1
|
Cervantes-Arellano MJ, Castelán-Martínez OD, Marín-Campos Y, Chávez-Pacheco JL, Morales-Ríos O, Ubaldo-Reyes LM. Educational interventions in pharmacovigilance to improve the knowledge, attitude and the report of adverse drug reactions in healthcare professionals: Systematic Review and Meta-analysis. Daru 2024; 32:421-434. [PMID: 38427161 PMCID: PMC11087385 DOI: 10.1007/s40199-024-00508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Underreporting of adverse drug reactions (ADRs) limits and delays the detection of signs. The aim of this systematic review with meta-analyses was to synthesize the evidence of educational interventions (EIs) efficacy in health professionals to increase ADR reporting, attitudes, and knowledge of pharmacovigilance. EVIDENCE ACQUISITION A systematic literature review was carried out to identify randomized clinical trials evaluating the efficacy of EI in pharmacovigilance in health professionals to improve ADR reports, knowledge, and attitude toward pharmacovigilance. ADR reports were pooled by calculating Odds Ratio (OR) with a 95% confidence interval (95%CI), while pharmacovigilance knowledge and attitude were pooled by calculating a mean difference (MD) with 95%CI. In addition, the subanalysis was performed by EI type. Meta-analysis was performed with RevMan 5.4 software. PROSPERO registry CRD42021254270. RESULTS Eight hundred seventy-five articles were identified as potentially relevant, and 11 were included in the systematic review. Metanalysis showed that EI increased ADR reporting in comparison with control group (OR = 4.74, [95%CI, 2.46 to 9.12], I2 = 93%, 5 studies). In subgroup analysis, the workshops (OR = 6.26, [95%CI, 4.03 to 9.73], I2 = 57%, 3 studies) increased ADR reporting more than telephone-based interventions (OR = 2.59, [95%CI, 0.77 to 8.73], I2 = 29%, 2 studies) or combined interventions (OR = 5.14, [95%CI, 0.97 to 27.26], I2 = 93%, 3 studies). No difference was observed in pharmacovigilance knowledge. However, the subanalysis revealed that workshops increase pharmacovigilance knowledge (SMD = 1.85 [95%CI, 1.44 to 2.27], 1 study). Only one study evaluated ADR reporting attitude among participants and showed a positive effect after the intervention. CONCLUSION EI improves ADR reports and increases pharmacovigilance knowledge. Workshops are the most effective EI to increase ADR reporting.
Collapse
Affiliation(s)
- Mónica J Cervantes-Arellano
- Anatomy Department, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Osvaldo D Castelán-Martínez
- Clinical Pharmacology Laboratory, UMIEZ, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México (UNAM), Batalla 5 de Mayo s/n Esquina Fuerte de Loreto, Col. Ejército de Oriente, Iztapalapa, Mexico City, C.P. 09230, Mexico.
| | - Yolanda Marín-Campos
- Pharmacology Department, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Juan L Chávez-Pacheco
- Clinical Pharmacology Laboratory, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Olga Morales-Ríos
- Unidad Habilitada de Apoyo al Predictamen, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Laura M Ubaldo-Reyes
- Anatomy Department, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| |
Collapse
|
2
|
Kanchan S, Gaidhane A. Print Media Role and Its Impact on Public Health: A Narrative Review. Cureus 2024; 16:e59574. [PMID: 38832199 PMCID: PMC11144588 DOI: 10.7759/cureus.59574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024] Open
Abstract
Print media plays a pivotal role in communicating public health information, acting as a vital channel for spreading awareness and encouraging healthy behaviors. This narrative review delves into the historical significance of print media in health communication while evaluating its relevance in today's digital media environment. Despite encountering significant hurdles like digital competition and financial limitations, print media remains indispensable for addressing crucial health issues and disseminating information during public health emergencies. Effectively utilizing print media for health promotion necessitates careful planning, thorough evaluation, and targeted distribution to ensure widespread impact and audience engagement. Employing a comprehensive search strategy, relevant literature was identified through electronic databases and manual searches of reference lists. The gathered literature underwent rigorous screening to align with the review's objectives, with key insights synthesized through iterative analysis. Print media remains a cornerstone of health communication, offering tangible avenues for information dissemination and audience interaction. However, its efficacy is subject to various factors, including technological advancements, evolving media landscapes, and challenges in content dissemination. Overcoming these obstacles requires innovative approaches and collaborative endeavors to harness the full potential of print media in advancing public health objectives.
Collapse
Affiliation(s)
- Sushim Kanchan
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Abhay Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|
3
|
Chang SJ, Kim GM, Kim JA. The effects of flipped learning and gamification on nursing students' patient safety education: A mixed method study. Heliyon 2024; 10:e29538. [PMID: 38655326 PMCID: PMC11036057 DOI: 10.1016/j.heliyon.2024.e29538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Background The importance of enhancing education to promote nursing students' patient safety competency is increasing. Hence, implementing diverse educational programs and assessing their outcomes is essential. Objectives To examine the effects of flipped learning and gamification on nursing students' patient safety education. Design A mixed-method design employing a quasi-experimental design with a pre-post control group design and qualitative thematic analysis. Methods The study was conducted at a South Korean university in W City from September to December 2022. It included 55 s-year nursing students. The experimental group (n = 28) participated in a 30-h patient safety education course using flipped learning and gamification, whereas the control group (n = 27) received only written patient safety education materials. Learning motivation, collective efficacy, patient safety competency, and game evaluations were measured. Data were analyzed using the χ2 test, Fisher's exact test, t-test, repeated-measures multivariate analysis of covariance, repeated measure analysis of covariance, and generalized estimating equations. Self-reflection journals on game participation experiences were analyzed using qualitative thematic analysis. Results Learning motivation scores did not differ significantly between groups for time, or interactions between groups and time, but collective efficacy and patient safety competency scores showed significant differences in the interactions between groups and time. The experimental group showed a high satisfaction score in game evaluation. Qualitative analyses were used to extract four themes-three positives: "fun and immersion differentiated from existing classes," "improved the learning outcomes and learning motivation," and "realized the value of collaboration and communication," and one negative: "feeling down due to unfamiliarity." Conclusions This program creates positive learning experiences and enhances nursing students' collective efficacy and patient-safety competencies. It is expected to be utilized in various future nursing courses.
Collapse
Affiliation(s)
- Soo Jung Chang
- Department of Nursing, Gangneung-Wonju National University, South Korea
| | - Geun Myun Kim
- Department of Nursing, Gangneung-Wonju National University, South Korea
| | - Jeong Ah Kim
- Department of Nursing, Seoil University, South Korea
| |
Collapse
|
4
|
Sawant U, Sen J. A Comprehensive Review of Magnesium Sulfate Infusion: Unveiling the Impact on Hemodynamic Stability During Laryngoscopy and Tracheal Intubation in Ear, Nose, and Throat Surgeries. Cureus 2024; 16:e57002. [PMID: 38681416 PMCID: PMC11046371 DOI: 10.7759/cureus.57002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
This comprehensive review explores the potential of magnesium sulfate infusion in mitigating hemodynamic instability during laryngoscopy and tracheal intubation in ear, nose, and throat (ENT) surgeries. Hemodynamic fluctuations during these procedures pose challenges, and magnesium sulfate, with its vasodilatory, antiarrhythmic, and neuroprotective properties, emerges as a promising intervention. The review critically examines existing literature, emphasizing patient selection criteria, dosage protocols, and a comparative analysis with other hemodynamic stabilizers. Safety considerations, including known adverse effects and risk-benefit assessments, and monitoring and management strategies are elucidated. The implications for ENT surgery are discussed, highlighting the potential for enhanced hemodynamic management and individualized approaches. The review concludes with a call for continued research, emphasizing the ongoing evolution of understanding and practice incorporating magnesium sulfate into perioperative care. The insights offered aim to guide clinicians in navigating this dynamic landscape for improved patient outcomes in ENT surgeries.
Collapse
Affiliation(s)
- Urvi Sawant
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jayashree Sen
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
5
|
Sunner C, Giles M, Ball J, Barker R, Hullick C, Oldmeadow C, Foureur M. Implementation and evaluation of a nurse-led intervention to augment an existing residential aged care facility outreach service with a visual telehealth consultation: stepped-wedge cluster randomised controlled trial. BMC Health Serv Res 2023; 23:1429. [PMID: 38110923 PMCID: PMC10726593 DOI: 10.1186/s12913-023-10384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Up to 75% of residents from residential aged care facilities (RACF) are transferred to emergency departments (ED) annually to access assessment and care for unplanned or acute health events. Emergency department presentations of RACF residents can be both expensive and risky, and many are unnecessary and preventable. Processes or triage systems to assess residents with a health event, prior to transfer, may reduce unnecessary ED transfer. The Aged Care Emergency (ACE) service is a nurse-led ED outreach service that provides telephone support to RACF nurses regarding residents' health events. This service is available Monday to Friday, 8am to 4 pm (ED ACE hours). The primary objective of this study was to assess whether the augmentation of the phone-based ED ACE service with the addition of a visual telehealth consultation (VTC) would reduce RACF rate of ED presentations compared to usual care. The secondary objectives were to 1) monitor presentations to ED within 48 h post VTC to detect any adverse events and 2) measure RACF staff perceptions of VTC useability and acceptability. METHODS This implementation study used a stepped wedge cluster randomised controlled trial design. Study settings were four public hospital EDs and 16 RACFs in two Local Health Districts. Each ED was linked to 4 RACFs with approximately 350 RACF beds, totalling 1435 beds across 16 participating RACFs. Facilities were randomised into eight clusters with each cluster comprising one ED and two RACFs. RESULTS A negative binomial regression demonstrated a 29% post-implementation reduction in the rate of ED presentations (per 100 RACF beds), within ED ACE hours (IRR [95% CI]: 0.71 [0.46, 1. 09]; p = 0.122). A 29% reduction, whilst not statistically significant, is still clinically important and impactful for residents and EDs. A post-hoc logistic regression demonstrated a statistically significant 69% reduction in the probability that an episode of care resulted in an ED presentation within ED ACE hours post-implementation compared to pre-implementation (OR [95% CI]: 0.31 [0.11, 0.87]; p = 0.025). CONCLUSION Findings have shown the positive impact of augmenting ACE with a VTC. Any reduction of resident presentations to a busy ED is beneficial to healthcare overall, but more so to the individual older person who can recover safely and comfortably in their own RACF. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ID ACTR N12619001692123) (02/12/2019) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378629andisReview=true.
