home total parenteral nutrition compared with dietary counselling (1 study); home‐based water chlorination and safe storage compared with education only (1 study); home‐based exercise programme compared with usual care (2 studies)

Participants

Male and female individuals living with HIV, including adults and children

10 trials included both men and women, and 1 trial included children only.

Settings

Homes of people living with HIV/AIDS

All interventions were delivered in the homes of people living with HIV/AIDS in communities in the USA (9 studies), France (1 study) and Uganda (1 study). In addition, 2 ongoing trials in Uganda were identified.

Outcomes

Primary outcomes: progression to HIV/AIDS, death

Secondary outcomes: psychosocial outcomes, quality of care, quality of life, number of inpatient days, number and type of opportunistic infections

Primary outcomes: viral load and CD4 counts; level of function; and health status, including physical functioning and well‐being, changes in body composition (e.g., weight, waist circumference), biochemical measures.

Secondary outcomes: a range of outcomes were measured including people's knowledge of HIV and medications; emotional distress and health‐related quality of life; costs; risk behaviours; and health service utilisation

Date of most recent search: September 2008

Limitations: this is a well‐conducted systematic review with only minor limitations.

Teams

Practice based interventions to promote collaboration vs no intervention

Reeves 2017

Review objective: to assess the impact of practice‐based interventions to improve collaboration between professionals on patient satisfaction, health outcomes and the effectiveness and the efficiency of the healthcare provided.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials that evaluate practice‐based interventions that are designed to improve collaboration between 2 or more health and/or social care professionals.

9 randomised trials: 8 studies compared an interprofessionalcollaboration (IPC) intervention with no intervention and evaluated the effects of different practice‐based IPC interventions: externally facilitated interprofessional activities (4 studies), interprofessional rounds (2 studies), interprofessional meetings (1 study), and interprofessional checklists (1 study). 1 study compared 1 type of interprofessional meeting with another type of interprofessional meeting.

Participants

Healthcare teams/groups composed of more than 1 type of health and social care professional, in any patient population

Teams/groups involving a combination of doctors, nurses, pharmacists, nutritionists/dietitians, social workers, case managers, physical therapists, speech pathologists, occupational therapists, service support staff and managers.

Settings

Any health or social care setting

Acute care or general hospital care (6 studies), telemetry unit of a community hospital (technology that allows remote measurement and reporting of information) (1 study), nursing home (1 study) and family medicine practices (1 study)

Country settings: Australia (2 studies), Belgium (1 study), Sweden (1 study), USA (4 studies) and the UK(1 study)

Outcomes

Patient/client health measures (e.g. mortality, cure rates); healthcare process outcomes (e.g. readmission rates, continuity of care, use of resources; patient or family satisfaction; interprofessional collaboration)

All studies reported at least 1 patient/client or healthcare process outcome. 4 studies assessed collaborative behaviour.

Date of most recent search: November 2015

Limitations: this is a well‐conducted systematic review with only minor limitations.

Where care is provided

Site of service delivery

HIV voluntary counselling and testing (VCT) at an optional location vs VCT at clinic

Bateganya 2010

Review objective: to assess the effectiveness of home‐based HIV VCT in improving the uptake of HIV testing.

Types of

What the review authors searched for

What the review authors found

Study designs and interventions

Randomised trials of home‐based HIV VCT with any of the following features.

‐ The provision of pre‐test counselling in the home followed by rapid HIV testing, or the collection of specimens sent later to laboratories for HIV testing

‐ The provision of HIV test results and post‐test counselling in the home

‐ Referral of patients tested at home who had HIV‐positive test results

1 published randomised trial in which VCT for HIV was offered at an alternative location, including patients' homes

Participants

Adults aged ≥15 years who were either HIV negative or unaware of their HIV status and were screened for HIV infection after giving informed consent

Male and female household members aged ≥15 years

Settings

Low‐ and middle‐income countries with a score of < 0.9 on the Human Development Index

Community setting in Lusaka, Zambia

Outcomes

1. Acceptance of HIV pre‐test counselling by people

2. Whether HIV post‐test counselling was offered and the test results received by people

3. Number of cases of HIV infection diagnosed based on rapid tests

1. Acceptability to participants of HIV pre‐test counselling alone

2. Acceptability to participants of HIV pre‐test counselling and HIV testing

3. Proportion of people who received HIV post‐test counselling and their HIV test results

Date of most recent search: December 2008

Limitations: this is a well‐conducted systematic review with only minor limitations, including some methodological problems.

