To the Editor.
—Lomas et al1 looked at two different methods of changing medical practices that had not been influenced by explicit practice guidelines. In this innovative study, the authors found that physicians in hospitals receiving an opinion leader education (OLE) intervention were less likely to perform inappropriate cesarean sections than physicians in control hospitals and hospitals receiving audit and feedback. Two aspects of the design and analysis of this study, however, make it difficult to determine whether or not the better compliance with cesarean section guidelines in the OLE group was actually due to the influence of the opinion leader on his or her fellow physicians.First, the higher compliance with cesarean section guidelines in the OLE group may have been due to the practices of the opinion leaders themselves. The four opinion leaders received 1½ days of intense training in the guidelines for performance of cesarean sections;
Ellerbeck E. Opinion Leaders vs Audit Feedback to Implement Practice Guidelines. JAMA. 1991;266(9):1217. doi:10.1001/jama.1991.03470090051023
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