Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Dec 1999; 49(449): 995–1001.
PMCID: PMC1313589

Recommendations for future studies: a systematic review of educational interventions in primary care settings.

Abstract

Systematic reviews are an important part of the current move towards evidence-based practice. Independent reviewers use a variety of search strategies to identify and assess relevant articles in the field of concern. Criteria for quality must be agreed and articles evaluated accordingly. This study systematically reviewed educational interventions targeting physicians in primary care (excluding hospital clinic and academic settings) to determine their effectiveness in changing behaviour and to investigate whether studies gave information about the resource implications of the interventions described and their rationale for choosing a particular target group. Studies in English, French, or German language journals were included. The review applied the criteria of the Cochrane Collaboration for methodological quality of studies (but was not conducted under the auspices of the Cochrane Collaboration). The results showed that relatively few studies had occurred in primary care compared with academic and hospital clinic settings. Many articles did not fit the criteria for rigour of method, and those that did were very heterogeneous in method and target group. Only two studies assessed resource implications, and one study also calculated economic benefits. The review suggests that future studies should either target geographical areas or doctors with an identifiable learning need associated with patient outcome, and that studies should be evaluated on their 'intention to educate'. Evaluations of educational initiatives need to describe the resource implications versus measurable benefits of the intervention to make their studies useful to policymakers and planners of educational provision.

