The document discusses strategies for promoting the implementation of evidence-based research findings in healthcare practices. It finds that passive dissemination of information is generally ineffective, while reminders, multifaceted interventions, and interactive educational meetings are consistently effective. Audit and feedback, local opinion leaders, and local consensus processes can be variably effective, while educational materials and didactic meetings have little to no effect. Effective implementation requires identifying problems and barriers, designing targeted interventions, and establishing goals, indicators, and changes to measure improvements.

1. CHANGING PRACTICE Evidence Based Implementation José Francisco García Gutiérrez Escuela Andaluza de Salud Pública PAHO HQ HSS/HRH

2. The Path Continuous Improvement Design & Evaluation Need Redesign Design Management Audit Implementation

4. NO MAGIC BULLETS ! All strategies are effective sometimes, but none is effective in all circumstances

5. Summary points Systematic reviews of rigorous studies provide the best evidence on the effectiveness of different strategies to promote the implementation of research findings Passive dissemination of information is generally ineffective It seems necessary to use specific strategies to encourage implementation of research based recommendations and to ensure changes in practice Further research on the relative effectiveness and efficiency of different strategies is required

6. Interventions to promote behavioural change among health professionals Bero, Grilli Grimshaw et al (1998). British Medical Journal. Bero, Grilli, Grimshaw and Oxman (1998). Cochrane Library .

7. Consistently effective interventions Reminders (manual or computerised) Multifaceted interventions (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing) Interactive educational meetings (participation of healthcare providers in workshops that include discussion or practice)

8. Interventions of variable effectiveness Audit and feedback (or any summary of clinical performance) The use of local opinion leaders (practitioners identified by their colleagues as influential) Local consensus processes (inclusion of participating practitioners in discussions to ensure that they agree that the chosen clinical problem is important and the approach to managing the problem is appropriate) Patient mediated interventions (any intervention aimed at changing the performance of healthcare providers for which specific information was sought from or given to patients)

9. Interventions that have little or no effect Educational materials (distribution of recommendations for clinical care, including clinical practice guidelines, audiovisual materials, and electronic publications) Didactic educational meetings (such as lectures)

11. TRADITIONAL MODEL OF DISEMINATION Publication of information Target audience Changes in clinical practice

12. DESIGN OF INTERVENTIONS Problem identification (Presentation) Evaluation of barriers (Diagnosis) Intervention design (Prescription) Behavioural change/ Quality improvement (Cure)

13. IMPLEMENTATION PLAN Objectives Key messages Target audience Responsible person Situation analysis Core improvement indicators DAFO: Identification of barriers & “ad hoc” interventions Proposal for improvement interventions Priorization Context adaptation

14. FROM THEORY TO ACTION Three key questions Setting up GOALS What are we trying to achieve Establishing INDICATORS How we do know that a change is an improvement Developing CHANGES What interventions might help to achieve improvements