Abstract:
RATIONALE, AIMS AND OBJECTIVES:Traditional continuing medical education programmes that offer passive learning have been shown to be poorly effective at changing doctors' clinical behaviour. A multifaceted evidence-based medicine (EBM) intervention was conducted at the largest health maintenance organization (HMO) in Israel, attempting to facilitate a change in doctors' attitudes, knowledge and clinical behaviour. No study thus far has examined the association between the teaching of EBM principles and doctors' clinical behaviour. This study evaluated the intervention programme through a controlled trial and before and after study. The objective of the evaluation is binary: first, to examine the impact of an educational intervention on family doctors' test ordering performance and drug utilization by their patients; and second, to assess the impact of the intervention on attitudes towards evidence-based practice and knowledge. METHODS:Controlled trial and before and after study. Primary care clinics comprising similar patient characteristics were randomly allocated to the experimental or to the control group. Doctors in the experimental group participated in an EBM educational intervention, while the control group did not take part in the intervention. Clinicians' test ordering performance and their patients' drug utilization were derived from the HMO's database before intervention, after workshops and after intervention. Participants in the controlled trial consisted of 75 doctors and their 106 349 patients. The before and after study evaluated intervention doctors' (n = 70) EBM attitudes and knowledge through a validated questionnaire before and after workshops. RESULTS:EBM workshops enhanced intervention doctors' EBM knowledge scores from 22.4/100 before workshops to 40.8/100 after workshops (P = 0.000). Doctors improved their ability to formulate clinical questions while enhancing their search strategy using Medline. In a linear regression model, two covariates, specialization (B = 12.59; P = 0.001) and habitually reading medical journals (B = 6.45; P = 0.052), best explained the variance in doctors' EBM knowledge scores, while controlling for pre-intervention scores (R(2) = 0.569; P = 0.000). Results from the controlled trial indicated that no statistically significant differences were found between intervention and control doctors' test ordering performances, and their patients' drug utilization. CONCLUSIONS:The results of the study suggest that the intervention positively influenced attitudes and knowledge; however, no statistically significant impact was found on doctors' test ordering performance and on their patients' drug utilization. The intervention's inability to change doctors' clinical behaviour might be remedied by improving future interventions through adding additional facets to the educational intervention, such as social marketing techniques and personal feedback. A longer and more extensive intervention might be more effective but is extremely difficult to execute as we found in this study. Future larger-scale interventions must incorporate the intervention into the routines of the organization, thus minimizing barriers towards EBM implementation.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Shuval K,Berkovits E,Netzer D,Hekselman I,Linn S,Brezis M,Reis Sdoi
10.1111/j.1365-2753.2007.00859.xsubject
Has Abstractpub_date
2007-08-01 00:00:00pages
581-98issue
4eissn
1356-1294issn
1365-2753pii
JEP859journal_volume
13pub_type
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00654.x
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abstract:RATIONALE, AIMS AND OBJECTIVES:Wristbands are essential for accurate patient identification. Some evidence suggests that missing wristbands is not an infrequent occurrence in acute hospitals. The National Patient Safety Agency (NPSA) has developed guidance on patient identification for hospitals in England and Wales. H...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.01004.x
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abstract:OBJECTIVES:The objectives of this paper were to investigate quality of care for individuals with osteoarthritis (OA) and to determine if those most in need had the outcome of a total joint replacement (TJR). Key quality indicators were involvement in treatment decisions, appropriate information provision and outcomes o...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01616.x
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abstract::Identified as a mental disorder by Emil Kraepelin and Eugen Bleuler (1858-1939), schizophrenia has been subject to various criticisms, on both political and scientific grounds. Still, until the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, as the'Spectrum of Schizophrenia and Othe...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12608
更新日期:2017-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Predictors of intimate partner violence (IPV) include husband, wife and relational characteristics. However, we know little about the proximal, day-to-day triggering of abusive events. The purpose of the study was to analyse the daily temporal relationships among environmental, relational...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/jep.12259
更新日期:2014-10-01 00:00:00
abstract:INTRODUCTION:Recently, some leaders of the evidence-based medicine (EBM) movement drew attention to the "unintended" negative consequences associated with EBM. The term 'cognitive biases plus' was introduced in part I to encompass cognitive biases, conflicts of interests, fallacies and certain behaviours. HYPOTHESIS:'...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/jep.12291
更新日期:2014-12-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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更新日期:2002-11-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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更新日期:1997-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
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更新日期:2020-05-26 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2012.01829.x
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abstract:RATIONALE, AIMS AND OBJECTIVES:Chronic disorders of consciousness (CDoC) pose significant problems of understanding for both medical professionals and the relatives and friends of the patient. This paper explores the tensions between the different interpretative resources that are drawn upon by lay people and professio...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12220
更新日期:2015-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12430
更新日期:2016-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.00989.x
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abstract:RATIONALE, AIMS AND OBJECTIVES:It has been proposed that delivery should be accomplished within 30 minutes after diagnosis of fetal distress. The objective of this study was to determine the decision-to-delivery interval (DDI) in emergency caesarean delivery for non-reassuring fetal heart rate (FHR). METHODS:A total o...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12613
更新日期:2016-12-01 00:00:00
abstract:RATIONALE, AIMS & OBJECTIVES:A variety of transition of care interventions has been evaluated to date to reduce readmissions. No studies evaluated effectiveness of clinical pharmacist's home-visits to recently discharged Medicare Advantage patients with the goal of preventing subsequent readmissions and urgent care use...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12495
更新日期:2016-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01688.x
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVES:The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilizati...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01277.x
更新日期:2010-12-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12561
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01511.x
更新日期:2012-02-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2011.01725.x
更新日期:2011-10-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.00980.x
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00768.x
更新日期:2007-12-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00620.x
更新日期:2006-04-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
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更新日期:2011-10-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2009.01210.x
更新日期:2010-08-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01460.x
更新日期:2010-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13492
更新日期:2020-10-25 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12677
更新日期:2017-06-01 00:00:00
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journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.1998.tb00088.x
更新日期:1998-11-01 00:00:00
abstract::Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the struct...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01387.x
更新日期:2010-04-01 00:00:00