Local opinion leaders: effects on professional practice and health care outcomes

Abstract

Background-Clinical practice is not always evidence-based and, therefore, may not optimise patient outcomes. Opinion leaders disseminating and implementing 'best evidence' is one method that holds promise as a strategy to bridge evidence-practice gaps. Objectives-To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes.

Kunnskapsbasert vurdering av delirium hos intensivpasienten

“…Ressursbruk som skal støtte en implementeringsprosess blir ofte glemt eller nedprioritert, slik det også ble i dette prosjektet. De foreslåtte tiltakene som skulle imøtekomme forventede utfordringer, slik som akademisering (41) og aktivisering av «superbrukere» (42), uteble fordi driften ikke tillot det. Grol og Wensing (43) hevder at mennesker beveger seg i ulikt tempo fra en endringsfase til neste, og at tiltakene må tilpasses i forhold til dette.…”

Development of a Theory-Based Intervention to Increase Prescription of Inspiratory Muscle Training by Health Professionals in the Management of People with Chronic Obstructive Pulmonary Disease

“…[13][14][15]44 Furthermore, there is no consensus on which interventions are the most effective. A recent Cochrane review on educational meetings concluded that while didactic education can change practice (median adjusted risk difference ¼ 7%), meetings that are partially or largely interactive are more effective (median adjusted risk difference ¼ 14%).…”

“…48 A review of educational outreach visits, also referred to as ''university-based educational detailing,'' ''academic detailing,'' or ''educational visiting,'' concluded that these visits, either alone or combined with other interventions, produced changes in clinical practice (median adjusted risk difference in compliance desired practice was 6%). 14 Flodgren et al 15 concluded that interventions using opinion leaders reduced non-compliance with desired practice in health professionals (10% absolute decrease), although little is IMT ¼ inspiratory muscle training; COPD ¼ chronic obstructive pulmonary disease known about the factors associated with the success of this intervention. A recent review reported that interventions tailored to address prospectively identified barriers to change are more likely to improve professional practice than either no intervention or dissemination of guidelines or educational materials alone.…”

“…Implementation will be informed by experience and creativity, as suggested by Ajzen, 58 but also by the aforementioned reviews of continuing medical education 45 and guideline dissemination and implementation. [13][14][15] Given that multifaceted guideline-dissemination interventions perform no better than a single intervention in terms of outcomes, 13 the latter would be chosen in order to minimize costs. Specifically, an expert on IMT in COPD (a researcher who has published in peer-reviewed journals on this topic) will deliver an interactive workshop to a small group of health professionals (< 25) in two 45-minute sessions.…”

“…12 A number of interventions that aim to change practice behavioursfor example, the use of reminders, audit and feedback, and opinion leaders-have been evaluated in the management of different conditions; they produced a median improvement of between 7% and 14% in patient outcomes. [13][14][15] Furthermore, there is no clear pattern of findings favouring one particular method or one particular context in which the intervention is effective. 13 Research has suggested that this may be due to the lack of a theoretical basis for most interventions that are developed to improve practice behaviours.…”