Table 3 KTE with providers
From: Preterm birth: the role of knowledge transfer and exchange
• Audit and feedback: challenges related to quality, sustainability and acceptance of audit, especially when enforced by an external agency | |||
• In-service training: neonatology: Need to reinforce good practices through adequate supervision, need for refresher courses, lack of standardised tools to evaluate the impact of training on health system goals, high costs, lack of capable trainers | |||
• Computerised reminders: less successful with more complex decision support systems, especially chronic disease management | |||
• Costs (especially with multifaceted interventions) | |||
• Structural and organisational capacity, shortages, long and irregular working hours, provider attitudes toward change (providers may resist change), provider competencies to build trust, comfort and patient centredness | |||
• Shortage of resources in health facilities | |||
• Variable standards of implementation of standard guidelines | |||
• Audit and feedback: In general, larger effects were seen if baseline compliance was low | |||
• Educational meetings: Larger effects were associated with higher attendance rates, mixed interactive and didactic meetings and interactive meetings | |||
Message | KTE strategy | Linking RTA approach | Outcomes |
Use most current evidence-based practice (neonatology and many other health topics) [3, 25] | In-service training and educational meetings; educational outreach | Exchange | Beneficial in improving provider compliance to standardised guidelines compared to receiving information leaflets and didactic lectures. Clearest and strongest effects with changing less-complex behaviours. |
Use most current evidence-based practice (many health topics) [3] | Local opinion leaders | Exchange | Behaviour change, quality of care. |
Use most current evidence-based practice (many health topics) [3, 23, 24] | Audit and feedback | Exchange | Behaviour change, quality of care. |
Use most current evidence-based practice (many health topics) [3] | Tailored interventions | Depends on modality | Behaviour change, quality of care. |
Use most current evidence-based practice (many health topics) [3] | Computerised reminders | Push or exchange (depending on modality) | Behaviour change, quality of care. |
Use most current evidence-based practice (many health topics) [40] | Printed bulletin (mass-mailed to providers) | Push | “…may improve evidence-based practice when there is a single clear message, if the change is relatively simple to accomplish, and there is a growing awareness by users of the evidence that a change in practice is required.” |
Use most current evidence-based practice (many health topics) [40] | Multifaceted interventions | Push or exchange (depending on modality) | Multifaceted interventions may be necessary to improve awareness and uptake of review evidence. |