Professional Intervention: Educational Outreach Visits

Definition: Use of a trained person who met with providers in their practice settings to give information with the intent of changing the provider’s practice. The information given may have included feedback on the performance of the provider(s). Can also be referred to as "academic detailing".

Effectiveness: Five high quality reviews (Beney, Faulkner, Forsetlund, O'Brien, Thomas) and three key reviews (Arnold, Davey, Shaw) were identified. One high quality review (O'Brien) found educational outreach visits to be generally effective in improving appropriate care and prescribing outcomes, while one key review (Arnold) reported mixed effects for this intervention on both these sets of outcomes. Four high quality reviews (Beney, Faulkner, Forsetlund, Thomas) and two key reviews (Davey, Shaw) had an insufficient number of studies to draw conclusions about the intervention.

Summary of Overall Findings from Reviews: 1/2 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective.

Summary of Findings Related to Prescribing: 1/2 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective for improving prescribing outcomes.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health service utilisation, costs, and patient outcomes. Cochrane Database of Systematic Reviews 2000 (3):CD000336. 9 (High)
Faulkner A, Mills N, Baxter K, Kinnersley P, Peters TJ, Sharp D. A systematic review of the effect of primary care-based service innovations on quality and patterns of referral to specialist secondary care. British Journal of General Practice 2003 53 (496):878-884. 8 (High)
Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009 15 (2):CD003030. 8 (High)
O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007 (4):CD000409. 8 (High)
Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database of Systematic Reviews 2000 (1):CD000349. 8 (High)
Akbari A, Mayhew A, Al-Alawi MA, Grimshaw J, Winkens R, Glidewell E, Pritchard C, Thomas R, Fraser C. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews 2008 8 (4):CD005471. 7 (Medium)
Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews 2005 (4):CD003539. 7 (Medium)
Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2005 (4):CD003543. 7 (Medium)
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB. Effectiveness of continuing medical education. Evidence Report — Technology Assessment (Full Rep) 2007 (149):1-69. 7 (Medium)
Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. American Journal of Geriatric Psychiatry 2008 16 (8):621-632. 7 (Medium)
Qureshi N, Allen J, Hapgood R. A systematic review of educational outreach visits for non-prescribing interventions in general practice. European Journal of General Practice 2002 8 (1):31-36. 7 (Medium)
Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2005 (3):CD005470. 7 (Medium)
Smolders M, Laurant M, Roberge P, van Balkom A, van Rijswijk E, Bower P, Grol R. Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety. Canadian Journal of Psychiatry 2008 53 (5):277-293. 7 (Medium)
van der Wees PJ, Jamtvedt G, Rebbeck T, de Bie RA, Dekker J, Hendriks EJ. Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review. Australian Journal of Physiotherapy 2008 54 (4):233-241. 7 (Medium)
Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2009 (3):CD000072. 7 (Medium)
Fahey T, Schroeder K, Ebrahim S. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2006 (4):CD005182. 6 (Medium)
Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organisational interventions to improve the management of depression in primary care. A systematic review. Journal of the American Medical Informatics Association 2003 289 (23):3145-3151. 6 (Medium)
Smith LA, Jones C, Meek S, Webster J. Review: Provider practice and user behavior interventions to improve prompt and effective treatment of malaria: do we know what works?. American Journal of Tropical Medicine and Hygiene 2009 80 (3):326-335. 6 (Medium)
Alvarez MP, Agra Y. Systematic review of educational interventions in palliative care for primary care physicians. Palliative Medicine 2006 20 :673-683. 5 (Medium)
Hakkennes S, Dodd K. Guideline implementation in allied health professions: a systematic review of the literature. Quality and Safety in Health Care 2008 17 (4):296-300. 5 (Medium)
Ryman TK, Dietz V, Cairns KL. Too little but not too late: Results of a literature review to improve routine immunization programs in developing countries. BMC Health Services Research 2008 8 (134) 5 (Medium)
Schlenk EA, Bernardo LM, Organist LA, Klem ML, Engberg S. Optimizing medication adherence in older patients: A systematic review. Journal of Clinical Outcomes Management 2008 15 (12):595-606. 5 (Medium)
Steinman MA, Ranji SR, Shojania KG, Gonzales R. Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies. 2006 44 (7):617-628. 5 (Medium)
Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. American Journal of Geriatric Pharmacotherapy 2008 6 (2):119-129. 5 (Medium)
Chaillet N, Dubé E, Dugas M, Audibert F, Tourigny C, Fraser WD, Dumont A. Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstetrics and Gynecology 2006 108 (5):1234-1245. 4 (Medium)
Fish A, Watson MC, Bond CM. Practice-based pharmaceutical services: A systematic review. International Journal of Pharmacy Practice 2002 10 (4):225-233. 4 (Medium)
Lu CY, Ross-Degnan D, Soumerai SB, Pearson SA. Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature 2001-2007 (Provisional abstract). BMC Health Services Research 2008 8 (75) 4 (Medium)
Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic review of interventions to improve prescribing. Annals of Pharmacotherapy 2009 43 (3):502-513. 4 (Medium)
Smits PBA, Verbeek JHAM, de Buisonjé CD. Problem based learning in continuing medical education: a review of controlled evaluation studies. British Medical Journal 2002 324 (7330):153-156. 4 (Medium)
van Steenkiste B, Grol R, van der Weijden T. Systematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases. Vascular Health and Risk Management 2008 4 (3):535-545. 4 (Medium)
Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. International Journal for Quality in Health Care 1994 6 (2):115-132. 4 (Medium)