Collapse
Affiliation(s)
- Carla Sunner
- Hunter New England Local Health District, Newcastle, 2300, Australia.
- University of Newcastle, Callaghan, 2308, Australia.
| | - Michelle Giles
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | - Jean Ball
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Roslyn Barker
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Carolyn Hullick
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | | | - Maralyn Foureur
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| |
Collapse
|
6
|
Neville HL, Shaw J, VanIderstine C, Burgess S, Dearing M, Isenor JE, Toombs K, Bowles SK. Environmental scan of current strategies to decrease sedative-hypnotic drug use and promote sleep in hospital patients. Int J Clin Pharm 2023; 45:1062-1073. [PMID: 37773305 DOI: 10.1007/s11096-023-01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/29/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Sedative-hypnotic drugs are often initiated in hospital to manage insomnia and anxiety. Guidelines discourage their use, particularly in older adults, due to risks of falls, fractures, and delirium. AIM To identify publicly available resources to decrease the use of sedative-hypnotic drugs and promote sleep in hospital. METHOD An advanced Google search with 6 search strategies was conducted. Key websites were also identified and searched. Hospital- or community-based resources using non-pharmacologic measures to reduce sedative-hypnotic drug use and/or to promote sleep were included if they were publicly available in English within the past 5 years. Full text screening and data extraction was performed independently by 2 reviewers; a third reviewer resolved disagreements by consensus. RESULTS A total of 79 resources met inclusion criteria, with 65 (82.3%) providing education and 31 (39.2%) describing sleep hygiene strategies. Other resources included deprescribing (17, 21.5%), relaxation training (13, 16.5%), cognitive behavioural therapy for insomnia (9, 11.4%), and policies (7, 8.9%). The resources primarily targeted patients (59, 74.7%) followed by healthcare providers (9, 11.4%). There were 9 resources (11.4%) that applied to both community and hospital settings, and another 2 (2.5%) designed specifically for hospital. CONCLUSION Many resources were available to patients and healthcare providers to reduce inappropriate or ineffective use of sedative-hypnotic drugs and promote better sleep. Specific resources for the hospital setting were infrequent and recommended that clinicians stop hospital-initiated sedatives when patients are discharged. Identified resources can be adapted by healthcare organizations to develop sedative-hypnotic prescribing programs and policies.
Collapse
Affiliation(s)
- Heather L Neville
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Jenna Shaw
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Carter VanIderstine
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kent Toombs
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | |
Collapse
|
7
|
Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study. J Rehabil Med 2023; 55:jrm4471. [PMID: 37548542 PMCID: PMC10424097 DOI: 10.2340/jrm.v55.4471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/05/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. DESIGN This study followed a participatory action research approach guided by the Knowledge to Action framework. METHODS Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. RESULTS Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. CONCLUSION Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes.
Collapse
Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane; Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane; Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast.
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Claire Stewart
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
| |
Collapse
|
8
|
Lyu X, Li S. Professional medical education approaches: mobilizing evidence for clinicians. Front Med (Lausanne) 2023; 10:1071545. [PMID: 37575990 PMCID: PMC10419302 DOI: 10.3389/fmed.2023.1071545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.
Collapse
Affiliation(s)
- Xiafei Lyu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Bora AM, Piechotta V, Kreuzberger N, Monsef I, Wender A, Follmann M, Nothacker M, Skoetz N. The effectiveness of clinical guideline implementation strategies in oncology-a systematic review. BMC Health Serv Res 2023; 23:347. [PMID: 37024867 PMCID: PMC10080872 DOI: 10.1186/s12913-023-09189-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023] Open
Abstract
IMPORTANCE Guideline recommendations do not necessarily translate into changes in clinical practice behaviour or better patient outcomes. OBJECTIVE This systematic review aims to identify recent clinical guideline implementation strategies in oncology and to determine their effect primarily on patient-relevant outcomes and secondarily on healthcare professionals' adherence. METHODS A systematic search of five electronic databases (PubMed, Web of Science, GIN, CENTRAL, CINAHL) was conducted on 16 december 2022. Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence outcomes (screening, referral, prescribing, attitudes, knowledge) in the oncological setting were targeted. The Cochrane risk-of-bias tool and the ROBINS-I tool were used for assessing the risk of bias. Certainty in the evidence was evaluated according to GRADE recommendations. This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42021268593. FINDINGS Of 1326 records identified, nine studies, five cluster RCTs and four controlled before-and after studies, were included in the narrative synthesis. All nine studies assess the effect of multi-component interventions in 3577 cancer patients and more than 450 oncologists, nurses and medical staff. PATIENT-LEVEL Educational meetings combined with materials, opinion leaders, audit and feedback, a tailored intervention or academic detailing may have little to no effect on overall survival, quality of life and adverse events of cancer patients compared to no intervention, however, the evidence is either uncertain or very uncertain. PROVIDER-LEVEL Multi-component interventions may increase or slightly increase guideline adherence regarding screening, referral and prescribing behaviour of healthcare professionals according to guidelines, but the certainty in evidence is low. The interventions may have little to no effect on attitudes and knowledge of healthcare professionals, still, the evidence is very uncertain. CONCLUSIONS AND RELEVANCE Knowledge and skill accumulation through team-oriented or online educational training and dissemination of materials embedded in multi-component interventions seem to be the most frequently researched guideline implementation strategies in oncology recently. This systematic review provides an overview of recent guideline implementation strategies in oncology, encourages future implementation research in this area and informs policymakers and professional organisations on the development and adoption of implementation strategies.
Collapse
Affiliation(s)
- Ana-Mihaela Bora
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Vanessa Piechotta
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Wender
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, C/O Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
10
|
Kengne Talla P, Makansi N, Michaud PL, Durand R, Allison PJ, Emami E. Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054671. [PMID: 36901681 PMCID: PMC10002179 DOI: 10.3390/ijerph20054671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 05/13/2023]
Abstract
During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.
Collapse
Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
- Correspondence:
| | - Nora Makansi
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
| | - Pierre-Luc Michaud
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS B3H 1W2, Canada
| | - Robert Durand
- Faculty of Dental Medicine, Université de Montreal, Montreal, QC H3T 1J4, Canada
| | - Paul J. Allison
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
| |
Collapse
|
11
|
Böttinger MJ, Elgeti M, Tschaggeny D, Wasner M, Diermayr G. Barrieren und Förderfaktoren für die Implementierung eines Konzepts zur Förderung evidenzbasierten Arbeitens in der Physiotherapie – Eine Mixed-Methods-Studie. PHYSIOSCIENCE 2023. [DOI: 10.1055/a-1720-8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Zusammenfassung
Hintergrund In der Physiotherapie in Deutschland besteht Bedarf an theoretisch und wissenschaftlich fundierten Implementierungsstrategien zur Förderung des evidenzbasierten Arbeitens (EBP). Bei der Entwicklung solcher Strategien ist es notwendig, die Rahmenbedingungen und Einflussfaktoren im individuellen Kontext zu erfassen und zu berücksichtigen. In diesem Zusammenhang wurde das „science4practice“-Konzept mit dem Ziel entwickelt, die Umsetzung von EBP in physiotherapeutischen Einrichtungen zu fördern.
Ziel Erhebung von Barrieren und Förderfaktoren für die Implementierung des „science4practice“-Konzepts.
Methode Im Rahmen einer Mixed-Methods-Studie wurden qualitative, semistrukturierte Interviews sowie eine quantitative Erhebung anhand eines Online- und Papierfragebogens durchgeführt. An den Interviews nahmen Geschäfts- und Therapieleitungen therapeutischer Einrichtungen sowie Physiotherapeut*innen ohne Leitungsverantwortung teil. An der quantitativen Befragung nahmen Physiotherapeut*innen ohne Leitungsverantwortung teil. Die Daten der Interviews wurden mittels thematischer Inhaltsanalyse ausgewertet. Die Daten der quantitativen Erhebung wurden deskriptiv analysiert.
Ergebnisse Aus den 15 durchgeführten Interviews konnten die mangelnden Fähigkeiten zur Literaturrecherche und -bewertung, negative Erfahrungen mit Veränderungsprozessen sowie unzureichende Zugangsmöglichkeiten zu wissenschaftlicher Literatur als Barrieren abgeleitet werden. Als Förderfaktoren wurden die Unterstützung durch Vorgesetzte sowie die Verfügbarkeit von Ressourcen für die Implementierung des Konzepts identifiziert. Die Umfrageergebnisse von 47 Physiotherapeut*innen ohne Leitungsverantwortung zeigen kumulierte Zustimmungswerte („trifft voll zu“ und „trifft eher zu“) von 83–91 % für die Bereitschaft zur Umsetzung des „science4practice“-Konzepts. Durch die Zusammenführung der quantitativen und qualitativen Daten konnte die Bereitschaft des Teams zur Konzeptumsetzung abschließend als Förderfaktor eingeordnet werden.
Schlussfolgerung Die Studie identifiziert Barrieren und Förderfaktoren aus Sicht der Teilnehmenden mit und ohne Leitungsverantwortung. Einerseits unterstreichen die Daten national und international identifizierte Barrieren wie mangelnde wissenschaftliche Kompetenzen oder unzureichende Zugänge zu wissenschaftlicher Literatur. Andererseits zeigen die Ergebnisse das Potential des Konzepts als EBP-Implementierungsvorhaben in der Physiotherapie in Deutschland. Im nächsten Schritt sollten Studien durchgeführt werden, um die Machbarkeit des Konzepts zu überprüfen.
