title: Local opinion leaders: effects on professional practice and health care outcomes.
abstract: BACKGROUND
  Clinical practice is not always evidence-based and, therefore, may not optimise patient outcomes. Opinion leaders disseminating and implementing 'best evidence' is one method that holds promise as a strategy to bridge evidence-practice gaps.
  
  
  OBJECTIVE
  To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes.
  
  
  METHODS
  We searched Cochrane EPOC Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, HMIC, Science Citation Index, Social Science Citation Index, ISI Conference Proceedings and World Cat Dissertations up to 5 May 2009. In addition, we searched reference lists of included articles.
  
  
  METHODS
  Studies eligible for inclusion were randomised controlled trials investigating the effectiveness of using opinion leaders to disseminate evidence-based practice and reporting objective measures of professional performance and/or health outcomes.
  
  
  METHODS
  Two review authors independently extracted data from each study and assessed its risk of bias. For each trial, we calculated the median risk difference (RD) for compliance with desired practice, adjusting for baseline where data were available. We reported the median adjusted RD for each of the main comparisons.
  
  
  RESULTS
  We included 18 studies involving more than 296 hospitals and 318 PCPs. Fifteen studies (18 comparisons) contributed to the calculations of the median adjusted RD for the main comparisons. The effects of interventions varied across the 63 outcomes from 15% decrease in compliance to 72% increase in compliance with desired practice. The median adjusted RD for the main comparisons were: i) Opinion leaders compared to no intervention, +0.09; ii) Opinion leaders alone compared to a single intervention, +0.14; iii) Opinion leaders with one or more additional intervention(s) compared to the one or more additional intervention(s), +0.10; iv) Opinion leaders as part of multiple interventions compared to no intervention, +0.10. Overall, across all 18 studies the median adjusted RD was +0.12 representing a 12% absolute increase in compliance in the intervention group.
  
  
  CONCLUSIONS
  Opinion leaders alone or in combination with other interventions may successfully promote evidence-based practice, but effectiveness varies both within and between studies. These results are based on heterogeneous studies differing in terms of type of intervention, setting, and outcomes measured. In most of the studies the role of the opinion leader was not clearly described, and it is therefore not possible to say what the best way is to optimise the effectiveness of opinion leaders.
authors.affiliation: Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, UK, OX3 7LF.
authors.forename: Gerd
authors.initials: G
authors.lastname: Flodgren
authors.forename: Elena
authors.initials: E
authors.lastname: Parmelli
authors.forename: Gaby
authors.initials: G
authors.lastname: Doumit
authors.forename: Melina
authors.initials: M
authors.lastname: Gattellari
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Brien
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: Martin P
authors.initials: MP
authors.lastname: Eccles
mesh_terms: D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D033181:Information Dissemination; D007857:Leadership; D011050:Policy Making; D010818:Practice Patterns, Physicians'; D017064:Process Assessment, Health Care; D011364:Professional Practice / Q000592:standards*; D016032:Randomized Controlled Trials as Topic