Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Clinical Science Building, Singapore, 308232, Singapore.
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
BMC Med. 2019 Jul 18;17(1):139. doi: 10.1186/s12916-019-1370-1.
Clinical practice guidelines are an important source of information, designed to help clinicians integrate research evidence into their clinical practice. Digital education is increasingly used for clinical practice guideline dissemination and adoption. Our aim was to evaluate the effectiveness of digital education in improving the adoption of clinical practice guidelines.
We performed a systematic review and searched seven electronic databases from January 1990 to September 2018. Two reviewers independently screened studies, extracted data and assessed risk of bias. We included studies in any language evaluating the effectiveness of digital education on clinical practice guidelines compared to other forms of education or no intervention in healthcare professionals. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to assess the quality of the body of evidence.
Seventeen trials involving 2382 participants were included. The included studies were diverse with a largely unclear or high risk of bias. They mostly focused on physicians, evaluated computer-based interventions with limited interactivity and measured participants' knowledge and behaviour. With regard to knowledge, studies comparing the effect of digital education with no intervention showed a moderate, statistically significant difference in favour of digital education intervention (SMD = 0.85, 95% CI 0.16, 1.54; I = 83%, n = 3, moderate quality of evidence). Studies comparing the effect of digital education with traditional learning on knowledge showed a small, statistically non-significant difference in favour of digital education (SMD = 0.23, 95% CI - 0.12, 0.59; I = 34%, n = 3, moderate quality of evidence). Three studies measured participants' skills and reported mixed results. Of four studies measuring satisfaction, three studies favoured digital education over traditional learning. Of nine studies evaluating healthcare professionals' behaviour change, only one study comparing email-delivered, spaced education intervention to no intervention reported improvement in the intervention group. Of three studies reporting patient outcomes, only one study comparing email-delivered, spaced education games to non-interactive online resources reported modest improvement in the intervention group. The quality of evidence for outcomes other than knowledge was mostly judged as low due to risk of bias, imprecision and/or inconsistency.
Health professions digital education on clinical practice guidelines is at least as effective as traditional learning and more effective than no intervention in terms of knowledge. Most studies report little or no difference in healthcare professionals' behaviours and patient outcomes. The only intervention shown to improve healthcare professionals' behaviour and modestly patient outcomes was email-delivered, spaced education. Future research should evaluate interactive, simulation-based and spaced forms of digital education and report on outcomes such as skills, behaviour, patient outcomes and cost.
临床实践指南是一种重要的信息来源，旨在帮助临床医生将研究证据融入临床实践中。数字教育越来越多地用于临床实践指南的传播和采用。我们的目的是评估数字教育在提高临床实践指南采用方面的有效性。
我们进行了系统评价，从 1990 年 1 月至 2018 年 9 月，检索了七个电子数据库。两名审查员独立筛选研究、提取数据并评估偏倚风险。我们纳入了评估数字教育与其他形式的教育或无干预措施对医疗保健专业人员的临床实践指南影响的研究，无论语言如何。我们使用推荐、评估、发展和评估（GRADE）方法来评估证据体的质量。
纳入了 17 项涉及 2382 名参与者的试验。纳入的研究差异很大，偏倚风险大多不明确或很高。它们主要集中在医生身上，评估了具有有限交互性的基于计算机的干预措施，并测量了参与者的知识和行为。关于知识，与无干预措施相比，比较数字教育效果的研究显示，数字教育干预具有统计学意义上的显著优势（SMD=0.85，95%CI 0.16，1.54；I=83%，n=3，中等质量证据）。比较数字教育与传统学习对知识影响的研究显示，数字教育的优势较小，无统计学意义（SMD=0.23，95%CI-0.12，0.59；I=34%，n=3，中等质量证据）。三项研究测量了参与者的技能，并报告了混合结果。四项研究测量了满意度，三项研究表明数字教育优于传统学习。九项研究评估了医疗保健专业人员的行为改变，只有一项研究比较了电子邮件传递的、有间隔的教育干预与无干预措施，报告了干预组的改善。三项研究报告了患者结局，只有一项研究比较了电子邮件传递的、有间隔的教育游戏与非互动在线资源，报告了干预组的适度改善。除知识以外的结局的证据质量由于偏倚、不精确和/或不一致而大多被判定为低质量。
临床实践指南的卫生专业人员数字教育至少与传统学习一样有效，并且在知识方面比无干预更有效。大多数研究报告医疗保健专业人员的行为和患者结局几乎没有差异。唯一显示改善医疗保健专业人员行为和适度改善患者结局的干预措施是电子邮件传递的、有间隔的教育。未来的研究应评估互动式、基于模拟和有间隔的数字教育，并报告技能、行为、患者结局和成本等结果。