Collapse
Affiliation(s)
| | | | | | - Mieke Wasner
- SRH Hochschule Heidelberg, Heidelberg, Deutschland
| | | |
Collapse
|
12
|
Falcão M, Allocca M, Rodrigues AS, Granjo P, Francisco R, Pascoal C, Rossi MG, Marques-da-Silva D, Magrinho SCM, Jaeken J, Castro LA, de Freitas C, Videira PA, de Andrés-Aguayo L, dos Reis Ferreira V. A Community-Based Participatory Framework to Co-Develop Patient Education Materials (PEMs) for Rare Diseases: A Model Transferable across Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:968. [PMID: 36673723 PMCID: PMC9859511 DOI: 10.3390/ijerph20020968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
At least 50% of chronic disease patients don't follow their care plans, leading to lower health outcomes and higher medical costs. Providing Patient Education Materials (PEMs) to individuals living with a disease can help to overcome these problems. PEMs are especially beneficial for people suffering from multisystemic and underrecognized diseases, such as rare diseases. Congenital disorders of glycosylation (CDG) are ultra-rare diseases, where a need was identified for PEMs in plain language that can clearly explain complex information. Community involvement in the design of PEMs is extremely important for diseases whose needs are underserved, such as rare diseases; however, attempts to involve lay and professional stakeholders are lacking. This paper presents a community-based participatory framework to co-create PEMs for CDG, that is transferable to other diseases. A literature review and questionnaire were performed, and only four articles describing the development of PEMS for rare diseases have been found, which demonstrates a lack of standardized approaches. The framework and PEMs were co-developed with CDG families and will be crucial in increasing health literacy and empowering families. We will close a gap in the creation of PEMs for CDG by delivering these resources in lay language in several languages.
Collapse
Affiliation(s)
- Marta Falcão
- Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon, 1349-008 Lisbon, Portugal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
| | - Mariateresa Allocca
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Institute of Biomolecular Chemistry, National Research Council of Italy, 80078 Pozzuoli, Italy
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Ana Sofia Rodrigues
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Pedro Granjo
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Rita Francisco
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Carlota Pascoal
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Maria Grazia Rossi
- IFILNOVA—Institute of Philosophy—Faculty of Social Sciences and Humanities, NOVA University of Lisbon, 1069-061 Lisbon, Portugal
| | - Dorinda Marques-da-Silva
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Salvador C. M. Magrinho
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- LAQV (Associate Lab for Green Chemistry)—Chemistry Department, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
| | - Jaak Jaeken
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Centre of Metabolic Diseases, Department of Pediatrics, KU Leuven, 3000 Leuven, Belgium
| | - Larisa Aragon Castro
- Swiss Personalized Health Network (SPHN), 3001 Bern, Switzerland
- EUPATI—European Patient’s Academy on Therapeutic Innovation, 3008 Bern, Switzerland
- SNSF Swiss National Science Foundation, 3001 Bern, Switzerland
| | - Cláudia de Freitas
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- EPI Unit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Paula A. Videira
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| | - Luísa de Andrés-Aguayo
- Center for Genomic Regulation (CRG), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
| | - Vanessa dos Reis Ferreira
- CDG & Allies—Professionals and Patient Associations International Network (CDG & Allies—PPAIN), Department of Life Sciences, School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- UCIBIO, Department of Life Sciences, NOVA School of Science and Technology, NOVA University of Lisbon, 2819-516 Caparica, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Department of Life Sciences, School of Science and Technology, NOVA University Lisbon, 2819-516 Caparica, Portugal
| |
Collapse
|
13
|
Kelly SE, McGowan J, Barnhardt K, Straus SE. Paper 4: a review of reporting and disseminating approaches for rapid reviews in health policy and systems research. Syst Rev 2022; 11:152. [PMID: 35906679 PMCID: PMC9338534 DOI: 10.1186/s13643-022-01897-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/31/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transparent reporting of rapid reviews enables appropriate use of research findings and dissemination strategies can strengthen uptake and impact for the targeted knowledge users, including policy-makers and health system managers. The aim of this literature review was to understand reporting and dissemination approaches for rapid reviews and provide an overview in the context of health policy and systems research. METHODS A literature review and descriptive summary of the reporting and disseminating approaches for rapid reviews was conducted, focusing on available guidance and methods, considerations for engagement with knowledge users, and optimizing dissemination. MEDLINE, PubMed, Google scholar, as well as relevant websites and reference lists were searched from January 2017 to March 2021 to identify the relevant literature with no language restrictions. Content was abstracted and charted. RESULTS The literature review found limited guidance specific to rapid reviews. Building on the barriers and facilitators to systematic review use, we provide practical recommendations on different approaches and methods for reporting and disseminating expedited knowledge synthesis considering the needs of health policy and systems knowledge users. Reporting should balance comprehensive accounting of the research process and findings with what is "good enough" or sufficient to meet the requirements of the knowledge users, while considering the time and resources available to conduct a review. Typical approaches may be used when planning the dissemination of rapid review findings; such as peer-reviewed publications or symposia and clear and ongoing engagement with knowledge users in crafting the messages is essential so they are appropriately tailored to the target audience. Consideration should be given to providing different products for different audiences. Dissemination measures and bibliometrics are also useful to gauge impact and reach. CONCLUSIONS Limited guidance specific to the reporting and dissemination of rapid reviews is available. Although approaches to expedited synthesis for health policy and systems research vary, considerations for the reporting and dissemination of findings are pertinent to all.
Collapse
Affiliation(s)
- Shannon E Kelly
- School of Epidemiology and Public Health, University of Ottawa, Suite 101, 600 Peter Morand Crescent, ON, K1G 5Z3, Ottawa, Canada. .,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, Suite 101, 600 Peter Morand Crescent, ON, K1G 5Z3, Ottawa, Canada
| | - Kim Barnhardt
- Communications, CMAJ, 1410 Blair Towers, Suite 500, ON, K1J 9B9, Ottawa, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's - Unity Health Toronto, 38 Shuter St, ON, M5B 1A6, Toronto, Canada
| |
Collapse
|
14
|
Geleta TA, Deriba BS. Exploring Enablers and Barriers to Utilize Printed Information, Education, and Communication Materials Among Healthcare Providers of North Shoa Zone, Oromia, Ethiopia. Healthc Policy 2022; 15:1303-1313. [PMID: 35818433 PMCID: PMC9270902 DOI: 10.2147/rmhp.s360417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Information, education, and communication (IEC) materials have paramount relevance in primary health care which mainly focused on disease prevention and control. They are a cost-effective approach for achieving better health outcomes in all clinical and public health interventions. This study aimed to explore enablers and barriers to utilize printed IEC materials among healthcare providers of North Shoa Zone, Oromia, Ethiopia, 2020. Methods A descriptive, qualitative study was conducted from December 1, 2020, to December 30, 2020, among health care providers. A judgmental sampling technique was used and 20 key informants were recruited considering their educational level, professional categories, working units, work experience, and types of health facilities. The data were collected by using a semi-structured interview guide. The transcribed data were uploaded into ATLAS. ti version 7.5.18 software. Then, the inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. Direct quotations were presented with a thick description of the findings. Results The findings of the study were discussed under four themes of enablers and four themes of barriers. The four themes of enablers were availability of printed IEC materials, distribution of printed IEC material, perceived usefulness of printed IEC materials, and support from the non-government organization. The four themes of barriers were printed IEC materials-related factors, patients related factors, health care provider’s related factors, and government-related factors. Conclusion In this study, we found that the utilization of IEC materials was influenced by a number of facilitators and barriers. Thus, all concerned bodies need to give due attention to IEC materials and work towards the improvement of the quality of IEC materials, provide training for health care providers, work to increase the availability of IEC materials, and distribute them to the health facilities.
Collapse
Affiliation(s)
- Tinsae Abeya Geleta
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
- Correspondence: Tinsae Abeya Geleta, Email
| | - Berhanu Senbeta Deriba
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
| |
Collapse
|
15
|
Adisso ÉL, Taljaard M, Stacey D, Brière N, Zomahoun HTV, Durand PJ, Rivest LP, Légaré F. Does Adding Training in Shared Decision Making for Home Care Teams to Providing Decision Guides Better Engage Frail Elders and Caregivers in Housing Decisions? :A Stepped-Wedge Cluster Randomized Trial. JMIR Aging 2022; 5:e39386. [PMID: 35759791 PMCID: PMC9533197 DOI: 10.2196/39386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10). Conclusions Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525
Collapse
Affiliation(s)
- Évèhouénou Lionel Adisso
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525 Chemin de la Canardière bureau A-3421, Québec, CA.,VITAM - Centre de recherche en santé durable, Quebec, QC, CA.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, CA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CA.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, CA
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CA.,School of Nursing, University of Ottawa, Ottawa, CA
| | - Nathalie Brière
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Direction des services multidisciplinaires, Quebec, QC, CA
| | - Hervé Tchala Vignon Zomahoun
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525 Chemin de la Canardière bureau A-3421, Québec, CA.,VITAM - Centre de recherche en santé durable, Quebec, QC, CA.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, CA.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, QC, CA.,Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, CA
| | - Pierre Jacob Durand
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, CA
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Quebec, QC, CA.,Canada Research Chair in Statistical Sampling and Data Analysis, Laval University, Quebec, QC, CA
| | - France Légaré
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525 Chemin de la Canardière bureau A-3421, Québec, CA.,VITAM - Centre de recherche en santé durable, 2525 Chemin de la Canardière bureau A-3421, Québec, CA.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, 2525 Chemin de la Canardière bureau A-3421, Québec, CA.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada, 2325 Rue de l'Université, Québec, QC G1V 0A6, QUEBEC, CA
| |
Collapse
|
16
|
Implementing and Evaluating the Impact of BoneRx: A Healthy Bone Prescription for Men with Prostate Cancer Initiating Androgen Deprivation Therapy. J Clin Med 2022; 11:jcm11102703. [PMID: 35628830 PMCID: PMC9144215 DOI: 10.3390/jcm11102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background: The initiation of Androgen Deprivation Therapy (ADT) results in rapid and profound hypogonadism, resulting in significant bone and muscle loss, increasing the risk for osteoporosis (OP), falls, and fractures. Despite this, there exist very low rates of guideline adherent care regarding bone health in this population. We developed and implemented a healthy bone prescription tool entitled BoneRx to facilitate the uptake of guideline-concordant bone health care into practice and increase patient awareness and promote the uptake of health bone behaviours (HBBs). Methods: We conducted a cross-sectional pre-BoneRx implementation (n = 143) vs. post-implementation (n = 149) cohort study to evaluate the impact on (i) bone health care, patient engagement in HBB, and patient knowledge and health beliefs regarding OP. Results: There was a significant difference pre- vs. post BoneRx implementation on receipt of baseline BMD (34.7% vs. 59.5%, p < 0.0001) and bone health counselling (32.4% vs. 59.9%, p < 0.0001). More participants in the post-BoneRx implementation cohort reported taking vitamin D supplements 57% vs. 81% (p < 0.001) and calcium supplements 39% vs. 61% (p < 0.001). Physical activity levels also significantly increased (p = 0.021). No differences were detected in OP knowledge or feelings of OP susceptibility, seriousness, or health motivation. Conclusion: BoneRx is a simple, cost-effective, and acceptable strategy that could improve the care of PCa survivors receiving ADT.
