Printed educational materials: effects on professional practice and healthcare outcomes

  • Review
  • Intervention

Authors

  • Anik Giguère,

    Corresponding author
    1. Department of Clinical Epidemiology, McMaster University, Health Information Research Unit (HIRU), Hamilton, ON, Canada
    2. CHU de Quebec, St-Sacrement Hospital, Research Center of the Centre d'excellence sur le vieillissement de Quebec, Quebec City, QC, Canada
    • Anik Giguère, Health Information Research Unit (HIRU), Department of Clinical Epidemiology, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. anikgiguere@videotron.ca.

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  • France Légaré,

    1. Population Health and Optimal Health Practices Research Axis, CHU de Québec Research Center, Université Laval, Québec City, Québec, Canada
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  • Jeremy Grimshaw,

    1. Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
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  • Stéphane Turcotte,

    1. Centre de Recherche du CHU de Québec (CRCHUQ) - Hôpital St-François d'Assise, Québec City, QC, Canada
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  • Michelle Fiander,

    1. Information Specialist, Consultant, Ottawa, Ontario, Canada
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  • Agnes Grudniewicz,

    1. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • Sun Makosso-Kallyth,

    1. St-François d'Assise Hospital, Research Centre of the CHU de Quebec, Québec City, QC, Canada
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  • Fredric M Wolf,

    1. University of Washington School of Medicine, Department of Medical Education & Biomedical Informatics, Seattle, WA, USA
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  • Anna P Farmer,

    1. University of Alberta, Department of Agricultural, Food and Nutritional Science and The Centre for Health Promotion Studies, Edmonton, AB, Canada
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  • Marie-Pierre Gagnon

    1. Traumatologie – Urgence – Soins Intensifs, Centre de recherche du CHU de Québec, Axe Santé des populations - Pratiques optimales en santé, Québec, QC, Canada
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Abstract

Background

Printed educational materials are widely used passive dissemination strategies to improve the quality of clinical practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines.

Objectives

To assess the effect of printed educational materials on the practice of healthcare professionals and patient health outcomes.

To explore the influence of some of the characteristics of the printed educational materials (e.g. source, content, format) on their effect on professional practice and patient outcomes.

Search methods

For this update, search strategies were rewritten and substantially changed from those published in the original review in order to refocus the search from published material to printed material and to expand terminology describing printed materials. Given the significant changes, all databases were searched from start date to June 2011. We searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health, and the EPOC Register.

Selection criteria

We included randomised controlled trials (RCTs), quasi-randomised trials, controlled before and after studies (CBAs) and interrupted time series (ITS) analyses that evaluated the impact of printed educational materials (PEMs) on healthcare professionals' practice or patient outcomes, or both. We included three types of comparisons: (1) PEM versus no intervention, (2) PEM versus single intervention, (3) multifaceted intervention where PEM is included versus multifaceted intervention without PEM. There was no language restriction. Any objective measure of professional practice (e.g. number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included.

Data collection and analysis

Two review authors undertook data extraction independently, and any disagreement was resolved by discussion among the review authors. For analyses, the included studies were grouped according to study design, type of outcome (professional practice or patient outcome, continuous or dichotomous) and type of comparison. For controlled trials, we reported the median effect size for each outcome within each study, the median effect size across outcomes for each study and the median of these effect sizes across studies. Where the data were available, we re-analysed the ITS studies and reported median differences in slope and in level for each outcome, across outcomes for each study, and then across studies. We categorised each PEM according to potential effects modifiers related to the source of the PEMs, the channel used for their delivery, their content, and their format.

Main results

The review includes 45 studies: 14 RCTs and 31 ITS studies. Almost all the included studies (44/45) compared the effectiveness of PEM to no intervention. One single study compared paper-based PEM to the same document delivered on CD-ROM. Based on seven RCTs and 54 outcomes, the median absolute risk difference in categorical practice outcomes was 0.02 when PEMs were compared to no intervention (range from 0 to +0.11). Based on three RCTs and eight outcomes, the median improvement in standardised mean difference for continuous profession practice outcomes was 0.13 when PEMs were compared to no intervention (range from -0.16 to +0.36). Only two RCTs and two ITS studies reported patient outcomes. In addition, we re-analysed 54 outcomes from 25 ITS studies, using time series regression and observed statistically significant improvement in level or in slope in 27 outcomes. From the ITS studies, we calculated improvements in professional practice outcomes across studies after PEM dissemination (standardised median change in level = 1.69). From the data gathered, we could not comment on which PEM characteristic influenced their effectiveness.

