Abstract
BackgroundThere are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses.MethodsThe objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228) formed the sample for this study. Using a standardised data extraction form, one reviewer (SH), extracted the relevant information from the methods and/or results sections of the trials.ResultsMeasures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively). Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%.ConclusionMost trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change in practice, resulted in a change in the ultimate end-point of patient health status.
Highlights
There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice
Knowledge of the outcome measures employed by studies investigating the effectiveness of strategies to change practice is vital, for the interpretation and application of the work done to date, and to inform future research in this expanding area of endeavour
Of the 235 studies included in the systematic review by Grimshaw et al, 228 were included in this review [2]
Summary
There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. Each year a vast number of studies are published and aim to assess the impact of various strategies for effectively disseminating and implementing clinical practice guidelines. In the most comprehensive review to date, Grimshaw et al systematically reviewed 235 studies evaluating the effectiveness and cost of various guideline development, dissemination, and implementation strategies [2]. The majority of the studies included in this review used measures of process rather than actual patient outcomes, even though only three of the guidelines were overtly evidence-based. The authors concluded that there is insufficient evidence to determine which guideline dissemination and implementation strategies are likely to be effective under different circumstances, and highlighted the need for further research
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