Cited by 1,070Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

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

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Flodgren, Gerd, Parmelli, Elena, Doumit, Gaby, Gattellari, Melina, O'Brien, Mary Ann, Grimshaw, Jeremy, Eccles, Martin P·2011·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd000125.pub4PMC PMC4172331

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Abstract

BACKGROUND: 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. OBJECTIVES: To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes. SEARCH STRATEGY: 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. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: 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. MAIN RESULTS: 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.

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Hoffmann-Eßer, W., Siering, U., Neugebauer, E. A. M., Brockhaus, A. C., Lampert, U., & Eikermann, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0174831 · Cited by 171
The Science of Using Science: Researching the Use of Research Evidence in Decision-Making
Langer, L., Tripney, J., & Gough, D. (2016) · UCL Discovery (University College London) · Cited by 164
How evidence based are recruitment strategies to randomized controlled trials in primary care? Experience from seven studies
Foy, R. (2003) · Family Practice · doi:10.1093/fampra/20.1.83 · Cited by 160
Tools developed and disseminated by guideline producers to promote the uptake of their guidelines
Flodgren, G., Hall, A. M., Goulding, L., Eccles, M., Grimshaw, J., Leng, G. C., & Shepperd, S. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010669.pub2 · Cited by 159
Self-citation
Optimal Methods for Guideline Implementation
Gross, P. A., Greenfield, S., Cretin, S., Ferguson, J., Grimshaw, J., Grol, R. P. T. M., Klazinga, N., Lorenz, W., Meyer, G. S., Riccobono, C. A., et al. (2001) · Medical Care · doi:10.1097/00005650-200108002-00006 · Cited by 168
Self-citation
Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians
Murthy, L., Shepperd, S., Clarke, M. J., Garner, S. E., Lavis, J. N., Perrier, L., Roberts, N. W., & Straus, S. E. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009401.pub2 · Cited by 155
Getting evidence into practice: what works in developing countries?
Siddiqi, K., Newell, J. N., & Robinson, M. (2005) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzi051 · Cited by 154
Why are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 155
What are the most effective strategies for improving quality and safety of health care?
Scott, I. (2009) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2008.01798.x · Cited by 153
Models, Strategies, and Tools.
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The Evidence for Evidence-Based Practice Implementation
Titler, M. G. (2008) · Cited by 148
Interventions to improve professional adherence to guidelines for prevention of device-related infections
Flodgren, G., Conterno, L. D. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006559.pub2 · Cited by 141
Self-citation
High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing
Paton, C., Barnes, T. R. E., Cavanagh, M.-R., Taylor, D. M., & Lelliott, P. T. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.042895 · Cited by 138
Study protocol for the translating research in elder care (TREC): building context – an organizational monitoring program in long-term care project (project one)
Estabrooks, C. A., Squires, J. E., Cummings, G. G., Teare, G. F., & Norton, P. (2009) · Implementation Science · doi:10.1186/1748-5908-4-52 · Cited by 136
Best Care at Lower Cost
Institute of Medicine (2013) · National Academies Press eBooks · doi:10.17226/13444 · Cited by 170
“Some successful strategies have involved using in-person educational methods, providing feedback on the process, employing opinion leaders or developing champions, or outlining an overall vision (Davis and TaylorVaisey, 1997; Flodgren et al., 2011; McCannon et al., 2006; O’Connor et al., 1996; Schectman et al., 2003;…”
Background
Physician screening for multiple behavioral health risk factors
Coups, E. J., Gaba, A., & Orleans, C. T. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.04.021 · Cited by 136
Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007
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Patient engagement in hospital health service planning and improvement: a scoping review
Liang, L., Cako, A., Urquhart, R., Straus, S. E., Wodchis, W. P., Baker, G. R., & Gagliardi, A. R. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-018263 · Cited by 145
Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap
Adler, A. J., Prabhakaran, D., Bovet, P., Kazi, D. S., Mancia, G., Mungal-Singh, V., & Poulter, N. R. (2015) · Global Heart · doi:10.1016/j.gheart.2015.04.006 · Cited by 133
The Role of Nursing Best Practice Champions in Diffusing Practice Guidelines: A Mixed Methods Study
Ploeg, J., Skelly, J., Rowan, M. S., Edwards, N. C., Davies, B., Grinspun, D. R., Bajnok, I., & Downey, A. M. (2010) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2010.00202.x · Cited by 132
“The literature suggests that when implementing change, leadership needs to involve change agents such as local champions or clinical opinion leaders to influence the practice of their peers (Doumit et al. 2007).”
The SPIRIT Action Framework: A structured approach to selecting and testing strategies to increase the use of research in policy
Redman, S., Turner, T., Davies, H. T. O., Williamson, A. B., Haynes, A. S., Brennan, S., Milat, A., O’Connor, D. A., Blyth, F., Jorm, L. R., et al. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.05.009 · Cited by 124
Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap
Atkins, M. S., Rusch, D. B., Mehta, T. G., & Lakind, D. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1050724 · Cited by 128
“To reach teachers, we turned to the key opinion leader literature that was prominent in HIV prevention, medicine, and industry but as yet had not been utilized successfully in education (for a review, see Flodgren et al., 2011).”
Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis
Fontaine, G., Vinette, B., Weight, C., Maheu‐Cadotte, M., Lavallée, A., Deschênes, M., Lapierre, A., Castiglione, S. A., Chicoine, G., Rouleau, G., et al. (2024) · Implementation Science · doi:10.1186/s13012-024-01398-0 · Cited by 142
Clinical nurse educators as agents for change: increasing research utilization
Milner, F. M., Estabrooks, C. A., & Humphrey, C. (2005) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2004.11.006 · Cited by 115
Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial
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Pediatricians' Role in Providing Mental Health Care for Children and Adolescents: Do Pediatricians and Child and Adolescent Psychiatrists Agree?
Heneghan, A. M., Garner, A. S., Storfer‐Isser, A., Kortepeter, K., Stein, R. E. K., & Horwitz, S. M. (2008) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e31817dbd97 · Cited by 116
The role of triage liaison physicians on mitigating overcrowding in emergency departments: a systematic review.
Rowe, B., Guo, X., Villa‐Roel, C., Schull, M., Holroyd, B., Bullard, M., Vandermeer, B., Ospina, M., & Innes, G. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2010.00984.x · Cited by 125
Implementation interventions to improve the management of non-specific low back pain: a systematic review
Mesner, S., Foster, N. E., & French, S. D. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-1110-z · Cited by 114
“The choice to use this tool was based on the following: it was developed specifically for use with implementation research studies attempting to change the practice of healthcare practitioners and organisation of healthcare systems; it is suitable for use with different study designs (RCT; nonrandomised controlled tri…”
Method
Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline
Bussières, A., Cancelliere, C., Ammendolia, C., Comer, C. M., Zoubi, F. A., Châtillon, C.-É., Chernish, G., Cox, J. M., Gliedt, J. A., Haskett, D., et al. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.03.147 · Cited by 119
Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders' perspectives
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What is quality in maternal and neonatal health care?
Raven, J., Tolhurst, R., Tang, S., & van den Broek, N. R. (2011) · Midwifery · doi:10.1016/j.midw.2011.09.003 · Cited by 114
“Using opinion leaders to promote change also appears to be more effective (Doumit et al., 2007).”
Background
Empowering Nurses With Evidence‐Based Practice Environments: Surveying Magnet®, Pathway to Excellence®, and Non‐Magnet Facilities in One Healthcare System
Wilson, M., Sleutel, M. R., Newcomb, P., Behan, D. B., Walsh, J., Wells, J. N. B., & Baldwin, K. M. (2015) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12077 · Cited by 111
Training Research: Practical Recommendations for Maximum Impact
Beidas, R. S., Koerner, K., Weingardt, K. R., & Kendall, P. C. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-011-0338-z · Cited by 115
“Studies on the effects of local opinion leaders (Atkins et al. 2008; Doumit et al. 2007) and ambassador programs (Rashiq et al. 2006) suggest that social processes are important in the natural diffusion processes of EBP following training.”
Background
Evidence-Based Practice Implementation in Community Mental Health Settings: The Relative Importance of Key Domains of Implementation Activity
Torrey, W. C., Bond, G. R., McHugo, G. J., & Swain, K. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-011-0357-9 · Cited by 108
“Research in leadership has included the influence of opinion leaders (Thomson O’Brien et al. 2000) and leadership styles in implementation (Aarons 2006; Corrigan et al. 2000).”
Background
Patient-mediated interventions to improve professional practice
Fønhus, M. S., Dalsbø, T. K., Johansen, M., Fretheim, A., Skirbekk, H., & Flottorp, S. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012472.pub2 · Cited by 107
Evaluating two implementation strategies for whiplash guidelines in physiotherapy: A cluster-randomised trial
Rebbeck, T., Maher, C. G., & Refshauge, K. M. (2006) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(06)70025-3 · Cited by 102

