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Leach MJ, Agnew T. Evidence implementation in Australian manual therapy practice: A cross-sectional study. J Bodyw Mov Ther 2023; 36:109-116. [PMID: 37949546 DOI: 10.1016/j.jbmt.2023.05.007] [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: 02/02/2023] [Accepted: 05/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Few studies have explored the determinants of evidence implementation in complementary manual therapy professions. Exploring the factors that impede or enable evidence implementation in complementary manual therapy professions is critical to determining the most appropriate strategies to optimise this practice, and enhance the quality of care. METHODS The study used a cross-sectional study design to examine Australian complementary medicine manual therapists' attitudes, skills, training, use, barriers and enablers to evidence implementation. Eligible therapists were invited to self-administer the 84-item Evidence-Based practice Attitude and utilization Survey online. RESULTS The survey was completed by 294 manual therapists (77% female; 65% aged ≥50 years). Participants were mostly supportive of, and reported a moderate to moderate-high level of skill in evidence implementation. However, the level of engagement in evidence implementation was low. The leading barriers to evidence implementation were lack of time, and lack of clinical evidence. While few participants reported skill-level as a barrier, most indicated a desire to develop the skills necessary to improve their engagement in evidence implementation. Participants also supported a range of other enabling strategies to foster evidence implementation in their practice, with most of these strategies targeting access to evidence. CONCLUSIONS Although participants reported few barriers to evidence implementation, there was a low level of engagement in this activity. The barriers to evidence implementation therefore warrant further exploration. This ongoing work will help better understand how to optimise evidence implementation in complementary manual therapy practice, and help drive improvements in patient care.
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Affiliation(s)
- Matthew J Leach
- Faculty of Health, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia.
| | - Tamara Agnew
- Faculty of Health, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia.
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Chung VC, Ho FF, Lao L, Liu J, Lee MS, Chan KW, Nilsen P. Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 109:154591. [PMID: 36610171 DOI: 10.1016/j.phymed.2022.154591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits. PURPOSE The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective. METHODS Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach. RESULTS Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice. CONCLUSION Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.
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Affiliation(s)
- Vincent Ch Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fai Fai Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, VA, United States
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kam Wa Chan
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Leach MJ, Veziari Y. Enablers and Barriers to Evidence Implementation in Complementary Medicine: A Systematic Review. Integr Med Res 2022; 11:100899. [DOI: 10.1016/j.imr.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022] Open
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Ehrenbrusthoff K, Braun T, Bahns C, Happe L, Kopkow C. Adherence to evidence-based practice across healthcare professionals in Germany: results from a cross-sectional, nationwide survey. BMC Health Serv Res 2022; 22:1285. [PMID: 36284307 PMCID: PMC9597997 DOI: 10.1186/s12913-022-08682-z] [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: 11/22/2021] [Accepted: 10/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to evidence-based practice (EBP) is considered a key competence to improve healthcare quality. In this study, we aimed to describe the EBP adherence of healthcare professionals working in Germany and to explore barriers and facilitators regarding the implementation of EBP in clinical practice. Methods A nationwide online survey was performed among healthcare professionals in Germany from January to April 2018 using the German version of the Evidence-based Practice Inventory (EBPI) questionnaire for a comprehensive assessment of adherence to EBP. Univariate logistic regression analyses were performed to explore the association between demographic and professional determinants and each EBPI dimension. Results We analysed data of 889 participants, including 318 physical therapists, 154 occupational therapists, 137 midwifes and 280 participants of six other healthcare professions. Approximately 70% of the participants generally demonstrated a positive attitude towards EBP and believed that EBP was useful in clinical practice. Broadly, 80% of the respondents evaluated themselves as being able to enact EBP behaviour in clinical practice. In contrast, less than 70% preferred to use quantitative information instead of their intuition to inform their habitual clinical behaviour. Still, 20 to 30% reported that EBP did not sufficiently account for their clinical experience and differences between patients. The strongest facilitators to EBP adherence across at least three dimensions of the EBPI were the availability of ≥ 60 min for scientific literature at work (OR: 9.67; 95% CI: 5.86; 16.30), followed by a master or higher academic degree (OR: 9.09, 95% CI: 5.86; 14.28) and the involvement in ≥ 1 scientific publication (OR: 7.06, 95% CI: 5.10; 9.85). Conclusions This study showed that healthcare professionals in Germany in general had a positive attitude towards EBP although they currently do not consider EBP principles in its entirety. The most important determinant positively influencing a healthcare professional’s decision to perform EBP was the time available for scientific literature at work. German healthcare professionals experience similar barriers towards the implementation of EBP in clinical practice compared to other international healthcare settings. These barriers should be targeted by future research. Trial registration German Clinical Trials Register (DRKS00013792). Registered 19 January 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08682-z.
