Table 3 Effectiveness of professional behaviour change strategies from selected EPOC systematic reviews

Printed Educational Materials

12 randomised trials

Median absolute improvement of care on categorical process outcomes (e.g., x-ray requests, prescribing and smoking cessation activities) of 4.3% (range −8.0% to +9.6%) across studies.

11 nonrandomised studies

Farmer et al.[37]

Educational Meetings

81 randomised trials (involving more than 11,000 health professionals)

Median absolute improvement in care of 6.0% (interquartile range +1.8% to 15.3%).

Forsetlund et al.[38]

Larger effects were associated with higher attendance rates, mixed interactive and didactic meetings and interactive meetings.

Smaller effects were observed for complex behaviours and for less serious outcomes.

Educational Outreach

69 randomised trials (involving more than 15,000 health professionals)

Median absolute improvements in:

·prescribing behaviours (17 comparisons) of 4.8% (interquartile range +3.0% to + 6.5%);

O’Brien et al.[39]

·other behaviours (17 comparisons) of 6.0% (interquartile range +3.6% to +16.0%).

The effects of educational outreach for changing more complex behaviours are less certain.

Local Opinion Leaders

18 randomised trials (involving more than 296 hospitals and 318 primary care physicians)

Median absolute improvement of care of 12.0% across studies (interquartile range +6.0% to +14.5%).

Flodgren et al.[40]

Audit and Feedback

118 randomised trials

Median absolute improvement of care of 5.0% (interquartile range +3% to +11%).

Jamtvedt et al.[41]

In general, larger effects were seen if baseline compliance was low.

Computerized Reminders

28 randomised trials

Median absolute improvement of care of 4.2% (interquartile range +0.8% to +18.8%).

Shojania et al.[42]

Comment: Most studies have examined the effects of relatively simple reminders; the results of more complex decision support systems, especially for chronic disease management, have been less successful.

Tailored Interventions

26 randomised trials

Meta-regression using 12 randomised trials. Pooled odds ratio of 1.52 (95% CI, 1.27 to 1.82, p < .001)

Baker et al.[43]