Collapse
|
17
|
Dray J, Licata M, Doherty E, Tully B, Williams B, Curtin S, White D, Lecathelinais C, Ward S, Hasson S, Elliott EJ, Wiggers J, Kingsland M. Enhancing clinician participation in quality improvement training: implementation and impact of an evidence-based initiative to maximise antenatal clinician participation in training regarding women’s alcohol consumption during pregnancy. BMC Health Serv Res 2022; 22:402. [PMID: 35351113 PMCID: PMC8962084 DOI: 10.1186/s12913-022-07717-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession. Methods A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession. Results Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (μ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles. Conclusions A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes. Trial registration Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).
Collapse
|
18
|
Houben F, van Hensbergen M, den Heijer CDJ, Dukers-Muijrers NHTM, Hoebe CJPA. Barriers and facilitators to infection prevention and control in Dutch psychiatric institutions: a theory-informed qualitative study. BMC Infect Dis 2022; 22:243. [PMID: 35277134 PMCID: PMC8914451 DOI: 10.1186/s12879-022-07236-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The unique characteristics of psychiatric institutions contribute to the onset and spread of infectious agents. Infection prevention and control (IPC) is essential to minimise transmission and manage outbreaks effectively. Despite abundant studies regarding IPC conducted in hospitals, to date only a few studies focused on mental health care settings. However, the general low compliance to IPC in psychiatric institutions is recognised as a serious concern. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at psychiatric institutions, and to identify recommendations reported by professionals to improve IPC.
Methods
A descriptive, qualitative study involving 16 semi-structured interviews was conducted (before COVID-19) among professionals from five Dutch psychiatric institutions. The interview guide and data analysis were informed by implementation science theories, and explored guideline, individual, interpersonal, organisational, and broader environment barriers and facilitators to IPC. Data was subjected to thematic analysis, using inductive and deductive approaches. This study followed the Consolidated criteria for Reporting Qualitative research (COREQ) guidelines.
Results
Our findings generated six main themes: (1) patients’ non-compliance (strongly related to mental illness); (2) professionals’ negative cognitions and attitude towards IPC and IPC knowledge deficits; (3) monitoring of IPC performance and mutual professional feedback; (4) social support from professional to patient; (5) organisational support and priority; and (6) financial and material resource limitations (related to financial arrangements regarding mental health services). The main recommendations reported by professionals included: (1) to increase awareness towards IPC among all staff members, by education and training, and the communication of formal agreements as institutional IPC protocols; (2) to make room for and facilitate IPC at the organisational level, by providing adequate IPC equipment and appointing a professional responsible for IPC.
Conclusions
IPC implementation in psychiatric institutions is strongly influenced by factors on the patient, professional and organisational level. Professional interaction and professional-patient interaction appeared to be additional important aspects. Therefore, a multidimensional approach should be adopted to improve IPC. To coordinate this approach, psychiatric institutions should appoint a professional responsible for IPC. Moreover, a balance between mental health care and IPC needs is required to sustain IPC.
Collapse
|
19
|
Trenerry C, Fletcher C, Wilson C, Gunn K. "She'll Be Right, Mate": A Mixed Methods Analysis of Skin Cancer Prevention Practices among Australian Farmers-An At-Risk Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052940. [PMID: 35270633 PMCID: PMC8910209 DOI: 10.3390/ijerph19052940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/23/2022]
Abstract
This study examined Australian farmers’ engagement with skin cancer prevention behaviours and explored what made it hard for them to be ‘SunSmart’ (barriers), and what could be done to make prevention easier (facilitators). In total, 498 farmers (83.1% male, 22–89 years, 50.8% grain, sheep, or cattle farmers) participated. The least frequently performed SunSmart behaviours (reported as never practiced during summer) were using SPF 30+ sunscreen (16.6%), wearing protective sunglasses (10.5%), and wearing protective clothing (8.6%). Greater engagement (i.e., higher scores on scale from Never to Always) with SunSmart behaviours was explained by gender (female), educational attainment (trade or technical college certificate vs. high school), personal skin cancer history, and skin sun sensitivity. Barriers reported by farmers related to personal preferences (e.g., short-sleeved rather than long-sleeved clothing), comfort, and perceived impracticality of sun protection. Farmers’ solutions included making protective clothing and sunscreen more appropriate for farm work (e.g., by making clothing more breathable). A personal health scare was the most reported motivation for skin cancer prevention. Findings highlight the need for increased access to sun-protective clothing and sunscreen that is suitable for wearing when working on farms, complemented by culturally appropriate health education messaging, to encourage more farmers to perform SunSmart behaviours.
Collapse
Affiliation(s)
- Camilla Trenerry
- School of Psychology, The University of Adelaide, Adelaide, SA 5000, Australia;
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Chloe Fletcher
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
| | - Carlene Wilson
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Olivia Newton John Cancer Wellness Research Centre, Austin Health, Heidelberg, VIC 3084, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3083, Australia
| | - Kate Gunn
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence:
| |
Collapse
|
20
|
Arsenault C, Rowe SY, Ross-Degnan D, Peters DH, Roder-DeWan S, Kruk ME, Rowe AK. How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review. BMJ Qual Saf 2022; 31:123-133. [PMID: 34006598 PMCID: PMC8784997 DOI: 10.1136/bmjqs-2020-011717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/22/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability. METHODS We conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance. RESULTS The primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI: -0.36 to -0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI: -0.68 to -0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time. CONCLUSIONS Time trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.
Collapse
Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Dennis Ross-Degnan
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - David H Peters
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sanam Roder-DeWan
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
21
|
Evaluating the Effectiveness of the Computer-Based Education Platform, Pharmacy5in5, on Pharmacists’ Knowledge of Anticholinergic Toxicity Using a Randomized Controlled Trial. PHARMACY 2022; 10:pharmacy10010008. [PMID: 35076604 PMCID: PMC8788520 DOI: 10.3390/pharmacy10010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Computer-based education has been widely implemented in healthcare professional development education. However, there has been little examination of the potential for computer-based education to enhance pharmacists’ knowledge. This study aims to assess the effectiveness of computer-based education on improving pharmacists’ knowledge compared to printed education material. Methods: This study was a web-based randomized controlled trial. Participants were randomly allocated to either an intervention group where they had access to the computer-based education module on Pharmacy5in5.ca or to a control group where they had access to printed educational material. Knowledge gain was assessed using a pre- and post-knowledge test. Results: A total of 120 pharmacists were recruited and 101 completed the post-knowledge test (50/60 in the intervention group; 51/60 in the control group). Both groups showed a significant increase in knowledge gain (intervention group: pre-test mean score 19.35 ± 3.56, post-test mean score 22.42 ± 3.812, p value < 0.001; control group pre-test mean score 19.22 ± 3.45, post-test mean score 23.29 ± 3.087, p value < 0.001). However, the difference in knowledge change was not significant between the two groups (22.42 vs. 23.29, p value = 0.333). Conclusions: In this study, a computer-based education module enhanced pharmacists’ knowledge to a similar degree to printed education material. Efforts should be made to provide computer-based education as an option to support pharmacists’ professional development.
Collapse
|
22
|
Ghozali M, Amalia Islamy ID, Hidayaturrohim B. Effectiveness of an educational mobile-app intervention in improving the knowledge of COVID-19 preventive measures. INFORMATICS IN MEDICINE UNLOCKED 2022; 34:101112. [PMID: 36285324 PMCID: PMC9585884 DOI: 10.1016/j.imu.2022.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
|
23
|
Howie AH, Klar N, Nash DM, Reid JN, Zwarenstein M. Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651]. BMC FAMILY PRACTICE 2021; 22:243. [PMID: 34895165 PMCID: PMC8666060 DOI: 10.1186/s12875-021-01592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022]
Abstract
Background Printed educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications. Methods A pragmatic, 2 × 2 factorial, cluster randomized controlled trial was designed to ascertain the effect of two PEM formats on physician prescribing: a postcard-sized message (“outsert”) or a longer narrative article (“insert”). Ontario family physician practices (clusters) were randomly allocated to receive the insert, outsert, both or neither. Physicians were eligible if they were in active practice and their patients were included if they were over 65 years with a diabetes diagnosis; both were unaware of the trial. Administrative databases at ICES (formerly the Institute for Clinical Evaluative Sciences) were used to link patients to their physician and to analyse prescribing patterns at baseline and 1 year following PEM mailout. The primary outcome was intensification defined as the addition of a new antihypertensive or cholesterol-lowering agent, or dose increase of a current drug, measured at the patient level. Analyses were by intention-to-treat and accounted for the clustering of patients to physicians. Results We randomly assigned 4231 practices (39% of Ontario family physicians) with a total population of 185,526 patients (20% of patients with diabetes in Ontario primary care) to receive the insert, outsert, both, and neither; among these, 4118 practices were analysed (n = 1025, n = 1037, n = 1031, n = 1025, respectively). No significant treatment effect was found for the outsert (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.98 to 1.04) or the insert (OR 0.99, 95% CI 0.96 to 1.02). Percent of intensification in the four arms was similar (approximately 46%). Adjustment for physician characteristics (e.g., age, sex, practice location) had no impact on these findings. Conclusions PEMs have no effect on physician’s adherence to recommendations for the management of diabetes-related complications in Ontario. Further research should investigate the effect of other strategies to narrow this evidence-to-practice gap. Trial registration ISRCTN72772651. Retrospectively registered 21 July 2005. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01592-9.