Site of service delivery

Units dedicated to care for people living with HIV/AIDS Institutions managing a high volume of people living with HIV/AIDS

Handford 2006

See under "Coordination of care/case management/people living with HIV/AIDS"

Site of service delivery

Home‐based care for people living with HIV/AIDS

Home‐based care for people living with HIV/AIDS vs other delivery options

Young 2010.

See under "Teams/multidisplinary team care for people living with HIV/AIDS"

Site of service delivery

Home‐based management of malaria

Okwundu 2013

Review objective: to evaluate home‐ and community‐based management strategies for treating malaria

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series studies that evaluated the effects of a home‐ or community‐based programme for treating malaria

7 randomised trials and 3 controlled before‐after studies. In all 10 studies, the intervention involved training low‐level health workers or mothers to give antimalarials provided free or at a highly‐subsidised cost.

8 studies compared presumptive treatment of all episodes of fever to standard (facility‐based) care.

2 studies compared home‐ or community‐based programmes using rapid diagnostic tests to confirm malaria with programmes using presumptive treatment.

Participants

People living in a malaria endemic setting

7 studies targeted children aged less than 6 years, and 3 studies treated all age groups.

Settings

Malaria endemic settings

Kenya (2 studies), Tanzania (2 studies), Uganda (2 studies); Burkina Faso, DR Congo, Ethiopia, Zambia (1 study in each country)

Outcomes

Primary: all‐cause mortality

Secondary: malaria‐specific mortality, hospitalisations, severe malaria, recommended treatment within 24 hours, any antimalarial treatment, parasitaemia, anaemia, adverse events

For home‐ or community‐based programmes versus facility‐based care: all‐cause mortality (1 study), hospitalisations (1 study), prompt treatment (2 studies), parasitaemia (2 studies), anaemia (3 studies)

For using rapid diagnostic tests versus clinical diagnosis: all‐cause mortality (2 studies), hospitalisations (1 study), treatment with an antimalarial (2 studies), treatment failure at day 7 (2 studies)

Date of most recent search: September 2012

Limitations: this was a well‐conducted systematic review with only minor limitations.

Site of service delivery

‐ Strategies for increasing ownership and use of insecticide‐treated bednets

Augustincic 2015

Review objective: to assess the evidence on the effectiveness and equity of strategies to increase ownership and proper use of insecticide‐treated bednets (ITNs)

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies evaluating interventions to increase ITN ownership and use

10 randomised trials: 4 studies used a combination of strategies focusing on ITN delivery to increase ITN ownership and appropriate ITN use; 2 studies focused on ITN delivery strategies only; and 7 studies examined appropriate use strategies

Participants

Individuals (children and adults) in

malaria endemic areas

Adults, children under 5 years, pregnant women, mothers of children under 5 years, rural cotton farmers

Settings

Not specified

Rural communities in Africa, India, and Iran

Outcomes

ITN ownership, ITN use and a range of secondary outcomes including (among others) equity ratio of household ITN ownership and adverse effects

ITN ownership, ITN use, and malaria morbidity

Date of most recent search: February 2013

Limitations: this was a well‐conducted review with only minor limitations.

Site of service delivery

Home care (different models) vs facility

Parker 2013

Review objective: to identify recent evidence on effectiveness and costs of care closer to home (CCTH) for children with long‐term conditions, including evidence on CCTH for children with short‐term health needs and those with palliative or end‐of‐life care needs.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials and other comparative studies with health economic data that assess any model of care that brings CCTH by preventing immediate inpatient admission and/or reducing length of stay of children, published since 1990

11 randomised trials and 15 health economic studies were included. The studies include 7 types of CCTH: for very low birthweight babies, for long‐erm conditions, for mental health problems, for acute medical conditions, home chemotherapy, home‐based alternative to clinic‐based care and telemedicine support

Participants

Children with acute, chronic, complex or palliative care needs

Diverse populations of children included, depending upon the health condition studied

Settings

Any home and hospital setting

Studies were from USA (3 studies), UK (3 studies) and 1 each from Canada, Finland, Germany, Australia and Brazil

Outcomes

Any measure of effectiveness, cost or cost‐effectiveness

Depending on the intervention: mortality, morbidity outcomes, costs

Date of most recent search: April 2007

Limitations: this is a well‐conducted review with minor limitations. However, the last search was in 2007.

