title: Changing physician behavior: what works?
abstract: OBJECTIVE
  There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice.
  
  
  METHODS
  Systematic review of reviews.
  
  
  METHODS
  We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data.
  
  
  RESULTS
  Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions.
  
  
  CONCLUSIONS
  Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.
authors.forename: Fargoi
authors.initials: F
authors.lastname: Mostofian
authors.forename: Cynthiya
authors.initials: C
authors.lastname: Ruban
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: 293 Wellington St N, Ste 110, Hamilton, ON, L8L 8E7. E-mail: bhandam@mcmaster.ca.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D014481:United States