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01-07-2018

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

Authors: Eva Kovacs, Dr. med. PhD, Ralf Strobl, Dr. rer. biol. hum., Dipl.-Stat., Amanda Phillips, MSc, Anna-Janina Stephan, MPH, Martin Müller, MPH, Prof. Dr., Jochen Gensichen, Prof. Dr. med. habil., Dipl.-Päd., MPH, Eva Grill, Prof. Dr., MPH

Published in: Journal of General Internal Medicine | Issue 7/2018

Abstract

Background

As clinical practice guidelines represent the most important evidence-based decision support tool, several strategies have been applied to improve their implementation into the primary health care system. This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs).

Methods

The studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results.

Results

The 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categories of knowledge transfer, diagnostic behaviour, prescription, counselling and patient-level results. The forest plot revealed a moderate overall effect size of 0.22 [0.15, 0.29] where single interventions were more effective (0.27 [0.17, 0.38]) than multifaceted interventions (0.13 [0.06, 0.19]).

Discussion

Guideline implementation strategies are heterogeneous. Reducing the complexity of strategies and tailoring to the local conditions and PCPs’ needs may improve implementation and clinical practice.

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Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, et al. Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci 2016;11:40. https://doi.org/10.1186/s13012-016-0396-4 CrossRefPubMedPubMedCentral

Bernstein AB, Hing E, Burt CW, Hall MJ. Trend data on medical encounters: tracking a moving target. Health Aff (Project Hope) 2001;20(2):58–72.CrossRef

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x CrossRefPubMedPubMedCentral

Gibson OR, Segal L, McDermott RA. A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing. BMC Health Serv Res 2013;13:336. https://doi.org/10.1186/1472-6963-13-336 CrossRefPubMedPubMedCentral

Fernandez A, Sturmberg J, Lukersmith S, Madden R, Torkfar G, Colagiuri R, et al. Evidence-based medicine: is it a bridge too far? Health Res Policy Syst 2015;13:66. https://doi.org/10.1186/s12961-015-0057-0 CrossRefPubMedPubMedCentral

Saarni SI, Gylling HA. Evidence based medicine guidelines: a solution to rationing or politics disguised as science? J Med Ethics 2004;30(2):171–5.CrossRefPubMedPubMedCentral

Brusamento S, Legido-Quigley H, Panteli D, Turk E, Knai C, Saliba V, et al. Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU Member States: a systematic review. Health Policy 2012;107(2–3):168–83. https://doi.org/10.1016/j.healthpol.2012.08.005 CrossRefPubMed

Legido-Quigley H, Panteli D, Brusamento S, Knai C, Saliba V, Turk E, et al. Clinical guidelines in the European Union: mapping the regulatory basis, development, quality control, implementation and evaluation across member states. Health Policy 2012;107(2–3):146–56. https://doi.org/10.1016/j.healthpol.2012.08.004 CrossRefPubMed

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282(15):1458–65.CrossRefPubMed

10.

Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From Theory to Intervention: Mapping Theoretically Derived Behavioural Determinants to Behaviour Change Techniques. Appl Psychol 2008;57(4):660–80. https://doi.org/10.1111/j.1464-0597.2008.00341.x CrossRef

11.

McAuley L, Ramsey C. Cochrane effective practice and organisation of care review group; data collection checklist. Ottawa: EPOC, University of Ottawa; 2002. http://methods.cochrane.org/sites/methods.cochrane.org.bias/files/public/uploads/EPOC%20Data%20Collection%20Checklist.pdf Accessed 15.02.2018.

12.

Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii-iv, 1–72.CrossRefPubMed

13.

Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies--a synthesis of systematic review findings. J Eval Clin Pract 2008;14(5):888–97. https://doi.org/10.1111/j.1365-2753.2008.01014.x CrossRefPubMed

14.

Grol R, Wensing M, Eccles MP, Davis D. Improving Patient Care: The Implementation of Change in Health Care Wiley-Blackwell Hoboken 2013.CrossRef

15.