Authors' conclusions

The results of this review suggest that when used alone and compared to no intervention, PEMs may have a small beneficial effect on professional practice outcomes. There is insufficient information to reliably estimate the effect of PEMs on patient outcomes, and clinical significance of the observed effect sizes is not known. The effectiveness of PEMs compared to other interventions, or of PEMs as part of a multifaceted intervention, is uncertain.

Resumo

Materiais educativos impressos: efeitos sobre a prática profissional e nos resultados dos cuidados de saúde

Introdução

Materiais educativos impressos são amplamente utilizados em estratégias de divulgação passiva para melhorar a qualidade da prática clínica e os resultados dos pacientes. Estes, tradicionalmente são apresentados em formatos de papel como monografias, publicações em revistas científicas e diretrizes clínicas.

Objetivos

Avaliar o efeito de materiais educativos impressos sobre a prática dos profissionais de saúde e nos resultados de saúde dos pacientes.

Explorar a influência de algumas das características dos materiais educativos impressos (por exemplo, fonte, conteúdo, formato) em seu efeito na prática profissional e nos resultados dos pacientes.

Métodos de busca

Para essa atualização, estratégias de busca foram reescritas e substancialmente modificadas das publicadas na revisão original, a fim de redirecionar a busca de materiais publicados para materiais impressos e expandir a terminologia usada para descrever os materiais impressos. Dadas as mudanças significativas, todas as bases de dados foram pesquisadas a partir da data de início em Junho de 2011. Foram pesquisadas as bases de dados: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health e registro EPOC.

Critério de seleção

Foram incluídos ensaios clínicos randomizados (ECR), ensaios clínicos quase randomizados, estudos controlados antes e depois (ECAD) e séries de casos temporais interruptas (STI) que avaliaram o impacto de materiais educativos impressos (MEIs) sobre a prática dos profissionais da saúde ou resultados dos pacientes, ou em ambos. Foram incluídos três tipos de comparações: (1) MEI versus nenhuma intervenção, (2) MEI versus intervenção única, (3) intervenção multifacetada na qual a MEI é incluída versus intervenção multifacetada sem MEI. Não houve restrição de idioma. Quaisquer medidas objetivas da prática profissional (por exemplo, número de exames solicitados, prescrições de um determinado medicamento) ou de resultados de saúde do paciente (por exemplo, pressão arterial) foram incluídas.

Coleta dos dados e análises

Dois revisores realizaram a extração dos dados de forma independente e desacordos foram resolvidos por discussão entre os revisores. Para análise, os estudos incluídos foram agrupados de acordo com o desenho do estudo, tipo de resultado (prática profissional ou resultado do paciente, contínua ou dicotômica) e tipo de comparação. Para ensaios clínicos controlados, foram informadas a mediana do tamanho de efeito para cada resultado dentro de cada estudo, a mediana do tamanho de efeito entre os resultados para cada estudo e a mediana desses tamanhos de efeito entre os estudos. Quando os dados eram disponíveis, foram reanalisados os estudos de STI e relatada diferença das medianas para cada resultado, entre os resultados para cada estudo e, em seguida, entre os estudos. Foi categorizado cada MEI de acordo com os potenciais efeitos modificadores relacionados à fonte do MEI, canal utilizado para divulgação, conteúdo e formato.

Principais resultados

A revisão incluiu 45 estudos: 14 ECR e 31 STI. Quase todos os estudos incluídos (44/45) compararam a efetividade do MEI versus nenhuma intervenção. Um único estudo comparou a MEI em papel ao mesmo documento divulgado em CD-ROM. Baseado em sete ECR e 54 resultados, a mediana da diferença do risco absoluto na categoria resultados práticos foi de 0,02 quando as MEIs foram comparadas a nenhuma intervenção (intervalo de 0 a +0,11). Baseado em três ECR e oito resultados, a mediana da melhora na diferença de média padronizada para os resultados da prática profissional contínua foi de 0,13 quando as MEIs foram comparadas a nenhuma intervenção (intervalo de -0,16 a +0,36). Apenas dois ECR e dois STI informaram resultados dos pacientes. Além disso, foram reanalisados ​​54 resultados de 25 estudos STI, por meio de regressão de séries temporais e observado melhora estatisticamente significante em 27 resultados. A partir dos estudos de STI, foram calculadas melhorias nos resultados de prática profissional entre os estudos após a divulgação do MEI (variação da mediana padronizada em nível = 1,69). A partir dos dados levantados, não se poderia deixar de comentar que as características dos MEIs influenciaram sua efetividade.