Site of service delivery

Maternity waiting home vs no waiting homes

Van Lonkhuijzen 2012

Review objective: to assess the effects of maternity waiting facilities on maternal and perinatal health in low‐resource settings

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials of maternity waiting homes; i.e. facilities within a 1 km or a 10‐minute walk from a medical facility designated for the lodging of pregnant women awaiting labour

No randomised trials of maternity waiting facilities in low‐resource settings were found

Participants

Pregnant women

None

Settings

Low‐resource countries

None

Outcomes

Indices of perinatal morbidity and mortality, maternal morbidity and mortality, obstetric intervention and maternal satisfaction

None

Date of most recent search: January 2012

Limitations: this is a well‐conducted systematic review with only minor limitations.

Site of service delivery

Community‐based interventions for childhood diarrhoea and pneumonia versus routine care

Das 2013

Review objective: to estimate the effect of community‐based interventions including community case management on the coverage of various commodities and on mortality due to diarrhoea and pneumonia

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, quasi‐experimental and observational studies of community‐based interventions

24 studies were found, including randomised trials, quasi‐experimental and observational studies.

Participants

Impacts on children under 5 years

Children under 5 years

Settings

Community‐based settings in any country

Asia and Africa: India, Bangladesh, Pakistan, Malaysia, Nepal, Tanzania, China, Fiji, Zambia, Mali, Mozambique, Thailand, Uganda

Outcomes

Care seeking rates, use of oral rehydration solutions and zinc for diarrhoea, antibiotics use and treatment failure rates for diarrhoea and pneumonia; and for case management studies: incidence of moderate or severe episodes of acute lower respiratory infection, diarrhoea‐specific mortality, pneumonia‐specific mortality, and all‐cause mortality

Use of oral rehydration solution in childhood diarrhoea, use of zinc in childhood diarrhoea, care seeking rates for diarrhoea, care‐seeking rates for pneumonia (12 studies); pneumonia case management outcomes (12 studies); diarrhoea case management outcomes (2 studies)

Date of most recent search: November 2012

Limitations: this review has important limitations. It does not provide any information on risk of bias. In addition, it does not report how studies were weighted in the analysis.

Site of service delivery

Early discharge from hospital for mothers and infants born at term versus standard discharge

Brown 2007

Review objective: to assess the safety, impact and effectiveness of a policy of early discharge for healthy mothers and term infants, with respect to the health and well‐being of mothers and babies

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials that evaluate a policy of early postnatal discharge from hospital for healthy mothers and infants born at term

10 trials of early discharge were included in the review. Early discharge defined as a discharge after < 48 hours (5 studies), < 60 hours (1 study), and after periods ranging from 12 to 72 hours (4 studies)

Participants

Women who give birth in a hospital to a healthy infant that weighs at least 2500 g at term (37 to 42 weeks) and are deemed eligible for 'early discharge'

Women were recruited after the birth (4 studies) or during pregnancy (6 studies)

Settings

Hospital based

Studies were undertaken in the USA (3 studies), Canada (3 studies), the UK (1 study), Spain (1 study), Sweden (1 study) and Switzerland (1 study).

Outcomes

Infant or maternal readmissions (and duration of the later), maternal emotional well‐being, breastfeeding problems, satisfaction and costs of care

Infant readmissions (8 studies), maternal readmissions (8 studies), maternal emotional well‐being (5 studies), breastfeeding problems (8 studies), satisfaction with care (4 studies), and costs of care (4 studies)

Date of most recent search: December 2008

Limitations: this is a well‐conducted systematic review with only minor limitations.