Wensing M, van der Weijden T, Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract 1998;48(427):991–7.PubMedPubMedCentral

16.

Standard Country or Area Codes for Statistical Use. The United Nations Statistics Division https://unstats.un.org/unsd/methodology/m49/overview/ Accessed 15.02.2018.

17.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100 CrossRefPubMedPubMedCentral

18.

Ogilvie D, Fayter D, Petticrew M, Sowden A, Thomas S, Whitehead M, et al. The harvest plot: a method for synthesising evidence about the differential effects of interventions. BMC Med Res Methodol 2008;8:8. https://doi.org/10.1186/1471-2288-8-8 CrossRefPubMedPubMedCentral

19.

Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org Accessed 15.02.2018.

20.

Eldridge S, Kerry S. A Practical Guide to Cluster Randomised Trials in Health Services Research. Chichester: Wiley; 2012.CrossRef

21.

Viechtbauer W. Conducting meta-analyses in {R} with the {metafor} package. J Stat Softw 2010;36(3):1–48.CrossRef

22.

R Core Team. A language and environment for statistical computing.: R Foundation for Statistical Computing, Vienna; 2014.

23.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–34.CrossRefPubMedPubMedCentral

24.

Aakhus E, Granlund I, Odgaard-Jensen J, Oxman AD, Flottorp SA. A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial. Implement Sci 2016;11:32. https://doi.org/10.1186/s13012-016-0397-3 CrossRefPubMedPubMedCentral

25.

Anderson D, Zlateva I, Khatri K, Ciaburri N. Using health information technology to improve adherence to opioid prescribing guidelines in primary care. Clin J Pain 2015;31(6):573–9. https://doi.org/10.1097/ajp.0000000000000177 CrossRefPubMedPubMedCentral

26.

Arts DL, Abu-Hanna A, Medlock SK, van Weert HC. Effectiveness and usage of a decision support system to improve stroke prevention in general practice: A cluster randomized controlled trial. PLoS One 2017;12(2):e0170974. https://doi.org/10.1371/journal.pone.0170974 CrossRefPubMedPubMedCentral

27.

Bermejo I, Schneider F, Kriston L, Gaebel W, Hegerl U, Berger M, et al. Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial. Int J Qual Health Care 2009;21(1):29–36. https://doi.org/10.1093/intqhc/mzn050 CrossRefPubMed

28.

Bonds DE, Hogan PE, Bertoni AG, Chen H, Clinch CR, Hiott AE, et al. A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study. Am Heart J 2009;157(2):278–84. https://doi.org/10.1016/j.ahj.2008.09.021 CrossRefPubMed

29.

Braun V, Heintze C, Rufer V, Welke J, Stein T, Mehrhof F, et al. Innovative strategy for implementing chronic heart failure guidelines among family physicians in different healthcare settings in Berlin. Eur J Heart Fail 2011;13(1):93–9. https://doi.org/10.1093/eurjhf/hfq181 CrossRefPubMed

30.

Chen JH, Hom J, Richman I, Asch SM, Podchiyska T, Johansen NA. Effect of opioid prescribing guidelines in primary care. Medicine 2016;95(35):e4760. https://doi.org/10.1097/md.0000000000004760 CrossRefPubMedPubMedCentral

31.

Dormuth CR, Carney G, Taylor S, Bassett K, Maclure M. A randomized trial assessing the impact of a personal printed feedback portrait on statin prescribing in primary care. J Contin Educ Heal Prof 2012;32(3):153–62. https://doi.org/10.1002/chp.21140 CrossRef

32.

Ennis J, Gillen D, Rubenstein A, Worcester E, Brecher ME, Asplin J, et al. Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study. BMC Nephrol 2015;16:163. https://doi.org/10.1186/s12882-015-0159-5 CrossRefPubMedPubMedCentral

33.

