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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Background
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Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals.
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“”(7) Unfortunately, this process can be slow, incomplete and faced with many barriers.(8) It has been established that educational materials and meetings on their own have unreliable or minimal influence on care delivery, therefore other mechanisms are required to achieve desirable changes in practice.”
Background
Barriers and potential solutions toward optimal prophylaxis against deep vein thrombosis for hospitalized medical patients: A survey of healthcare professionals
Lloyd, N. S., Douketis, J. D., Cheng, J., Schünemann, H. J., Cook, D. J., Thabane, L., Pai, M., Spencer, F. A., & Haynes, R. B. (2011) · Journal of Hospital Medicine · doi:10.1002/jhm.929 · Cited by 28
The Promise and Pitfalls of Pragmatic Clinical Trials for Improving Health Care Quality
Haff, N., & Choudhry, N. K. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.3376 · Cited by 28
The development and implementation of a curriculum to improve clinicians' self-directed learning skills: a pilot project
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A Narrative Review of Recent Developments in Knowledge Translation and Implications for Mental Health Care Providers
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The Effect of a Translating Research into Practice (TRIP)-Cancer Intervention on Cancer Pain Management in Older Adults in Hospice
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Improving the Quality of Care for Older Adults Using Evidence-Informed Clinical Care Pathways
Holroyd-Leduc, J. M., Steinke, V., Elliott, D., Mullin, K., Elder, K., Callender, S., & Hildebrand, K. A. (2013) · Canadian Geriatrics Journal · doi:10.5770/cgj.16.62 · Cited by 26
General practitioners’ knowledge of whiplash guidelines improved with online education
Rebbeck, T. J., Macedo, L. G., Paul, P. R., Trevena, L. J., & Cameron, I. D. (2013) · Australian Health Review · doi:10.1071/ah13057 · Cited by 27
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Taking stock of current societal, political and academic stakeholders in the Canadian healthcare knowledge translation agenda
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The timing of elective caesarean delivery between 2000 and 2009 in England
Gurol‐Urganci, I., Cromwell, D. A., Edozien, L. C., Onwere, C., Mahmood, T. A., & van der Meulen, J. (2011) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-11-43 · Cited by 27
“These include dissemination of educational materials, educational meetings and local opinion leaders, although their success was highly dependent upon context [22,23].”
Background
Evaluation of the implementation of a bowel management protocol in intensive care: effect on clinician practices and patient outcomes
Knowles, S., McInnes, E., Elliott, D., Hardy, J., & Middleton, S. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12448 · Cited by 27
“Local opinion leaders as part of an implementation intervention have been shown to increase compliance with the desired practice (Flodgren et al. 2011).”
Background
A Population-Based Study of the Effects of a Regional Guideline for Completion Axillary Lymph Node Dissection on Axillary Surgery in Patients with Breast Cancer
Tsao, M. W., Cornacchi, S. D., Hodgson, N., Simunovic, M. R. I., Thabane, L., Cheng, J., O’Brien, M. A., Strang, B. K., Mukherjee, S. D., & Lovrics, P. J. (2016) · Annals of Surgical Oncology · doi:10.1245/s10434-016-5310-4 · Cited by 27
Self-citation
Diagnosis and management of tuberculosis by private practitioners in Manila, Philippines
Auer, C., Lagahid, J. Y., Tanner, M., & Weiss, M. G. (2005) · Health Policy · doi:10.1016/j.healthpol.2005.07.004 · Cited by 27
Presence of a Physician Safety Champion Is Associated with a Reduction in Urinary Catheter Utilization in the Pediatric Intensive Care Unit
Zavalkoff, S. R., Korah, N., & Quach, C. (2015) · PLoS ONE · doi:10.1371/journal.pone.0144222 · Cited by 26
Implementation of effective practices in health facilities: a systematic review of cluster randomised trials
Allanson, E., Tunçalp, Ö., Vogel, J. P., Khan, D. N., Oladapo, O. T., Long, Q., & Gülmezoglu, A. M. (2017) · BMJ Global Health · doi:10.1136/bmjgh-2016-000266 · Cited by 29
“A Cochrane review on local opinion leaders as an intervention found that it may have some impact on changing professional practice, but the method of delivery and its role as a stand-alone intervention are difficult to define.(66) There is often poor or no reporting on how leaders are identified, recruited and support…”
Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review
Buja, A., Toffanin, R., Claus, M., Ricciardi, W., Damiani, G., Baldo, V., & Ebell, M. H. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020626 · Cited by 26
Stakeholder selected strategies for obesity prevention in childcare: results from a small-scale cluster randomized hybrid type III trial
Swindle, T., McBride, N. M., Selig, J. P., Johnson, S. L., Whiteside-Mansell, L., Martin, J., Staley, A., & Curran, G. M. (2021) · Implementation Science · doi:10.1186/s13012-021-01119-x · Cited by 26
The judicious use of antibiotics—An investment towards optimized health care
Gaur, A. H., & English, B. K. (2006) · The Indian Journal of Pediatrics · doi:10.1007/bf02825829 · Cited by 26
The Veterans Affairs Experience: Comparative Effectiveness Research In A Large Health System
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Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients’ fecal incontinence: a pilot study preceding a cluster-randomized controlled trial
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“The local opinion leader was recruited after the educational meeting based on the informant method [39].”
Method
Increases in Network Ties Are Associated With Increased Cohesion Among Intervention Participants
Gesell, S. B., Barkin, S. L., Sommer, E. C., Thompson, J. R., & Valente, T. W. (2015) · Health Education & Behavior · doi:10.1177/1090198115599397 · Cited by 26
“networks as crucial mediators in the onset, development, and maintenance of health behaviors (Badaly, 2013; Flodgren et al., 2011; Hammond, 2009; Kelly et al., 1991; Shoham et al., 2012; Valente et al., 2007; Valente, Fujimoto, Chou, & Spruijt-Metz, 2009; Valente, Watkins, Jato, van der Straten, & Tsitsol, 1997).”
