Fahey et al should be congratulated for trying to work out how GPs can best manage hypertension in primary care.1 However, I feel that their systematic review has overlooked a number of points when it comes to the selection, analysis and summation of trials that relate to educational interventions for patients and doctors. In their discussion, they state that, ‘Education alone, directed either to patients or health professionals appears unlikely to influence control of blood pressure as a single intervention, as results were highly heterogeneous …’
What the reviewers have failed to appreciate is that educational interventions cannot be treated as ‘single interventions’. Unlike a tablet, educational interventions are, by their very nature, complex interventions, as they involve teachers/tutors, learners and the context in which they learn. Thus, they are not as amenable to more traditional forms of systematic review or meta-analysis.2 Furthermore, by only including randomised controlled trials in their review, they have left out a potential goldmine of studies that might have told us more about the value of this type of complex intervention.3
In order to further our understanding of educational interventions, what we need is not a summation of data to tell us if it works, but a more theory-driven understanding of why it works, for whom, in what circumstances and to what extent.4,5 Only then will we be able to harness the power of education for the benefit of our patients and ourselves.
- © British Journal of General Practice, 2006.
