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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“produce positive effects including opinion leaders (Flodgren et al., 2007) and feedback on”
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“Identifying and preparing champions to model evidencebased practice alone or in combination with other implementation strategies may successfully promote evidence-based practice.(30,31) Local opinion leaders are colleagues who are perceived as influential in assisting others to change professional behavior to reflect…”
Background
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“Given their critical role in the implementation of complex interventions, there is a growing interest in opinion leaders in the literature [35-40].”
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Background
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“Previous studies suggest that including opinion leaders from each segment would enhance the impact of local decisions [37,70,71].”
Background
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“Lastly, the literature supports the effectiveness of having an opinion leader, alone or combined with other interventions, to facilitate clinicians’ practice behaviour change [110, 111] and promote the adherence to EBP [112].”
Background
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“These and other similar findings 20 suggest that at least in the initial product introduction phase, training and supervision investments should be targeted at those most likely to become “ provider champions ” who may build momentum around LNG IUS provision and demonstrate the potential of the LNG…”
Background
Implementing clinical guidelines
Mayer, J., Kipps, C., & Cock, H. R. (2019) · Practical Neurology · doi:10.1136/practneurol-2017-001814 · Cited by 18
Feasibility and usefulness of a leadership intervention to implement evidence-based falls prevention practices in residential care in Canada
Gifford, W., Lewis, K. B., Eldh, A. C., Fiset, V., Abdul-Fatah, T., Åberg, A. C., Thavorn, K., Graham, I. D., & Wallin, L. (2019) · Pilot and Feasibility Studies · doi:10.1186/s40814-019-0485-7 · Cited by 22
“In contrast, informal leaders include point of care staff who are perceived by their colleagues to be credible and influential for influencing change and evidence-based practice [14].”
Background
Cross sectional study of Australian midwives knowledge and use of sterile water injections for pain relief in labour
Lee, N., Mårtensson, L. B., & Kildea, S. V. (2012) · Women and Birth · doi:10.1016/j.wombi.2011.11.002 · Cited by 19
Off-label prescribing in palliative care – a cross-sectional national survey of Palliative Medicine doctors
To, T. H. M., Agar, M. R., Shelby‐James, T., Abernethy, A. P., Doogue, M. P., Rowett, D. S., Ko, D. N., & Currow, D. C. (2012) · Palliative Medicine · doi:10.1177/0269216312464263 · Cited by 19
Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine
Hardy, J. R., Spruyt, O., Quinn, S. J., Devilee, L., & Currow, D. C. (2014) · Internal Medicine Journal · doi:10.1111/imj.12442 · Cited by 19
Adherence to the guideline ‘Triage in emergency departments’: a survey of Dutch emergency departments
Janssen, M. A., van Achterberg, T., Adriaansen, M. J. M., Kampshoff, C. S., & Groot, J. M. (2011) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2011.03698.x · Cited by 19
Dysphagia screening after acute stroke: a quality improvement project using criteria-based clinical audit
Sivertsen, J., Graverholt, B., & Espehaug, B. (2017) · BMC Nursing · doi:10.1186/s12912-017-0222-6 · Cited by 19
Five steps from evidence to effect: exercising clinical freedom to implement research findings
Kulier, R., Gee, H., & Khan, K. S. (2008) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2008.01821.x · Cited by 19
Theory in Implementing Evidence-Based Findings into Health Care Practice
Sales, A. E., Smith, J. L., Curran, G. M., & Kochevar, L. K. (2006) · Cited by 19
Physician attitudes toward strategies to promote the adoption of medical evidence into clinical practice.
