Advertisement

Journal of General Internal Medicine

, Volume 26, Issue 4, pp 419–426 | Cite as

Interventions Encouraging the Use of Systematic Reviews in Clinical Decision-Making: A Systematic Review

  • Laure PerrierEmail author
  • Kelly Mrklas
  • Sasha Shepperd
  • Maureen Dobbins
  • K. Ann McKibbon
  • Sharon E. Straus
Reviews

Abstract

Background

Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in clinical decision-making.

Purpose

To systematically review the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians.

Data Sources

Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and LISA were searched from the earliest date available until July 2009.

Study Selection and Data Extraction

Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a clinician. Information about the study population, features of each intervention, methods used to measure the use of systematic reviews and those used to measure professional performance or health care outcomes, existence and use of statistical tests, study outcomes, and comparative data were extracted.

Data Synthesis

A total of 8,104 titles and abstracts were reviewed, leading to retrieval of 189 full-text articles for assessment; five of these studies met all inclusion criteria. All five studies reported on professional performance behavior; none reported on patient health outcomes. One study reported positive outcomes in improving preventive care. Three studies focused on obstetrical care, with two reporting no impact on professional practice change, and one study reporting increases in the use of prophylactic oxytocin and episiotomy. One study found no improvement in the sealant rate of newly erupted molars among dentists in Scotland.

Limitations

The small number of studies available for examination indicates the difficulty in summarizing and identifying key aspects in successful strategies that encourage clinicians to use systematic reviews in decision-making. Other concerns lay in selective reporting and lack of blinding during data collection.

Conclusions

The limited empirical data render the strength of evidence weak for the effectiveness and types of interventions that encourage clinicians to use systematic reviews in clinical decision making.

KEY WORDS

systematic review evidence-based practice decision-making review literature as a topic 

Notes

Acknowledgements

We are grateful to David Newton for his technical assistance.

Funders

Canadian Institutes of Health Research, and each author’s institution. The funding source had no role in the study design, collection, analysis, and interpretation of results, in the writing of the report, or in the decision to submit the paper for publication.

Prior presentations

May 19, 2010, Cochrane Canada 8th Annual Symposium

Conflict of interest

None disclosed.

