J Clin Outcomes Manage
Engaging physicians to change practice
Abstract Objective: To review the literature relating to strategies commonly used to influence physician behavior. Methods: The MEDLINE database and Cochrane Database of Systematic Reviews were searched to find pertinent meta-analyses, systematic reviews, and randomized controlled trials. Additional studies were identified by reviewing the reference lists of reviewed articles. Results: Multifaceted educational strategies that incorporate at least 1 active intervention are more effective for changing physician behavior than any single intervention. Active interventions (eg, academic detailing, reminders, clinical decision support systems) have consistently been shown to improve processes of care over passive approaches (eg, printed educational materials and formal continuing medical education). Both audit and feedback and local opinion leader influence are variably successful methods for influencing physician practice. The effectiveness of economic incentives for improving clinical practice has not been well studied. Conclusion: Active interventions should be adopted as part of a multifaceted strategy to engage physicians to change behavior. Strategies that can be automated at the point of care and made scalable over a large number of patients (eg, computerized reminders and other forms of clinical decision support) should receive special consideration. Additional research is needed to understand the impact of physician-centered interventions, especially performance-based economic incentives, on patient outcomes and health care costs.
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