Site of service delivery

Out‐of‐facility vs facility‐based HIV and reproductive health services for youth

Denno 2012

Review objective: to estimate the effectiveness of out‐of facility HIV and reproductive health services in increasing HIV and reproductive health service use by young people.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled observational studies, interrupted time series and studies examining the percentage of a target population reached with outreach‐based services

20 studies met the inclusion criteria, including 10 containing comparative data (1 randomised trial, 2 non‐randomised trials, 2 interrupted time series studies, 2 controlled and 1 uncontrolled before‐after studies and 2 cross‐sectional studies). 5 of the 20 studies investigated the delivery of emergency contraception through community‐based pharmacies. Other interventions were community youth programme promoters, integrated youth centres, mail‐based interventions or distributing commodities. Many studies included some health education component.

Participants

Adolescents and/or young adults

Most patients were between 10 and 24 years old.

Settings

Out‐of‐health facility locations, including pharmacies, detention centers, on the street, in parks, and in community centers. School‐based outreach was excluded from the review

USA (8 studies), UK (3 studies), the Netherlands (3 studies), Canada (1 study), Denmark (1 study), France (1 study), Malawi (1 study), Mexico (1 study), Zambia (1 study)

Outcomes

Use of HIV or reproductive health services or receipt/use of related commodities

Proportion screened for chlamydia (4 studies); proportion following through on HIV‐related referral (1 study); counselling and testing (1 study); emergency contraception use (5 studies); number of contraceptive users over time (1 study); condom use at last sexual encounter (1 study)

Date of most recent search: March 2010

Limitations: this is a well‐conducted systematic review with only minor limitations.

Site of service delivery

Decentralised vs centralised HIV care for initiation and maintenance of anti‐retroviral therapy

Kredo 2013

Review objective: to assess the effects of decentralised HIV care in relation to initiation and maintenance of antiretroviral therapy (ART).

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised and non‐randomised trials, controlled before‐after studies and well‐designed cohort studies assessing any form of decentralised care delivery model for the initiation of ART, continuation of ART, or both.

16 included studies: 2cluster trials, 2 prospective cohorts and 12 retrospective cohort studies

The studies examined partial decentralisation (6 studies), full decentralisation (7 studies), and decentralisation from facility to community (3 studies).

Participants

HIV‐infected patients at the point of initiating treatment, and patients already on treatment requiring maintenance and follow‐up.

HIV infected patients. 3 included children only, 2 included adults and children and the rest included adults only.

Settings

Community, health centre and hospital settings.

Studies from rural and urban areas in South Africa (4 studies), Malawi (3 studies), Ethiopia (2 studies), Uganda (2 studies), Kenya (1 study), Swaziland (1 study), and Thailand (1 study). 1 study examined data from 5 countries in Africa (Kenya, Lesotho, Mozambique, Rwanda and Tanzania).

Outcomes

Primary: lost to care at 1 year, death, and a composite outcome of both.

Secondary: time to starting antiretroviral therapy, new diagnoses of tuberculosis co‐infection, virologic and immunologic response to ART, new AIDS‐defining illness, patient satisfaction with care, and cost to the provider

All primary outcomes, virologic and immunologic response to ART, costs to people living with HIV/AIDS and costs to the health service, and patient satisfaction with care

Date of most recent search: March 2013

Limitations: this is well‐conducted systematic review with only minor limitations.

Site of service delivery

‐ Workplace programmes for HIV and tuberculosis versus no programme

Yassi 2013

Review objective: to determine the effectiveness of workplace programmes for the diagnosis or treatment of HIV or tuberculosis (TB)

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, quasi‐experimental or comparative observational studies assessing workplace programmes to diagnose and/or manage HIV and/or TB, and analytical studies if none of the previous designs was found.

3 studies among healthcare workers (1 controlled before‐after study, 1 uncontrolled before‐after study, and 1 descriptive study) and 7 among employees in other sectors (1 cluster‐randomised trial, 2 interrupted time series, 4 qualitative/quantitative descriptive studies)

Participants

Health workers and employees in any sector (including private and public workplaces)

Health workers at hospitals and medical centres. Small‐ and medium‐sized businesses

Settings

Workplaces (all countries)

South Africa (7 studies), Botswana (jointly with South Africa), Rwanda, Zambia and Zimbabwe (1 each)

Outcomes

Incidence of infection, absenteeism, worker retention, uptake of voluntary counselling and testing, uptake of treatment, morbidity, mortality, working conditions, cost (or cost‐benefit), discrimination or stigma, job loss, services to the community

Mortality, active TB cases, adverse effects of medicines, uptake of HIV testing and appropriate treatment, adoption of HIV‐preventative behaviours, knowledge and attitudes about HIV, stigma and morale

Date of most recent search: 2009

Limitations: this is a well‐conducted systematic review with only minor limitations.

