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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Bell, S., Kitchen, T., John, M., Scarr, C., Kelly, K., Bailey, C., James, K., Watkins, A., Macgillivray, E., Edey, T., et al. (2020) · BMJ Open Quality · doi:10.1136/bmjoq-2019-000854 · Cited by 40
Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol
Scott, S. D., Grimshaw, J., Klassen, T. P., Nettel‐Aguirre, A., & Johnson, D. W. (2011) · Implementation Science · doi:10.1186/1748-5908-6-133 · Cited by 40
Self-citation
Development and pilot evaluation of a complex intervention to improve experienced continuity of care in patients with cancer
King, M., Jones, L., McCarthy, O., Rogers, M. M., Richardson, A., Williams, R., Tookman, A. J., & Nazareth, I. (2008) · British Journal of Cancer · doi:10.1038/sj.bjc.6604836 · Cited by 39
“However, identifying appropriate leaders can be labour intensive and unreliable (Doumit et al, 2007).”
Background
Applying a Health Network approach to translate evidence-informed policy into practice: A review and case study on musculoskeletal health
Briggs, A. M., Bragge, P., Slater, H., Chan, M. T.-L., & Towler, S. C. B. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-394 · Cited by 39
“The identification of local, domain-specific leaders, often termed ‘champions’, supported within a distributed leadership framework, is well recognised as effective model to promote change, motivate participation from others and drive complex and multidimensional projects [32,67,68] and has also been identified as a f…”
Background
Barriers to the implementation of clinical guidelines for maternal alcohol consumption in antenatal services: A survey using the theoretical domains framework
Doherty, E. L., Kingsland, M., Wiggers, J. H., Anderson, A., Elliott, E. J., Symonds, I., Tully, B., Dray, J., & Wolfenden, L. (2019) · Health Promotion Journal of Australia · doi:10.1002/hpja.258 · Cited by 39
Association of Physician Peer Influence With Subsequent Physician Adoption and Use of Bevacizumab
Keating, N. L., O’Malley, A. J., Onnela, J.-P. “., Gray, S. W., & Landon, B. E. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.18586 · Cited by 39
A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region
Sharma, M., Teerawattananon, Y., Dabak, S. V., Isaranuwatchai, W., Pearce, F., Pilasant, S., Sabirin, J., Mayxay, M., Guerrero, M., Phuong, N. K., et al. (2021) · Health Research Policy and Systems · doi:10.1186/s12961-020-00647-0 · Cited by 39
“A Cochrane review has also shown that identifying ‘champions’ or ‘opinion leaders’ is needed to bridge the research-to-policy gap [30].”
Background
A cluster-randomized trial to improve stroke care in hospitals
Lakshminarayan, K., Borbas, C., McLaughlin, B., Morris, N. E., Vazquez, G., Luepker, R. V., & Anderson, D. C. (2010) · Neurology · doi:10.1212/wnl.0b013e3181df096b · Cited by 38
Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review
Gittus, M., Chong, J., Sutton, A., Ong, A. C. M., & Fotheringham, J. (2023) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-023-02667-9 · Cited by 40
Health Care Providers as Agents of Change: Integrating PrEP With Other Sexual and Reproductive Health Services for Adolescent Girls and Young Women
O’Malley, G., Beima‐Sofie, K., Roche, S. D., Rousseau, E., Travill, D., Omollo, V. O., Delany‐Moretlwe, S., Bekker, L., Bukusi, E. A., Kinuthia, J., et al. (2021) · Frontiers in Reproductive Health · doi:10.3389/frph.2021.668672 · Cited by 38
Contextualizing Western guidelines for stroke and low back pain to a developing country (Philippines): an innovative approach to putting evidence into practice efficiently
Gonzalez-Suarez, C., Dizon, J. M. R., King, Lorenzo, L., Valdecanas, Gambito, Fidel, & Grimmer, K. A. (2012) · Journal of Healthcare Leadership · doi:10.2147/jhl.s35370 · Cited by 41
A framework to improve evidence-informed decision-making in health service management
Liang, Z., Howard, P. F., Leggat, S. G., & Murphy, G. (2012) · Australian Health Review · doi:10.1071/ah11051 · Cited by 38
Case-Based Training of Evidence-Based Clinical Practice in Primary Care and Decreased Mortality in Patients With Coronary Heart Disease
