BACKGROUND: Current understanding of implementation methods is limited, and research has focused on changing doctors' behaviors. AIM: Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes. METHODS: Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses' self-reported barriers informed development of tailored strategies. RESULTS: In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10-17% of patients) in performance for the assessment of UI and greater rates of improvement (20-30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients' age did not alter results. CONCLUSIONS: Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses' performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with "no intervention" control groups and longer follow-up are needed.
RCT Entities:
BACKGROUND: Current understanding of implementation methods is limited, and research has focused on changing doctors' behaviors. AIM: Our aim was to evaluate the impact of audit and feedback and educational outreach in improving nursing practice and patient outcomes. METHODS: Using a factorial design, cluster randomized controlled trial, we evaluated 194 community nurses in 157 family practices and 1078 patients with diagnosis of urinary incontinence (UI) for nurses compliance with evidence-linked review criteria for the assessment and management of UI and impact on psychologic and social well-being and symptoms. In the outreach arms, nurses' self-reported barriers informed development of tailored strategies. RESULTS: In comparison with educational materials alone, the implementation methods tested did not improve care at 6 months follow-up. Moderate rates of improvement (10-17% of patients) in performance for the assessment of UI and greater rates of improvement (20-30% of patients) for the management of care were found but effects were similar across arms. Improvement in patient outcomes was more consistently positive for educational outreach than for audit and feedback but differences were not significant. Adjustment for caseload size, severity or duration of UI and patients' age did not alter results. CONCLUSIONS: Printed educational materials alone may be as effective as audit and feedback and educational outreach in improving nurses' performance and outcomes of care for people with UI. Greater understanding of the underlying processes in improving performance within multidisciplinary teams through further, theory-driven studies with "no intervention" control groups and longer follow-up are needed.
Authors: M A O'Brien; S Rogers; G Jamtvedt; A D Oxman; J Odgaard-Jensen; D T Kristoffersen; L Forsetlund; D Bainbridge; N Freemantle; D A Davis; R B Haynes; E L Harvey Journal: Cochrane Database Syst Rev Date: 2007-10-17
Authors: Lois H Thomas; Caroline L Watkins; Beverley French; Christopher Sutton; Denise Forshaw; Francine Cheater; Brenda Roe; Michael J Leathley; Christopher Burton; Elaine McColl; Jo Booth Journal: Trials Date: 2011-05-20 Impact factor: 2.279
Authors: Lalith Senarathna; Nick A Buckley; Michael J Dibley; Patrick J Kelly; Shaluka F Jayamanna; Indika B Gawarammana; Andrew H Dawson Journal: PLoS One Date: 2013-08-19 Impact factor: 3.240
Authors: Heather L Colquhoun; Jamie C Brehaut; Anne Sales; Noah Ivers; Jeremy Grimshaw; Susan Michie; Kelly Carroll; Mathieu Chalifoux; Kevin W Eva Journal: Implement Sci Date: 2013-06-10 Impact factor: 7.327