Conclusão dos autores

Os resultados desta análise sugerem que quando aplicada sozinha e comparada a nenhuma intervenção, as MEIs podem ter um pequeno efeito benéfico sobre os resultados da prática profissional. Há insuficiente informação para estimar com segurança os efeitos das MEIs sobre os resultados dos pacientes e não é conhecido o tamanho de efeito observado na importância clínica. A efetividade das MEIs comparada a outras intervenções ou das MEIs como parte de uma intervenção multifacetada é incerta.

Notas de tradução

Traduzido por: Rodrigo Jensen, Unidade de Medicina Baseada em Evidências da Unesp, Brasil Contato: portuguese.ebm.unit@gmail.com

摘要

纸本教学材料:对于医疗专业实践及医疗保健结果的影响

研究背景

作为一种广泛使用的被动式传播方式,纸本教学材料(Printed educational materials,PEMs)被用以改善临床实践以及病患结果。它通常表现为纸本形式,例如专著、同行评议期刊上的文章以及临床指南。

研究目的

评价纸本教学材料对于医疗人员的医疗实践和患者结局的影响。

研究一些纸本教材的特性(如来源、内容、形式)是否会影响其对医疗实践及患者结局的作用。

检索策略

此次更新,重写了检索策略,与之前发表的综述有了实质性的差异,将关注点由出版材料到印刷材料,并且扩大印刷材料术语。鉴于上述重大变化,检索下列电子数据库由建库到2011年6月的数据: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health,以及EPOC Register.

标准/纳入排除标准

我们纳入随机对照试验(RCT)、半随机对照试验,前后对照研究及间断时间序列分析,这些研究评估了纸本教材对于医疗实践及/或患者结局的影响。有三种类型的比较:(1)纸本教材与无干预,(2)纸本教材与单一的干预,(3)含有纸本教材的多方面干预与没有纸本教材的多方面干预。没有语言限制。任何客观测量了专业实践(如数量的测试,处方的特定药物)或病人的健康结果(如血压)的研究都纳入。

数据收集与分析

两个评价者独立进行数据提取,任何分歧通过综述作者间的讨论进行解决。为了分析,将纳入研究根据研究设计类型,结局类型(专业实践或患者结局,连续变量或二分类变量)和对照类型进行分组。对于对照试验,我们报告每篇研究中每项结局的中位效应量数,每个研究中各结局效应量的中位数,及各个研究之间其效应量的中位数。若数据可获取,我们重新分析间断时间序列研究并报告每个结局中位数在斜坡和水平的差异,交叉每个研究成果并交叉各个研究。我们按照潜在影响因子给各纸本教材分类,这些影响因子包括:材质,运输的渠道,内容以及格式。

主要结果

本篇系统评价纳入45项研究,14项随机对照试验和31项中断序列研究(ITS)。几乎所有纳入的研究(45篇中有44篇)都是与无干预对照纸本教材的有效性。仅有一项研究比较了基于纸本教材,和拷贝在光盘上的相同文档。基于七项随机对照试验和54个研究结果,PEMs相较无干预措施(范围0 ~ +0.11),不同种类实践结局的绝对风险差异为中位数为0.02。基于三项随机对照试验和8个研究结果,PEMs相较无干预措施(范围-0.16 ~ +0.36),不同种类实践结局的绝对风险差异中位数的+0.11),不同种类实践结局的绝对风险差异为中位数为0.13。只有两项随机对照试验和两项中断序列研究(ITS)报告了患者的治疗效果。此外,我们根据25项中断序列研究(ITS)再次分析了54个研究结果,利用时间序列回归,观察了27个结果的水平或斜率的统计学显著改善。根据中断序列研究(ITS),我们计算了这些研究中专业实践结果在PEM传播方式后的改进(标准中值变化水平=1.69)。根据收集到的数据,我们不能评价PEM的特性影响效果。

作者结论

这篇综述的结果认为,相对于无干预措施,单独使用纸本教材对医疗实践结果可能产生很小的有利影响,但没有足够的信息来可靠地估计对患者预后的影响及影响的大小,临床意义尚不清楚。纸本教材对比其他干预措施的效果,或者纸本教材作为多种干预措施的一部分的效果比较并不明确。

翻译注解

更新译者:王迪,审校:孙瑾。北京中医药大学循证医学中心。2017年7月15日。原译者:中国循证卫生保健协作网。重庆医科大学公共卫生与管理学院,翻译时间:2012年

Plain language summary

Printed educational materials: effects on professional practice and healthcare outcomes

Medical journals and clinical practice guidelines are common channels to distribute scientific information to healthcare providers, as they allow a wide distribution at relatively low costs. Delivery of printed educational materials is meant to improve healthcare professionals' awareness, knowledge, attitudes, and skills, and ultimately improve professional practice and patients' health outcomes. Results of this review suggest that printed educational materials slightly improve healthcare professional practice compared to no intervention, but a lack of results prevent any conclusion on their impact on patient outcomes.

