Changing clinical practice: Which interventions work?

Abstract

Changing clinical practice is a complex challenge. A framework is presented for integrating the perspectives of continuing education, technology assessment, and quality assurance. The effectiveness of cwrent interventions is reviewed. We describe what is known about practice determinants, the most important of which are physician age, clinical training, knowledge, skill, personal characteristics, practice setting, arid reimbursement policies. The rehtive importance of these factors varies and seems to be condition-specif c, an important point to be considered in the selection of pi-actice interventions.Interventions aimed at having an impact on the practice setting (e.g., practice aids or audit programs), 01-on reimbursement policy (e.g., the fee allowed for a service) are more likely to bring about a change in practice than are interventions aimed at changing physician knowledge or skill. This is attributed to the greater relevance of these interventionsfor the individual physician, and to the opportunities provided for practicing them and for feedback. The cost and .feasibility of using the various types cf interventions to bring about practice change hmte to be carefully Haighed against the expected benefit f o r patients. Those seeking to select strategies that will optimize the effectiveness of interventions will need to consider the relative importance of physician abilities and attitudes, pi-actice harriers, and economic disincentives to practice change.

Canadian Psychiatrists' Current Attitudes, Practices, and Knowledge regarding Fitness to Drive in Individuals with Mental Illness: A Cross-Canada Survey

“…However, the recently completed Canadian study of family physicians' practices related to driving assessment of the elderly used a questionnaire that was rigorously developed and pilot tested (9). We created a slightly modified version and selected variables according to a framework that classified potential factors affecting clinical practices into predisposing, enabling, and reinforcing factors (11). When creating new questions, we followed Dillman's guidelines on writing questions (12).…”

Structured Interview and Uniform Assessment Improves Diagnostic Reliability

“…There is literature that suggests that merely providing information to physicians may result in only minimal effect on practice behavior Lomas 1991). Others have found that more effective methods for effecting change involves communication, peer pressure, and education (Adelson et al 1997;Tamblyn and Battista 1993). Changing physician practice behavior requires an active process of psychoeducation, ongoing prompts, active supervision and involvement in process, and auditing to assure adherence to procedures (Avorn and Soumerai 1983;Davis et al 1995).…”

'Ten golden rules' for designing software in medical education: results from a formative evaluation of DIALOG

“…The ultimate evaluation of any educational intervention or product in medicine is to demonstrate a change in clinical practice. There is evidence to suggest that in general CME works well in improving physician competence and generally less well in changing practice performance (Tamblyn & Battista, 1993;Wensing & Grol, 1994).…”