Knowledge Translation and Exchange

To identify the shortcomings and suggest methods to enhance the learning and clinical practice by physicians, a study was carried out by Andrew D. Oxman, MD, MSc; Mary Ann Thomson, BHSc(PT); David A. Davis, MD; R. Brian Haynes, MD, PhD. It was observed that there were constraints in the use of research evidence. In the journal under review three main messages have been conveyed by the authors and the target audience is the family physician.

The study found that there is a need for rational drug prescribing. There are no wonder drugs and the health professionals need interventions in varying combinations to make the prescribing of drugs effective. The underlying cause was that no research evidence was available for health providers as a guide line. For instance, overwhelming evidence was found for the use of thrombolytic therapy in patients who suffered from myocardial infarction but these were never reflected in the recommendations by experts in textbooks and review articles. This reflects shortcomings in the management of health science information by physicians. ‘Outreach visits’ was found to be very effective in rational drug prescribing to a great extent. This requires the use of a trained person to meet the providers in their practice settings and provide information. ‘Outreach visits’ also known as academic detailing or counter detailing was very effective in reducing inappropriate prescribing. In four studies reductions of 12 % to 49 % was reported as a result of counter detailing. Cummings and coworkers also reported the effectiveness of detailing in smoking cessation. The providers should be willing to co-operate when ‘outreach visits’ are arranged. Market research was an important component of outreach visits which reduced the incidence of inappropriate prescribing. Using the audit/feedback strategy one study reported an increase of over 40% in the median weighted rate of prescriptions for generic drugs. Hence a combination of different interventions revealed how effective drug prescribing can be achieved. The target audience in this case is the family physician.

Just as there is a need for rational drug prescribing, there is a need in the area of health professional performance to include appropriate diagnostic strategies. The reasons for suboptimal performance have to be determined and the barriers to change have to be identified. The diagnostic strategies bear a direct relation to quality assurance activities. This again calls for a closer collaboration of the researches in the areas of health services. To enhance the diagnostic practices, workshops did effect changes as did the result of outreach visits in assisting diagnosis. To combat the shortcomings and to increase performance the interventions have to be selected carefully in the light of the diagnosed problem. Research findings if properly documented and if easily available to the providers can serve as the guide line is diagnostic strategies. The target audience in this case too was the physicians.

The study also brought to light how non-physician health care professionals or nurses could be assisted to enhance performance in the field of health care. Obviously in this case the target audience is the nurse. Local opinion leaders or use of providers explicitly nominated by their colleagues to be ‘educationally influential’ did help in some improvement of the care of patients with arthritis and respiratory disease as per the findings of Stross and collaborators. In the case of nurses workshops help to be beneficial.

The journal states that definitive conclusions cannot be derived at as there were inadequacies in reporting but nevertheless several interventions were found to improve provider performance. Educational materials and conferences demonstrated no changes in the performance or health outcome. The use of a variety of interventions, such as audit and feedback, reminders and outreach visits, patient-mediated interventions or opinion leaders have demonstrated changes in the professional performance.

Finally the journal states that continuous efforts have to be maintained to improve and standardize the reporting of the trials of intervention to improve professional performance. A broad framework has to be developed to design and select the appropriate interventions where gaps between evidence and practice were found. Current practice shows that the providers diverge from the evidence-based recommendations, which denies the patients the benefits of medical research. One fifth to one half of the primary care practitioners in the United States were not aware or were not using evidence about six common procedures. The findings did not reflect in the recommendations by experts in the textbooks and review articles. In conclusion it stated that there are no ‘magic bullets’ for improving the quality of health care.

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