Information and communication technology

E‐Health

Mobile phone messaging for long‐term illnesses vs usual care

De Jongh 2012

Review objective: to assess the effects of mobile phone messaging applications designed to facilitate self‐management of long‐term illnesses, on health outcomes and the capacity of patients to self‐manage their conditions.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies, or interrupted time series studies with at least 3 time points before and after the intervention.

4 randomised trials were included. Text messaging was used as an intervention in all the included studies. Multimedia message services (MMS) were not used in any of the included studies.

2 studies of interventions for diabetes and hypertension respectively used one‐way communication between an automated system and the study participants. 1 study about diabetes used 2‐way communication between patients and an automated system, and 1 study about asthma used 2‐way communication between patients and their physicians.

Participants

Patients with long‐term illnesses

182 participants: people with diabetes aged between 8 and 25 years (2 studies, N = 99); people over 18 years with hypertension (1 study, N = 67); people of any age with asthma (1 study, N = 16)

Settings

Any

Outpatient services in the USA, the UK, Spain and Croatia

Outcomes

Primary outcomes: health outcomes as a result of the intervention, including physiological measures (e.g. blood pressure) and capacity to self‐manage long‐term conditions (e.g. lifestyle modification).

Secondary outcomes: user (patient, caregiver or healthcare provider) evaluation of the intervention (e.g. satisfaction); health service utilisation following the intervention; costs (direct and indirect) of the intervention; user perceptions of safety; potential harms or adverse effects of the intervention, such as misreading or misinterpretation of data

Primary outcomes: clycaemic control (Hb1Ac) in people with diabetes (2 trials); diabetic ketoacidosis (DKA) (1 trial), severe hypoglycaemia (1 trial), systolic and diastolic blood pressure(1 trial), forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) in people with asthma (1 trial). The following outcomes were also evaluated across the 4 trials: self‐efficacy for diabetes, diabetes social support interview, diabetes knowledge scale, hypertension treatment adherence at 6 months, diabetes treatment adherence, adherence of people with asthma to peak expiratory flow measurement.

Secondary outcomes: participant evaluation of the intervention and health services utilisation were evaluated in 1 trial

Date of most recent search: June 2009

Limitations: this is well‐conducted systematic review with only minor limitations.

E‐Health

Mobile phone messaging reminders for attendance at healthcare appointments vs various other interventions

Gurol‐Urganci 2013

Review objective: to assess the effects of mobile phone messaging reminders for attendance at healthcare appointments.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials evaluating the use of reminders for healthcare appointments sent from a healthcare provider to a patient using SMS or MMS compared with no intervention, or other modes of communication.

8 randomised trials involving a total of 6615 people evaluated a text messaging intervention compared to usual practice (in 7 studies, the usual practice was no reminders). The messages were sent 24 to 72 hours before the appointment and included the participant's name and appointment details. 2 studies included instructions (i.e. to call a specified number if the patient was unable to attend), and 2 emphasised the importance of attending the appointment. 3 studies used a web‐based platform to send the messages, 1 used a modem linked to electronic medical records, and 3 did not describe the platform used. In 1 study, messages were sent either manually or through an automated delivery system.

Participants

Any type of participants regardless of age, gender and ethnicity; patients with any type and stage of disease

Patients that required an appointment in the clinic or practice (3 studies), middle‐ and high‐ income employees or owners of local companies (1 study)

Settings

Any setting

Australia (1 study), China (2 studies), Kenya (1 study), Malaysia (2 studies) and the UK (UK) (2 studies). The settings were: 1 hospital health promotion centre; 1 inner‐city general practice; 6 ENT clinics (in 1 hospital); 9 primary care clinics; and 12 governmental health clinics.

Outcomes

Primary outcome: rate of attendance at healthcare appointments

Secondary outcomes: health outcomes (e.g. blood pressure, clinical assessments), user evaluation of the intervention, user perceptions of safety, costs, and potential harms

All studies reported attendance rates at healthcare appointments. The costs of the interventions were reported in 2 studies. None of the included studies reported health outcomes, user perceptions of safety, or potential harms of the intervention. Only 1 study measured some form of user evaluation (proportion of participants contacted who had a mobile phone and who were willing to be contacted by SMS).

