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Local opinion leaders: effects on professional practice and health care outcomes

1999; Cochrane; Linguagem: Inglês

10.1002/14651858.cd000125

1469-493X

MA O'Brien, AD Oxman, R. Brian Haynes, D A Davis, Nick Freemantle, EL Harvey,

Health Policy Implementation Science

Objectives To determine the effectiveness of using local opinion leaders in improving health care professional practice or patient outcomes. Both the theory of diffusion of innovations and the social influences model of behaviour change suggest that using local opinion leaders to transmit norms and model appropriate behaviour may improve health professional practice. Local opinion leaders may also enhance the ability of local providers to determine root causes of variation in practice. Search methods Computerised MEDLINE and CINAHL searches were combined with a review of reference lists from articles to identify trials of interventions aimed at improving the practice of health care professionals. Selection criteria Design = random allocation of participants to one or more intervention group(s); participants = health care professionals excluding students; intervention = use of local opinion leaders defined as health professionals nominated by their colleagues as 'educationally influential', the investigators must explicitly state that the opinion leaders were identified by their colleagues; outcomes = objectively measured provider performance in a health care setting (such as number of tests ordered, prescriptions for a particular drug) or patient outcome (including blood pressure, number of caesarean sections). Data collection and analysis The quality of trials was assesed by two reviewers using eight criteria. Information regarding methods, subjects, interventions, and outcomes was extracted. Main results Six trials met all selection criteria. The targeted behaviour in all trials was the general management of a variety of patient problems including osteoarthritis, rheumatoid arthritis, chronic lung disease, vaginal birth after caesarian section, labour and delivery, and urinary catheter care. Five of six trials demonstrated some improvement in health professional practice for at least one outcome variable. In three trials that measured patient outcomes, only one achieved an impact upon practice that was of practical importance: a local opinion leader was effective in improving the rate of vaginal birth after previous caesarian section. Authors' conclusions Use of local opinion leaders results in mixed effects on professional practice. However, it is not clear what local opinion leaders do and replicable descriptions are needed. Further research is required to determine if opinion leaders can be identified and in which circumstances they are likely to influence the practice of their peers.