Intervention Review

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

  1. Mary Ann O'Brien1,*,
  2. Stephen Rogers2,
  3. Gro Jamtvedt3,
  4. Andrew D Oxman3,
  5. Jan Odgaard-Jensen4,
  6. Doris Tove Kristoffersen5,
  7. Louise Forsetlund6,
  8. Daryl Bainbridge7,
  9. Nick Freemantle8,
  10. Dave Davis9,
  11. R. Brian Haynes10,
  12. Emma Harvey11

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 19 AUG 2007

DOI: 10.1002/14651858.CD000409.pub2


How to Cite

O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis D, Haynes RB, Harvey E. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000409. DOI: 10.1002/14651858.CD000409.pub2.

Author Information

  1. 1

    Juravinski Cancer Centre, Supportive Cancer Care Research Unit, Hamilton, Ontario, Canada

  2. 2

    University College London, Department of Primary Care and Population Sciences, London, UK

  3. 3

    Norwegian Knowledge Centre for Health Services, Oslo, Norway

  4. 4

    Norwegian Knowledge Centre for the Health Services, Oslo, Norway

  5. 5

    Norwegian Knowledge Centre for Health Services, Department of Quality Measurement and Patient Safety , Oslo, Norway

  6. 6

    Norwegian Knowledge Centre for the Health Services, Quality Improvement, Organisation and Prevention Department, Oslo, Norway

  7. 7

    Juravinski Cancer Centre, Supportive Cancer Care Research Unit, Hamilton, ON, Canada

  8. 8

    University of Birmingham, Department of Primary Care and General Practice, Birmingham, UK

  9. 9

    Association of American Medical Colleges, Continuing Health Care Education and Improvement, Washington, DC, USA

  10. 10

    McMaster University, Departments of Clinical Epidemiology & Biostatistics, and Medicine, Hamilton, Ontario, Canada

  11. 11

    SaltaSustainable, Leeds, UK

*Mary Ann O'Brien, Supportive Cancer Care Research Unit, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada. maryann.o'brien@hrcc.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

教育性扩展访问:对医疗专业实践与卫生保健结果的影响

研究背景

Educational outreach visits( EOVs, 教育性扩展访问)被认为是一种可以改善卫生保健服务的干预措施。这种面对面访问的形式起源于以大学为基础的教育详述、学术详述及教育访问。

研究目的

评价EOVs对医疗专业实践或患者结局的影响。

检索方法

为了获得最新数据,我们检索了截止于2007年3月Cochrane EPOC register中的文献。在原始系统评价中,我们检索了包括MEDLINE和CINAHL在内的很多文献数据库。

纳入标准

我们纳入的随机试验中,采用了一些客观指标测量EOVs对医疗专业实践或卫生保健结局的影响。EOV被定义为由一个受过专门培训的人,对卫生服务专业人员在其工作环境中做个人访问。

数据收集与分析

两位评价者独立收集资料和评估研究质量。我们使用气泡图(bubble plots) 和盒形图(box plots) 直观地审视资料,实施定量和定性分析,并使用Meta-回归分析检查早期可能的异质性来源。我们假设以八个因素去解释估计值间的差异。我们仅对二分类变量、有基线研究数据、有低、中度偏倚风险的研究进行直观的和统计学分析,比较有无EOV干预措施的效果差异。

主要结果

我们纳入了包括15,000名以上医疗专业人员在内的69篇研究。其中的28篇研究(以及34个对照)计算中位数及四分位差。以期望行为调整后的风险差(RD)中位数为5.6%( 四分位差: 3.0%∼9.0%)。就开处方行为而言,调整后RDs高度一致(17个对照,中位数: 4.8%,四分位差: 3.0%∼6.5%),但是对于其他不同形式的医疗行为(17个对照) ,中位数是6.0%,四分位差: 3.6%∼16.0%。大量可能的因素(8个 )限制了Meta-回归分析的开展,且只有31个对照。我们尚无法提供在调整RDs后存在差异的令人信服的解释。18个对照有连续型变量结果,该结果调整后的中位数为21%( 四分位差: 11%∼41%)。有8篇试验(12个对照)将包括EOV的干预措施与其他形式的干预(通常是评估与反馈)作比较,包括EOV的干预措施效果略微优于评估与反馈。只有6篇研究评价不同形式的访问,结果是不分优劣。个别访问与团队访问做比较的研究,没有得到明确的结果(3篇试验) 。

作者结论

单独的EOV或合并其他干预措施对开处方行为的影响不明显,但是具有潜在的重要性。而其对其他专业行为具有从低到中等不同程度的影响效果,但这种差异无法由本次系统评价进行解释。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

教育性扩展访问:对医疗专业实践与卫生保健结果的影响

教育性扩展访问:改进为患者提供的卫生保健服务

目前已建立了很多方法来改善为病人的医疗保健服务,其中之一就是提供教育性扩展访问。由受过训练的人在医师执业地访问医师,为他们提供信息以改善实践。提供的信息可以包括反馈他们的绩效、或基于改变而需要克服的障碍。这些面对面访问的形式正是来源于大学的教育详述、学术详述和教育访问。

本次系统评价检索到69篇评价EOVs的研究。EOVs是为了改善提供给病人的医疗保健服务而产生的。当试着去改变医生的药品处方时,EOVs能够持续地产生微弱影响;如果众多的病人受到影响,那么EOVs可能有其潜在的重要性。对于其他形式的医疗专业实践,例如筛选试验,EOVs促使其产生低度或中度的改变。但是效果是有差异的,且导致其差异的原因仍无法解释。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 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。