© 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 13 (2007) 581–598 581 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2007 The Authors; Journal compilation © 2007 Blackwell Publishing Ltd? 2007134581598Original Article Impact of EBM intervention on knowledge and behaviourK. Shuval et al . Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors’ attitudes, knowledge and clinical behaviour: a controlled trial and before and after study Kerem Shuval MPH, 1 Eldar Berkovits MD, 2 Doron Netzer MD, 3 Igal Hekselman MD MHA, 4 Shai Linn MD DrPH, 5 Mayer Brezis MD MPH, 6 Shmuel Reis MD MHPE 7 1 PhD, School of Public Health, University of Haifa, Haifa, Israel 2 Director of the Continuing Care Unit, Haifa & Western Galilee district, Clalit Health Services, Israel 3 Director of Utility Review, Sharon-Shomron District, Clalit Health Services, Israel 4 Medical Director, Health Insurance System & Clalit Mushlam, Clalit Health Services, Israel 5 Professor and Head, School of Public Health, Haifa University, Haifa, and Head, Clinical Epidemiology Unit, Rambam Medical Center, Haifa, Israel 6 Director, Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 7 Director Department of Medical Education, The R & B Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, and Member, The Galil Center for Medical Informatics and Telemedicine, and the Department of Family Medicine, The R & B Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel Abstract Rationale, aims and objectives Traditional continuing medical education programmes that offer passive learning have been shown to be poorly effective at changing doctors’ clinical behaviour. A multifaceted evidence-based medicine (EBM) intervention was con- ducted at the largest health maintenance organization (HMO) in Israel, attempting to facilitate a change in doctors’ attitudes, knowledge and clinical behaviour. No study thus far has examined the association between the teaching of EBM principles and doctors’ clinical behaviour. This study evaluated the intervention programme through a controlled trial and before and after study. The objective of the evaluation is binary: first, to examine the impact of an educational intervention on family doctors’ test ordering performance and drug utilization by their patients; and second, to assess the impact of the intervention on attitudes towards evidence-based practice and knowledge. Methods Controlled trial and before and after study. Primary care clinics comprising similar patient characteristics were randomly allocated to the experimental or to the control group. Doctors in the experimental group participated in an EBM educational intervention, while the control group did not take part in the intervention. Clinicians’ test ordering performance and their patients’ drug utilization were derived from the HMO’s database before intervention, after workshops and after intervention. Participants in the controlled trial consisted of 75 doctors and their 106 349 patients. The before and after study evaluated intervention doctors’ ( n = 70) EBM attitudes and knowledge through a validated questionnaire before and after workshops. Results EBM workshops enhanced intervention doctors’ EBM knowledge scores from 22.4/100 before workshops to 40.8/100 after workshops ( P = 0.000). Doctors improved their ability to formulate clinical questions while enhancing their search strategy using Medline. In a linear regression model, two covariates, specialization (B = 12.59; P = 0.001) and habitually reading medical journals (B = 6.45; P = 0.052), best explained the variance in doctors’ EBM knowledge scores, while controlling for pre-intervention scores (R 2 = 0.569; P = 0.000). Results from the controlled trial indicated that no statisti- cally significant differences were found between intervention and control doctors’ test ordering performances, and their patients’ drug utilization. Conclusions The results of the study suggest that the intervention positively influenced attitudes and knowledge; however, no statistically significant impact was found on doctors’ test ordering performance and on their patients’ drug utilization. The intervention’s inabil- ity to change doctors’ clinical behaviour might be remedied by improving future interven- Keywords before and after study, continuing medical education, controlled trial, evaluation, evidence-based medicine, primary care, quality of care Correspondence Kerem Shuval Yale Prevention Research Center Griffin Hospital 130 Division Street Derby CT 06418 USA E-mails: kerem.shuval@yalegriffinprc.org; kerem.shuval@gmail.com Accepted for publication: 23 January 2007