Collapse
Affiliation(s)
- Alison H Howie
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada
| | - Danielle M Nash
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.,ICES, Toronto, ON, Canada
| | | | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.,ICES, Toronto, ON, Canada.,Department of Family Medicine, Western Centre for Public Health and Family Medicine, 1465 Richmond St, London, ON, N6G 2M1, Canada
| |
Collapse
|
24
|
Haskell L, Tavender EJ, Wilson CL, O'Brien S, Babl FE, Borland ML, Cotterell E, Sheridan N, Oakley E, Dalziel SR. Development of targeted, theory-informed interventions to improve bronchiolitis management. BMC Health Serv Res 2021; 21:769. [PMID: 34344383 PMCID: PMC8335893 DOI: 10.1186/s12913-021-06724-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite international guidelines providing evidence-based recommendations on appropriate management of infants with bronchiolitis, wide variation in practice occurs. This results in infants receiving care of no benefit, with associated cost and is potentially harmful. Theoretical frameworks are increasingly used to develop interventions, utilising behaviour change techniques specifically chosen to target factors contributing to practice variation, with de-implementation often viewed as harder than implementing. This paper describes the stepped process using the Theoretical Domains Framework (TDF) to develop targeted, theory-informed interventions which subsequently successfully improved management of infants with bronchiolitis by de-implementing ineffective therapies. Explicit description of the process and rationale used in developing de-implementation interventions is critical to dissemination of these practices into real world clinical practice. METHODS A stepped approach was used: (1) Identify evidence-based recommendations and practice variation as targets for change, (2) Identify factors influencing practice change (barriers and enablers) to be addressed, and (3) Identification and development of interventions (behaviour change techniques and methods of delivery) addressing influencing factors, considering evidence of effectiveness, feasibility, local relevance and acceptability. The mode of delivery for the intervention components was informed by evidence from implementation science systematic reviews, and setting specific feasibility and practicality. RESULTS Five robust evidence-based management recommendations, targeting the main variation in bronchiolitis management were identified: namely, no use of chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline. Interventions developed to target recommendations addressed seven TDF domains (identified following qualitative clinician interviews (n = 20)) with 23 behaviour change techniques chosen to address these domains. Final interventions included: (1) Local stakeholder meetings, (2) Identification of medical and nursing clinical leads, (3) Train-the-trainer workshop for all clinical leads, (4) Local educational materials for delivery by clinical leads, (5) Provision of tools and materials targeting influencing factors, and prompting recommended behaviours, and (6) Audit and feedback. CONCLUSION A stepped approach based on theory, evidence and issues of feasibility, local relevance and acceptability, was successfully used to develop interventions to improve management of infants with bronchiolitis. The rationale and content of interventions has been explicitly described allowing others to de-implement unnecessary bronchiolitis management, thereby improving care.
Collapse
Affiliation(s)
- Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand. .,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Emma J Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Curtin University, Perth, Western Australia, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Austalia, Western Australia, Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.,School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | | | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
25
|
Bègue C, Desmidt L, Bellanger W, Tessier-Cazeneuve C, Petit A, Couturier AL. Pre-return to work consultation and therapeutic part-time work: Cross-sectional study on level of knowledge and use by general practitioners in France. Eur J Gen Pract 2021; 27:158-165. [PMID: 34259583 PMCID: PMC8281089 DOI: 10.1080/13814788.2021.1948007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND In France, general practitioners (GPs) may use two tools specifically designed to help employees who experience difficulties in returning to work after sick leave: the pre-return-to-work (PRW) medical consultation and therapeutic part-time (TPT) work. OBJECTIVES The objective was to investigate the level of knowledge and use of these two tools by GPs in Maine-et-Loire, France. METHODS This cross-sectional study was performed using a telephone questionnaire to evaluate the level of knowledge of GPs and the use of these two tools in patients having difficulties returning to work. RESULTS Among the 200 randomly selected GPs, 122 responded (response rate: 61%). More than half of the interviewed GPs declared they 'often' (46%) or 'always' (14%) contacted the occupational physician in these situations. Moreover, 62.2% and 32.7% believed that they had a 'vague' or 'very good' level of knowledge, and 41% and 51% declared either 'frequent' or 'regular' level of use of the PRW medical consultation, respectively. Regarding TPT work, 47% and 53% reported a 'very good' or 'vague' level of knowledge, and 41% and 51% a 'frequent' or 'regular' level of use, respectively. GPs who had a better level of knowledge of this tool reported a higher level of use (p < 0.001). CONCLUSION This study shows that while the level of knowledge and use of the PRW medical consultation and TPT work is good, it is not optimal. This could be improved by organising training courses for GPs. Obstacles to their wider use could be investigated further in a qualitative study.
Collapse
Affiliation(s)
- Cyril Bègue
- Univ Angers, Département de Médecine Générale, Angers, France.,Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, Angers, France
| | - Lucille Desmidt
- Univ Angers, Département de Médecine Générale, Angers, France
| | | | | | - Audrey Petit
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, Angers, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, Angers, France
| | | |
Collapse
|
26
|
Michalowski M, Wilk S, Michalowski W, O’Sullivan D, Bonaccio S, Parimbelli E, Carrier M, Le Gal G, Kingwell S, Peleg M. A Health eLearning Ontology and Procedural Reasoning Approach for Developing Personalized Courses to Teach Patients about Their Medical Condition and Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7355. [PMID: 34299806 PMCID: PMC8307382 DOI: 10.3390/ijerph18147355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022]
Abstract
We propose a methodological framework to support the development of personalized courses that improve patients' understanding of their condition and prescribed treatment. Inspired by Intelligent Tutoring Systems (ITSs), the framework uses an eLearning ontology to express domain and learner models and to create a course. We combine the ontology with a procedural reasoning approach and precompiled plans to operationalize a design across disease conditions. The resulting courses generated by the framework are personalized across four patient axes-condition and treatment, comprehension level, learning style based on the VARK (Visual, Aural, Read/write, Kinesthetic) presentation model, and the level of understanding of specific course content according to Bloom's taxonomy. Customizing educational materials along these learning axes stimulates and sustains patients' attention when learning about their conditions or treatment options. Our proposed framework creates a personalized course that prepares patients for their meetings with specialists and educates them about their prescribed treatment. We posit that the improvement in patients' understanding of prescribed care will result in better outcomes and we validate that the constructs of our framework are appropriate for representing content and deriving personalized courses for two use cases: anticoagulation treatment of an atrial fibrillation patient and lower back pain management to treat a lumbar degenerative disc condition. We conduct a mostly qualitative study supported by a quantitative questionnaire to investigate the acceptability of the framework among the target patient population and medical practitioners.
Collapse
Affiliation(s)
- Martin Michalowski
- Nursing Informatics, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Szymon Wilk
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznań, Poland;
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Dympna O’Sullivan
- School of Computer Science, Technological University Dublin, D02 HW71 Dublin, Ireland;
| | - Silvia Bonaccio
- Telfer School of Management, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (W.M.); (S.B.)
| | - Enea Parimbelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy;
| | - Marc Carrier
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Grégoire Le Gal
- Department of Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Stephen Kingwell
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Mor Peleg
- Department of Information Systems, University of Haifa, Haifa 3498838, Israel;
| |
Collapse
|
27
|
Simunovic M, Urbach DR, Fahim C, O’Brien MA, Earle CC, Brouwers M, Gatov E, Grubac V, McCormack D, Baxter N. High-Intensity vs Low-Intensity Knowledge Translation Interventions for Surgeons and Their Association With Process and Outcome Measures Among Patients Undergoing Rectal Cancer Surgery. JAMA Netw Open 2021; 4:e2117536. [PMID: 34269805 PMCID: PMC8285735 DOI: 10.1001/jamanetworkopen.2021.17536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Surgeon-directed knowledge translation (KT) interventions for rectal cancer surgery are designed to improve patient measures, such as rates of permanent colostomy and in-hospital mortality, and to improve survival. OBJECTIVE To evaluate the association of sustained, iterative, integrated KT rectal cancer surgery interventions directed at all surgeons with process and outcome measures among patients undergoing rectal cancer surgery in a geographic region. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used administrative data from patients who underwent rectal cancer surgery from April 1, 2004, to March 31, 2015, in 14 health regions in Ontario, Canada. Follow-up was completed on March 31, 2020. EXPOSURES Surgeons in 2 regions were offered intensive KT interventions, including annual workshops, audit and feedback sessions, and, in 1 of the 2 regions, operative demonstrations, from 2006 to 2012 (high-intensity KT group). Surgeons in the remaining 12 regions did not receive these interventions (low-intensity KT group). MAIN OUTCOMES AND MEASURES Among patients undergoing rectal cancer surgery, proportions of preoperative pelvic magnetic resonance imaging (MRI), preoperative radiotherapy, and type of surgery were evaluated, as were in-hospital mortality and overall survival. Logistic regression models with an interaction term between group and year were used to assess whether process measures and in-hospital mortality differed between groups over time. RESULTS A total of 15 683 patients were included in the analysis (10 052 [64.1%] male; mean [SD] age, 65.9 [12.1] years), of whom 3762 (24.0%) were in the high-intensity group (2459 [65.4%] male; mean [SD] age, 66.4 [12.0] years) and 11 921 (76.0%) were in the low-intensity KT group (7593 [63.7%] male; mean [SD] age, 65.7 [12.1] years). A total of 1624 patients (43.2%) in the high-intensity group and 4774 (40.0%) in the low-intensity KT group underwent preoperative MRI (P < .001); 1321 (35.1%) and 4424 (37.1%), respectively, received preoperative radiotherapy (P = .03); and 967 (25.7%) and 2365 (19.8%), respectively, received permanent stoma (P < .001). In-hospital mortality was 1.6% (59 deaths) in the high-intensity KT group and 2.2% (258 deaths) in the low-intensity KT group (P = .02). Differences remained significant in multivariable models only for permanent stoma (odds ratio [OR], 1.67; 95% CI, 1.24-2.24; P < .001) and in-hospital mortality (OR, 0.67; 95% CI, 0.51-0.87; P = .003). In both groups over time, significant increases in the proportion of patients undergoing preoperative MRI (from 6.3% to 67.1%) and preoperative radiotherapy (from 16.5% to 44.7%) occurred, but there were no significant changes for permanent stoma (25.4% to 25.3% in the high-intensity group and 20.0% to 18.3% in the low-intensity group) and in-hospital mortality (0.8% to 0.8% in the high-intensity group and 2.2% to 1.8% in the low-intensity group). Time trends were similar between groups for measures that did or did not change over time. Patient overall survival was similar between groups (hazard ratio, 1.00; 95% CI, 0.90-1.11; P = .99). CONCLUSIONS AND RELEVANCE In this quality improvement study, between-group differences were found in only 2 measures (permanent stoma and in-hospital mortality), but these differences were stable over time. High-intensity KT group interventions were not associated with improved patient measures and outcomes. Proper evaluation of KT or quality improvement interventions may help avoid opportunity costs associated with ineffective strategies.
