>Fineberg in 1987 reviewed 28 "landmark" studies, and found tha tonly >2 had
>an immediate (1-2 year) impact on practice. Sorry, don't have >the full
>reference handy...should be able to find it via Medline with >that
>information.
>
>Mark
Here is the review by Fineberg
Clinical evaluation: how does it influence medical practice?
Fineberg HV Bull Cancer 1987 74:3 333-46
Abstract
This paper reviews reports of the effects of clinical evaluations on
physician awareness and behavior. Among the reviewed papers, there are 28
studies of the effect of specific randomized clinical trials (RCTs) on 19
different medical practices. After analyzing these 28 papers, there remain
two (7%) where the RCT has clear implications for practice, where the
pattern of practice reported quantitatively over time conforms fully to the
RCT findings, where the RCT preceded the change in the pattern of practice,
and where findings from the RCT differ from the results of other forms of
evaluation. The majority of the reviewed papers do not support an inference
that RCTs have a strong, direct influence in changing established clinical
practices. Clinical evaluation is one among many factors bearing on changes
in medical practices. Improving the care of patients requires both improved
methods of evaluation and more effective translation of the results of
evaluation into practice. Evaluations are likely to exert a greater impact
on medical practices if they are buttressed by attention to other
controllable factors, like channels of communication and environmental
constraints and incentives, that affect the adoption and abandonment of
medical practices.
Cheers and warm regards,
Badri
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 5039 652
Fax: 00 971 3 672022.
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For a quick up date on current health literature with an emphasis
on evidence based practice please visit
http://www.geocities.com/jscan_uae
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