Educational outreach visits: effects on professional practice and health care outcomes.
BACKGROUND
Outreach visits have been identified as an intervention that may improve the practice of health care professionals, in particular prescribing. This type of 'face to face' visit has been referred to as university-based educational detailing, public interest detailing, and academic detailing.


OBJECTIVE
To assess the effects of outreach visits on improving health professional practice or patient outcomes.


METHODS
We searched MEDLINE up to March 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles.


METHODS
Randomised trials of outreach visits (defined as a personal visit by a trained person to a health care provider in his or her own setting). The participants were health care professionals.


METHODS
Two reviewers independently extracted data and assessed study quality.


RESULTS
Eighteen studies were included involving more than 1896 physicians. All of the outreach visit interventions consisted of several components, including written materials and conferences. Reminders or audit and feedback complemented some visits. In 13 studies, the targeted behaviours were prescribing practices. In three studies, the behaviours were preventive services, including counselling for smoking cessation. In two studies, the outreach visits were directed toward improving the general management of common problems encountered in general practice, including asthma, diabetes, otitis media, hypertension, anxiety, and acute bronchitis. All studies examined physician behaviour and in three studies other health professionals such as nurses, nursing home attendants or health care workers were targeted. Positive effects on practice were observed in all studies. Only one study measured a patient outcome. Few studies examined the cost effectiveness of outreach.


CONCLUSIONS
Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Further research is needed to assess the effects of outreach visits for other aspects of practice and to identify key characteristics of outreach visits that are important to its success. The cost-effectiveness of outreach visits is not well evaluated.
Thomson O'Brien
M A
MA
McMaster Evidence-based Practice Centre, McMaster University, Department of Clinical Epidemiology and Biostatistics, HSC 3H7, Hamilton, Ontario, Canada, L8N 3Z5. maobrien@fhs.mcmaster.ca
Oxman
A D
AD
Davis
D A
DA
Haynes
R B
RB
Freemantle
N
N
Harvey
E L
EL
D004502:Education, Medical, Continuing; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D011364:Professional Practice / Q000592:standards*