Collapse
Affiliation(s)
- Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Mary Ann O’Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C. Earle
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Brouwers
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Evgenia Gatov
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Vanja Grubac
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel McCormack
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Nancy Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
28
|
Moldskred PS, Snibsøer AK, Espehaug B. Improving the quality of nursing documentation at a residential care home: a clinical audit. BMC Nurs 2021; 20:103. [PMID: 34154606 PMCID: PMC8215798 DOI: 10.1186/s12912-021-00629-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice. Methods A criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0–3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019. Results None of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95 % confidence interval 0.3–0.6) for “aims for nursing care” to 1.1 (0.9–1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p < 0.001) was noted for all criteria except for “evaluation/progress reports” (p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8–1.1) for “evaluation/progress reports” to 1.9 (1.5–2.2) for “nursing assessment on admission”. Conclusions A criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.
Collapse
Affiliation(s)
- Preben Søvik Moldskred
- Luranetunet Care Centre, Solstrandvegen 39, 5200, Os, Norway. .,Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.
| | - Anne Kristin Snibsøer
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway.,Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, 5020, Bergen, Norway
| |
Collapse
|
29
|
Dieberger AM, van Poppel MNM, Watson ED. Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5869. [PMID: 34070723 PMCID: PMC8198094 DOI: 10.3390/ijerph18115869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.
Collapse
Affiliation(s)
- Anna M. Dieberger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria;
| | - Estelle D. Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrews Road, Parktown, Johannesburg 2193, South Africa;
- Department of Exercise Sciences, Faculty of Science, The University of Auckland, Building 907, Suiter Street, Newmarket, Auckland 1142, New Zealand
| |
Collapse
|
30
|
Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review. Crit Care Explor 2021; 3:e0391. [PMID: 33912832 PMCID: PMC8078296 DOI: 10.1097/cce.0000000000000391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVE: Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome. DATA SOURCES: PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials. STUDY SELECTION: We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome. DATA EXTRACTION: Two authors independently performed study selection and data extraction using a standardized form. DATA SYNTHESIS: Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Measurements and Main Results: Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome. Conclusions: There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.
Collapse
|
31
|
Rosana P, Danaei G, Gutierrez L, Cavallo A, Lopez MV, Irazola V. An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina. BMC Public Health 2021; 21:567. [PMID: 33752644 PMCID: PMC7986565 DOI: 10.1186/s12889-021-10569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/04/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). METHODS We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC's catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC's staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). RESULTS A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. CONCLUSION The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.
Collapse
Affiliation(s)
- Poggio Rosana
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
| | - Goodarz Danaei
- Department of Global Health and Populations. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Gutierrez
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Ana Cavallo
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - María Victoria Lopez
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| |
Collapse
|
32
|
Goorts K, Dizon J, Milanese S. The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review. BMC Health Serv Res 2021; 21:241. [PMID: 33736631 PMCID: PMC7977260 DOI: 10.1186/s12913-021-06190-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group. METHODS Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation. RESULTS A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies. CONCLUSION Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.
Collapse
Affiliation(s)
- Kaat Goorts
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Leuven, Belgium
| | - Janine Dizon
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, Australia
| | - Steve Milanese
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, Australia.
| |
Collapse
|
33
|
Walsh KA, Byrne S, McSharry J, Browne J, Irving K, Hurley E, Rochford-Brennan H, Geoghegan C, Presseau J, Timmons S. Developing a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. HRB Open Res 2021; 4:23. [PMID: 34136749 PMCID: PMC8185579 DOI: 10.12688/hrbopenres.13228.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention, in accordance with the ‘Guidance for reporting intervention development studies in health research’ (GUIDED) checklist. The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.
Collapse
Affiliation(s)
- Kieran A Walsh
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12XH60, Ireland.,Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, T12YN60, Ireland.,School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, T12YN60, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91TK33, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Eimir Hurley
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Helen Rochford-Brennan
- Expert by Experience, N/A, N/A, Ireland.,Irish Dementia Working Group, The Alzheimer Society of Ireland, Dublin, Ireland
| | | | - Justin Presseau
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12XH60, Ireland
| |
Collapse
|
34
|
de Vasconcelos LP, Melo DOD, Stein AT, de Carvalho HB. Even High-Quality CPGs Seldom Include Implementation Strategies. Front Pharmacol 2021; 11:593894. [PMID: 33519455 PMCID: PMC7845482 DOI: 10.3389/fphar.2020.593894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Implementation is a key step in ensuring that high-quality clinical practice guideline (CPG) recommendations are followed and have a positive impact. This step must be planned during CPG development. This study aims to inform professionals tasked with developing and implementing CPGs regarding implementation strategies and tools reported in high-quality CPGs for chronic non-communicable diseases (NCDs). Methods: NCD guidelines were selected based on Appraisal of Guideline Research and Evaluation (AGREE) II assessment. CPGs with a score of ≥60% in AGREE II domains 3 (rigor of development), 5 (applicability), and 6 (editorial independence), were considered high quality. The content related to implementation was extracted from CPG full texts and complementary materials. Implementation strategies and tools were assessed and classified using Mazza taxonomy. Results: Twenty high-quality CPGs were selected, most of which were developed by government institutions (16; 80%) with public funding (16; 80%); almost half (9; 45%) addressed the treatment of cardiovascular diseases. The countries with the most high-quality CPGs were the UK (6; 30%) and Colombia (5; 25%). These countries also had the highest average number of strategies, Colombia with 28 (SD = 1) distributed in all levels, and the UK with 15 (SD = 7), concentrating on professional and organizational levels. Although the content of the Colombian CPGs was similar regardless the disease, the CPGs from the UK were specific and contained data-based feedback reports and information on CPG compliance. Implementation strategies most frequently identified were at the professional level, such as distributing reference material (18; 80%) and educating groups of healthcare professionals (18; 80%). At the organizational level, the most frequent strategies involve changes in structure (15; 75%) and service delivery method (13; 65%). Conclusion: Countries with established CPG programs, such as the UK and Colombia, where identified as having the highest number of high-quality CPGs, although CPG implementation content had significant differences. Among high-quality CPGs, the most common implementation strategies were at the professional and organizational levels. There is still room for improvement regarding the implementation strategies report, even among high-quality CPGs, especially concerning monitoring of implementation outcomes and selection of strategies based on relevant implementation barriers.
Collapse
Affiliation(s)
| | - Daniela Oliveira De Melo
- Department of Pharmaceutical Science, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Airton Tetelbom Stein
- Department of Collective Health, Federal University of Health Sciences of Porto Alegre, São Paulo, Brazil
| | | |
Collapse
|
35
|
Farrokhi S, Russell Esposito E, McPherson D, Mazzone B, Condon R, Patterson CG, Schneider M, Greco CM, Delitto A, Highsmith MJ, Hendershot BD, Maikos J, Dearth CL. Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE): Protocol for a Multisite Pragmatic Clinical Trial. PAIN MEDICINE 2020; 21:S45-S52. [PMID: 33313735 DOI: 10.1093/pm/pnaa367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (CPGs) can improve the outcomes and cost-effectiveness of LBP care, PT CPG adherence remains below 50%. The Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE) trial will evaluate the effectiveness of an active PT CPG implementation strategy using an education, audit, and feedback model for reducing pain, disability, medication use, and cost of LBP care within the DOD and VA health care systems. DESIGN The RESOLVE trial will include 3,300 to 7,260 patients with LBP across three DOD and two VA medical facilities using a stepped-wedge study design. An education, audit, and feedback model will be used to encourage physical therapists to better adhere to the PT CPG recommendations. The Oswestry Disability Index and the Defense and Veterans Pain Rating Scale will be used as primary outcomes. Secondary outcomes will include the LBP-related medication use, medical resource utilization, and biopsychosocial predictors of outcomes. Statistical analyses will be based on the intention-to-treat principle and will use linear mixed models to compare treatment conditions and examine the interactions between treatment and subgrouping status (e.g., limb loss). SUMMARY The RESOLVE trial will provide a pragmatic approach to evaluate whether better adherence to PT CPGs can reduce pain, disability, medication use, and LBP care cost within the DOD and VA health care systems.
Collapse
Affiliation(s)
- Shawn Farrokhi
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Naval Medical Center San Diego, San Diego, California
| | - Elizabeth Russell Esposito
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Danielle McPherson
- Naval Medical Center San Diego, San Diego, California.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Brittney Mazzone
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Naval Medical Center San Diego, San Diego, California
| | - Rachel Condon
- Naval Medical Center San Diego, San Diego, California
| | | | | | | | | | - M Jason Highsmith
- US Department of Veterans Affairs, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Brad D Hendershot
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jason Maikos
- US Department of Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
| | - Christopher L Dearth
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
36
|
Population Health Management in Diabetes Care: Combining Clinical Audit, Risk Stratification, and Multidisciplinary Virtual Clinics in a Community Setting to Improve Diabetes Care in a Geographically Defined Population. An Integrated Diabetes Care Pilot in the North East Locality, Oxfordshire, UK. Int J Integr Care 2020; 20:21. [PMID: 33335462 PMCID: PMC7716785 DOI: 10.5334/ijic.5177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Disparities in diabetes care are prevalent, with significant inequalities observed in access to, and outcomes of, healthcare. A population health approach offers a solution to improve the quality of care for all with systematic ways of assessing whole population requirements and treating and monitoring sub-groups in need of additional attention. Description of the care practice: Collaborative working between primary, secondary and community care was introduced in seven primary care practices in one locality in England, UK, caring for 3560 patients with diabetes and sharing the same community and secondary specialist diabetes care providers. Three elements of the intervention included 1) clinical audit, 2) risk stratification, and 3) the multi-disciplinary virtual clinics in the community. Methods: This paper evaluates the acceptability, feasibility and short-term impact on primary care of implementing a population approach intervention using direct observations of the clinics and surveys of participating clinicians. Results and discussion: Eighteen virtual clinics across seven teams took place over six months between March and July 2017 with organisation, resources, policies, education and approximately 150 individuals discussed. The feedback from primary care was positive with growing knowledge and confidence managing people with complex diabetes in primary care. Conclusion: Taking a population health approach helped to identify groups of people in need of additional diabetes care and deliver a collaborative health intervention across traditional organisational boundaries.