Borenstein, J. E., Chiou, C., Henning, J. M., Wilson, A., Hohlbauch, A., Richards, M. S., Ofman, J. J., & Weingarten, S. R. (2003) · PubMed · Cited by 19
Screening Mothers for Intimate Partner Abuse at Well-Baby Care Visits
Thompson, R. S., & Krugman, R. D. (2001) · JAMA · doi:10.1001/jama.285.12.1628 · Cited by 19
Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes
Basinska, K., Zúñiga, F., Simon, M., Geest, S. D., Guerbaaï, R.-A., Wellens, N. I. H., Nicca, D., & Brunkert, T. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02878-y · Cited by 18
Psychotherapy Knowledge Translation and Interpersonal Psychotherapy: Using Best-Education Practices to Transform Mental Health Care in Canada and Ethiopia
Ravitz, P., Wondimagegn, D., Pain, C., Araya, M., Alem, A., Baheretibeb, Y., Hanlon, C., Fekadu, A., Park, J., Fefergrad, M., et al. (2014) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2014.68.4.463 · Cited by 18
Implementation of Pharmaceutical Practice Guidelines by a Project Model Based
Mahmoudi, L., Karamikhah, R., Mahdavinia, A., Samiei, H., Petramfar, P., & Niknam, R. (2015) · Medicine · doi:10.1097/md.0000000000001744 · Cited by 18
“Hence, we used a combination of different methods such as preprinted order forms, local experts’ opinion as well as audit and feedback to optimize the compliance of the healthcare workers.(26) In our setting, such interventions led to 65.”
Method
Working to improve survival and health for babies born very preterm: the WISH project protocol
the WISH Project Team, Crowther, C. A., Middleton, P., Bain, E., Ashwood, P., Bubner, T., Flenady, V., Morris, J. M., & McIntyre, S. J. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-239 · Cited by 18
Use of Three Evidence-Based Postoperative Pain Assessment Practices by Registered Nurses
Carlson, C. L. (2009) · Pain Management Nursing · doi:10.1016/j.pmn.2008.07.001 · Cited by 18
Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users’ engagement in activities
Killaspy, H. T., Cook, S., Mundy, T., Craig, T., Holloway, F. A., Leavey, G., Marston, L., McCrone, P., Koeser, L., Arbuthnott, M., et al. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-216 · Cited by 19
“The Predisposing stage aims to facilitate a focus on the need for change and gain local service “sign up” [26].”
Background
Transplant Education Practices and Attitudes in Dialysis Centers: Dialysis Leadership Weighs In
Waterman, A. D. (2012) · Journal of Nephrology & Therapeutics · doi:10.4172/2161-0959.s4-007 · Cited by 18
“Other research has shown that when opinion leaders endorse key quality improvement priorities, staffs are more likely to comply with and disseminate successful interventions to patients [26, 28, 35, 36].”
Background
Knowledge transfer: what drug information would specialist doctors need to support their clinical practice? Results of a survey and of three focus groups in Italy
Formoso, G., Rizzini, P., Bassi, M., Bonfanti, P., Rizzardini, G., Campomori, A., & Mosconi, P. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0355-7 · Cited by 18
“If we consider qualitative limits in the current offer of information to physicians, lack of EBM training in medical schools and time constraints, relying on the perceived authoritativeness of experts, local opinion leaders, [19] journals or societies may be an expected outcome and may often be a necessary shortcut to…”
Background
Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management
Agbejule, O. A., Hart, N. H., Ekberg, S., Koczwara, B., Ladwa, R., Simonsen, C., Pinkham, E. P., & Chan, R. J. (2021) · BMC Cancer · doi:10.1186/s12885-021-08394-3 · Cited by 19
Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice
Leal, I. M., Martinez, J., Britton, M., Chen, T. A., Correa-Fernández, V., Kyburz, B., Nitturi, V., Obasi, E. M., Drenner, K. L., Williams, T., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19137664 · Cited by 19
“Research studies confirm the effectiveness of using learning processes that employ experts to lead and facilitate peer learning [73,74], which particularly, in this case, produces collective knowledge that is then disseminated to the larger community [50,51].”
