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Keane, Martin (2010) Putting research evidence into practice. Drugnet Ireland , Issue 32, Winter 2009 , pp. 10-11.

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In 1998 the US Institute of Medicine published a landmark report on bridging the gap between practice and research in community-based drug and alcohol treatment.1 Subsequently, EU Action Plans 2000–2004,2 2005–20083 and 2009–20124 called on EU member states to promote and disseminate evidence-based practice interventions to reduce demand for drugs. The recently published National Drugs Strategy (interim) 2009–2016 5 notes that  

a significant body of knowledge on evidence-based best practice in relation to dealing with problem drug use has been built up. However, a key challenge is to disseminate best practice among service providers to ensure that it is applied. (S. 5.41)
 
This article presents the findings from a recent systematic review that evaluated the effectiveness of opinion leaders in changing practitioners’ behaviour, and sought to determine how this strategy might be used to bridge the research-to-practice gap in the alcohol and other drugs (AOD) field.6 This work formed part of a larger systematic review to evaluate the effectiveness of a range of implementation strategies. In their report on the larger review, the authors state that ‘the rationale behind the use of opinion leaders as an educational strategy is that new information will be integrated more efficiently into practice if a respected peer trains a practitioner’.7  
 
The authors define an opinion leader as an educationally influential individual who is (i) a recognised expert in their field; (ii) more likely than others to facilitate the flow of new information; and (iii) has well-developed interpersonal skills. Also known as change agents and knowledge brokers, opinion leaders interpret the meaning of technically or conceptually difficult information for standard users.
 
Methods
They authors undertook a systematic review of the literature covering the period from 1966–March 2005, using a wide range of electronic databases, relevant websites and hand-searching of reference lists. Inclusion criteria limited the review to controlled studies that collected baseline data and had a study period of at least three months. Outcome measures included process outcomes to assess utilisation of the innovation, e.g. changes in health care professionals’ behaviour and patient outcomes to assess the impact of the innovation on patients’ health status. The quality of the studies was assessed on three domains, strength and relevance of the evidence and size of the effect, and was rated as good, average or poor.
 
Results
Four papers met the inclusion criteria for this review – one good-quality systematic literature review comprising eight randomised controlled trials, and three good-quality primary studies. A qualitative synthesis of the data was undertaken, as, due to the heterogeneity of the studies, a meta-analysis was not possible as no common measure of effect was considered justified. Since none of the included studies were conducted in the AOD context, evidence is based on results from studies of health care professionals, e.g. physicians, nurses and surgeons. The studies used opinion leaders primarily to improve adherence to guidelines for management of various chronic conditions, e.g. asthma, heart disease and arthritis, which, according to the authors, have important parallels in management of AOD-related problems.
 
Overall, opinion leaders in the 11 studies identified showed variable effectiveness in changing professional practice. Levels of effectiveness varied from not significant to small-to-modest in some process outcomes in the better-quality studies; process outcomes assessed changes in the behaviour of health professionals. Overall, patient outcomes were not significantly improved by the use of opinion leaders. The authors conclude: ‘While it may make intuitive sense for the use of well-respected peers to disseminate innovations, current evidence is sparse and inconsistent and fails to support the use of opinion leaders as change agents. These equivocal results may reflect the heterogeneity across studies.’
 
 
1. Institute of Medicine (1998) Bridging the gap between practice and research: forging partnerships with community-based drug and alcohol treatment. Washington DC: National Academy Press.
2. Council of the European Union (2000) EU Action Plan on Drugs 2000–2004. Brussels: Council of the European Union.
3. Council of the European Union (2005) EU Action Plan on Drugs 2005–2008. Brussels: Council of the European Union.
4. Council of the European Union (2009) EU Action Plan on Drugs 2009–2012. Brussels: Council of the European Union.
5. Department of Community, Rural and Gaeltacht Affairs (2009) National Drugs Strategy (interim) 2009–2016. Dublin: Department of Community, Rural and Gaeltacht Affairs.
6. Bywood P, Lunnay B and Roche A (2009) Effectiveness of opinion leaders for getting research into practice in the alcohol and other drugs field: results from a systematic literature review. Drugs: education, prevention and policy, 16(3): 205–216.
7. Bywood P, Lunnay B and Roche A (2008) Effective dissemination: a systematic review of implementation strategies for the AOD field. Adelaide: National Centre for Education and Training on Addiction. p. 44.
Item Type
Article
Publication Type
International, Open Access, Article
Drug Type
All substances
Intervention Type
General / Comprehensive
Issue Title
Issue 32, Winter 2009
Date
18 January 2010
Page Range
pp. 10-11
Publisher
Health Research Board
Volume
Issue 32, Winter 2009
EndNote
Accession Number
HRB (Available)

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