Physician Behavior Change: A Systematic Review

Abstract

Evidence-based medicine (EBM) has been advocated as one of the central dogmas of health care since the late 20th century. EBM provides health care entities the prospect to revolutionize health care practices and improve the standard of health care for everyone. Therefore, the potential benefits for adopting EBM practices cannot be overlooked. However, physicians face an increasingly difficult challenge, both personal and professional, when adopting EBM practices. Therefore, knowledge of effective strategies for driving physician behavioral is necessary. To this effort, this systematic review is tasked to compile and analyze the literature focused on physician behavior change. After a review of 1970 studies, 29 different studies were meticulously evaluated by 2 separate reviewers. Studies were then categorized into 5 broad distinctions based on their assessed outcomes: (1) physician knowledge; (2) ordering of tests; (3) compliance with protocols; (4) prescription of medications; and (5) complication rates. The testing group was focused on osteoporosis screening, using educational interventions. Protocol compliance studies were heterogeneous, ranging from diagnosing supracondylar fractures in pediatric patients to antimicrobial administration. Prescription pattern studies were primarily focused around the management of osteoporosis. Multimodal interventions seemed to be more effective when producing change. However, due to the variability in intervention type and outcomes assessment, it is difficult to conclude the most effective intervention for driving physician behavioral change. Physician behavior and specifically surgeon behavior are disproportionately influenced by mentors, fellowship training, and memories of excellent or catastrophic outcomes much more so than literature and data. Adopting evidence-based practices (EBM) and value centric care may provide an opportunity for physicians to improve personal performance.