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

 

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 methods

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.

 

Plain language summary

Educational outreach visits to change health care professional care for patients

There have been many ways developed to improve how health care professionals care for their patients. One way to improve how health care professionals practice is to provide educational outreach visits. Trained people visit clinicians where they practice and provide them with information to change how they practice. The information given may include feedback about their performance, or may be based on overcoming obstacles to change. This type of face-to-face visit has also been referred to as university-based educational detailing, academic detailing, and educational visiting.

This review found 69 studies that evaluated educational outreach visits. Educational outreach visits appear to improve the care delivered to patients. When trying to change how health care professionals prescribe medications, outreach visits consistently provide small changes in prescribing, which might be potentially important when hundreds of patients are affected. For other types of professional practice, such as providing screening tests, outreach visits provide small to moderate changes in practice. But the effects really varied and why it varied could not be explained.

 

摘要

背景

教育性的延申訪視:專業實務與健康照護的效果

教育的延伸訪問(Educational outreach visits, EOVs)被認為是一種介入措施，它可以改善健康照護專業實務。這種面對面訪問的形式起源於以大學為基礎的教育詳述、教師的詳述、及教育訪問。

目標

評估EOVs在健康專業實務或病人照護的效果

搜尋策略

為了提供最新訊息，我們搜尋登錄於2007年3月的Cochrane EPOC。在最初的檢閱中，我們搜尋很多書目資料庫，包括MEDLINE和CINAHL。

選擇標準

EOVs的隨機試驗報告專業成果或健康照護成果的客觀測量。一個EOV被定義為由一個受過訓練的人，在他自己健康照護專業環境中做個人的視察。

資料收集與分析

兩位評論者個別取得資料及評估研究品質。我們使用氣泡圖(bubble plots)和盒形圖(box plots)去檢視審查資料。我們實施量性的和質性的分析。我們使用複回歸檢查潛在的異質性來源，作為選擇的決定。我們假設以八個因素去解釋影響估計值的差異。在有EOV的介入和沒有介入作比較中，我們最初的檢視及統計分析中，僅包括有二分結果的、基本資料的、和低或中度危險偏差的研究。

主要結論

包括69篇研究，超過15,000名健康專業人員。為了比較，28篇研究(34種比較)提供中位數及四分位數範圍的計算。中位數調整危險差別 (risk difference, RD) 與實務一致是5.6%(四分位數範圍從3.0%到9.0%)。調整RDs後與規定非常一致(17種比較，中位數是4.8%，四分位數範圍從3.0%到6.5%)，但是其他不同型式的專業成就(17種比較)，中位數是6.0%，四分位數範圍從3.6%到16.0%。大量潛在的解釋因素(8)限制了複回歸(Metaregression)，且只有31種比較，無法提供在調整RDs後觀察差異的一個令人信服的解釋。18種比較有持續的結果，一個中位數調整21%的有關的改進(四分位數範圍從11%到41%)。有8篇試驗(12種比較)，其介入措施包括EOV，與其他形式的介入作比較，通常是審查及回饋。包括EOV的介入措施，有輕微的優於審查及回饋。只有6篇研究評價不同形式的訪問，結果是不相上下的比較。當個別訪問與團隊訪問比較(3篇試驗)，結果是混淆的。

作者結論

單獨的EOV或合併其他介入措施是有其特定的效果的，效果是相對的一致與小量的，但是卻非常的重要。在其他專業表現的成效具有小至中度的改善，但無法從本次回顧去解釋其差異性。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

教育延伸訪問用以改變病人的健康專業照護,已有很多方法被發展,用以改變病人的健康專業照護。其中一個去改善專業實務的健康照護的方法是提供教育延伸訪問。由受過訓練的人去訪問臨床醫師，他們實踐及提供臨床醫師資訊以去改變。給予的資訊可以包括回饋他們的績效、或基於克服改變的障礙。這些面對面訪問的形式也是參考大學的教育詳述，詳述的大學教師，和教育訪問。 這篇評論找到69篇評值EOVs的研究。EOVs為了改善對病人的照顧服務而產生。其試著去改變健康照護專業人員的藥物處方，延伸訪問持續的在開立處方上提供小的改變，當數以百計的病人受影響時，可見EOVs可能有其潛在的重要性。為了其他型態的專業實務，例如提供篩檢試驗，延伸訪問對實務提供小量到中度的改變。但是效果真的不盡相同，導致其效果無法被解釋。