32 Digital education for guidelines adoption and adherence: preliminary findings from a systematic review

Abstract

Objectives To present preliminary findings from our systematic review of the literature on digital education for guidelines adoption and adherence. Method Digital education holds promise for enhancing health professionals’ education worldwide. and is increasingly employed as part of continuing medical education. Clinical practice guidelines are evidence-based recommendations intended to optimise patient care. They are an important source of information for clinicians, designed to help them assimilate, evaluate and implement the evidence in making decisions about appropriate and effective care for their patients. As part of a global initiative evaluating effectiveness of digital education for healthcare professionals’ education, we performed a systematic review focusing on the use of digital education for clinical practice guidelines adoption and adherence. We considered eligible studies focusing on all healthcare professionals, using any digital education modality and employing different comparisons regardless of the setting or language. We employed a sensitive search strategy focusing and the standard Cochrane methods and searched seven electronic databases from January 1990 to August 2017. Results We found 18 studies involving 4474 participants. Thirteen studies were randomised controlled trials (RCTs) and five were cluster RCTs (cRCTs). The interventions were diverse and included online modules, videos, emails, text messaging and virtual patients. Knowledge was the most widely reported outcome among all the studies. Overall, the reported findings for the studies were mixed. Satisfaction outcomes show that digital interventions are favoured over traditional learning interventions. Evidence was mostly judged as low quality due to high or unclear risk of bias, inconsistency, and indirectness and imprecision, and publication bias. The included studies were largely from high-income countries and many were poorly reported in terms of the intervention content, the employed learning theory, and the control group. There was often a lack of baseline evaluation, outcome measure validity information, patient-focused, behavioural or economic outcomes etc. None of the included studies reported unintended or adverse effects of the interventions. Conclusions The evidence on the effectiveness of digital learning for guideline implementation in healthcare professionals is mixed. Further research on cost and patient-related, as well as adverse effects of digital interventions are needed.