Flodgren Gerd, Parmelli Elena, Doumit Gaby, Gattellari Melina, O'Brien Mary Ann, Grimshaw Jeremy, Eccles Martin P
Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, UK, OX3 7LF.
Cochrane Database Syst Rev. 2011 Aug 10(8):CD000125. doi: 10.1002/14651858.CD000125.pub4.
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.
To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes.
We searched Cochrane EPOC Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, HMIC, Science Citation Index, Social Science Citation Index, ISI Conference Proceedings and World Cat Dissertations up to 5 May 2009. In addition, we searched reference lists of included articles.
Studies eligible for inclusion were randomised controlled trials investigating the effectiveness of using opinion leaders to disseminate evidence-based practice and reporting objective measures of professional performance and/or health outcomes.
Two review authors independently extracted data from each study and assessed its risk of bias. For each trial, we calculated the median risk difference (RD) for compliance with desired practice, adjusting for baseline where data were available. We reported the median adjusted RD for each of the main comparisons.
We included 18 studies involving more than 296 hospitals and 318 PCPs. Fifteen studies (18 comparisons) contributed to the calculations of the median adjusted RD for the main comparisons. The effects of interventions varied across the 63 outcomes from 15% decrease in compliance to 72% increase in compliance with desired practice. The median adjusted RD for the main comparisons were: i) Opinion leaders compared to no intervention, +0.09; ii) Opinion leaders alone compared to a single intervention, +0.14; iii) Opinion leaders with one or more additional intervention(s) compared to the one or more additional intervention(s), +0.10; iv) Opinion leaders as part of multiple interventions compared to no intervention, +0.10. Overall, across all 18 studies the median adjusted RD was +0.12 representing a 12% absolute increase in compliance in the intervention group.
AUTHORS' CONCLUSIONS: Opinion leaders alone or in combination with other interventions may successfully promote evidence-based practice, but effectiveness varies both within and between studies. These results are based on heterogeneous studies differing in terms of type of intervention, setting, and outcomes measured. In most of the studies the role of the opinion leader was not clearly described, and it is therefore not possible to say what the best way is to optimise the effectiveness of opinion leaders.
临床实践并非总是基于证据，因此可能无法使患者获得最佳治疗效果。意见领袖传播和实施“最佳证据”是一种有望弥合证据与实践差距的策略。
评估使用当地意见领袖对改善专业实践和患者治疗效果的有效性。
我们检索了Cochrane EPOC小组试验注册库、Cochrane对照试验中央注册库、MEDLINE、EMBASE、英国医学期刊数据库、科学引文索引、社会科学引文索引、ISI会议论文集和世界范围学位论文数据库，检索截止至2009年5月5日。此外，我们还检索了纳入文章的参考文献列表。
符合纳入标准的研究为随机对照试验，旨在调查使用意见领袖传播循证实践的有效性，并报告专业表现和/或健康结果的客观测量指标。
两位综述作者独立从每项研究中提取数据，并评估其偏倚风险。对于每项试验，我们计算了符合期望实践的中位数风险差异（RD），并在数据可用时对基线进行了调整。我们报告了每项主要比较的中位数调整后RD。
我们纳入了18项研究，涉及296家以上医院和318名初级保健医生。15项研究（18项比较）为主要比较的中位数调整后RD计算提供了数据。在63项结果中，干预措施的效果各不相同，从符合期望实践的降低15%到提高72%不等。主要比较的中位数调整后RD分别为：i）意见领袖与无干预相比，+0.09；ii）单独意见领袖与单一干预相比，+0.14；iii）意见领袖与一种或多种其他干预措施相比，+0.10；iv）意见领袖作为多种干预措施的一部分与无干预相比，+0.10。总体而言，在所有18项研究中，中位数调整后RD为+0.12，代表干预组符合率绝对提高了12%。
单独或与其他干预措施相结合的意见领袖可能成功促进循证实践，但研究内部和研究之间的有效性存在差异。这些结果基于在干预类型、环境和测量结果方面存在差异的异质性研究。在大多数研究中，意见领袖的作用没有得到明确描述，因此无法确定优化意见领袖有效性的最佳方法。