Date of most recent search: August 2012

Limitations: this is well‐conducted systematic review with only minor limitations.

E‐Health

Mobile phone messaging to promote adherence to antiretroviral therapy vs usual care

Mbuagbaw 2013

Review objective: to determine whether mobile phone text‐messaging is efficacious in enhancing adherence to ART in people with HIV infection.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials in which patients receiving ART or their caregivers (for children) were provided with mobile phone text messages to promote adherence to ART

3 randomised trials comparing text messaging to a control condition. In 2 studies, weekly text messages reminders were compared to standard care. In the other study, short or long text messages, either daily or weekly, were compared to the provision of a cell phone, but without study‐related communication.

Participants

Adults or children receiving ART

The studies included adults only

Settings

Any setting

Kenya (2 studies) and Cameroon (1 study)

Outcomes

The primary outcomes were adherence to ART and viral load suppression. The secondary outcomes were quality of life, mortality, losses to follow‐up, transfers and withdrawals

All studies reported adherence to ART at 48 or 52 weeks and viral load suppression at 52 weeks. 1 study reported mortality, losses to follow‐up, transfers and withdrawals. 1 study reported quality of life.

Date of most recent search: this review included 3 studies, which were the only published studies of which the authors were aware that met their selection criteria up until September 2013.

Limitations: this is a well‐conducted review that analysed individual patient data from 3 randomised trials. However, a systematic search for other relevant studies was not undertaken.

Health information systems

Women carrying their own case notes in pregnancy vs less detailed health cards

Brown 2011

Review objective: to evaluate the effects of women carrying their own case notes during pregnancy.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials of interventions in which pregnant women were given their own case notes to carry during pregnancy

3 trials in which pregnant women were given their complete antenatal records to carry and control groups were given a co‐op card (short summary card with no clinical progress information)

Participants

Pregnant women

Pregnant women recruited at their first antenatal booking visit

Settings

Antenatal care services

Antenatal care services within the public health sector in the UK (2 studies) and Australia (1 study)

Outcomes

Primary: maternal satisfaction and control, administrative efficiency

Secondary: partner involvement, health‐related behaviours, clinical outcomes

Primary: maternal satisfaction and control (3 studies),

administrative efficiency information (2 studies)

Secondary: breastfeeding initiation (1 study), smoking cessation (2 studies), and clinical outcomes (1 study)

Date of most recent search: March 2011

Limitations: this is a well‐conducted systematic review with only minor limitations. An updated version of this review found 1 additional randomised trial, which did not change the conclusions of the review (see related literature). This summary has not yet been updated to incorporate the additional trial.

Patient reminder and recall systems

Interventions to improve childhood vaccination including reminders for routine childhood vaccination vs usual care

Oyo‐Ita 2016

Review objective: to assess the effectiveness of intervention strategies to improve immunisation coverage in LMICs

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies (CBAs) and interrupted time series studies that evaluate patient‐oriented (health education or incentives), provider‐oriented (audit and feedback, reminders) or health system‐oriented (outreach programmes, interventions oriented to improve quality) interventions to increase immunisation coverage

14 studies were included: 10 cluster‐randomised trials and 4 individually randomised trials. Interventions included health education (6 studies), monetary incentives (4 studies), health education plus parent reminders (2 studies), provider‐oriented interventions (1 study), home visits (1 study), integration of immunisation services with intermittent preventive treatment of malaria in infants (1 study), regular immunisation outreach sessions (1 study) and a combination of provider training and quality assurance (1 study). Several studies evaluated more than 1 intervention

Participants

Healthcare personnel who deliver immunisation. Children under 5 years who receive immunisation or their caregivers

Children birth to 4 years (10 studies), primary healthcare workers (1 study), general adult population (1 study), and pregnant and postpartum women (2 studies)

Settings

Low‐ and middle‐income countries

Ambulatory care settings in: Georgia (1 study), Ghana (1 study), Honduras (1 study), India (2 studies), Mali (1 study), Mexico (1 study), Nepal (1 study), Nicaragua (1 study), Pakistan (4 studies) and Zimbabwe (1 study)