Collapse
|
37
|
Cahill LS, Carey LM, Lannin NA, Turville M, Neilson CL, Lynch EA, McKinstry CE, Han JX, O'Connor D. Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation. Cochrane Database Syst Rev 2020; 10:CD012575. [PMID: 33058172 PMCID: PMC8095062 DOI: 10.1002/14651858.cd012575.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.
Collapse
Affiliation(s)
- Liana S Cahill
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Occupational Therapy, School of Allied Health, Australian Catholic University, Fitzroy, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Allied Health, Alfred Health, Melbourne, Australia
| | - Megan Turville
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Stroke, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Cheryl L Neilson
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, Australia
| | - Elizabeth A Lynch
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
| | - Carol E McKinstry
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, Australia
| | - Jia Xi Han
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
38
|
Andrade AQ, LeBlanc VT, Kalisch-Ellett LM, Pratt NL, Moffat A, Blacker N, Westaway K, Barratt JD, Roughead EE. Determinants of usefulness in professional behaviour change interventions: observational study of a 15-year national program. BMJ Open 2020; 10:e038016. [PMID: 33055116 PMCID: PMC7559049 DOI: 10.1136/bmjopen-2020-038016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Educational, and audit and feedback interventions are effective in promoting health professional behaviour change and evidence adoption. However, we lack evidence to pinpoint which particular features make them most effective. Our objective is to identify determinants of quality in professional behaviour change interventions, as perceived by participants. DESIGN We performed a comparative observational study using data from the Veterans' Medicines Advice and Therapeutics Education Services program, a nation-wide Australian Government Department of Veterans' Affairs funded program that provides medicines advice and promotes physician adoption of best practices by use of a multifaceted intervention (educational material and a feedback document containing individual patient information). SETTING Primary care practices providing care to Australian veterans. PARTICIPANTS General practitioners (GPs) targeted by 51 distinct behaviour change interventions, implemented between November 2004 and June 2018. PRIMARY AND SECONDARY OUTCOME MEASURES We extracted features related to presentation (number of images, tables and characters), content (polarity and subjectivity using sentiment analysis, number of external links and medicine mentions) and the use of five behaviour change techniques (prompt/cues, goal setting, discrepancy between current behaviour and goal, information about health consequences, feedback on behaviour). The main outcome was perceived usefulness, extracted from postintervention survey. RESULTS On average, each intervention was delivered to 9667 GPs. Prompt and goal setting strategies in the audit and feedback were independently correlated to perceived usefulness (p=0.030 and p=0.005, respectively). The number of distinct behaviour change techniques in the audit and feedback was correlated with improved usefulness (Pearson's coefficient 0.45 (0.19, 0.65), p=0.001). No presentation or content features in the educational material were correlated with perceived usefulness. CONCLUSIONS The finding provides additional evidence encouraging the use of behaviour change techniques, in particular prompt and goal setting, in audit and feedback interventions.
Collapse
Affiliation(s)
- Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Vanessa T LeBlanc
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Anna Moffat
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Natalie Blacker
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Kerrie Westaway
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - John D Barratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
39
|
Development and psychometric evaluation of Nurses and Midwives' Perceptions of their Roles in Primary Healthcare. Int J Nurs Sci 2020; 7:460-465. [PMID: 33195759 PMCID: PMC7644550 DOI: 10.1016/j.ijnss.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to develop Nurses and Midwives' Perceptions of their Roles in Primary Healthcare (NMPR-PHC) and evaluate its psychometric properties. Methods A cross-sectional survey was performed to recruit a convenient sample of 150 registered nurses and midwives from various primary healthcare settings in Jordan. Reliability was evaluated by examining the internal consistency and split-half reliability of the item. A exploratory factor analysis was performed to assess the factor structure of the NMPR-PHC. Results The final version of NMPR-PHC contained 18 items. Exploratory factor analysis revealed six factors (care coordination and interprofessional collaboration, workplace facilitators of the primary healthcare, management of care, research, workplace constraints of primary healthcare, and advanced education) for the questionnaire which explained 66.49% of the total variance. The Cronbach's α of the total scale was 0.834, the subscales Cronbach's α were ranging between 0.662 and 0.770, and the split-half reliability of the total scale was 0.734. Conclusion The overall performance of the questionnaire showed promising sound psychometric properties. The NMPR-PHC can be recommended for use as a tool for the assessment of nurses and midwives' perceptions of their roles in primary healthcare.
Collapse
|
40
|
Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
Collapse
Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | |
Collapse
|
41
|
Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
42
|
Giguère A, Zomahoun HTV, Carmichael PH, Uwizeye CB, Légaré F, Grimshaw JM, Gagnon MP, Auguste DU, Massougbodji J. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2020; 8:CD004398. [PMID: 32748975 PMCID: PMC8475791 DOI: 10.1002/14651858.cd004398.pub4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Printed educational materials are widely used dissemination strategies to improve the quality of healthcare professionals' practice and patient health outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines. This is the fourth update of the review. OBJECTIVES To assess the effect of printed educational materials (PEMs) on the practice of healthcare professionals and patient health outcomes. To explore the influence of some of the characteristics of the printed educational materials (e.g. source, content, format) on their effect on healthcare professionals' practice and patient health outcomes. SEARCH METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health, and EPOC Register from their inception to 6 February 2019. We checked the reference lists of all included studies and relevant systematic reviews. SELECTION CRITERIA We included randomised trials (RTs), controlled before-after studies (CBAs) and interrupted time series studies (ITSs) that evaluated the impact of PEMs on healthcare professionals' practice or patient health outcomes. We included three types of comparisons: (1) PEM versus no intervention, (2) PEM versus single intervention, (3) multifaceted intervention where PEM is included versus multifaceted intervention without PEM. Any objective measure of professional practice (e.g. prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included. DATA COLLECTION AND ANALYSIS Two reviewers undertook data extraction independently. Disagreements were resolved by discussion. For analyses, we grouped the included studies according to study design, type of outcome and type of comparison. For controlled trials, we reported the median effect size for each outcome within each study, the median effect size across outcomes for each study and the median of these effect sizes across studies. Where data were available, we re-analysed the ITS studies by converting all data to a monthly basis and estimating the effect size from the change in the slope of the regression line between before and after implementation of the PEM. We reported median changes in slope for each outcome, for each study, and then across studies. We standardised all changes in slopes by their standard error, allowing comparisons and combination of different outcomes. We categorised each PEM according to potential effects modifiers related to the source of the PEMs, the channel used for their delivery, their content, and their format. We assessed the risks of bias of all the included studies. MAIN RESULTS We included 84 studies: 32 RTs, two CBAs and 50 ITS studies. Of the 32 RTs, 19 were cluster RTs that used various units of randomisation, such as practices, health centres, towns, or areas. The majority of the included studies (82/84) compared the effectiveness of PEMs to no intervention. Based on the RTs that provided moderate-certainty evidence, we found that PEMs distributed to healthcare professionals probably improve their practice, as measured with dichotomous variables, compared to no intervention (median absolute risk difference (ARD): 0.04; interquartile range (IQR): 0.01 to 0.09; 3,963 healthcare professionals randomised within 3073 units). We could not confirm this finding using the evidence gathered from continuous variables (standardised mean difference (SMD): 0.11; IQR: -0.16 to 0.52; 1631 healthcare professionals randomised within 1373 units ), from the ITS studies (standardised median change in slope = 0.69; 35 studies), or from the CBA study because the certainty of this evidence was very low. We also found, based on RTs that provided moderate-certainty evidence, that PEMs distributed to healthcare professionals probably make little or no difference to patient health as measured using dichotomous variables, compared to no intervention (ARD: 0.02; IQR: -0.005 to 0.09; 935,015 patients randomised within 959 units). The evidence gathered from continuous variables (SMD: 0.05; IQR: -0.12 to 0.09; 6,737 patients randomised within 594 units) or from ITS study results (standardised median change in slope = 1.12; 8 studies) do not strengthen these findings because the certainty of this evidence was very low. Two studies (a randomised trial and a CBA) compared a paper-based version to a computerised version of the same PEM. From the RT that provided evidence of low certainty, we found that PEM in computerised versions may make little or no difference to professionals' practice compared to PEM in printed versions (ARD: -0.02; IQR: -0.03 to 0.00; 139 healthcare professionals randomised individually). This finding was not strengthened by the CBA study that provided very low certainty evidence (SMD: 0.44; 32 healthcare professionals). The data gathered did not allow us to conclude which PEM characteristics influenced their effectiveness. The methodological quality of the included studies was variable. Half of the included RTs were at risk of selection bias. Most of the ITS studies were conducted retrospectively, without prespecifying the expected effect of the intervention, or acknowledging the presence of a secular trend. AUTHORS' CONCLUSIONS The results of this review suggest that, when used alone and compared to no intervention, PEMs may slightly improve healthcare professionals' practice outcomes and patient health outcomes. The effectiveness of PEMs compared to other interventions, or of PEMs as part of a multifaceted intervention, is uncertain.
