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Pintado-Outumuro E, Morin-Fraile V, Salvador-González B, Benito L, Julve-Ibáñez M, Sancho-Campos MP, Alves-Tafur C, Lumillo-Gutiérrez I. Exploring the factors influencing evidence-based approaches to advanced chronic kidney disease: a qualitative study involving nurses and physicians. BMC PRIMARY CARE 2024; 25:177. [PMID: 38773496 PMCID: PMC11107048 DOI: 10.1186/s12875-024-02418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Advanced chronic kidney disease (ACKD) is associated with a high risk of adverse cardiovascular and renal events and has a significant impact on quality of life and life expectancy. Several studies have identified areas for improvement in their management in primary care. Some professional and environmental factors can act as key barriers to appropriate care. OBJECTIVE To analyse attitudes, subjective norms, and perceived behavioural control among primary care professionals related to the implementation of an evidence-based approach for individuals with ACKD in primary care. METHODOLOGY This was a qualitative study using an interpretative phenomenological approach based on the theory of planned behaviour. Two aspects of the evidence-based approach were explored: the implementation of clinical practice guidelines and the utilisation of electronic kidney disease records within the scope of this study. Primary care nurses and physicians participated in a previous pilot interview and five focus groups. Subsequently, a thematic analysis of the gathered data was conducted. FINDINGS Thirty-three primary care professionals participated. The emerging themes included: experiences in the management of ACKD (highlighting a distinct profile of older, frail patients with comorbidities masking CKD and a CKD follow-up primarily focused on analytical monitoring and drug adjustment); factors in the professional environment influencing the use of scientific evidence (such as time constraints, excessive electronic health records, and unfamiliar reference guidelines); attitudes towards the application of recommendations on ACKD (recognising limitations of computer systems despite considering them as guidance); and capacities to implement evidence-based recommendations (acknowledging formative needs and challenges in coordinating care with nephrology services). CONCLUSIONS Several psychological elements identified through the TBP hinder the adequate implementation of an evidence-based approach for individuals with CKD. Attitudes have been identified as factors modulating the use of standardised electronic records. Instead, subjective norms (influences from the professional environment) and perceived behavioral control (perception of capabilities) acted as barriers to the proper application of clinical practice guidelines and standardised records. IMPLICATIONS FOR PRACTICE Strategies aimed at optimising the management of people with ACKD should focus not only on training but also on improving attitudes, organisational structures, IT systems and coordination between primary care and nephrology.
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Grants
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
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Affiliation(s)
- Elena Pintado-Outumuro
- Primary Care Center El Pla. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, 08980, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Victoria Morin-Fraile
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain
| | - Betlem Salvador-González
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Llúcia Benito
- Fundamental and Clinic Nursing Department, Faculty of Nursing, University of Barcelona, Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Gran Via, 199, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - Maricel Julve-Ibáñez
- Primary Care Center El Castell, Servei d'Atenció Primària Delta del Llobregat, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Castelldefels, 08860, Barcelona, Spain
| | - M-Pilar Sancho-Campos
- Primary Care Center Sant Ildefons. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, 08940, Spain
| | - Carolina Alves-Tafur
- Primary Care Center Montclar and Primary Care Center Camps Blancs. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Iris Lumillo-Gutiérrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain.
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain.
- Chronicity and Complexity Care Unit (UTACC) Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, 08940, Spain.
