Effectiveness of Discrete Strategies and Implementation Bundles for Improving Clinician Prescription of Clinical Practice Guideline-Recommended Medications for Atherosclerotic Occlusive Disease: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis assessed randomized trials of strategies to improve prescription of guideline-strongly-recommended medications for adults with atherosclerotic occlusive disease. Across 31 trials evaluating 29 strategies or bundles, the bundle combining case management, team changes, continuous quality improvement, audit and feedback, and clinician and patient education had the largest reported effect on prescribing (relative risk, 2.62 [95% CI, 2.08-3.29]; moderate certainty). Team changes alone also improved prescribing and were associated with reduced major adverse cardiac event risk.

Key findings

• The five-component implementation bundle improved recommended medication prescription (relative risk, 2.62 [95% CI, 2.08-3.29]; moderate certainty).
• Team changes improved prescription of all strongly recommended medications (relative risk, 1.23 [95% CI, 1.11-1.36]; moderate certainty).
• Meta-regression suggested patient education strategies were more effective for statin prescription (P =0.037) and prescription of all recommended medications (P =0.006).
• Bundles combining case management, team changes, facilitated information relay, and audit and feedback reduced all-cause death and new vascular event risk.

Why it matters

Medication underprescribing in atherosclerotic occlusive disease is a target for implementation efforts. These findings suggest that coordinated, multicomponent approaches—particularly those involving team changes and patient education—can improve prescribing, with some strategies also associated with better clinical outcomes. The results help distinguish potentially useful implementation components, while the certainty and trial evidence should guide how strongly they inform service-level decisions.