Thomson O'Brien M A, Oxman A D, Haynes R B, Davis D A, Freemantle N, Harvey E L
McMaster Evidence-based Practice Centre, McMaster University, Department of Clinical Epidemiology and Biostatistics, HSC 3H7, Hamilton, Ontario, CANADA, L8N 3Z5.
Cochrane Database Syst Rev. 2000(2):CD000125. doi: 10.1002/14651858.CD000125.
Both the theory of diffusion of innovations and the social influences model of behaviour change suggest that using local opinion leaders to transmit norms and model appropriate behaviour may improve health professional practice.
To assess the effects using local opinion leaders on the practice of health professionals or patient outcomes.
We searched MEDLINE to May 1998, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles.
Randomised trials of the use of local opinion leaders (defined as health professionals nominated by their colleagues as being educationally influential). The participants were health care professionals responsible for patient care.
Two reviewers independently extracted data and assessed study quality.
Eight studies were included involving more than 296 health professionals. A variety of patient problems were targeted, including acute myocardial infarction, cancer pain, osteoarthritis, rheumatoid arthritis, chronic lung disease, vaginal birth after caesarean section, labour and delivery, and urinary catheter care. Six of seven trials that measured health professional practice demonstrated some improvement for at least one outcome variable, and in two trials, the results were statistically significant and clinically important. In three trials that measured patient outcomes, only one achieved an impact upon practice that was of practical importance: local opinion leaders were effective in improving the rate of vaginal birth after previous caesarean section.
REVIEWER'S CONCLUSIONS: Using local opinion leaders results in mixed effects on professional practice. However, it is not always clear what local opinion leaders do and replicable descriptions are needed. Further research is required to determine if opinion leaders can be identified and in which circumstances they are likely to influence the practice of their peers.
创新扩散理论和行为改变的社会影响模型均表明，利用当地意见领袖传播规范并示范恰当行为，可能会改善卫生专业人员的实践。
评估利用当地意见领袖对卫生专业人员的实践或患者结局的影响。
我们检索了截至1998年5月的MEDLINE、继续医学教育研究与发展资源库，以及相关系统评价和文章的参考文献列表。
关于使用当地意见领袖（定义为由同事提名具有教育影响力的卫生专业人员）的随机试验。参与者为负责患者护理的卫生保健专业人员。
两名综述作者独立提取数据并评估研究质量。
纳入了八项研究，涉及296名以上卫生专业人员。针对了多种患者问题，包括急性心肌梗死、癌痛、骨关节炎、类风湿关节炎、慢性肺病、剖宫产术后阴道分娩、分娩及导尿管护理。在七项衡量卫生专业人员实践的试验中，六项至少在一个结局变量上显示出一定改善，两项试验的结果具有统计学显著性且具有临床意义。在三项衡量患者结局的试验中，只有一项对实践产生了具有实际重要性的影响：当地意见领袖在提高既往剖宫产术后阴道分娩率方面有效。
利用当地意见领袖对专业实践产生的效果不一。然而，当地意见领袖的具体作用并不总是明确，需要可重复的描述。需要进一步研究以确定是否能够识别意见领袖以及他们可能在哪些情况下影响同行的实践。