Kiessling, A., LEWITT, M. S., & Henriksson, P. (2011) · The Annals of Family Medicine · doi:10.1370/afm.1248 · Cited by 38
Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation
Cahill, L. S., Carey, L. M., Lannin, N. A., Turville, M. L., & O’Connor, D. A. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012575 · Cited by 38
Priorities for Closing the Evidence-Practice Gaps in Poststroke Aphasia Rehabilitation: A Scoping Review
Shrubsole, K., Worrall, L. E., Power, E., & O’Connor, D. A. (2017) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.08.474 · Cited by 39
Implementation of a leg ulcer strategy
Moffatt, C. J., & Franks, P. J. (2004) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2004.06200.x · Cited by 38
From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pre-test/post-test study design
Middleton, S., Lydtin, A., Comerford, D., Cadilhac, D. A.-M., McElduff, P., Dale, S., Hill, K. M., Longworth, M., Ward, J., Cheung, N. W., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011568 · Cited by 38
“To design that intervention, we had incorporated best practice from the field of implementation science to design a standardised intervention comprising systematic local barrier identification,(20) reinforcement of multidisciplinary teamwork,(21) local adaptation(22) and use of site champions.(23) This cluster randomi…”
Method
Characteristics of Physician Leaders Working to Improve the Quality of Care in Acute Myocardial Infarction
Holmboe, E. S., Bradley, E. H., Mattera, J. A., Roumanis, S. A., Radford, M. J., & Krumholz, H. M. (2003) · The Joint Commission Journal on Quality and Safety · doi:10.1016/s1549-3741(03)29033-x · Cited by 38
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Spence, K., & Henderson-Smart, D. J. (2010) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2010.01895.x · Cited by 37
Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information
Acolet, D., Allen, E., Houston, R., Wilkinson, A. R., Costeloe, K., & Elbourne, D. R. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2010.207522 · Cited by 40
Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: a network modelling approach
Nooraie, R. Y., Dobbins, M., & Marin, A. (2014) · Implementation Science · doi:10.1186/1748-5908-9-29 · Cited by 37
“found that opinion leaders alone or in combination with other interventions may successfully promote evidence-informed practice, and the effect of opinion leaders is comparable with other well-known interventions such as distribution of educational materials and audit and feedback [44].”
Result
Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial
Dumont, A., Betrán, A. P., Kaboré, C., de Loenzien, M., Lumbiganon, P., Bohren, M. A., Mac, Q. N. H., Opiyo, N., Carroli, G., Annerstedt, K. S., et al. (2020) · Implementation Science · doi:10.1186/s13012-020-01029-4 · Cited by 38
The NICE schizophrenia guidelines: the challenge of implementation1
Rowlands, P. (2004) · Advances in Psychiatric Treatment · doi:10.1192/apt.10.6.403 · Cited by 37
A Community-based Program for Cardiovascular Health Awareness
Chambers, L. W., Kaczorowski, J. A., Dolovich, L. R., Karwalajtys, T. L., Hall, H., McDonough, B., Hogg, W., Farrell, B. J., Hendriks, A., & Levitt, C. A. (2005) · Canadian Journal of Public Health · doi:10.1007/bf03405169 · Cited by 37
Implementation strategies for health systems in low-income countries: an overview of systematic reviews
Tomás Pantoja, C., Opiyo, N., Ciapponi, A., Dudley, L., Gagnon, M., Herrera, C. A., Lewin, S. A., Martí, S. G., Oxman, A. D., Paulsen, E., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011086 · Cited by 38
Active Surveying: A Probabilistic Approach for Identifying Key Opinion Leaders
Sharara, H., Getoor, L. C., & Norton, M. (2012) · Cited by 36
Overview of interventions to enhance primary‐care provider management of patients with substance‐use disorders
Anderson, P. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00113.x · Cited by 35
Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence
Stergiou‐Kita, M. (2010) · Australian Occupational Therapy Journal · doi:10.1111/j.1440-1630.2009.00842.x · Cited by 35
The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre–post implementation study in the U.S.
