Table 3.
Effectiveness of professional behaviour change strategies from selected EPOC systematic reviews
|
Intervention |
Number of studies/individuals |
Effect sizes |
|---|---|---|
| Review | ||
|
Printed Educational Materials |
12 randomised trials |
Median absolute improvement of care on categorical process outcomes (e.g., x-ray requests, prescribing and smoking cessation activities) of 4.3% (range −8.0% to +9.6%) across studies. |
| |
11 nonrandomised studies |
|
| Farmer et al.[37] |
|
|
|
Educational Meetings |
81 randomised trials (involving more than 11,000 health professionals) |
Median absolute improvement in care of 6.0% (interquartile range +1.8% to 15.3%). |
| Forsetlund et al.[38] |
|
|
| |
|
Larger effects were associated with higher attendance rates, mixed interactive and didactic meetings and interactive meetings. |
| |
|
Smaller effects were observed for complex behaviours and for less serious outcomes. |
|
Educational Outreach |
69 randomised trials (involving more than 15,000 health professionals) |
Median absolute improvements in: |
| |
|
·prescribing behaviours (17 comparisons) of 4.8% (interquartile range +3.0% to + 6.5%); |
| O’Brien et al.[39] |
|
|
| |
|
·other behaviours (17 comparisons) of 6.0% (interquartile range +3.6% to +16.0%). |
| |
|
The effects of educational outreach for changing more complex behaviours are less certain. |
|
Local Opinion Leaders |
18 randomised trials (involving more than 296 hospitals and 318 primary care physicians) |
Median absolute improvement of care of 12.0% across studies (interquartile range +6.0% to +14.5%). |
| Flodgren et al.[40] |
|
|
|
Audit and Feedback |
118 randomised trials |
Median absolute improvement of care of 5.0% (interquartile range +3% to +11%). |
| Jamtvedt et al.[41] |
|
|
| |
|
In general, larger effects were seen if baseline compliance was low. |
|
Computerized Reminders |
28 randomised trials |
Median absolute improvement of care of 4.2% (interquartile range +0.8% to +18.8%). |
| Shojania et al.[42] |
|
|
| |
|
Comment: Most studies have examined the effects of relatively simple reminders; the results of more complex decision support systems, especially for chronic disease management, have been less successful. |
|
Tailored Interventions |
26 randomised trials |
Meta-regression using 12 randomised trials. Pooled odds ratio of 1.52 (95% CI, 1.27 to 1.82, p < .001) |
| Baker et al.[43] |