Authors: Flodgren, G., Parmelli, E., Doumit, G., Gattellari, M., O'Brien, M. A., Grimshaw, J., & Eccles, M. P.
Affiliations: University of Oxford (GB)
University of Modena and Reggio Emilia (IT)
Cleveland Clinic (US)
UNSW Sydney (AU)
McMaster University; School of Rehabilitation Science, Institute for Applied Health Sciences, Faculty of Health Sciences; 1400 Main Street West Room 403 Hamilton Ontario Canada L8S 1C7
Ottawa Health Research Institute; Clinical Epidemiology Program; 1053 Carling Avenue Ottawa ON Canada K1Y 4E9
Newcastle University (GB)
ORCID: Flodgren, Gerd
Parmelli, Elena
Doumit, Gaby
Gattellari, Melina
Grimshaw, Jeremy
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2011-08-10
Volume: 6
Issue: 8
Pages: CD000125-CD000125
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd000125.pub4
PMC: PMC4172331
OpenAlex: W1656816330
Cited by: 1,070
References: 117
Citations by year: 2026: 4 · 2025: 25 · 2024: 33 · 2023: 57 · 2022: 52 · 2021: 62 · 2020: 59 · 2019: 52 · 2018: 51 · 2017: 57 · 2016: 53 · 2015: 64 · 2014: 71 · 2013: 69 · 2012: 55
FWCI: 13.05
Type: journal article
Language: en
Update notices: new_version (2019-06-24)
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Newcastle University ePrints (Newcastle Univesity)
Funders: National Institute for Health and Care Research (10/4001/03)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: opinion leaders, evidence-based practice, knowledge-practice gap, professional practice change, health care outcomes, clinical teaching, primary care, hospital care, patient outcomes, evidence dissemination, health professions education, patient safety, quality of care, health professional confidence
MeSH terms: Humans, Leadership, Practice Patterns, Physicians', Policy Making, Professional Practice, Randomized Controlled Trials as Topic, Process Assessment, Health Care, Evidence-Based Medicine, Information Dissemination

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

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