Background
Toward a socioethical approach to behavior change
Mah, M. W., & Meyers, G. (2006) · American Journal of Infection Control · doi:10.1016/j.ajic.2005.09.004 · Cited by 17
The effects of guideline implementation for proton pump inhibitor prescription on two pulmonary medicine wards
van Vliet, E. P. M., Steyerberg, E. W., Otten, H. J. A. M., Rudolphus, A., Knoester, P. D., Hoogsteden, H. C., van Gelder, T., Kuipers, E. J., & SIERSMA, P. D. (2008) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03875.x · Cited by 18
Use of personal protective equipment in Canadian pediatric emergency departments
Reid, S. M., Farion, K. J., Suh, K. N., Audcent, T. A., Barrowman, N. J., & Plint, A. C. (2011) · Canadian Journal of Emergency Medicine · doi:10.2310/10.2310/8000.2011.110253 · Cited by 18
“A recent Cochrane review provides support for the use of local opinion leaders in the successful promotion of evidence-based practice.(28) Despite the fact that we did not find recent PPE training to be correlated with knowledge, respondents felt that receiving ongoing education around PPE and infection control would…”
Method
What has the Cochrane Collaboration ever done for newborn infants?
McGuire, W., Fowlie, P., & Soll, R. (2009) · Archives of Disease in Childhood: Fetal and Neonatal Edition · doi:10.1136/adc.2007.133561 · Cited by 23
Manual paper reminders: effects on professional practice and health care outcomes
Tomás Pantoja, C., Green, M., Grimshaw, J., Denig, P., Durieux, P., Gill, P. S., Colomer, N., Castañón, C., & Léniz, J. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001174.pub3 · Cited by 18
Self-citation
Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project
Tintorer, D. L., Manresa‐Domínguez, J. M., Ribera, E. P., Beneyto, S. F., Mundet, X., & Saigí-Rubió, F. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0739-0 · Cited by 21
“While most studies have focused on analysing the results of CoCP use [29–31], on the promotion of evidence-based clinical practice [32, 33] and on final decision-making [34], it is crucial to consider the determinants of the use of CoCPs in order to fully understand the use thereof.”
Background
A randomized trial to assess the impact of opinion leader endorsed evidence summaries on the use of secondary prevention strategies in patients with coronary artery disease: the ESP-CAD trial protocol [NCT00175240]
McAlister, F. A., Fradette, M., Graham, M. M., Majumdar, S. R., Ghali, W. A., Williams, R., Tsuyuki, R. T., McMeekin, J., Grimshaw, J., & Knudtson, M. L. (2006) · Implementation Science · doi:10.1186/1748-5908-1-11 · Cited by 18
Self-citation
Evaluation of two evidence‐based knowledge transfer interventions for physicians. A cluster randomized controlled factorial design trial: the CardioDAS Study
Amsallem, E., Kasparian, C., Cucherat, M., Chabaud, S., Haugh, M. C., Boissel, J., & Nony, P. (2007) · Fundamental and Clinical Pharmacology · doi:10.1111/j.1472-8206.2007.00513.x · Cited by 18
Identification of potential opinion leaders in child health promotion in Sweden using network analysis
Guldbrandsson, K., Nordvik, M. K., & Bremberg, S. G. (2012) · BMC Research Notes · doi:10.1186/1756-0500-5-424 · Cited by 18
“the socio-metric method and the informant method were assessed to be equally valid [4].”
BackgroundMethodInfluential
Economic Evidence at the Local Level
Gool, K. V., Gallego, G., Haas, M. R., Viney, R. C., Hall, J. P., & Ward, R. L. (2007) · PharmacoEconomics · doi:10.2165/00019053-200725120-00006 · Cited by 19
Guidelines in the intensive care unit
Sinuff, T., & Cook, D. J. (2003) · Clinics in Chest Medicine · doi:10.1016/s0272-5231(03)00098-4 · Cited by 18
Stakeholder Engagement for Development Impact Evaluation and Evidence Synthesis
Oliver, S. R., Roche, C., Stewart, R. J., Bangpan, M., Dickson, K., Pells, K., Cartwright, N. D., Hargreaves, J., & Gough, D. (2018) · doi:10.51744/cip3 · Cited by 19
“, 2010); using opinion leaders to disseminate evidence-based practice (Flodgren et al., 2011); the science of science use (Langer et al.”