Full Text

The Full Text of this article is available as a PDF (55K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. [PubMed]
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992 Sep 2;268(9):1111–1117. [PubMed]
  • Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. [PubMed]
  • Barnum SR, Jones JL, Müller-Ladner U, Samimi A, Campbell IL. Chronic complement C3 gene expression in the CNS of transgenic mice with astrocyte-targeted interleukin-6 expression. Glia. 1996 Oct;18(2):107–117. [PubMed]
  • Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. Int J Qual Health Care. 1994 Jun;6(2):115–132. [PubMed]
  • McConnell TS, Cushing AH, Bankhurst AD, Healy JL, McIlvenna PA, Skipper BJ. Physician behavior modification using claims data: tetracycline for upper respiratory infection. West J Med. 1982 Nov;137(5):448–450. [PMC free article] [PubMed]
  • Wilson DM, Taylor DW, Gilbert JR, Best JA, Lindsay EA, Willms DG, Singer J. A randomized trial of a family physician intervention for smoking cessation. JAMA. 1988 Sep 16;260(11):1570–1574. [PubMed]
  • Feder G, Griffiths C, Highton C, Eldridge S, Spence M, Southgate L. Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London. BMJ. 1995 Dec 2;311(7018):1473–1478. [PMC free article] [PubMed]
  • Dietrich AJ, O'Connor GT, Keller A, Carney PA, Levy D, Whaley FS. Cancer: improving early detection and prevention. A community practice randomised trial. BMJ. 1992 Mar 14;304(6828):687–691. [PMC free article] [PubMed]
  • Stross JK, Bole GG. Evaluation of an educational program for primary care practitioners, on the management of osteoarthritis. Arthritis Rheum. 1985 Jan;28(1):108–111. [PubMed]
  • White PT, Pharoah CA, Anderson HR, Freeling P. Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract. 1989 May;39(322):182–186. [PMC free article] [PubMed]
  • Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med. 1983 Jun 16;308(24):1457–1463. [PubMed]
  • Bearcroft PW, Small JH, Flower CD. Chest radiography guidelines for general practitioners: a practical approach. Clin Radiol. 1994 Jan;49(1):56–58. [PubMed]
  • Bexell A, Lwando E, von Hofsten B, Tembo S, Eriksson B, Diwan VK. Improving drug use through continuing education: a randomized controlled trial in Zambia. J Clin Epidemiol. 1996 Mar;49(3):355–357. [PubMed]
  • Emslie C, Grimshaw J, Templeton A. Do clinical guidelines improve general practice management and referral of infertile couples? BMJ. 1993 Jun 26;306(6894):1728–1731. [PMC free article] [PubMed]
  • Evans CE, Haynes RB, Birkett NJ, Gilbert JR, Taylor DW, Sackett DL, Johnston ME, Hewson SA. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA. 1986 Jan 24;255(4):501–504. [PubMed]
  • Jennett PA, Laxdal OE, Hayton RC, Klaassen DJ, Swanson RW, Wilson TW, Spooner HJ, Mainprize GW, Wickett RE. The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ. 1988 Mar;22(2):139–145. [PubMed]
  • Kendrick T, Burns T, Freeling P. Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. BMJ. 1995 Jul 8;311(6997):93–98. [PMC free article] [PubMed]
  • Oakeshott P, Kerry SM, Williams JE. Randomized controlled trial of the effect of the Royal College of Radiologists' guidelines on general practitioners' referrals for radiographic examination. Br J Gen Pract. 1994 May;44(382):197–200. [PMC free article] [PubMed]
  • Onion CW, Dutton CE, Walley T, Turnbull CJ, Dunne WT, Buchan IE. Local clinical guidelines: description and evaluation of a participative method for their development and implementation. Fam Pract. 1996 Feb;13(1):28–34. [PubMed]
  • Putnam RW, Curry L. Impact of patient care appraisal on physician behaviour in the office setting. Can Med Assoc J. 1985 May 1;132(9):1025–1029. [PMC free article] [PubMed]
  • Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995 Sep 25;155(17):1877–1884. [PubMed]
  • Rutz W, von Knorring L, Wålinder J, Wistedt B. Effect of an educational program for general practitioners on Gotland on the pattern of prescription of psychotropic drugs. Acta Psychiatr Scand. 1990 Dec;82(6):399–403. [PubMed]
  • Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W. A randomized trial of continuing medical education. N Engl J Med. 1982 Mar 4;306(9):511–515. [PubMed]
  • Howe A. Detecting psychological distress: can general practitioners improve their own performance? Br J Gen Pract. 1996 Jul;46(408):407–410. [PMC free article] [PubMed]
  • Winkens RA, Pop P, Grol RP, Kester AD, Knottnerus JA. Effect of feedback on test ordering behaviour of general practitioners. BMJ. 1992 Apr 25;304(6834):1093–1096. [PMC free article] [PubMed]
  • Zaat JO, van Eijk JT, Bonte HA. Laboratory test form design influences test ordering by general practitioners in The Netherlands. Med Care. 1992 Mar;30(3):189–198. [PubMed]
  • Fullard E, Fowler G, Gray M. Promoting prevention in primary care: controlled trial of low technology, low cost approach. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1080–1082. [PMC free article] [PubMed]
