No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.
OBJECTIVE
To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes.


METHODS
MEDLINE, SCISEARCH, CINAHL and the Research and Development Resource Base in CME were searched for trials of educational interventions in the health care professions published between 1970 and 1993 inclusive.


METHODS
Studies were selected if they provided objective measurements of health professional performance or health outcomes and employed random or quasi-random allocation methods in their study designs to assign individual subjects or groups. Interventions included such activities as conferences, outreach visits, the use of local opinion leaders, audit and feedback, and reminder systems.


METHODS
Details extracted from the studies included the study design; the unit of allocation (e.g., patient, provider, practice, hospital); the characteristics of the targeted health care professionals, educational interventions and patients (when appropriate); and the main outcome measure.


RESULTS
The inclusion criteria were met by 102 trials. Areas of behaviour change included general patient management, preventive services, prescribing practices, treatment of specific conditions such as hypertension or diabetes, and diagnostic service or hospital utilization. Dissemination-only strategies, such as conferences or the mailing of unsolicited materials, demonstrated little or no changes in health professional behaviour or health outcome when used alone. More complex interventions, such as the use of outreach visits or local opinion leaders, ranged from ineffective to highly effective but were most often moderately effective (resulting in reductions of 20% to 50% in the incidence of inappropriate performance).


CONCLUSIONS
There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.
Oxman
A D
AD
Health Services Research Unit, National Institute of Public Health, Oslo, Norway.
Thomson
M A
MA
Davis
D A
DA
Haynes
R B
RB
D006801:Humans; D019411:Clinical Laboratory Techniques; D003625:Data Collection; D003920:Diabetes Mellitus / Q000628:therapy; D003936:Diagnosis, Computer-Assisted; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted; D006761:Hospitals / Q000706:statistics & numerical data; D006973:Hypertension / Q000628:therapy; D011314:Preventive Health Services; D011364:Professional Practice; D011787:Quality of Health Care; D016540:Smoking Cessation; D016896:Treatment Outcome