Effective Practice & Organisation of Care (EPOC): Cochrane Reviews

This post courtesy of Anne Taylor-Vaisey:

Following is a list of current systematic reviews from the EPOC Cochrane review group. Included are the ‘plain language summaries‘ and links to the full abstracts. Full text of the Cochrane reviews is available by subscription only. (The Cochrane Database of Systematic Reviews 2005 Issue 4. Copyright © 2005 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Not included in this list are organizational interventions, structural interventions, or reviews to improve specific types of practice. All are available here.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

Educational meetings are one of the most common types of continuing education for health professionals, and an important aim of continuing education is to influence professional practice. This review looked at whether educational meetings and workshops aimed at qualified health professionals were effective in improving professional practice or health care outcomes. The following types of planned educational activities were included: meetings, conferences, lectures, workshops, seminars, symposia and courses that occurred off-site from the practice setting. The review found that interactive workshops could result in moderately large changes in professional practice. Lectures or presentations alone were unlikely to change professional practice.


Educational outreach visits: effects on professional practice and health care outcomes

An outreach visit is a personal visit to a health care provider in his or her own setting. It is also called 'detailing', and is a strategy commonly used by pharmaceutical companies. The review found that educational outreach visits combined with social marketing strategies appears to change professional practice, especially prescribing. The effects are small to moderate, although potentially important.


Local opinion leaders: effects on professional practice and health care outcomes

Local opinion leaders can also theoretically influence the behaviour of their colleagues. However, exactly how they might influence them remains unclear. The review concluded that while most trials found some benefit from using local opinion leaders to improve practice, only a few found any important impact on patients' outcomes. If it is possible to identify local opinion leaders, they may be important agents for change for some problems, but not others.


Audit and feedback: effects on professional practice and health care outcomes

Providing healthcare professionals with data about their performance (audit and feedback) may help improve their practice.

Audit and feedback can improve professional practice, but the effects are variable. When it is effective, the effects are generally small to moderate. The results of this review do not provide support for mandatory or unevaluated use of audit and feedback.


Mass media interventions: effects on health services utilisation

Mass media information on health-related issues may induce changes in health services utilisation, both through planned campaigns and unplanned coverage. Further research could target how best to compose media messages, and whether they have a different impact on members of the public and health professionals. More information is needed on whether mass media coverage brings about appropriate use of services in those patients who will benefit most.


Interprofessional education: effects on professional practice and health care outcomes

Interprofessional education (IPE) is defined as any type of educational, training or teaching initiative involving more than one profession in joint, interactive learning. This review looked at the effectiveness of IPE compared to educational interventions in which doctors, nurses etc were learning separately from one another. Although a large body of literature was identified on the evaluation of IPE, none of the studies met the inclusion criteria for the review. More rigorous studies, such as randomised trials, are needed in order to provide reliable evidence of the impact of IPE on professional practice and health care outcomes.


Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

Some strategies to change the practice or behaviour of health care professionals are successful in improving health care while others are not. One explanation may be that there are different barriers to change in different settings and at different times. Change may be more likely if the strategies are specifically chosen to address the identified barriers. Barriers could be related to the individual (e.g. uncertainty about the risks of a procedure); related to social issues (e.g. peer pressure to perform a certain way); or related to the organisation (e.g. no access to equipment). And to successfully change behaviour, barriers should be identified and a strategy developed to overcome those barriers. In other words, it is thought that strategies tailored to overcome barriers should be more effective to change behaviour than non-tailored strategies or no strategy at all.

Fifteen studies evaluated tailored strategies for behaviour change in health care professionals. The results were mixed. It is therefore, unclear whether tailored strategies are more effective than non-tailored strategies or no strategy. Due to a small number of studies, it is also not possible to determine whether strategies tailored to overcome organisational barriers are more effective than those that were not. It is also not clear whether all barriers or important barriers were identified and addressed by the strategies. More research about how to identify and overcome barriers is needed.


Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians

This review examined the impact of different payment systems on primary care physician behaviour. Three payment systems were included: capitation (payment is made for every patient for whom care is provided), salary, and fee for service (payment is made for every item of care provided). There was some evidence that primary care physicians provide a greater quantity of primary care services under fee for service payment compared with capitation and salary, although long-term effects are unclear. There was no evidence, however, concerning other important outcomes such as patient health status, or comparing the relative impact of salary versus capitation payment.


Target payments in primary care: effects on professional practice and health care outcomes

This review looked at the effects of target payments on the behaviour of primary care physicians (e.g. general practitioners and family physicians). Under a target payments system a lump sum is paid to physicians who provide a certain quantity or level of care. Two studies assessed the impact of target payments on immunisation rates. There was some evidence that target payments resulted in an increase in immunisations by primary care physicians. However there was insufficient evidence to provide a clear answer as to whether target payments were an effective method of improving quality of care.


Telemedicine versus face to face patient care: effects on professional practice and health care outcomes

Telemedicine is using telecommunications technology for medical diagnosis and health care. It includes transmitting test results down phone lines, using video technology for long distance consultations or education, and many other uses. The review found studies showing various forms of telemedicine are feasible, but there is not yet enough evidence to show the effects on health outcomes or costs of many expensive uses of technology. Overall, people self-monitoring at home or having video consultations were satisfied with their experience. More research is needed to assess the effects of the range of telemedicine techniques.


Guidelines in professions allied to medicine

The issuing of clinical guidelines to nurses, midwives, dieticians and other health-care professionals allied to medicine may reduce variations in practice and improve patient care. This review found that, despite limited research, there is some evidence that guidelines can improve care and that professional roles can be substituted effectively, for instance a nurse can perform the function of a physician in certain circumstances. Such interventions offer the possibility of reduced costs but further research is needed in all areas of this topic.


Organisational infrastructures to promote evidence based nursing practice

Organisational infrastructures may be important in the development of evidence based nursing practice. We did not find any evaluated infrastructure developments that were of sufficient quality to be included in the systematic review. There are no clear implications for organisational practice as there is no good evidence about the impact of organisational infrastructures on the development of evidence based nursing practice.


Teaching critical appraisal skills in health care settings

Critical appraisal involves interpreting information in a systematic and objective manner. This review looked at whether teaching critical appraisal skills to health professionals led to changes in the process of care, patient outcomes or health professionals' knowledge/awareness. The review found that teaching critical appraisal skills to health professionals improved their knowledge of these skills. However there was a lack of good quality evidence as to whether teaching critical appraisal skills led to changes in the process of care or to changes in patient outcomes.


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