Collapse
Affiliation(s)
- Anik Giguère
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Canada
- VITAM Research center on Sustainable Health, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR-SUPPORT Unit of Québec, Centre de recherche sur les soins et les services de première ligne - Université Laval, Quebec, Canada
| | | | - Claude Bernard Uwizeye
- Laval University Research Center on Primary Health Care and Services (CERSSPL-UL), Québec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec City, Canada
| | - David U Auguste
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada
| | - José Massougbodji
- Health and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR-SUPPORT Unit of Québec, Quebec SPOR-SUPPORT Unit, Québec, Canada
| |
Collapse
|
43
|
Cidav Z, Mandell D, Pyne J, Beidas R, Curran G, Marcus S. A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implement Sci 2020; 15:28. [PMID: 32370752 PMCID: PMC7201568 DOI: 10.1186/s13012-020-00993-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts. METHODS We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data. RESULTS This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost. CONCLUSION TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.
Collapse
Affiliation(s)
- Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas, Little Rock, USA
- Veterans Healthcare System, North Little Rock, AR, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center, Leonard Davis Institute of Health Economics, Philadelphia, USA
| | - Geoffrey Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Steven Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
44
|
Towiwat P, Phungoen P, Tantrawiwat K, Laohakul P, Aiewruengsurat D, Thanadetsuntorn C, Ruchakorn N, Sangsawangchot P, Buttham B. Quality of gout care in the emergency departments: a multicentre study. BMC Emerg Med 2020; 20:27. [PMID: 32312248 PMCID: PMC7171834 DOI: 10.1186/s12873-020-00319-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To report on prevalence of gout flare in emergency departments and to report the quality of gout care in emergency departments and causes of admission at emergency departments. METHODS A retrospective chart review of visits that had a primary diagnosis in gout by the International Classification of Diseases, the tenth revision, at emergency departments from 6 universities in Thailand over a 5 year period from 1 January 2012 to 31 December 2016. RESULTS Six hundred thirty-two visits were included to the study. Prevalence of gout flare in emergency departments was 0.04. Only 29.3% of the visits had arthrocentesis. 628/632 (99.4%) and 519/585 (88.7%) of the visits were prescribed medications in emergency departments and had home medications, respectively. Although all visits that were prescribed colchicine in emergency departments received adequate doses of colchicine, it was also found that more than 2.4 mg/day of colchicine was prescribed (3/394, 0.8%) for home medications. In addition, 183/343 (53.4%) of the visits with normal renal function were prescribed non-steroidal anti-inflammatory drugs (NSAIDs). However, prescribed NSAIDs in abnormal renal function (42/343, 12.2%) was also found. The interruption of dosing, including increase, decrease, addition or discontinuance of urate lowing therapy in a gout flare period was 42/632 (6.6%). The most common cause of admission was acute gouty arthritis (31/47, 66.0%). CONCLUSIONS Quality of gout care in the emergency departments was not good. Inappropriate management of gout flare in emergency departments was demonstrated in our study, particularly with regard to investigations and pharmacological management. Gaps between clinicians and guidelines, the knowledge of clinicians, and overcrowding in emergency departments were hypothesized in the results.
Collapse
Affiliation(s)
- Patapong Towiwat
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kitti Tantrawiwat
- Department of Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Pavita Laohakul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Duangkamol Aiewruengsurat
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Chokchai Thanadetsuntorn
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopparat Ruchakorn
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Passagorn Sangsawangchot
- Department of Internal Medicine, Faculty of Medicine, Srinakharinthawirot University, Bangkok, Thailand
| | - Bodin Buttham
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000 Thailand
| |
Collapse
|
45
|
Cheewakriangkrai C, Kietpeerakool C, Charoenkwan K, Pattanittum P, John D, Aue‐aungkul A, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer. Cochrane Database Syst Rev 2020; 3:CD013253. [PMID: 32168393 PMCID: PMC7069600 DOI: 10.1002/14651858.cd013253.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diagnosis of endometrial (womb) cancer is normally made at an early stage, as most women with the disease experience abnormal vaginal bleeding, which prompts them to seek medical advice. However, delays in presentation and referral can result in delay in diagnosis and management, which can lead to unfavourable treatment outcomes. This is particularly a problem for pre- and peri-menopausal women. Providing educational information to women and healthcare providers regarding symptoms relating to endometrial cancer may raise awareness of the disease and reduce delayed treatment. OBJECTIVES To assess the effectiveness of health education interventions targeting healthcare providers, or individuals, or both, to promote early presentation and referral for women with endometrial cancer symptoms. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), both individually randomised and cluster-RCTs. In the absence of RCTs we planned to include well-designed non-randomised studies (NRS) with a parallel comparison assessing the benefits of any type of health education interventions. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated whether potentially relevant studies met the inclusion criteria for the review, but none were found. MAIN RESULTS A comprehensive search of the literature yielded the following results: CENTRAL (1022 references), MEDLINE (2874 references), and Embase (2820 references). After de-duplication, we screened titles and abstracts of 4880 references and excluded 4864 that did not meet the review inclusion criteria. Of the 16 references that potentially met the review inclusion, we excluded all 16 reports after reviewing the full texts. We did not identify any ongoing trials. AUTHORS' CONCLUSIONS There is currently an absence of evidence to indicate the effectiveness of health education interventions involving healthcare providers or individuals or both to promote early presentation and referral for women with endometrial cancer symptoms. High-quality RCTs are needed to assess whether health education interventions enhance early presentation and referral. If health education interventions can be shown to reduce treatment delays in endometrial cancer, further studies would be required to determine which interventions are most effective.
Collapse
Affiliation(s)
- Chalong Cheewakriangkrai
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Porjai Pattanittum
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Public Health FacultyMitraparp RoadMueng DistrictKhon KaenKhon KaenThailand40002
| | | | - Apiwat Aue‐aungkul
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | | |
Collapse
|
46
|
Karas M, Sheen NJL, North RV, Ryan B, Bullock A. Continuing professional development requirements for UK health professionals: a scoping review. BMJ Open 2020; 10:e032781. [PMID: 32161156 PMCID: PMC7066625 DOI: 10.1136/bmjopen-2019-032781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD. DESIGN A scoping review. SEARCH STRATEGY We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession. RESULTS CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning. CONCLUSIONS Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.
Collapse
Affiliation(s)
- Marek Karas
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Nik J L Sheen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Rachel V North
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
47
|
Gruß I, Pihlstrom DJ, Kaplan CD, Yosuf N, Fellows JL, Guerrero EG, Polk DE. Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice. JDR Clin Trans Res 2020; 6:87-95. [PMID: 32040925 DOI: 10.1177/2380084420903999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation. METHODS We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process. RESULTS Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties. CONCLUSION Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.
Collapse
Affiliation(s)
- I Gruß
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - C D Kaplan
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - N Yosuf
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - J L Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - E G Guerrero
- I-Lead Institute-Research to End Healthcare Disparities Corp, Santa Monica, CA, USA
| | - D E Polk
- University of Pittsburgh, Pitt Dental Medicine, Pittsburgh, PA, USA
| |
Collapse
|
48
|
Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2020; 2:CD011779. [PMID: 32036618 PMCID: PMC7008062 DOI: 10.1002/14651858.cd011779.pub3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.
Collapse
Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Meghan Finch
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | | |
Collapse
|
49
|
Froggatt K, Best A, Bunn F, Burnside G, Coast J, Dunleavy L, Goodman C, Hardwick B, Jackson C, Kinley J, Davidson Lund A, Lynch J, Mitchell P, Myring G, Patel S, Algorta GP, Preston N, Scott D, Silvera K, Walshe C. A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT. Health Technol Assess 2020; 24:1-140. [PMID: 31971506 PMCID: PMC7008353 DOI: 10.3310/hta24060] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. OBJECTIVES To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. DESIGN The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. SETTING Nursing homes in England providing care for people with dementia. PARTICIPANTS Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. INTERVENTION Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. MAIN OUTCOME MEASURES The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity. RESULTS Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. CONCLUSIONS A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. FUTURE WORK In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. TRIAL REGISTRATION Current Controlled Trials ISRCTN14948133. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ashley Best
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Frances Bunn
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Girvan Burnside
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Joanna Coast
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Claire Goodman
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Ben Hardwick
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Clare Jackson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jennifer Lynch
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Paul Mitchell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shakil Patel
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Guillermo Perez Algorta
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Kate Silvera
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| |
Collapse
|
50
|
Fontaine G, Cossette S, Maheu-Cadotte MA, Deschênes MF, Rouleau G, Lavallée A, Pépin C, Ballard A, Chicoine G, Lapierre A, Lavoie P, Blondin J, Mailhot T. Effect of implementation interventions on nurses' behaviour in clinical practice: a systematic review, meta-analysis and meta-regression protocol. Syst Rev 2019; 8:305. [PMID: 31806051 PMCID: PMC6896305 DOI: 10.1186/s13643-019-1227-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Practitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses' behaviour in clinical practice and improve patients' health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes-i.e. mechanisms of action-targeted by interventions to change nurses' behaviour in clinical practice, and the constituent components-i.e. behaviour change techniques-included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses' behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques. METHODS We will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses' behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International's NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software. DISCUSSION This review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses' behaviour change in clinical practice. Results will provide key insights regarding which causal processes-i.e. mechanisms of action-should be targeted by these interventions, and which constituent components-i.e. behaviour change techniques-should be included in these interventions to increase their effectiveness. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).
Collapse
Affiliation(s)
- Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
| | - Marc-André Maheu-Cadotte
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
- Research Center, Université de Montréal Hospital Center, Montréal, Canada
| | - Marie-France Deschênes
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Center for Innovation in Nursing Education, Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Geneviève Rouleau
- Research Center, Université de Montréal Hospital Center, Montréal, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, CHU Sainte-Justine, Montréal, Canada
| | - Catherine Pépin
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Institute of Public Health Research, Université de Montréal, Montréal, Canada
| | - Ariane Ballard
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, CHU Sainte-Justine, Montréal, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Université de Montréal Hospital Center, Montréal, Canada
| | - Alexandra Lapierre
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
- Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
- Center for Innovation in Nursing Education, Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Jérémie Blondin
- School of Librarianship and Information Science, Université de Montréal, Montréal, Canada
| | - Tanya Mailhot
- Department of Pharmacy and Health Systems Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| |
Collapse
|