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Multiple implementation strategies were applied to change clinical practice (Table 18).
Several trials have been performed studying the use of single and multiple implementation strategies [ 5, 8- 10].
National Institute for Health Research NIHRR) What is already known on the topic ● Multiple implementation strategies can improve guideline adherence ● Raising awareness through audit and education are especially effective methods of implementation of guidelines.
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Regarding engaging men as clients, the use of multiple communication and implementation strategies, including community outreach and the hosting of male targeted clinic days, was found to attract a greater number of male clients than prior to the project's implementation in the area.
As it may be impossible to apply the method of one study to another context completely, these approaches enable systematic reviewing of interventions which may have multiple components, multiple outcomes and different implementation strategies.
Most of the reviews indicate that effective implementation strategies often have multiple components and that the use of one single strategy, such as reminders only or one educational intervention, is less effective than a combination of strategies.
To implement these spatial interventions, robust implementation strategies are needed.
There is a strong call for multiple arm cluster randomized controlled trials to investigate the (cost-) effectiveness of various different implementation strategies [ 10, 13].
For the implementation of guidelines, multifaceted implementation strategies are probably more effective than single strategies, as multifaceted strategies address multiple barriers to guideline adherence [ 16].
Such studies should explore activities and implementation strategies that could easily be adopted in GP practices and should comprise multiple components of the CCM with a view to preventing complications and improving outcomes for patients with COPD.
But with thoughtful finance and implementation strategies, municipalities can find ways to package together a series of improvements and minimize the financial burden by working with multiple parties and private investors.
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