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Cited by 1,279Pharmaceutical industry and healthcareHealth Policy Implementation ScienceInnovations in Medical Education

Educational outreach visits: effects on professional practice and health care outcomes

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O'Brien, Mary Ann, Rogers, Stephen, Jamtvedt, Gro, Oxman, Andrew D, Odgaard-Jensen, Jan, Kristoffersen, Doris Tove, Forsetlund, Louise, Bainbridge, Daryl +4 more·2007·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd000409.pub2PMC PMC7032679
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Abstract

BACKGROUND: Educational outreach visits (EOVs) have been identified as an intervention that may improve the practice of healthcare professionals. This type of face-to-face visit has been referred to as university-based educational detailing, academic detailing, and educational visiting. OBJECTIVES: To assess the effects of EOVs on health professional practice or patient outcomes. SEARCH STRATEGY: For this update, we searched the Cochrane EPOC register to March 2007. In the original review, we searched multiple bibliographic databases including MEDLINE and CINAHL. SELECTION CRITERIA: Randomised trials of EOVs that reported an objective measure of professional performance or healthcare outcomes. An EOV was defined as a personal visit by a trained person to healthcare professionals in their own settings. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. We used bubble plots and box plots to visually inspect the data. We conducted both quantitative and qualitative analyses. We used meta-regression to examine potential sources of heterogeneity determined a priori. We hypothesised eight factors to explain variation across effect estimates. In our primary visual and statistical analyses, we included only studies with dichotomous outcomes, with baseline data and with low or moderate risk of bias, in which the intervention included an EOV and was compared to no intervention. MAIN RESULTS: We included 69 studies involving more than 15,000 health professionals. Twenty-eight studies (34 comparisons) contributed to the calculation of the median and interquartile range for the main comparison. The median adjusted risk difference (RD) in compliance with desired practice was 5.6% (interquartile range 3.0% to 9.0%). The adjusted RDs were highly consistent for prescribing (median 4.8%, interquartile range 3.0% to 6.5% for 17 comparisons), but varied for other types of professional performance (median 6.0%, interquartile range 3.6% to 16.0% for 17 comparisons). Meta-regression was limited by the large number of potential explanatory factors (eight) with only 31 comparisons, and did not provide any compelling explanations for the observed variation in adjusted RDs. There were 18 comparisons with continuous outcomes, with a median adjusted relative improvement of 21% (interquartile range 11% to 41%). There were eight trials (12 comparisons) in which the intervention included an EOV and was compared to another type of intervention, usually audit and feedback. Interventions that included EOVs appeared to be slightly superior to audit and feedback. Only six studies evaluated different types of visits in head-to-head comparisons. When individual visits were compared to group visits (three trials), the results were mixed. AUTHORS' CONCLUSIONS: EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.

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  • It is uncertain whether tailored implementation is more effective than other non-tailored interventions.

    “but is unable to determine whether this approach is more effective than selecting other interventions.”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as O'Brien 2007

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  1. Hendryx 1998 {published data only} Hendryx MS, Fieselmann JF, Bock MJ, Wakefield DS, Helms CM, Bentler SE. Outreach Education to Improve Quality of Rural ICU Care. American Journal of Respiratory and Critical Care Medicine 1998;158:418-23.

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Authors
O'Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., Haynes, R. B., & Harvey, E.
Affiliations
  • Juravinski Cancer Centre; Supportive Cancer Care Research Unit; 699 Concession Street Hamilton Ontario Canada L8V 5C2
  • Whittington Hospital (GB)
  • Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
  • Norwegian Knowledge Centre for the Health Services; PO Box 7004, St. Olavs Plass Oslo Norway N-0130
  • Juravinski Cancer Centre (CA)
  • University of Birmingham (GB)
  • Association of American Medical Colleges (US)
  • McMaster University (CA)
  • SaltaSustainable; 31 Victoria Street Leeds UK LS7 4PA
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2007-10-17
Volume
2008
Issue
4
Pages
CD000409-CD000409
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd000409.pub2
PMC
PMC7032679
OpenAlex
W2161868218
Cited by
1,279
References
123
Citations by year
2026: 10 · 2025: 21 · 2024: 35 · 2023: 43 · 2022: 45 · 2021: 59 · 2020: 65 · 2019: 52 · 2018: 69 · 2017: 71 · 2016: 70 · 2015: 75 · 2014: 58 · 2013: 83 · 2012: 69
FWCI
9.14
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
academic detailing, professional practice change, drug prescribing, guideline adherence, patient outcomes, audit and feedback, health professions education, health worker motivation
MeSH terms
Education, Medical, Continuing, Health Personnel, Humans, Patient Compliance, Practice Patterns, Physicians', Professional Practice, Outcome Assessment, Health Care

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