Resumo para leigos

Materiais educativos impressos: efeitos sobre a prática profissional e nos resultados do cuidado

Revistas médicas e diretrizes de prática clínica são canais comuns para divulgar informação científica para os profissionais de saúde, uma vez que permitem uma ampla divulgação a custos relativamente baixos. A distribuição de materiais educativos impressos se destina a melhorar a consciência, conhecimento, atitudes dos profissionais de saúde e melhorar a prática profissional e os resultados de saúde dos pacientes. Os resultados desta revisão sugerem que os materiais educativos impressos melhoram um pouco a prática dos profissionais de saúde comparado a nenhuma intervenção, mas a falta de resultados impedem qualquer conclusão sobre o seu impacto nos resultados dos pacientes.

Notas de tradução

Traduzido por: Rodrigo Jensen, Unidade de Medicina Baseada em Evidências da Unesp, Brasil Contato: portuguese.ebm.unit@gmail.com

எளியமொழிச் சுருக்கம்

அச்சிடப்பட்ட விளக்கக் கல்வி பொருள்கள்: தொழில்முறை பயிற்சி மற்றும் ஆரோக்கிய பராமரிப்பு பயன்களின் மீதான விளைவுகள்

ஒப்பீட்டளவில், குறைந்த செலவுகளில் ஒரு பரந்த பகிர்மானத்தை அனுமதிப்பதால், அறிவியல் தகவலை ஆரோக்கிய பராமரிப்பு வல்லுநர்களுக்கு பகிர மருத்துவ பத்திரிகைகள் மற்றும் மருத்துவ நடைமுறை பரிந்துரைகள் பொதுவான வழிவகைகளாக இருக்கின்றன. அச்சிடப்பட்ட விளக்கக் கல்வி பொருள்களை வழங்குதல், ஆரோக்கிய பராமரிப்பு வல்லுநர்களின் விழிப்புணர்வு, அறிவு, மனப்பாங்குகள், மற்றும் திறன்கள் ஆகியவற்றை மேம்படுத்த, மற்றும் முடிவாக, தொழில்முறை பயிற்சி மற்றும் நோயாளிகளின் ஆரோக்கிய விளைவுகளை மேம்படுத்த கருதப்படுகின்றன. சிகிச்சையின்மையோடு ஒப்பிடும் போது, அச்சிடப்பட்ட விளக்கக் கல்வி பொருள்கள் ஆரோக்கிய பராமரிப்பு வல்லுநர் பயிற்சியை சிறிதளவு மேம்படுத்துகிறது என்று இந்த திறனாய்வின் முடிவுகள் பரிந்துரைக்கின்றன, ஆனால் நோயாளி விளைவுகளின் மீதான அவற்றின் தாக்கத்தின் மீதான ஒரு தீர்மானத்தை முடிவுகள் இல்லாதது தடுக்கிறது.

மொழிபெயர்ப்பு குறிப்புகள்

மொழிபெயர்ப்பாளர்கள்: சிந்தியா ஸ்வர்ணலதா ஸ்ரீகேசவன், தங்கமணி ராமலிங்கம், ப்ளசிங்டா விஜய், ஸ்ரீகேசவன் சபாபதி.

概要

纸本教学材料:对于医疗专业实践及医疗保健结果的影响

医学期刊及临床实践指南是常见的为医务人员传播科学信息的渠道,传播范围广且花费较低。印制并传播教材的目的是改善医疗保健提供者的认知、知识、态度和技能,然后从根本上提高专业实践并改善患者健康结局。这篇综述认为相对于无干预措施,纸本教材也许对医疗实践有略微改善的效果,由于结果不充分,尚不能确定其对患者结局的影响。

翻译注解

更新译者:王迪,审校:孙瑾。北京中医药大学循证医学中心。2017年7月15日。原译者:中国循证卫生保健协作网。重庆医科大学公共卫生与管理学院,翻译时间:2012年

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