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Bougioukas KI, Bouras EC, Avgerinos KI, Dardavessis T, Haidich A. How to keep up to date with medical information using web‐based resources: a systematised review and narrative synthesis. Health Info Libr J 2020; 37:254-292. [DOI: 10.1111/hir.12318] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/20/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Konstantinos I. Bougioukas
- Department of Hygiene Social‐Preventive Medicine and Medical Statistics Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Emmanouil C. Bouras
- Department of Hygiene Social‐Preventive Medicine and Medical Statistics Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Theodore Dardavessis
- Department of Hygiene Social‐Preventive Medicine and Medical Statistics Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Anna‐Bettina Haidich
- Department of Hygiene Social‐Preventive Medicine and Medical Statistics Medical School Aristotle University of Thessaloniki Thessaloniki Greece
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Campbell JM. What's the evidence for this evidence? ACTA ACUST UNITED AC 2016; 14:1-2. [PMID: 27635738 DOI: 10.11124/jbisrir-2016-003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Jared M Campbell
- Research Fellow, Implementation Science, The Joanna Briggs Institute
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Campbell JM, Umapathysivam K, Xue Y, Lockwood C. Evidence-Based Practice Point-of-Care Resources: A Quantitative Evaluation of Quality, Rigor, and Content. Worldviews Evid Based Nurs 2015; 12:313-27. [PMID: 26629973 DOI: 10.1111/wvn.12114] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinicians and other healthcare professionals need access to summaries of evidence-based information in order to provide effective care to their patients at the point-of-care. Evidence-based practice (EBP) point-of-care resources have been developed and are available online to meet this need. This study aimed to develop a comprehensive list of available EBP point-of-care resources and evaluate their processes and policies for the development of content, in order to provide a critical analysis based upon rigor, transparency and measures of editorial quality to inform healthcare providers and promote quality improvement amongst publishers of EBP resources. DESIGN A comprehensive and systematic search (Pubmed, CINAHL, and Cochrane Central) was undertaken to identify available EBP point-of-care resources, defined as "web-based medical compendia specifically designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, and evidence-based information (and possibly also guidance) to clinicians." MAIN OUTCOME MEASURES A pair of investigators independently extracted information on general characteristics, content presentation, editorial quality, evidence-based methodology, and breadth and volume. RESULTS Twenty-seven summary resources were identified, of which 22 met the predefined inclusion criteria for EBP point-of-care resources, and 20 could be accessed for description and assessment. Overall, the upper quartile of EBP point-of-care providers was assessed to be UpToDate, Nursing Reference Centre, Mosby's Nursing Consult, BMJ Best Practice, and JBI COnNECT+. LINKING EVIDENCE TO ACTION The choice of which EBP point-of-care resources are suitable for an organization is a decision that depends heavily on the unique requirements of that organization and the resources it has available. However, the results presented in this study should enable healthcare providers to make that assessment in a clear, evidence-based manner, and provide a comprehensive list of the available options.
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Affiliation(s)
- Jared M Campbell
- Research Fellow, Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Kandiah Umapathysivam
- Research Fellow, Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Yifan Xue
- Research Fellow, Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Craig Lockwood
- Associate Professor, Joanna Briggs Institute, School of Translational Health Science, Faculty of Health Science, University of Adelaide, South Australia, Australia
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De Rosis S, Seghieri C. Basic ICT adoption and use by general practitioners: an analysis of primary care systems in 31 European countries. BMC Med Inform Decis Mak 2015; 15:70. [PMID: 26296994 PMCID: PMC4546151 DOI: 10.1186/s12911-015-0185-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 07/17/2015] [Indexed: 01/18/2023] Open
Abstract
Background There is general consensus that appropriate development and use of information and communication technologies (ICT) are crucial in the delivery of effective primary care (PC). Several countries are defining policies to support and promote a structural change of the health care system through the introduction of ICT. This study analyses the state of development of basic ICT in PC systems of 31 European countries with the aim to describe the extent of, and main purposes for, computer use by General Practitioners (GPs) across Europe. Additionally, trends over time have been analysed. Methods Descriptive statistical analysis was performed on data from the QUALICOPC (Quality and Costs of Primary Care in Europe) survey, to describe the geographic differences in the general use of computer, and in specific computerized clinical functions for different health-related purposes such as prescribing, medication checking, generating health records and research for medical information on the Internet. Results While all the countries have achieved a near-universal adoption of a computer in their primary care practices, with only a few countries near or under the boundary of 90 %, the computerisation of primary care clinical functions presents a wide variability of adoption within and among countries and, in several cases (such as in the southern and central-eastern Europe), a large room for improvement. Conclusions At European level, more efforts could be done to support southern and central-eastern Europe in closing the gap in adoption and use of ICT in PC. In particular, more attention seems to be need on the current usages of the computer in PC, by focusing policies and actions on the improvement of the appropriate usages that can impact on quality and costs of PC and can facilitate an interconnected health care system. However, policies and investments seem necessary but not sufficient to achieve these goals. Organizational, behavioural and also networking aspects should be taken in consideration.
