Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 22 (4) Volume 22, Issue 4, Fall 2002 J Contin Educ Health Prof 2002; 22(4):237-243 INNOVATIONS IN CONTINUING EDUCATION Changing physicians' behavior: what works and thoughts on getting more things to work Grimshaw JM Eccles MP Walker AE Thomas RE A b s t r a c t Health services research consistently demonstrates a gap between research-based best clinical practice and what doctors actually do. Traditionally, the profession of medicine has behaved as if dissemination of research findings in peer-reviewed journals will eliminate this gap, even though professionals typically have less than 1 hour per week to read. This problem is complicated by the fact that physicians have not been trained generally to appraise published research, which is of variable quality in any event. Physicians interested in changing their practices also encounter organizational, peer group, and individual barriers at the same time as they face information overload and patient expectations. In a word, physicians' abilities to manage information is overwhelmed. This article both summarizes initiatives to improve physicians' information management through efforts to synthesize available evidence and describes the current evidence base of effectiveness and efficiency of dissemination and implementation strategies. We conclude that there is an imperfect evidence base to support decisions regarding strategies that are likely to be appropriate and effective under varying circumstances. Since this problem is compounded by the lack of a theoretical base for conceptualizing physician behavior change, we suggest exploring the applicability of behavioral theories to the understanding of professional behavior change. We also suggest exploring the use of theory-based process evaluations alongside randomized trials of dissemination and implementation strategies to further test theories and to explore causal mechanisms. Further research is required to explore determinants of provider behavior to better identify modifiable and non-modifiable effect modifiers, to develop methods of identifying barriers and facilitators to change, and to estimate the efficiency of dissemination and implementation strategies in the presence of different barriers and effect modifiers. Lessons for Practice Implementation of effective change strategies requires a better understanding of the determinants of physician behavior change as well as identification of the barriers to change and facilitators of change. Although dissemination and implementation strategies ought to be based on findings from well-conceived and well- executed studies, few existing studies show these attributes. Plans for dissemination and implementation should focus on areas in which population-based improvement in clinical outcomes can clearly be expected and the costs associated with realizing the desired clinical changes are minimized given the outcomes sought. MeSH Terms: Behavior; Education, Medical, Continuing; Evidence-Based Medicine; Health Services Research; Information Dissemination; Information Management; Models, Educational; Physician's Practice Patterns; Program Evaluation Publication Type: Review
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