Outcomes

Primary outcomes: proportion of children who received DTP3 by 1 year; proportion of children who received all recommended vaccinations by 2 years of age

Secondary outcomes: occurrence of vaccine‐preventable diseases, number of under‐fives immunised, costs, attitudes of caregivers and clients to vaccination, adverse events

DTPs coverage (6 studies), proportion of the target population that was fully immunised (11 studies), percentage change in immunisation coverage over time (2 studies). Other outcomes reported were coverage for specific vaccines (3 studies), costs (1 study), received at least 1 vaccine (1 study), completion of schedule (1 study). None of the studies provided data on the attitudes of caregivers and clients to vaccination

Date of most recent search: May 2016 for most databases

Limitations: this is well‐conducted systematic review with only minor limitations.

Quality and safety systems

Quality/safety monitoring and improvement systems

Medication review for hospitalised adult patients vs standard care

Christensen 2016

Review objective: to assess whether medication review improves health outcomes of hospitalised adult patients.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, including cluster‐randomised trials, assessing medication review

10 randomised trials were included. The medication review was performed by a pharmacist (4 trials), by a team of pharmacists and pharmacy technicians (1 trial), by a physician (2 trials), by a pharmacist or a physician (1 trial) and by a team of pharmacists and physicians (2 trials). The medication review ended with a written recommendation to the prescribing physicians, sometimes combined with medicines counselling, patient education and telephone follow‐up. 7 trials provided additional interventions besides medication review.

Participants

Hospitalised adult patients receiving medication review by a physician, pharmacist or other healthcare professional

Participants were elderly with a mean age around 80 years in all trials except 3, in which the mean participant age was 59, 61 and 70 years.

Settings

Hospital setting, worldwide

USA (2 studies) and Europe (Belgium, Denmark, Ireland, Northern Ireland, and Sweden) (8 studies)

Outcomes

Mortality, hospital readmission, hospital emergency department contacts (all‐cause and due to adverse medicines events), and adverse medicine events.

Mortality (9 trials), hospital readmissions (7, with 1 due to adverse medicine events), hospital emergency department contacts (4, with 1 due to adverse medicine events), and adverse medicine events (1 study)

Date of most recent search: May 2015

Limitations: this is well‐conducted systematic review with only minor limitations.

Quality monitoring and improvement systems

Interventions to improve antibiotic prescribing to hospital inpatients

Davey 2013

Review objective: to estimate the effectiveness of professional interventions that, alone or in combination, are effective in antibiotic stewardship for hospital inpatients.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies of interventions directed to antibiotic stewardship

89 included studies (95 interventions): 25 randomised trials, 3 non‐randomised trials, 5 controlled before‐after studies, and 56 interrupted time series studies. 84% of the interventions targeted the antibiotic prescribed and the remaining 16% aimed to change exposure of patients to antibiotics by targeting the decision to treat or the duration of treatment.

Participants

Healthcare professionals who prescribe antibiotics to hospital inpatients

Interventions were delivered by multidisciplinary teams (39%), specialist physicians in infectious diseases or microbiology (33%), pharmacists (20%), and department physicians (8%).

Settings

Hospital settings worldwide

USA (48), UK (12 studies), Netherlands (6 studies), Canada (4 studies), Switzerland (3 studies), Australia (3 studies), Thailand (2 studies), Colombia (2 studies), France (2 studies), Germany (2 studies), Spain (2 studies), Israel (2 studies), Austria (1 study), Belgium (1 study), Brazil (1 study), Hong Kong (1 study), Italy (1 study), Norway (1 study), and Sweden (1 study)

Outcomes

Antibiotic prescribing process measures (decision to treat, choice of medicine, dose, route or duration of treatment); clinical outcome measures (mortality, length of hospital stay); microbial outcome measure (colonisation or infection with clostridium difficile or antibiotic‐resistant bacteria)

Appropriate prescribing of antibiotics, microbial outcomes, patient outcomes (mortality), length of stay, readmissions

Date of most recent search: February 2009

Limitations: this is well‐conducted systematic review with only minor limitations.

