Steve Van den Bulck

and 5 more

Rationale, aims and objectives: Little is known about the effect of electronic audit and feedback (A&F) in primary care and its features affecting intervention effectiveness. The aim of this systematic review is: 1) to assess electronic A&F’s effectiveness in primary care and 2) to investigate facilitating factors of electronic A&F in primary care, as proposed in previous research. These factors are the use of benchmarks, frequency, cognitive load and evidence-based aspect of the feedback. Methods: The authors searched MEDLINE, Embase, CINAHL and CENTRAL from 2010 onwards by replicating the search strategy provided in the last Cochrane review on A&F. Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias of the included studies using a tool provided by Cochrane. Results: Our search resulted in 8,744 records, including the 140 RCTs from the last Cochrane Review, of which 431 full-text articles were assessed for their eligibility. Twenty-nine articles were included, of which 22 studies (76%) showed an effect of the electronic A&F intervention. Of these, only 3 studies (10.5%), targeting the quality of diabetes care and the prescription of antibiotics by dentist & physicians, met all the investigated feedback features and were effective. There was a high heterogeneity in the results and the design of the A&F interventions, causing a meta-analysis to be unreliable. Conclusion: This systematic review included 29 articles describing an electronic A&F intervention in primary care, of which 22 studies (76%) showed an effect of the intervention. It was not feasible to compare the different electronic A&F interventions and their facilitating factors because they were designed and implemented very diversely. Developing a framework or methodology for automated A&F interventions in primary care could be useful for investigating future interventions although further research is necessary.