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Table 1 Characteristics of included systematic reviews

From: Changing prescribing behaviours with educational outreach: an overview of evidence and practice

Author (year)

Aim

Population

Number of studies

Intervention of focus

Outcome measured

Author’s conclusions

Quality appraisalb

Alagoz et al. (2018) [20]

Identify the efficacy of external change agentsa on organisational change in health care.

Staff in primary care clinics and general practices.

21 studies (20 cluster RCTs, 1 RCT)

External change agents

Practice level change

Thirteen of 21 multifaceted interventions that included at least two components (from EO, educational materials, audit and feedback, coaching [practice facilitation] and system support) were efficacious at changing practice behaviour.

Practice facilitation, or individualised follow-up coaching, was an important component of successful interventions.

9/13

Baker et al. (2015) [21]

Compare the efficacy of tailored interventions vs. non- tailored interventions (e.g. EO programs) at improving professional practice and health outcomes.

Health professionals

32 cluster RCTs

Tailored interventions vs. non- tailored interventions (e.g. EO programs)

Implementation of recommended practice (e.g. following prescribing guidelines)

Tailored interventions can be more efficacious than non-tailored interventions, but the effect tends to be small to moderate.

Due to the small number of studies, the authors remain uncertain if there is a true difference in the efficacy of the interventions.

12/16

Chauhan et al. (2017) [22]

Establish the efficacy and feasibility of behaviour change interventions in primary health care settings on patient and professional outcomes.

GPs, nurses, midwives, physician assistants, pharmacists, social workers, psychologists and dieticians who primarily manage patients with chronic disease.

138 systematic reviews (3502 individual studies)

Behaviour change interventions

Health professional behaviour change

Interventions that include enablement, education and training delivered in the context of collaborative teamwork can change the behaviour of health professionals working in primary care.

11/12

Chhina et al. (2013) [23]

To report the efficacy EO (as a stand-alone intervention) has on prescription behaviour in primary care

Family physicians (GPs)

15 studies (11 RCTs, 4 observational)

Educational outreach as a stand-alone intervention

Prescription rates of various medications

Educational outreach, as a stand-alone intervention, was moderately efficacious at changing prescribing behaviour of family physicians. Few studies examined regulated medications, such as benzodiazepines, and these studies reported inconsistent findings.

8/13

Clyne et al. (2016) [2]

Establish the efficacy of interventions aimed at reducing PIP of medications to older adults in the community

GPs

12 RCTs

Academic detailing delivered as part of a multifaceted intervention

Rates of PIP

Multifaceted interventions including academic detailing modestly reduced PIP in older adults. However, only three studies contributed to this finding.

8/13

Forsetlund, Eike, Gjerberg, and Vist (2011) [24]

Identify the efficacy of interventions that intend to reduce PIP in care homes

Prescribers in nursing homes

20 RCTs

Not limited to any intervention

Use of or prescribing of medications

Educational interventions (e.g. isolated or multifaceted EO, educational meetings) can reduce inappropriate medication use. However, it is unclear which of these interventions are more efficacious due to poor quality evidence.

9/13

Green, Taylor, and Torgerson (2012) [25]

Identify the educational interventions that can improve prescribing behaviours.

Doctors, medical students and health professionals.

187 systematic reviews (unclear number of primary studies)

Medical education at all levels

Health professional behaviour

Active educational strategies (e.g. EO) appeared more efficacious at changing behaviour than passive strategies (e.g. giving an information leaflet).

8/12

Johnson and May (2015) [26]

Identify the components of successful behaviour change interventions targeted towards professional practice behaviours.

Health professionals in primary and secondary care.

67 systematic reviews (unclear number of individual studies)

Professional behaviour change interventions

Professional practice behaviours

Interventions that include normative restructuring, relational restructuring, modifying peer group norms via programs like EO, emphasising expectations of external groups (e.g. via audit and feedback) might successfully change professional practice behaviours.

9/12

Kamarudin, Penm, Chaar, and Moles (2013) [27]

Identify educational interventions and methods that can improve prescribing behaviour

Medical (e.g. GPs) and non-medical prescribers

47 studies (20 RCTs, 15 non-RCTs, 12 before-after)

Educational outreach

Inappropriate prescribing

Educational outreach can successfully reduce inappropriate prescribing of benzodiazepines and dietary supplements.

Heterogeneity between studies limits ability to draw confident conclusions.

8/13

Loganathan, Singh, Franklin, Bottle, and Majeed (2011) [28]

Establish the efficacy of interventions aimed at reducing inappropriate prescribing in care homes.

Health professionals prescribing medications to older adults

16 studies (11 cluster RCTs, 3 before-and-after, 2 RCTs)

Interventions to reduce inappropriate prescribing.

Inappropriate prescribing

There is no current intervention that is efficacious at improving prescribing in care homes. However, education has shown the most promise, especially when delivered in an interactive way (e.g. workshops) with more than one health professional (e.g. physicians and nurses) and followed-up.

7/13

O’Brien et al. (2008) [6]

Identify the efficacy of EO visits on health professional practice and patient outcomes

Health professionals

69 RCTs

Educational outreach

Professional performance (e.g. prescribing behaviours) and healthcare outcomes

Educational outreach visits had a smaller, but more consistent, effect on prescribing behaviours compared to other behaviours (e.g. cardiovascular screening). Educational outreach visits delivered alone or with other interventions (e.g. reminders) have small effects on prescribing behaviour.

12/16

Ostini et al. (2009) [29]

Establish the efficacy of different interventions on supporting the adoption of safe, appropriate and/or cost- effective prescribing.

Health professionals prescribing medications outside of the hospital inpatient setting.

29 studies (22 RCTs, 4 controlled before-and-after, 3 controlled clinical trials)

Not limited to any intervention

Safe, appropriate and/or cost-effective prescribing

Educational outreach and audit and feedback interventions were most researched and show positive results for changing prescribing behaviours.

5/13

Smith and Tett (2010) [10]

Identify interventions used to improve the prescribing of benzodiazepines

Health professionals

32 studies (16 RCTs, 4 controlled trials, 2 observational, 2 convenience sample, 3 cohort, 1 randomised trial, 2 quasi-experimental)

Not limited to any intervention

Inappropriate/appropriate prescribing of benzodiazepines

Multifaceted interventions might be more successful than isolated education interventions at reducing benzodiazepine prescribing.

N/A

Thompson Coon et al. (2014) [30]

Establish the efficacy of interventions used to reduce inappropriate prescribing of antipsychotics to older adults who have dementia and reside in care.

Health professionals

22 studies (11 before-and-after, 6 RCTs, 5 controlled clinical trials)

Not limited to any intervention

Change in use of antipsychotics

Interventions to reduce inappropriate prescribing, such as educational outreach, might work in the short term.

8/13

  1. Notes
  2. aExternal change agents are defined by Alagoz et al., 2018 as people external to the primary care clinic who influence the practices of the clinic in a desirable way
  3. bThe overall score is calculated from all items that were applicable to the study. For detail, see Table 2
  4. EO educational outreach, GP general practitioner, PIP potentially inappropriate prescribing, RCT randomised controlled trial, RT randomised trial