Franx G, Huyser J, Koetsenruijter J, van der Feltz-Cornelis CM, Verhaak PF, Grol RP, et al. Implementing guidelines for depression on antidepressant prescribing in general practice: a quasi-experimental evaluation. BMC Fam Pract 2014;15:35. https://doi.org/10.1186/1471-2296-15-35 CrossRefPubMedPubMedCentral

34.

French SD, McKenzie JE, O'Connor DA, Grimshaw JM, Mortimer D, Francis JJ, et al. Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial. PLoS One 2013;8(6):e65471. https://doi.org/10.1371/journal.pone.0065471 CrossRefPubMedPubMedCentral

35.

Grunfeld E, Manca D, Moineddin R, Thorpe KE, Hoch JS, Campbell-Scherer D, et al. Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial. BMC Fam Pract 2013;14:175. https://doi.org/10.1186/1471-2296-14-175 CrossRefPubMedPubMedCentral

36.

Harris MF, Parker SM, Litt J, van Driel M, Russell G, Mazza D, et al. Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial. BMJ Open 2015;5(12):e009397. https://doi.org/10.1136/bmjopen-2015-009397 CrossRefPubMedPubMedCentral

37.

Heppe DB, Bucher-Bartelson B, Estacio RO, Krantz MJ. Impact of cardiovascular disease guideline dissemination on provider knowledge. Am J Med Sci 2012;343(1):56–60. https://doi.org/10.1097/MAJ.0b013e31822817e6 CrossRefPubMed

38.

Hunt JS, Siemienczuk J, Gillanders W, LeBlanc BH, Rozenfeld Y, Bonin K, et al. The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study. Inform Prim Care 2009;17(3):165–74.PubMed

39.

Ioannidis G, Papaioannou A, Thabane L, Gafni A, Hodsman A, Kvern B, et al. The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC). BMC Med Educ 2009;9:54. https://doi.org/10.1186/1472-6920-9-54 CrossRefPubMedPubMedCentral

40.

Kiessling A, Lewitt M, Henriksson P. Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease. Ann Fam Med 2011;9(3):211–8. https://doi.org/10.1370/afm.1248 CrossRefPubMedPubMedCentral

41.

Licskai C, Sands T, Ong M, Paolatto L, Nicoletti I. Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care. Int J Qual Health Care 2012;24(5):538–46. https://doi.org/10.1093/intqhc/mzs043 CrossRefPubMedPubMedCentral

42.

Liddy C, Hogg W, Singh J, Taljaard M, Russell G, Deri Armstrong C, et al. A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care. Implement Sci 2015;10:150. https://doi.org/10.1186/s13012-015-0341-y CrossRefPubMedPubMedCentral

43.

Mahlknecht A, Abuzahra ME, Piccoliori G, Enthaler N, Engl A, Sonnichsen A. Improving quality of care in general practices by self-audit, benchmarking and quality circles. Wien Klin Wochenschr 2016;128(19–20):706–18. https://doi.org/10.1007/s00508-016-1064-z CrossRefPubMedPubMedCentral

44.

Mallen CD, Nicholl BI, Lewis M, Bartlam B, Green D, Jowett S, et al. The effects of implementing a point-of-care electronic template to prompt routine anxiety and depression screening in patients consulting for osteoarthritis (the Primary Care Osteoarthritis Trial): A cluster randomised trial in primary care. PLoS Med 2017;14(4):e1002273. https://doi.org/10.1371/journal.pmed.1002273 CrossRefPubMedPubMedCentral

45.

Mold JW, Aspy CB, Smith PD, Zink T, Knox L, Lipman PD, et al. Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study. Implement Sci 2014;9:169. https://doi.org/10.1186/s13012-014-0169-x CrossRefPubMedPubMedCentral

46.

Peters-Klimm F, Campbell S, Muller-Tasch T, Schellberg D, Gelbrich G, Herzog W, et al. Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial. Trials 2009;10:68. https://doi.org/10.1186/1745-6215-10-68 CrossRefPubMedPubMedCentral

47.