  • Lassen LC, Kristensen FB. Peer comparison feedback to achieve rational and economical drug therapy in general practice: a controlled intervention study. Scand J Prim Health Care. 1992 Mar;10(1):76–80. [PubMed]
  • Perera DR, LoGerfo JP, Shulenberger E, Ylvisaker JT, Kirz HL. Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. J Fam Pract. 1983 Apr;16(4):785–788. [PubMed]
  • Cowan PF. An intervention to improve the assessment of alcoholism by practicing physicians. Fam Pract Res J. 1994 Mar;14(1):41–49. [PubMed]
  • De Santis G, Harvey KJ, Howard D, Mashford ML, Moulds RF. Improving the quality of antibiotic prescription patterns in general practice. The role of educational intervention. Med J Aust. 1994 Apr 18;160(8):502–505. [PubMed]
  • Newton-Syms FA, Dawson PH, Cooke J, Feely M, Booth TG, Jerwood D, Calvert RT. The influence of an academic representative on prescribing by general practitioners. Br J Clin Pharmacol. 1992 Jan;33(1):69–73. [PMC free article] [PubMed]
  • Palmer RH, Hargraves JL. Quality improvement among primary care practitioners: an overall appraisal of results of the Ambulatory Care Medical Audit Demonstration Project. Med Care. 1996 Sep;34(9 Suppl):SS102–SS113. [PubMed]
  • Pond CD, Mant A, Kehoe L, Hewitt H, Brodaty H. General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? Fam Pract. 1994 Jun;11(2):141–147. [PubMed]
  • Ray WA, Blazer DG, 2nd, Schaffner W, Federspiel CF, Fink R. Reducing long-term diazepam prescribing in office practice. A controlled trial of educational visits. JAMA. 1986 Nov 14;256(18):2536–2539. [PubMed]
  • Schellevis FG, van Eijk JT, van den Lisdonk EH, vd Velden J, van Weel C. Implementing guidelines in general practice. Evaluation of process and outcome of care in chronic diseases. Int J Qual Health Care. 1994 Sep;6(3):257–266. [PubMed]
  • Szonyi G, Millard RJ. Controlled trial evaluation of a General Practitioner education package on incontinence: use of a mailed questionnaire. Br J Urol. 1994 Jun;73(6):615–620. [PubMed]
  • Yeo GT, de Burgh SP, Letton T, Shaw J, Donnelly N, Swinburn ME, Phillips S, Bridges-Webb C, Mant A. Educational visiting and hypnosedative prescribing in general practice. Fam Pract. 1994 Mar;11(1):57–61. [PubMed]
  • Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Res Med Educ. 1988;27:72–77. [PubMed]
  • Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993 Jun;8(6):318–324. [PubMed]
  • Putnam RW, Curry L. Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved? CMAJ. 1989 Apr 1;140(7):806–809. [PMC free article] [PubMed]
  • Kottke TE, Brekke ML, Solberg LI, Hughes JR. A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I. JAMA. 1989 Apr 14;261(14):2101–2106. [PubMed]
  • Lane DS, Polednak AP, Burg MA. Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines. J Fam Pract. 1991 Oct;33(4):359–368. [PubMed]
  • Grol R, Mokkink H, Schellevis F. The effects of peer review in general practice. J R Coll Gen Pract. 1988 Jan;38(306):10–13. [PMC free article] [PubMed]
  • Grant GB, Gregory DA, van Zwanenberg TD. Development of a limited formulary for general practice. Lancet. 1985 May 4;1(8436):1030–1032. [PubMed]
  • Hamley JG, Brown SV, Crooks J, Knox JD, Murdoch JC, Patterson AW. Prescribing in general practice and the provision of drug information. J R Coll Gen Pract. 1981 Nov;31(232):654–660. [PMC free article] [PubMed]
  • Frame PS, Kowulich BA, Llewellyn AM. Improving physician compliance with a health maintenance protocol. J Fam Pract. 1984 Sep;19(3):341–344. [PubMed]
  • Madlon-Kay DJ. Improvement in family physician recognition and treatment of hypercholesterolemia. Arch Intern Med. 1989 Aug;149(8):1754–1755. [PubMed]
  • Moran JA, Kirk P, Kopelow M. Measuring the effectiveness of a pilot continuing medical education program. Can Fam Physician. 1996 Feb;42:272–276. [PMC free article] [PubMed]
  • Fleming DM, Lawrence MS. Impact of audit on preventive measures. Br Med J (Clin Res Ed) 1983 Dec 17;287(6408):1852–1854. [PMC free article] [PubMed]
  • Schaffner W, Ray WA, Federspiel CF, Miller WO. Improving antibiotic prescribing in office practice. A controlled trial of three educational methods. JAMA. 1983 Oct 7;250(13):1728–1732. [PubMed]
  • Tracey JM. Peer review. Part 1: Attitudes to internal and external standards. N Z Med J. 1991 Jan 23;104(904):8–10. [PubMed]
  • Tracey JM, Arroll B, Richmond DE, Barham PM. The validity of general practitioners' self assessment of knowledge: cross sectional study. BMJ. 1997 Nov 29;315(7120):1426–1428. [PMC free article] [PubMed]
  • Rutz W, von Knorring L, Wålinder J. Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand. 1992 Jan;85(1):83–88. [PubMed]
  • Stern JM, Simes RJ. Publication bias: evidence of delayed publication in a cohort study of clinical research projects. BMJ. 1997 Sep 13;315(7109):640–645. [PMC free article] [PubMed]
  • Tracey JM. Peer review. Part 2: The influence of internal and external standards on outcome. N Z Med J. 1991 Feb 27;104(906):66–67. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...