Background
A systematic review of measures of implementation players and processes: Summarizing the dearth of psychometric evidence
Dorsey, C. N., Mettert, K. D., Puspitasari, A. J., Damschroder, L. J., & Lewis, C. C. (2021) · Implementation Research and Practice · doi:10.1177/26334895211002474 · Cited by 15
Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders’ perspectives on relevance and standardised evaluation
Briggs, A. M., Jordan, J. M., Speerin, R., Jennings, M. D., Bragge, P., Chua, J., & Slater, H. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1173-9 · Cited by 17
Organizational capacity for patient and family engagement in hospital planning and improvement: interviews with patient/family advisors, managers and clinicians
Anderson, N. N., Baker, G. R., Moody, L., Scane, K., Urquhart, R., Wodchis, W. P., & Gagliardi, A. R. (2021) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzab147 · Cited by 17
Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care
Bagot, K. L., Bladin, C., Vu, M. H., Bernard, S. A., Smith, K. L., Hocking, G., Coupland, T., Hutton, D., Badcock, D., Budge, M. M., et al. (2023) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13923 · Cited by 20
Sustained improvement in vancomycin dosing and monitoring post-implementation of guidelines: Results of a three-year follow-up after a multifaceted intervention in an Australian teaching hospital
Phillips, C. J., McKinnon, R. A., Woodman, R. J., & Gordon, D. (2017) · Journal of Infection and Chemotherapy · doi:10.1016/j.jiac.2017.09.010 · Cited by 18
“1 Commonly recommended interventions by these organisations are: educational sessions [17], academic detailing [18-20], continuing medical education (CME) [21-22], provision of printed educational material [23], use of opinion leaders to endorse guidelines [24], and engaging target populations who will use the guideli…”
Improving capacity for evidence-based practice in South East Asia: evaluating the role of research fellowships in the SEA-ORCHID Project
Short, J., McDonald, S. J., Turner, T., Martis, R., & the SEA-ORCHID Study Group (2010) · BMC Medical Education · doi:10.1186/1472-6920-10-37 · Cited by 17
The perceived impact of advanced practice nurses (APNs) on promoting evidence-based practice amongst frontline nurses: findings from a collective case study
McDonnell, A., Gerrish, K., Kirshbaum, M. N., Nolan, M., Tod, A., & Preston, L. R. (2012) · Journal of research in nursing · doi:10.1177/1744987112446241 · Cited by 17
Knowledge of caries risk factors/indicators among Japanese and Irish adult patients with different socio-economic profiles: a cross-sectional study
Nishi, M., Harding, M., Kelleher, V., Whelton, H. P., & Allen, P. (2017) · BMC Oral Health · doi:10.1186/s12903-017-0345-x · Cited by 17
“The Japanese study targeted a population deemed to have a high interest in preventive dentistry, in order to investigate the current status of caries risk knowledge among potential opinion leaders [11] of personalised caries prevention programmes (i.”
Identifying educationally influential specialists: Issues arising from the use of “classic” criteria
Wright, F. C., Ryan, D. P., Dodge, J. E., Last, L. D., Law, C., & Smith, A. J. (2004) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.1340240405 · Cited by 17
A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]
Wright, F. C., Law, C., Last, L. D., Klar, N. S., Ryan, D. P., & Smith, A. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-4 · Cited by 17
A mixed-methods study to explore opinions of research translation held by researchers working in a Centre of Research Excellence in Australia
Lynch, E. A., Ramanathan, S. A., Middleton, S., Bernhardt, J. A., Nilsson, M., & Cadilhac, D. A.-M. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022357 · Cited by 16
“23 The party(s) responsible for research-to-practice Open access translation must have buy-in and credibility with the end-users, 23 24 which might recommend particular individuals to coordinate particular projects regardless of their research or clinical background.”
Background
Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study
Archambault, P. M., Rivard, J., Smith, P. Y., Sinha, S. K., Morin, M., LeBlanc, A., Couturier, Y., Pelletier, I., Ghandour, E. K., Légaré, F., et al. (2020) · JMIR Research Protocols · doi:10.2196/17363 · Cited by 16

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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