Quality monitoring and improvement systems

Decision support to improve healthcare process and health outcomes for people living with HIV/AIDS

Decision support with clinical information system to improve healthcare process and health outcomes for people living with HIV/AIDS

Pasricha 2012

Review objective:to assess the effectiveness of decision support (DS) and clinical information system (CIS) interventions for people living with HIV

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Comparative studies that examined the impact of DS and CIS interventions compared to usual care, another (non‐ chronic care model) intervention, or both

16 studies were included in the review: 2 randomised trials, 1 non‐randomised trial, 4 prospective and 5 retrospective cohorts, 1 cross‐sectional study, 2 time series, and 1 prospective time‐motion study

Participants

Healthcare providers caring for individuals known to be living with HIV

Ambulatory patients. Participants in 1 study were children and the rest were adults (mostly men under 50 years).

Settings

Ambulatory setting

USA (10 studies), UK (1 study), France (1 study), Switzerland (1 study), South Africa (1 study), Zambia (1 study) and Uganda (1 study)

Outcomes

Immunologic or virologic outcomes such as CD4 count or viral load; medical outcomes such as mortality, progression to AIDS, opportunistic infections, adherence to medication, and risk behaviours; psychosocial outcomes such as quality of life or psychological health and well‐being; economic outcomes such as healthcare utilisation (length of stay, visits), costs; and healthcare process/provider performance outcomes

Process and health outcome measures

Date of most recent search: February 2011

Limitations: this is well‐conducted systematic review with only minor limitations.

Working conditions of health workers

Staff support

Managerial supervision to improve quality of primary health care

Bosch‐Capblanch 2011

Review objective: to summarise opinions on the definition of supervision of primary healthcare; to compare these definitions to supervision in practice; and to appraise the evidence of effects of supervision on sector performance.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Routine supervision visits by health staff from a centre (such as a district office) to primary health care (PHC) staff in both urban and rural areas. Randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series studies

5 cluster‐randomised trials and 4 controlled before‐after studies. The interventions were: routine supervision, enhanced supervision, less intensive supervision, and no supervision

Participants

Healthcare units (health centres) or providers (including lay health workers) at the PHC level

Studies took place in Africa (Benin, Ethiopia, Kenya, South Africa, Zimbabwe), Asia (Nepal, the Philippines, Thailand) and Latin America (Brazil)

Settings

Health services, rural or urban, in low‐ and middle‐income countries

Rural areas (5 studies) and settings that were both rural and urban (3 studies). 1 study did not specify the study area.

Outcomes

Service quality measures, including changes in provider practice, adherence to guidelines or service coverage. Also, population or patient satisfaction, change in provider knowledge and provider satisfaction with supervision

Service quality, user satisfaction, provider knowledge and satisfaction. Other outcomes included the cost of supervision and service utilisation.

Date of most recent search: March 2011

Limitations: this is well‐conducted systematic review with only minor limitations.

Complex interventions cutting across delivery categories and across the other overviews

Package of multiple interventions

Emergency obstetric referral interventions

Hussein 2012

Review objective: to assess the effects of referral interventions that enable pregnant women to reach health facilities during an emergency after the decision to refer has been made.

Types of

What the review authors searched for

What the review authors found

Study designs and Interventions

Any randomised trial or quasi‑experimental studies looking at phase II (delays in reaching an appropriate facility) interventions to improve referral of emergency obstetric conditions

19 studies: cluster‐randomised trials (4 studies), before‐after studies (9 studies), and observational cohort studies (6 studies)

14 interventions: organisational interventions (6 studies), structural interventions (7 studies), mixed interventions (structural and organisational) (1 study)

Participants

Pregnant and postpartum women with an obstetric complication

Pregnant women and postpartum women with obstetric complications

Settings

Low‐ and middle‐income countries

Rural settings in low‐ and middle‐income countries: Bangladesh (6 studies), Zimbabwe (4 studies), Guatemala (1 study), Pakistan (1 study), India (1 study), Nepal (1 study), Indonesia (1 study), Zambia (1 study), Malawi (1 study), Burkina Faso (2 studies)

Outcomes

Maternal and neonatal mortality and stillbirths

Maternal mortality (7 studies), neonatal mortality (6 studies), and stillbirths (7 studies). 1 study reported on both neonatal and stillbirths.

Date of most recent search: November 2010

Limitations: this is well‐conducted systematic review with only minor limitations.