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Local opinion leaders: effects on professional practice and health care outcomes
Open accessAbstract
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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“This extension enables the i-PARIHS framework to consider the impact individuals and teams have in supporting or resisting an innovation.”
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“Systematic reviews of KT interventions to change HCPs’ practice consistently indicate that interventions are haphazardly designed and poorly specified, limiting our ability for replication, understanding, and generalizability [5, 6].”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [5]
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Metadata
- 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)
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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