Redaelli M, Vollmar HC, Simic D, Maly-Schurer C, Loscher S, Koneczny N. [Guideline implementation study on asthma: Results of a pragmatic implementation approach]. Z Evid Fortbild Qual Gesundhwes 2015;109(2):124–31. https://doi.org/10.1016/j.zefq.2015.04.015 CrossRefPubMed

48.

Romera I, Montejo AL, Aragones E, Arbesu JA, Iglesias-Garcia C, Lopez S, et al. Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial. BMC Psychiatry 2013;13:83. https://doi.org/10.1186/1471-244x-13-83 CrossRefPubMedPubMedCentral

49.

Secher N, Mikkelsen MM, Adelborg K, Mikkelsen R, Grove EL, Rubak JM, et al. Direct mail improves knowledge of basic life support guidelines in general practice: a randomised study. Scand J Trauma Resusc Emerg Med 2012;20:72. https://doi.org/10.1186/1757-7241-20-72 CrossRefPubMedPubMedCentral

50.

Shah BR, Bhattacharyya O, Yu CH, Mamdani MM, Parsons JA, Straus SE, et al. Effect of an educational toolkit on quality of care: a pragmatic cluster randomized trial. PLoS Med 2014;11(2):e1001588. https://doi.org/10.1371/journal.pmed.1001588 CrossRefPubMedPubMedCentral

51.

Sinnema H, Majo MC, Volker D, Hoogendoorn A, Terluin B, Wensing M, et al. Effectiveness of a tailored implementation programme to improve recognition, diagnosis and treatment of anxiety and depression in general practice: a cluster randomised controlled trial. Implement Sci 2015;10:33. https://doi.org/10.1186/s13012-015-0210-8 CrossRefPubMedPubMedCentral

52.

Sipila R, Helin-Salmivaara A, Korhonen MJ, Ketola E. Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study. BMC Fam Pract 2011;12:87. https://doi.org/10.1186/1471-2296-12-87 CrossRefPubMedPubMedCentral

53.

Skoglund I, Bjorkelund C, Petzold M, Gunnarsson R, Moller M. A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs. Scand J Prim Health Care 2013;31(2):67–72. https://doi.org/10.3109/02813432.2012.757071 CrossRefPubMedPubMedCentral

54.

Soler N, Ballester E, Martin A, Gobartt E, Miravitlles M, Torres A. Changes in management of chronic obstructive pulmonary disease (COPD) in primary care: EMMEPOC study. Respir Med 2010;104(1):67–75. https://doi.org/10.1016/j.rmed.2009.08.003 CrossRefPubMed

55.

Tahvonen P, Oikarinen H, Niinimaki J, Liukkonen E, Mattila S, Tervonen O. Justification and active guideline implementation for spine radiography referrals in primary care. Acta Radiol 2017;58(5):586–92. https://doi.org/10.1177/0284185116661879 CrossRefPubMed

56.

Valles-Fernandez R, Rodriguez-Blanco T, Mengual-Martinez L, Rosell-Murphy M, Prieto-De Lamo G, Martinez-Frutos F, et al. Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study. BMJ Open 2012;2(2):e000507. https://doi.org/10.1136/bmjopen-2011-000507 CrossRefPubMedPubMedCentral

57.

Verbiest ME, Presseau J, Chavannes NH, Scharloo M, Kaptein AA, Assendelft WJ, et al. Use of action planning to increase provision of smoking cessation care by general practitioners: role of plan specificity and enactment. Implement Sci 2014;9:180. https://doi.org/10.1186/s13012-014-0180-2 CrossRefPubMedPubMedCentral

58.

Vidal-Pardo JI, Perez-Castro TR, Lopez-Alvarez XL, Santiago-Perez MI, Garcia-Soidan FJ, Muniz J. Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project]. Int J Clin Pract 2013;67(8):750–8. https://doi.org/10.1111/ijcp.12145 CrossRefPubMed

59.

