Schulungen: Wirkungen auf die Arbeitsweise von Fachkräften und Endpunkte der Gesundheitsversorgung
Abstract
Background
Educational outreach visits (EOVs) have been identified as an intervention that may improve the practice of healthcare professionals. This type of face‐to‐face visit has been referred to as university‐based educational detailing, academic detailing, and educational visiting.
Objectives
To assess the effects of EOVs on health professional practice or patient outcomes.
Search methods
For this update, we searched the Cochrane EPOC register to March 2007. In the original review, we searched multiple bibliographic databases including MEDLINE and CINAHL.
Selection criteria
Randomised trials of EOVs that reported an objective measure of professional performance or healthcare outcomes. An EOV was defined as a personal visit by a trained person to healthcare professionals in their own settings.
Data collection and analysis
Two reviewers independently extracted data and assessed study quality. We used bubble plots and box plots to visually inspect the data. We conducted both quantitative and qualitative analyses. We used meta‐regression to examine potential sources of heterogeneity determined a priori. We hypothesised eight factors to explain variation across effect estimates. In our primary visual and statistical analyses, we included only studies with dichotomous outcomes, with baseline data and with low or moderate risk of bias, in which the intervention included an EOV and was compared to no intervention.
Main results
We included 69 studies involving more than 15,000 health professionals. Twenty‐eight studies (34 comparisons) contributed to the calculation of the median and interquartile range for the main comparison. The median adjusted risk difference (RD) in compliance with desired practice was 5.6% (interquartile range 3.0% to 9.0%). The adjusted RDs were highly consistent for prescribing (median 4.8%, interquartile range 3.0% to 6.5% for 17 comparisons), but varied for other types of professional performance (median 6.0%, interquartile range 3.6% to 16.0% for 17 comparisons). Meta‐regression was limited by the large number of potential explanatory factors (eight) with only 31 comparisons, and did not provide any compelling explanations for the observed variation in adjusted RDs. There were 18 comparisons with continuous outcomes, with a median adjusted relative improvement of 21% (interquartile range 11% to 41%). There were eight trials (12 comparisons) in which the intervention included an EOV and was compared to another type of intervention, usually audit and feedback. Interventions that included EOVs appeared to be slightly superior to audit and feedback. Only six studies evaluated different types of visits in head‐to‐head comparisons. When individual visits were compared to group visits (three trials), the results were mixed.
Authors' conclusions
EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small, but potentially important. Their effects on other types of professional performance vary from small to modest improvements, and it is not possible from this review to explain that variation.
Laienverständliche Zusammenfassung
Schulungen für medizinische Fachkräfte zur Veränderung der Gesundheitsversorgung von Patienten
Bisher gab es viele Verbesserungsvorschläge für eine bessere Patientenversorgung durch medizinische Fachkräfte. Einer davon beinhaltet persönliche Schulungen, die darauf abzielen die Arbeitsweise zu verbessern. Diese Schulungen finden im Rahmen von Besuchen im Arbeitsumfeld statt, wo ausgebildete Mitarbeiter Klinikern Informationen darüber anbieten, wie sie ihr Arbeiten verändern können. Diese Informationen enthalten Feedback zur geleisteten Arbeit, oder darüber, wie man Hürden überwindet, um Veränderung in der Praxis zu erreichen. Diese persönlichen Besuche werden im Englischen auch "university‐based academic detailing", "academic detailing" oder "educational visiting" genannt.
Dieser Review hat 69 Studien eingeschlossen, die solche Schulungen auswerten. Scheinbar verbessern Schulungen die Versorgung von Patienten. Durch Schulungen wurden konsistente, kleine Veränderungen bezüglich der Verschreibung erreicht. Diese Veränderung ist möglicherweise wichtig, wenn große Gruppen von Patienten betroffen sind. Für andere Aspekte der Versorgung, wie z.B. Screenings, können Schulungen kleine bis moderate praktische Veränderungen erreichen. Jedoch variierten die Ergebnisse stark, was anhand dieser Arbeit nicht erklärt werden kann.
