Freemantle N, Harvey E L, Wolf F, Grimshaw J M, Grilli R, Bero L A
Centre for Health Economics, University of York, Heslington, York, Yorkshire, UK, Y01 5DD.
Cochrane Database Syst Rev. 2000;1997(2):CD000172. doi: 10.1002/14651858.CD000172.
It is often assumed that merely providing information in an accessible form will influence practice. Although such a strategy is still widely used in an attempt to change behaviour, there is a growing awareness that simply providing information may not lead to appropriate changes in the practice of health care professionals.
To assess the effects of printed educational materials in improving the behaviour of health care professionals and patient outcomes.
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, reference lists of articles, and contacted content area experts.
Randomised trials, interrupted time series analyses and non equivalent group designs with pre-post measures of interventions comparing 1. Printed educational materials versus a non-intervention control; and 2. Printed educational materials plus additional implementation strategies versus printed educational materials alone. The participants were any health care professionals provided with printed educational materials aimed at improving their practice and/or patient outcomes.
Two reviewers independently extracted data and assessed study quality.
Eleven studies were included involving more than 1848 physicians. It proved impractical to examine the impact of interventions quantitatively because of poor reporting of results and inappropriate primary analyses. Nine studies examined comparison 1. Estimates of the benefit from printed educational materials ranged from -3% to 243.4% for provider outcomes, and from -16.1% to 175.6% for patient outcomes, although the practical importance of these changes is, at best, small. Six studies (seven comparisons) examined comparison 2. Benefits attributable to additional interventions ranged from -11.8% to 92.7% for professional behaviour, and -24.4% to 74.5% for patient outcomes. Two of the 14 estimates of professional behaviour, and two of the 11 estimates of patient outcomes were statistically significant.
REVIEWER'S CONCLUSIONS: The effects of printed educational materials compared with no active intervention appear small and of uncertain clinical significance. These conclusions should be viewed as tentative due to the poor reporting of results and inappropriate primary analyses. The additional impact of more active interventions produced mixed results. Audit and feedback and conferences/workshops did not appear to produce substantial changes in practice; the effects in the evaluations of educational outreach visits and opinion leaders were larger and likely to be of practical importance. None of the studies included full economic analyses, and thus it is unclear to what extent the effects of any of the interventions may be worth the costs involved.
人们常常认为，仅仅以易于获取的形式提供信息就会影响医疗行为。尽管这种策略仍被广泛用于试图改变行为，但人们越来越意识到，仅仅提供信息可能不会导致医疗保健专业人员的行为发生适当改变。
评估印刷教育材料在改善医疗保健专业人员行为和患者结局方面的效果。
我们检索了Cochrane有效实践与医疗组织小组的专门登记册、文章的参考文献列表，并联系了各领域的专家。
随机试验、中断时间序列分析以及采用干预前后测量的非等效组设计，比较1. 印刷教育材料与无干预对照组；2. 印刷教育材料加额外实施策略与单纯印刷教育材料。参与者为任何获得旨在改善其实践和/或患者结局的印刷教育材料的医疗保健专业人员。
两名评价员独立提取数据并评估研究质量。
纳入了11项研究，涉及1848名以上医生。由于结果报告不佳和主要分析不当，定量研究干预措施的影响不切实际。9项研究进行了比较1。印刷教育材料对医疗服务提供者结局的益处估计范围为-3%至243.4%，对患者结局的益处估计范围为-16.1%至175.6%，尽管这些变化的实际重要性至多很小。6项研究（7次比较）进行了比较2。额外干预措施对专业行为的益处范围为-11.8%至92.7%，对患者结局的益处范围为-24.4%至74.5%。14项专业行为估计中有2项，11项患者结局估计中有2项具有统计学意义。
与无积极干预相比，印刷教育材料的效果似乎很小且临床意义不确定。由于结果报告不佳和主要分析不当，这些结论应视为初步结论。更积极干预措施的额外影响产生了混合结果。审核与反馈以及会议/研讨会似乎并未在实践中产生实质性变化；教育外展访问和意见领袖评估中的效果更大且可能具有实际重要性。没有一项研究包括完整的经济分析，因此不清楚任何干预措施的效果在多大程度上可能值得所涉及的成本。