Wentworth AL, Fox CH, Kahn LS, Glaser K, Cadzow R. Two years after a quality improvement intervention for chronic kidney disease care in a primary care office. Am J Med Qual 2011;26(3):200–5. https://doi.org/10.1177/1062860610381916 CrossRefPubMed

60.

Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012;10:CD004398. https://doi.org/10.1002/14651858.CD004398.pub3 CrossRefPubMed

61.

Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009(2):Cd003030. https://doi.org/10.1002/14651858.CD003030.pub2

62.

Francke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 2008;8:38. https://doi.org/10.1186/1472-6947-8-38 CrossRefPubMedPubMedCentral

63.

Unverzagt S, Oemler M, Braun K, Klement A. Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review. Fam Pract 2014;31(3):247–66. https://doi.org/10.1093/fampra/cmt080 CrossRefPubMed

64.

Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):Cd000259. https://doi.org/10.1002/14651858.CD000259.pub3

65.

Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009(3):Cd001096. https://doi.org/10.1002/14651858.CD001096.pub2

66.

Arditi C, Rege-Walther M, Wyatt JC, Durieux P, Burnand B. Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2012;12:Cd001175. https://doi.org/10.1002/14651858.CD001175.pub3

67.

Squires JE, Sullivan K, Eccles MP, Worswick J, Grimshaw JM. Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews. Implement Sci 2014;9:152. https://doi.org/10.1186/s13012-014-0152-6 CrossRefPubMedPubMedCentral

68.

Solberg LI. Guideline implementation: what the literature doesn't tell us. Jt Comm J Qual Improv 2000;26(9):525–37.PubMed

69.

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci 2015;10:53. https://doi.org/10.1186/s13012-015-0242-0 CrossRefPubMedPubMedCentral

70.

Davies P, Walker AE, Grimshaw JM. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci 2010;5:14. https://doi.org/10.1186/1748-5908-5-14 CrossRefPubMedPubMedCentral

71.

Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev. 2015(4):Cd005470. https://doi.org/10.1002/14651858.CD005470.pub3

72.

Hoomans T, Evers SM, Ament AJ, Hubben MW, van der Weijden T, Grimshaw JM, et al. The methodological quality of economic evaluations of guideline implementation into clinical practice: a systematic review of empiric studies. Value Health 2007;10(4):305–16. https://doi.org/10.1111/j.1524-4733.2007.00175.x CrossRefPubMed

73.

Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting, and evaluation in health care. Prev Med 2010;51(5):421–4. https://doi.org/10.1016/j.ypmed.2010.08.005 CrossRefPubMed

74.

Flodgren G, Hall AM, Goulding L, Eccles MP, Grimshaw JM, Leng GC, et al. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. Cochrane Database Syst Rev. 2016(8):Cd010669. https://doi.org/10.1002/14651858.CD010669.pub2

75.

Krahn M, Naglie G. The next step in guideline development: incorporating patient preferences. JAMA 2008;300(4):436–8. https://doi.org/10.1001/jama.300.4.436 CrossRefPubMed

76.

Hajjaj FM, Salek MS, Basra MK, Finlay AY. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice. J R Soc Med 2010;103(5):178–87. https://doi.org/10.1258/jrsm.2010.100104 CrossRefPubMedPubMedCentral

Title: Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care
Authors: Eva Kovacs, Dr. med. PhD
Ralf Strobl, Dr. rer. biol. hum., Dipl.-Stat.
Amanda Phillips, MSc
Anna-Janina Stephan, MPH
Martin Müller, MPH, Prof. Dr.
Jochen Gensichen, Prof. Dr. med. habil., Dipl.-Päd., MPH
Eva Grill, Prof. Dr., MPH
Publication date: 01-07-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 7/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-018-4435-5

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