A systematic review of pharmacogenetic testing in primary care: Attitudes of patients, general practitioners, and pharmacists

Abstract Background Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients’ alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners’ and primary care nurses’ routine delivery of alcohol SBI in adults. Methods A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were ‘Environmental Context and Resources’ (n = 158, e.g. lack of time), ‘Beliefs about Capabilities’ (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and ‘Skills’ (n = 99, e.g. lack of training). Conclusions This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity. Systematic review registration PROSPERO CRD42016052681

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WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

British Journal of General Practice ◽

10.3399/bjgp18x697085 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697085

Author(s):

Trudy Bekkering ◽

Bert Aertgeerts ◽

Ton Kuijpers ◽

Mieke Vermandere ◽

Jako Burgers ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Clinical Practice ◽

Primary Care Physicians ◽

Urinary Stones ◽

Care Practice ◽

Supporting Evidence ◽

Supervised Exercise ◽

Review Team ◽

New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

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Faculty Opinions recommendation of Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717958774.793464360 ◽

2012 ◽

Author(s):

Evgeny Krupitsky ◽

Elena Blokhina

Keyword(s):

Systematic Review ◽

Primary Care ◽

Alcohol Misuse ◽

Task Force ◽

Meta Analysis ◽

Preventive Services ◽

Behavioral Counseling ◽

The U.S

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Faculty Opinions recommendation of Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717958774.793463955 ◽

2012 ◽

Author(s):

George Woody

Keyword(s):

Systematic Review ◽

Primary Care ◽

Alcohol Misuse ◽

Task Force ◽

Meta Analysis ◽

Preventive Services ◽

Behavioral Counseling ◽

The U.S

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Faculty Opinions recommendation of What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725980299.793512636 ◽

2015 ◽

Author(s):

Saravana Kumar

Keyword(s):

Systematic Review ◽

Primary Care ◽

Primary Care Physician ◽

Patient Outcomes ◽

Care Physician ◽

Educational Materials ◽

Physician Knowledge ◽

Meta Analyses ◽

Printed Educational Materials

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Faculty Opinions recommendation of Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US preventive services task force.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726105109.793532169 ◽

2017 ◽

Author(s):

Katherine Williams

Keyword(s):

Systematic Review ◽

Primary Care ◽

Task Force ◽

Preventive Services ◽

Postpartum Women ◽

Treatment Of Depression ◽

The Us

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The Effects Of Practice Size On Quality Of Care In Primary Care Settings: A Systematic Review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201210270-00001 ◽

2012 ◽

Vol 10 (27) ◽

pp. 1549-1633

Author(s):

Ng Kok Ping ◽

Ng Charis Wei Ling

Keyword(s):

Systematic Review ◽

Primary Care ◽

Quality Of Care ◽

Primary Care Settings ◽

Practice Size

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Approaches for combining primary care electronic health record data from multiple sources: a systematic review of observational studies

BMJ Open ◽

10.1136/bmjopen-2020-037405 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037405

Author(s):

Daniel Dedman ◽

Melissa Cabecinha ◽

Rachael Williams ◽

Stephen J W Evans ◽

Krishnan Bhaskaran ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Electronic Health Record ◽

Observational Studies ◽

Meta Analysis ◽

Data Sources ◽

Health Record ◽

Two Stage ◽

One Stage ◽

Electronic Health

ObjectiveTo identify observational studies which used data from more than one primary care electronic health record (EHR) database, and summarise key characteristics including: objective and rationale for using multiple data sources; methods used to manage, analyse and (where applicable) combine data; and approaches used to assess and report heterogeneity between data sources.DesignA systematic review of published studies.Data sourcesPubmed and Embase databases were searched using list of named primary care EHR databases; supplementary hand searches of reference list of studies were retained after initial screening.Study selectionObservational studies published between January 2000 and May 2018 were selected, which included at least two different primary care EHR databases.Results6054 studies were identified from database and hand searches, and 109 were included in the final review, the majority published between 2014 and 2018. Included studies used 38 different primary care EHR data sources. Forty-seven studies (44%) were descriptive or methodological. Of 62 analytical studies, 22 (36%) presented separate results from each database, with no attempt to combine them; 29 (48%) combined individual patient data in a one-stage meta-analysis and 21 (34%) combined estimates from each database using two-stage meta-analysis. Discussion and exploration of heterogeneity was inconsistent across studies.ConclusionsComparing patterns and trends in different populations, or in different primary care EHR databases from the same populations, is important and a common objective for multi-database studies. When combining results from several databases using meta-analysis, provision of separate results from each database is helpful for interpretation. We found that these were often missing, particularly for studies using one-stage approaches, which also often lacked details of any statistical adjustment for heterogeneity and/or clustering. For two-stage meta-analysis, a clear rationale should be provided for choice of fixed effect and/or random effects or other models.

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