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Randomized controlled trials in de-implementation research: a systematic scoping review.

Aleksi J Raudasoja1,2, Petra Falkenbach3,4, Robin W M Vernooij5,6

  • 1Faculty of Medicine, University of Helsinki, Helsinki, Finland. raudasoja.aleksi@gmail.com.

Implementation Science : IS
|October 1, 2022
PubMed
Summary
This summary is machine-generated.

De-implementation research, focused on reducing low-value care, faces limitations affecting reliability. Future studies need simpler designs, better controls, and context-specific tailoring for improved effectiveness.

Keywords:
Clinical trialsCluster randomized trialDe-implementationLow-value careMethodsOveruseRandomized controlled trialScoping reviewTrial design

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Area of Science:

  • Health Services Research
  • Implementation Science

Background:

  • Rising healthcare costs necessitate reducing low-value medical practices.
  • De-implementation is crucial for enhancing health outcomes and controlling expenditures.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) of de-implementation interventions.
  • To synthesize findings and provide recommendations for future de-implementation research.

Main Methods:

  • Searched MEDLINE and Scopus for individual and cluster RCTs up to May 2021.
  • Assessed study eligibility, characteristics, outcomes, interventions, theories, and risk of bias.

Main Results:

  • 227 RCTs were included, mostly cluster trials (64%) in primary care (66%).
  • Interventions primarily targeted physicians (85%) to reduce drug treatment (72%).
  • High risk of bias was noted in 60% of trials due to missing data, baseline imbalances, and allocation concealment issues.

Conclusions:

  • Current de-implementation trials, mainly in primary care targeting drug use, have limitations impacting reliability and applicability.
  • Research gaps include de-implementation in secondary/tertiary care and interventions for non-physicians.
  • Future trials should adopt simpler designs, better confounder control, larger cluster numbers, context tailoring, and theoretical underpinnings.