January, 2017 - SUPPORT Summary of a systematic review | print this article |

What are the effects of interventions to encourage the use of systematic reviews in clinical decision making?

Clinical decision making is often not based on the best available evidence. Reasons for this vary, and may be related to factors within the healthcare setting, patients, or health practitioners. Interventions have been designed to encourage the use of systematic reviews in making clinical decisions as one way of improving clinical decision making.

 

Key messages

 

  • It is uncertain whether targeted multifaced or single interventions (such as training) improve informed decision making by practitioners.
  • Multifaceted interventions may improve awareness and use of evidence based resources, such as searching for systematic reviews using online libraries.
  • None of the included studies was conducted in a low income country.

 

Background

Multifaceted and simple interventions - including components such as educational visits by experts, workshops and other types of training, reminders, audit and feedback, and provision of resources - have been evaluated to determine their effectiveness for improving clinical decision making. These interventions have been targeted at different audiences with different outcome measures in different settings.




About the systematic review underlying this summary

Review objectives: To assess the effectiveness of interventions for seeking, appraising, and applying evidence from systematic reviews in clinical decisions.
Type of What the review authors searched for What the review authors found
Study designs & interventions Quantitative studies using any intervention to encourage use of systematic reviews in clinical decision making
Five randomised trials that examined strategies ranging from multifaceted to simple interventions.
Participants Healthcare practitioners of any specialty involved in providing patient care. Physicians (4 studies) one each in Canada, Thailand, UK, and Uruguay; Midwives (3 studies) one each in Thailand, UK, and Uruguay; Residents (1 study Uruguay); Interns (1 study Thailand); Students (1 study Thailand); Dentists (1 study Scotland)
Settings All settings
Primary care (1 study), hospitals (3 studies), dental practice (1 study)
Outcomes Change in professional performance (prescribing patterns, use of diagnostic tests), health outcomes for patients (return visits, adverse events, length of stay, decrease in admissions), and measures of health care provider satisfaction, knowledge, or attitude.
All five studies provided objective performance measures. Patient health outcome measures and measures of healthcare provider satisfaction were not reported in any study.
Date of most recent search: July 2009
Limitations: This is a well conducted systematic review with only minor limitations.

Perrier L, Mrklas K, Shepperd S, et al. Interventions encouraging the use of systematic reviews in clinical decision making: a systematic review. J Gen Intern Med 2011; 26:419-26.

Summary of findings

This review includes five studies all conducted in middle and high income countries. All five trials reported some form of professional performance measure. Reported outcome measures varied and included measures of preventive performance, up to datedness of practice, prescription patterns, uptake of recommended practices, and other measures.

One study in 40 hospitals in Thailand and Mexico reported a measure of healthcare provider satisfaction, which was their awareness and use of the WHO Reproductive Health Library. This multifaceted intervention included organizational buy in, use of facilitators, provision of print materials, and interactive workshops on using the WHO Reproductive Health Library.


 

  • It is uncertain whether multifaceted or simple interventions (such as use of facilitators and provision of printed materials) improve clinical decision making as measured by professional performance. The certainty of this evidence is very low.
  • Multifaceted interventions may improve awareness and use of the WHO Reproductive Health Library. The certainty of this evidence is low.

 

Interventions for encouraging use of systematic reviews in clinical decision making

People: All healthcare practitioners providing care to patients.
Settings
:  Hospitals, primary care and other healthcare settings.
Intervention
: Multifaceted or simple interventions (such as workshops, use of facilitators and provision of materials).
Comparison
: No intervention.
Outcomes Impact Certainty of the evidence
(GRADE)
Changes in physician performance
It is uncertain whether interventions geared towards encouraging use of systematic reviews in clinical decision making lead to positive changes in physician performance.
Very low

Interventions may improve awareness and use of libraries to search for systematic reviews.
Low
GRADE: GRADE Working Group grades of evidence (see above and last page)

 

 

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

All studies included in the review were conducted in middle and high income countries.

 

  • The studies included a variety of interventions including workshops, educational visits, provision of materials, and use of facilitators.

The applicability of these findings to low income countries is uncertain.

 

  • Important issues to consider in adopting these interventions include acceptance by the end user and integration into the healthcare system.
EQUITY
The included studies did not report data regarding differential effects of the interventions across different population groups.
Interventions that are effective could reduce health inequity if targeted at disadvantaged settings, as a result of providing better quality of care to disadvantaged populations. Conversely, they could increase inequity if targeted at both more and less advantaged settings, if they were more acceptable and easier to integrate into healthcare systems in more advantaged settings.
ECONOMIC CONSIDERATIONS
None of the included studies assessed costs associated with the interventions.

The cost and cost effectiveness of these interventions are uncertain.

 

  • Implementing these interventions requires financial and human resources. The need for and availability of these resources need to be assessed prior to implementation.
MONITORING & EVALUATION

The review found that some interventions lead to positive changes but they did not adequately measure patient and practitioner performance outcomes.

 

  • No studies of the effect of these interventions in low income countries were found.

Rigorous impact evaluations of these strategies should be considered before scaling up their use.

 

  • These studies should be randomised trials and should use standardised outcomes that include changes in practitioner performance, changes in patient health outcomes, and measures of practitioner and patient satisfaction.

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgements were made see:www.supportsummaries.org/methods

 

Additional information

Related literature

Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005; 4: CD003539.

 

This summary was prepared by

Michael Gathu, KEMRI Wellcome Trust Research Programme, Kenya.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Laure Perrier and Airton Stein.

 

This review should be cited as

Perrier L, Mrklas K, Shepperd S, et al. Interventions encouraging the use of sys-tematic reviews in clinical decision-making: a systematic review. J Gen Intern Med 2011; 26:419-26.

 

The summary should be cited as

Gathu M. What are the effects of interventions to encourage the use of systematic reviews in clinical decision-making? A SUPPORT Summary of a systematic review. January 2017. www.supportsummaries.org

 

Keywords

 evidence informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care

 

This summary was prepared with additional support from:

 KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.

 

 

 

 

 

 

 

 

 



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