Titler, M. G., Conlon, P. F., Reynolds, M. A., Ripley, R. T., Tsodikov, A. D., Wilson, D. S., & Montie, M. (2015) · Applied Nursing Research · doi:10.1016/j.apnr.2015.12.004 · Cited by 36
Factors Associated With the Provision of Hospice Care for Children
Lindley, L. C., Mark, B. A., Lee, S.-Y. D., Domino, M. E., Song, M., & Vann, J. J. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.03.010 · Cited by 36
“However, there is emerging evidence that champions also may be effective in fostering change in health care practices such as providing care for children.(38,39) In fact, recent studies have found that although a champion may be effective in implementing smaller changes like adopting new technology, more than one cham…”
Background
Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability
Moldovan, F., Moldovan, L., & Bataga, T. (2023) · Medicina · doi:10.3390/medicina59040796 · Cited by 35
Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies
Slade, S. C., Kent, P. M., Bucknall, T. K., Molloy, E., Patel, S., & Buchbinder, R. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007265 · Cited by 38
Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services
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Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis
Chan, Y., Ibrahim, M. A. B., Wong, C., Ooi, C. K., & Chow, A. L. (2019) · Epidemiology and Infection · doi:10.1017/s095026881800331x · Cited by 35
“Therefore, the provision of continuing education to senior physicians in the ED can enhance antibiotic prescribing practices in the ED [43].”
Background
Use of quality circles for primary care providers in 24 European countries: an online survey of European Society for Quality and Safety in family practice delegates
Rohrbasser, A., Kirk, U. B., & Arvidsson, E. (2019) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2019.1639902 · Cited by 35
“They may influence QC participants’ and change their behaviour [16].”
Background
Champions for improved adherence to guidelines in long-term care homes: a systematic review
Hall, A. M., Flodgren, G., Richmond, H., Welsh, S. M., Thompson, J., Furlong, B., & Sherriff, A. (2021) · Implementation Science Communications · doi:10.1186/s43058-021-00185-y · Cited by 36
“A champion is different than an opinion leader [18]; unlike opinion leaders, champions are typically equal to their peers or colleagues and do not have a higher social or work status [18].”
BackgroundSelf-citation
A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation
Matthews, J. J., Hall, A. M., Hernon, M., Murray, A., Jackson, B., Taylor, I. M., Toner, J., Guérin, S., Lonsdale, C., & Hurley, D. A. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0921-1 · Cited by 38
“Recent Cochrane systematic reviews have recommended [a] continuing education meetings [17], [b] educational outreach visits [18], [c] local opinion leaders [19] and [d] audit and feedback [20] as effective evidence-based strategies to change professional practice.”
Background
Getting clinical trial results into practice: design, implementation, and process evaluation of the ALLHAT Dissemination Project
Bartholomew, L. K., Cushman, W. C., Cutler, J. A., Davis, B. R., Dawson, G., Einhorn, P. T., Graumlich, J. F., Piller, L. B., Pressel, S., Roccella, E. J., et al. (2009) · Clinical Trials · doi:10.1177/1740774509338234 · Cited by 34
Barriers and facilitators to the quality use of essential medicines for maternal health in low–resource countries: An Ishikawa framework
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Barriers and Facilitators to Implementing Delirium Rounds in a Clinical Trial Across Three Diverse Hospital Settings
Yevchak, A. M., Fick, D. M., McDowell, J. A., Monroe, T. B., Lewallen, K. M., Grove, L., Kolanowski, A. M., Waller, J. L., & Inouye, S. K. (2013) · Clinical Nursing Research · doi:10.1177/1054773813505321 · Cited by 34
Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery‐oriented training
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Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial
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“They should be willing and able to submit the expanded data set monthly and allocate a QI team consisting of at least one intensivist and one nurse, of which one member is appointed “local champion” who is the key contact person for NICE researchers [43].”
Background

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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