The design and interpretation of experimental studies to examine the effectiveness and efficiency of implementation strategies intended to change professional practice are gaining increasing attention. It has been argued that variations of the simple randomised design are most appropriate in this setting. The principles of block designs and their applicability in this field are reviewed critically, as are the choice of outcomes and approaches to economic analysis. We conclude that more complex designs are not superior per se, and that the design, choice of implementation method and topic, and analysis of such experiments should reflect the circumstances of the study.
Get full access to this article
View all access options for this article.
References
1.
AntmanEMLauJKupelnickBMostellerFChalmersTC. A comparison of results of meta-analyses of randomised control trials and recommendations of clinical experts. Journal of the American Medical Association1992; 268: 240–248
2.
EcclesMFreemantleNMasonJMFor the North of England Evidence Based Guideline Development Project. Evidence based clinical practice guideline: ACE-inhibitors in the primary care management of adults with symptomatic heart failure. BMJ1998; 316: 1369–1375
3.
BloorKFreemantleN. Lessons from international experience in controlling pharmaceutical expenditure. II: Influencing doctors. BMJ1996; 312: 1525–1527
4.
Effective Health Care. Implementing clinical practice guidelines. Bulletin no. 8. Leeds: University of Leeds, 1994
5.
FreemantleNWoodJCrawfordF. Evidence into practice, experimentation and quasi experimentation: are the methods up to the task?Journal of Epidemiology and Community Health1998; 52: 75–81
6.
FreemantleNHarveyEGrimshawJWolfFOxmanAGrilliRBeroL. The effectiveness of printed educational materials in changing the behaviour of healthcare professionals. In: FreemantleNBeroLGrilliRGrimshawJOxmanA, eds. Effective professional practice module. The Cochrane database of systematic reviews, 1996: issue 3
7.
RussellIGrimshawJ. The effectiveness of referral guidelines: a review of the methods and findings of published evaluations. In: RolandMCoulterA, eds. Hospital referrals, vol 1. Oxford: Oxford University Press, 1992: 179–211
8.
NortonPGDempseyU. Self-audit: its effect on quality of care. Journal of Family Practice1985; 21: 289–291
North of England Study of Standards and Performance in General Practice. Medical audit in general practice: effects on doctors' clinical behaviour and the health of patients with common childhood conditions. BMJ1992; 304: 1480–1488
11.
MaimanLABeckerMHLiptakGSNazarianLFRoundsKA. Improving pediatricians' compliance-enhancing practices: a randomised trial. American Journal of Diseases of Children1988; 142: 773–779
12.
RabinDLBoekelooBOMarxESBowmanMARussellNKWillisAG. Improving office-based physicians' prevention practices for sexually transmitted diseases. Annals of Internal Medicine1994; 121: 513–519
13.
FreemantleNDrummondMF. Should clinical trials with concurrent economic analyses be blinded?Journal of the American Medical Association1997; 277: 63–64
14.
CookTDCampbellDT. Quasi-experimentation: design and analysis issues for field settings. Chicago: Rand McNally, 1979
15.
OakeshottPKerrySMWilliamsJE. Randomized controlled trial of the effect of the Royal College of Radiologists' guidelines on general practitioners' referrals for radiographic examination. British Journal of General Practice1994; 44: 197–200
16.
LomasJEnkinMAndersonGMHannahWJVaydaESingerJ. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous caesarean section. Journal of the American Medical Association1991; 265: 2202–2207
17.
WoodJFreemantleN. Choosing an appropriate unit of analysis in trials of interventions that attempt to influence practice. Journal of Health Services Research and Policy1999; 4: 44–48
18.
FreemantleNWattIMasonJ. Developments in the purchasing process in the NHS: towards an explicit politics of rationing. Public Administration1993; 71: 535–548
