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Opinion leaders vs audit and feedback to implement practice guidelines.

Seventy six physicians in 16 Ontario counties were randomly assigned (by county) into three groups (one serving as a control) for an intervention to increase the use of a guideline for increasing trial labor after a caesarean. One group was given feedback after record audits regarding the guideline. The other group of hospitals used a process for nominating opinion leaders, (four emerged) who then attended a 1 1/2 day workshop on evidence to the practice guidelines and basic principles of behaviour change. They then had two mailings to their colleagues over the two year period, hosted a community meeting, and maintained their regular communication with colleagues, but logging these for the study. After 24 months, 3552 case charts were audited and the control and audit/feedback groups showed no change. The rates of trial of labor increased 46% and the rates of vaginal births increased 85%. Only the opinion leader group had a reduction in overall cesarean section rates. "The use of opinion leaders improved the quality of care."