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Affiliation(s)
- Sabina De Rosis
- Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa, 56127, Italy.
| | - Chiara Seghieri
- Scuola Superiore Sant'Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa, 56127, Italy
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Vrdoljak D, Petric D, Diminić Lisica I, Kranjčević K, Došen Janković S, Delija I, Puljak L. Knowledge and attitudes towards evidence-based medicine of mentors in general practice can be influenced by using medical students as academic detailers. Eur J Gen Pract 2015; 21:170-5. [PMID: 26108154 DOI: 10.3109/13814788.2015.1046124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient. OBJECTIVE To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers. METHODS An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students' task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student. RESULTS Students' EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine. CONCLUSION Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.
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Affiliation(s)
- Davorka Vrdoljak
- a Department of Family Medicine , University of Split School of Medicine , Split , Croatia
| | - Dragomir Petric
- a Department of Family Medicine , University of Split School of Medicine , Split , Croatia
| | - Ines Diminić Lisica
- b Department of Family Medicine , University of Rijeka, School of Medicine , Rijeka , Croatia
| | - Ksenija Kranjčević
- c Department of Family Medicine , Zagreb University School of Medicine, School of Public Health Andrija Stampar , Zagreb , Croatia
| | | | - Ita Delija
- d Health Centre of Splitsko-Dalmatinska County , Split , Croatia
| | - Livia Puljak
- e Laboratory for Pain Research, University of Split School of Medicine , Split , Croatia
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Rader T, Pardo Pardo J, Stacey D, Ghogomu E, Maxwell LJ, Welch VA, Singh JA, Buchbinder R, Légaré F, Santesso N, Toupin April K, O'Connor AM, Wells GA, Winzenberg TM, Johnston R, Tugwell P. Update of strategies to translate evidence from cochrane musculoskeletal group systematic reviews for use by various audiences. J Rheumatol 2013; 41:206-15. [PMID: 24293571 DOI: 10.3899/jrheum.121307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For rheumatology research to have a real influence on health and well-being, evidence must be tailored to inform the decisions of various audiences. The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. While systematic reviews provided by the CMSG fill a major gap in meeting the need for high-quality evidence syntheses, our work does not end at the completion of a review. The term "knowledge translation" (KT) refers to the activities involved in bringing research evidence to various audiences in a useful form so it can be used to support decision making and improve practices. Systematic reviews give careful consideration to research methods and analysis. Because the review is often long and detailed, the clinically relevant results may not be apparent or in the optimal form for use by patients and their healthcare practitioners. This paper describes 10 formats, many of them new, for ways that evidence from Cochrane Reviews can be translated with the intention of meeting the needs of various audiences, including patients and their families, practitioners, policy makers, the press, and members of the public (the "5 Ps"). Current and future knowledge tools include summary of findings tables, patient decision aids, plain language summaries, press releases, clinical scenarios in general medical journals, frequently asked questions (Cochrane Clinical Answers), podcasts, Twitter messages, Journal Club materials, and the use of storytelling and narratives to support continuing medical education. Future plans are outlined to explore ways of improving the influence and usefulness of systematic reviews by providing results in formats suitable to our varied audiences.
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Affiliation(s)
- Tamara Rader
- From the Cochrane Musculoskeletal Group (CMSG), Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
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Lukacs B, Cornu JN, Aout M, Tessier N, Hodée C, Haab F, Cussenot O, Merlière Y, Moysan V, Vicaut E. Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia in Real-life Practice in France: A Comprehensive Population Study. Eur Urol 2013; 64:493-501. [DOI: 10.1016/j.eururo.2013.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/16/2013] [Indexed: 11/25/2022]
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