SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
August, 2016 - SUPPORT Summary of a systematic review | print this article | download PDF
Opinion leaders are a small number of individuals within a community who have an influence on what the rest of the community does. They are active media users, who interpret the meaning of media messages or content for lower-end media users. Because of their influence, it is thought that opinion leaders may be able to persuade healthcare providers to use the best available evidence when treating and managing patients.
Key messages
People making decisions concerning interventions to improve healthcare worker performance.
Flodgren G, Parmelli E, Doumit G, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD000125.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
In order to reduce inappropriate patient management and improve patient outcomes, it is important to speed up and optimise the process of translating research evidence into policy and practice. One way of doing this may be through the use of local opinion leaders. Opinion leaders are active voices in their community, who speak out and often get asked for advice. Such individuals are held in high esteem by those who accept their opinions.
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Review objectives: To assess the effectiveness of local opinion leaders in improving the behaviour of healthcare professionals and patient outcomes. |
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| Type of | What the review authors searched for | What the review authors found |
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Study designs & interventions |
Randomized trials. |
18 randomized trials in which opinion leaders delivered educational initiatives to members of their own healthcare profession. |
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Participants |
Healthcare professionals in charge of patient care. |
Physicians (14); nurses (2); physicians, nurses and midwives (2). |
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Settings |
Any healthcare setting. |
Hospitals (14), primary care practice (1), both primary and secondary care (1), and undefined healthcare settings (2); in the United States of America (10), Canada (6), China (1), and Argentina and Uruguay (1). |
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Outcomes |
Objective measures of professional performance and/or patient outcomes. |
General management of a clinical problem (all 18 randomized trials). |
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Date of most recent search: May 2009 |
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Limitations: This is a well-conducted systematic review with only minor limitations. |
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Flodgren G, Parmelli E, Doumit G, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD000125.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
The review identified 18 randomized trials involving more than 296 hospitals and 318 primary care physicians, mostly in high-income countries. Targeted behaviours involved the general management of a clinical problem in obstetrics (5), cardiology (4), oncology (3), and other medical conditions (6) . Opinion leaders were used alone in five trials, and supplemented by other strategies (such as audit and feedback, reminders, faxed evidence summaries, printed educational materials, educational meetings, and workshops) in 13 trials. The duration of follow-up varied widely, ranging from one week to 18 months.
Combining evidence from the 18 studies show that:
Local opinion leaders alone or together with other intervention(s) compared with no intervention, the same other intervention or other interventions for improving compliance with desired practice |
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| People: Physicians (14 studies); nurses (2); physicians, nurses and midwives (2) Settings: Hospitals (14), primary care practice (1), both primary and secondary care (1), and undefined healthcare settings (2); in USA (10), Canada (6), China (1), and Argentina and Uruguay (1) Intervention: Local opinion leaders with or without other interventions Comparison: No intervention or other intervention(s) |
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| Outcomes | Adjusted absolute improvement (risk difference)*Median (Interquartile range) |
Number of studies | Certainty of the evidence (GRADE) |
Comments | |
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Compliance with desired practice |
Median +12% (+6% to +14.5%) |
18 studies |
Moderate |
The effects of opinion leader interventions varied across the 63 outcomes reported, from 15% decrease in compliance to 72% increase in compliance with desired practice. The median adjusted absolute increase for the main comparisons were: i) Opinion leaders versus no intervention, +9%; ii) Opinion leaders alone vs a single intervention, +14%; iii) Opinion leaders with one or more additional intervention(s) vs the one or more additional intervention(s), +10%; and iv) Opinion leaders as part of multiple interventions compared to no intervention, +10%. |
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GRADE: GRADE Working Group grades of evidence (see above and last page) * The post-intervention risk differences are adjusted for pre-intervention differences between the comparison groups. $ We rated down the evidence for heterogeneity of effects. The effects of interventions across the 63 outcomes reported varied from a 15% decrease in compliance to a 72% increase in compliance with desired practice. |
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| Findings | Interpretation* |
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| APPLICABILITY | |
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The findings of the review are based on studies using a variety of different interventions, performed in a variety of different settings, targeting a number of different clinical conditions, and aimed at changing a number of different outcomes. |
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| EQUITY | |
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The included trials did not provide data regarding differential effects of local opion leader interventions between gender and across various levels of advantage in society. |
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| ECONOMIC CONSIDERATIONS | |
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No data on the costs of interventions or cost savings were reported in the included studies. |
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| MONITORING & EVALUATION | |
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No evidence from low-income countries was reported in this review. |
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| *Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods | |
Related literature
Althabe F, Buekens P, Bergel E, Belizán JM, Campbell KM, Moss N, Hartwell T,Wright LL. A Behavioural Intervention to Improve Obstetrical Care. N Engl J Med 2008;358:1929-40.
Berner ES, Baker CS, Funkhouser E,Heudebert GR, Allison JJ, Fargason CA, et al.Do local opinion leaders augment hospital quality improvement efforts? A randomized trial to promote adherence to unstable angina guidelines. Medical Care 2003;41:420-31.
Cabana KK. Evans SD, Mellins RB, Brown RW, Lin X, Kacirotiand N, Clark NM. Impact of Physician Asthma Care Education on Patient Outcomes. Pediatrics 2006;117:2149–2157.
Guadagnoli E, Soumerai SB, Gurwitz JH, Borbas C, Shapiro CL, Weeks JC, et al.Improving discussion of surgical treatment options for patients with breast cancer: local medical opinion leaders versus audit and performance feedback. Breast Cancer Research and Treatment 2000;61:171-75.
Majumdar SR, Tsuyuki RT, McAlister FA . Impact of opinion leader-endorsed evi-dence summaries on the quality of prescribing for patients with cardiovascular disease: A randomized controlled trial. Am Heart J 2007;153:22.e1222.e8.
This summary was prepared by
Charles Shey Wiysonge, Centre for Evidence-based Health Care, Stellenbosch University, & Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Conflict of interest
None declared. For details, see: www.supportsummaries.org/coi
Acknowledgements
This summary has been peer reviewed by: Gerd Flodgren and Edgardo Abalos.
This review should be cited as
Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, Eccles MP. Local opinion leaders:
effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2011,Issue 8. Art. No.: CD000125. DOI:10.1002/14651858.CD000125.pub4.
The summary should be cited as
Wiysonge CS. Does use of local opinion leaders improve professional practice and patient outcomes? A SUPPORT Summary of a systematic review. August 2016. www.supportsummaries.org
Keywords
All Summaries:
evidence-informed health policy, evidence-based, systematic review, health systems research, healthcare, low and middle-income countries, developing countries, primary healthcare.
This summary was prepared with additional support from:
The South African Cochrane Centre, the only centre of the international Cochrane Collaboration in Africa, aims to ensure that health care decision making in Africa is informed by high quality, timely and relevant research evidence. www.mrc.ac.za/cochrane/cochrane.htm