Ethical approval

Not required

References

  1. 1.
    Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362(9391):1225–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Olson KL, Bungard TJ, Tsuyuki RT. Cholesterol risk management: a systematic examination of the gap from evidence to practice. Pharmacotherapy. 2001;21(7):807–17.PubMedCrossRefGoogle Scholar
  3. 3.
    Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005; Issue 4. Art. No.: CD003539. doi:  10.1002/14651858.CD003539.pub2.
  4. 4.
    Buchan H. Gaps between best evidence and practice: causes for concern. Med J Aust. 2004;180(6 Suppl):S48–9.PubMedGoogle Scholar
  5. 5.
    Villar J, Carroli G, Gulmezoglu AM. The gap between evidence and practice in maternal healthcare. Int J Gynaecol Obstet. 2001;75(Suppl 1):S47–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2009]. The Cochrane Collaboration, 2008. Available from http://www.cochrane-handbook.org. Accessed August 21, 2010.
  7. 7.
    Laupacis A, Straus S. Systematic reviews: time to address clinical and policy relevance as well as methodological rigor. Ann Intern Med. 2007;147(4):273–4.PubMedGoogle Scholar
  8. 8.
    De Vito C, Nobile CG, Furnari G, Pavia M, De Giusti M, Angelillo IF, Villari P. Physicians' knowledge, attitudes and professional use of RCTs and meta-analyses: a cross-sectional survey. Eur J Public Health. 2009;19(3):297–302.PubMedCrossRefGoogle Scholar
  9. 9.
    Dawes M, Sampson U. Knowledge management in clinical practice: a systematic review of information seeking behavior in physicians. Int J Med Inform. 2003;71(1):9–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson PM, Watt IS, Hardman GF. Survey of medical directors’ views and use of the Cochrane Library. Br J Clin Governance. 2001;6(1):34–9.CrossRefGoogle Scholar
  11. 11.
    Kerse N, Arroll B, Lloyd T, Young J, Ward J. Evidence databases, the Internet, and general practitioners: the New Zealand story. N Z Med J. 2001;114(1127):89–91.PubMedGoogle Scholar
  12. 12.
    Ram FSF, Wellington SR. General practitioners use of the Cochrane Library in London. Prim Care Respir J. 2002;11(4):123–5.Google Scholar
  13. 13.
    Estabrooks CA, Chong H, Brigidear K, Profetto-McGrath J. Profiling Canadian nurses' preferred knowledge sources for clinical practice. Can J Nurs Res. 2005;37(2):118–40.PubMedGoogle Scholar
  14. 14.
    Berlin JA. Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet. 1997;350(9072):185–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 2001;135(11):982–9.PubMedGoogle Scholar
  16. 16.
    Lemelin J, Hogg W, Baskerville N. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. CMAJ. 2001;164(6):757–63.PubMedGoogle Scholar
  17. 17.
    Gülmezoglu AM, Langer A, Piaggio G, Lumbiganon P, Villar J, Grimshaw J. Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices. BJOG. 2007;114(1):16–23.PubMedGoogle Scholar
  18. 18.
    Wyatt JC, Paterson-Brown S, Johanson R, Altman DG, Bradburn MJ, Fisk NM. Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units. BMJ. 1998;317(7165):1041–6.PubMedGoogle Scholar
  19. 19.
    Althabe F, Buekens P, Bergel E, Belizán JM, Campbell MK, Moss N, Hartwell T, Wright LL, Guidelines Trial Group. A behavioral intervention to improve obstetrical care. N Engl J Med. 2008;358(18):1929–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Clarkson JE, Turner S, Grimshaw JM, Ramsay CR, Johnston M, Scott A, Bonetti D, Tilley CJ, Maclennan G, Ibbetson R, Macpherson LM, Pitts NB. Changing clinicians' behavior: a randomized controlled trial of fees and education. J Dent Res. 2008;87(7):640–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Krahn J, Sauerland S, Rixen D, Gregor S, Bouillon B, Neugebauer EA. Applying evidence-based surgery in daily clinical routine: a feasibility study. Arch Orthop Trauma Surg. 2006;126(2):88–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Langham J, Tucker H, Sloan D, Pettifer J, Thom S, Hemingway H. Secondary prevention of cardiovascular disease: a randomised trial of training in information management, evidence-based medicine, both or neither: the PIER trial. Br J Gen Pract. 2002;52(483):818–24.PubMedGoogle Scholar
  23. 23.
    Mukohara K, Schwartz MD. Electronic delivery of research summaries for academic generalist doctors: a randomised trial of an educational intervention. Med Educ. 2005;39(4):402–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Seers K, Crichton N, Carroll D, Richards S, Saunders T. Evidence-based postoperative pain management in nursing: is a randomized-controlled trial the most appropriate design? J Nurs Manag. 2004;12(3):183–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Laure Perrier
    • 1
    • 2
    Email author
  • Kelly Mrklas
    • 3
  • Sasha Shepperd
    • 4
  • Maureen Dobbins
    • 5
  • K. Ann McKibbon
    • 6
  • Sharon E. Straus
    • 7
    • 8
  1. 1.Office of Continuing Education and Professional Development, Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  3. 3.Faculty of MedicineUniversity of CalgaryCalgaryCanada
  4. 4.Department of Public HealthUniversity of OxfordOxfordUnited Kingdom
  5. 5.School of NursingMcMaster UniversityHamiltonCanada
  6. 6.Department of Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonCanada
  7. 7.Faculty of MedicineUniversity of TorontoTorontoCanada
  8. 8.Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada

Personalised recommendations