Background
Pressure algometry and palpation of the upper limb peripheral nervous system in subjects with hand osteoarthritis are repeatable and suggest central changes
Pedersini, P., Négrini, S., Cantero‐Téllez, R., Bishop, M. D., & Villafañe, J. H. (2019) · Journal of Hand Therapy · doi:10.1016/j.jht.2018.06.003 · Cited by 26
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Sving, E., Fredriksson, L., Gunningberg, L., & Mamhidir, A. (2016) · Journal of Clinical Nursing · doi:10.1111/jocn.13668 · Cited by 25
“…of implementing evidence-based care, for example there are those concerning tailored interventions, opinion leaders, education and feedback on results, all of which may successfully promote evidence-based practice (Forsetlund et al. 2009, Baker et al. 2010, Flodgren et al. 2011, Ivers et al. 2012).”
Background
Creating room for evidence‐based practice: Leader behavior in hospital wards
Renolen, Å., Hjälmhult, E., Høye, S., Danbolt, L. J., & Kirkevold, M. (2019) · Research in Nursing & Health · doi:10.1002/nur.21981 · Cited by 25
“Engaged opinion leaders, implementation leaders, or champions working in close collaboration with the leader teams may also influence such success (Abbott, Foster, Marin, & Dykes, 2014; Flodgren et al., 2011; Mair et al., 2012).”
Background
The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review
Doherty, E., Kingsland, M., Wiggers, J., Wolfenden, L., Hall, A. E., McCrabb, S., Tremain, D., Hollis, J., Licata, M., Wynne, O., et al. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00368-1 · Cited by 16
Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia
Bierbaum, M., Rapport, F., Arnolda, G., Delaney, G. P., Liauw, W., Olver, I., & Braithwaite, J. (2022) · PLoS ONE · doi:10.1371/journal.pone.0279116 · Cited by 23
Diagnostic, design and implementation of an integrated model of care in France: a bottom-up process with a continuous leadership
de Stampa, M., Vedel, I., Mauriat, C., Bagaragaza, E., Routelous, C., Bergman, H., Lapointe, L., Cassou, B., Ankri, J., & Henrard, J. (2010) · International Journal of Integrated Care · doi:10.5334/ijic.598 · Cited by 25
Interinstitutional Variation in Management Decisions for Treatment of 4 Common Types of Cancer
Weeks, J. C., Uno, H., Taback, N., Ting, G. V., Cronin, A. M., D’Amico, T. A., Friedberg, J. W., & Schrag, D. (2014) · Annals of Internal Medicine · doi:10.7326/m13-2231 · Cited by 25
An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial
Kennedy, C. C., Ioannidis, G., Giangregorio, L., Adachi, J. D., Thabane, L., Morin, S. N., Crilly, R. G., Marr, S., Josse, R. G., Lohfeld, L. H., et al. (2012) · Implementation Science · doi:10.1186/1748-5908-7-48 · Cited by 25
Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial
Bosch, M., McKenzie, J. E., Mortimer, D., Tavender, E. J., Francis, J., Brennan, S., Knott, J. C., Ponsford, J. L., Pearce, A. P., O’Connor, D. A., et al. (2014) · Trials · doi:10.1186/1745-6215-15-281 · Cited by 27
Self-citation
Exploring why quality circles work in primary health care: a realist review protocol
Rohrbasser, A., Mickan, S. M., & Harris, J. (2013) · Systematic Reviews · doi:10.1186/2046-4053-2-110 · Cited by 27
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Background
Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before–after pilot study
Cadilhac, D. A.-M., Andrew, N. E., Stroil-Salama, E., Hill, K. M., Middleton, S., Horton, E., Meade, I., Kuhle, S., Nelson, M. R., & Grimley, R. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016010 · Cited by 25
Using memes and memetic processes to explain social and conceptual influences on student understanding about complex socio‐scientific issues
Yoon, S. A. (2008) · Journal of Research in Science Teaching · doi:10.1002/tea.20256 · Cited by 26
Interventions to improve the implementation of evidence-based healthcare in prisons: a scoping review
Blackaby, J., Byrne, J., Bellass, S., Canvin, K., & Foy, R. (2023) · Health & Justice · doi:10.1186/s40352-022-00200-x · Cited by 41
Initiation is recognized as a fundamental early phase of integrated knowledge translation (IKT): qualitative interviews with researchers and research users in IKT partnerships
Zych, M. M., Berta, W. B., & Gagliardi, A. R. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4573-4 · Cited by 25
“The impact of connector roles on research use and impact has been variable [40, 41], hence further research is needed on how best to choose, train and operationalize such entities.”
Background
Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership
de Stampa, M., Vedel, I., Mauriat, C., Bagaragaza, E., Routelous, C., Bergman, H., Lapointe, L., Cassou, B., Ankri, J., & Henrard, J. (2010) · International Journal of Integrated Care · doi:10.5334/ijic.506 · Cited by 24
Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study
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“Specific benefits have been reported for patients with diabetes [5], hypertension [6], obesity [7] and depression [8].”
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“1999), and it has been suggested that opportunities for networking and the use of local opinion leaders may be successful strategies for influencing the dissemination of research findings to physicians (Grol et al. 1998; Kaufman et al. 1999; O’Brien et al. 1999; Bellamy et al. 2000; Ray et al. 2001; Verstappen et al.…”
Background
Do knowledge infrastructure facilities support Evidence-Based Practice in occupational health? An exploratory study across countries among occupational physicians enrolled on Evidence-Based Medicine courses
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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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