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Affiliation(s)
- Katja Ehrenbrusthoff
- grid.454254.60000 0004 0647 4362Department of Applied Health Sciences, Division of Physiotherapy, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Tobias Braun
- grid.454254.60000 0004 0647 4362Department of Applied Health Sciences, Division of Physiotherapy, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany ,grid.512879.0HSD Hochschule Döpfer GmbH (University of Applied Sciences), Waidmarkt 3 & 9, 50676 Cologne, Germany
| | - Carolin Bahns
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus – Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany
| | - Lisa Happe
- grid.5560.60000 0001 1009 3608Department for Health Services Research, Assistance Systems and Medical Device Technology, Carl Von Ossietzky University Oldenburg, Ammerländer Heerstr. 114, Oldenburg, Germany
| | - Christian Kopkow
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus – Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany
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Factors Affecting Tendency and Adherence to Traditional Persian Medicine: A Qualitative Study. Jundishapur J Nat Pharm Prod 2021. [DOI: 10.5812/jjnpp.107933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Adherence to medications is crucial for them to be effective. Traditional Persian Medicine (TPM) is an ancient medical discipline originated from old Persia and is currently used along with modern medicine in Iran. Evaluating the factors affecting adherence to TPM can have far-reaching implications for policymakers to make informed decisions. Objectives: This qualitative study investigates the factors affecting tendency and adherence to TPM among Iranians. Methods: We collected data from stakeholders in TPM using a focus group involving 13 participants and by conducting four in-depth interviews. The saturation point was reached at the 4th interview. We recorded all the interviews and then transcribed them verbatim for thematic content analysis. Results: We obtained 297 codes and 29 sub-themes for the factors affecting adherence to TPM, including the factors affecting compliance and tendency. Then we extracted the main themes. People’s beliefs, the inherent characteristics of traditional medicine and its status quo, attempts to bring about positive changes to TPM, and the problems facing the modern health system were the main factors affecting adherence to TPM. Conclusions: Despite many strenuous efforts in Iran to study TPM along with the lines of evidence-based medicine, policymaking, financing, patients’ and healthcare providers’ education, popular beliefs, and administrative transparency are needed to be addressed more adequately to promote adherence to TPM and help build integrative medicine in Iran’s healthcare system.
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Wong CHL, Tse JVH, Nilsen P, Ho L, Wu IXY, Chung VCH. Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong. BMC Complement Med Ther 2021; 21:200. [PMID: 34266433 PMCID: PMC8280573 DOI: 10.1186/s12906-021-03372-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023] Open
Abstract
Background In response to the World Health Organization’s recommendation, policy makers have been adopting evidence-based healthcare approach to promote the development of traditional, complementary and integrative medicine (TCIM) into Hong Kong’s health system. Disseminating synopses of clinical evidence from systematic reviews or randomized trials is regarded as a potentially effective strategy to promote evidence uptake. The study aimed to identify barriers and facilitators to implementing this strategy among Hong Kong Chinese medicine practitioners (CMPs). Methods Twenty-five CMPs aged under 45 years and trained in Hong Kong after reunification with China in 1997 were interviewed individually. Four clinical evidence synopses of randomized trials and systematic reviews on Chinese medicine interventions were presented, and CMPs were asked to comment on their applicability in routine practice. The Consolidated Framework for Implementation Research (CFIR) was applied to guide interview and analysis. Results The barriers included: i) CMPs’ perceived difficulties in applying complex evidence in decision-making and ii) inadequate training and limited consultation time. The facilitators were i) availability of publicly accessible and user-friendly synopses, ii) formation of community of evidence-based practice among CMPs with input from key opinion leaders, iii) opportunity for interprofessional collaborations with conventional healthcare providers, and iv) patients’ demand for evidence-based clinical advice. Besides, i) CMPs’ knowledge and beliefs in evidence-based healthcare approach, ii) presentations of evidence-based information in the synopses, and iii) clinical decision making as influenced by quality of evidence reported acted as both barriers and facilitators. Conclusions This CFIR-based qualitative study investigated how the World Health Organization recommendation of promoting evidence use in routine practice was perceived by CMPs trained in Hong Kong after reunification with China in 1997. Key barriers and facilitators to applying evidence were identified. Such results will inform tailoring of implementation strategies for promoting evidence uptake, in the context of a well-developed health system dominated by conventional medicine. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03372-5.
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Affiliation(s)
- Charlene Hoi Lam Wong
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jeffrey Van Ho Tse
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Building 511-001, Entrance 76, plan 13, Campus US, 58183, Linköping, Sweden
| | - Leonard Ho
- School of Chinese Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Rm 527 5/F, 238 Shangmayuanling Alley, Kaifu District, Changsha, China.
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
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Veziari Y, Kumar S, Leach M. Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review. BMC Complement Med Ther 2021; 21:201. [PMID: 34266441 PMCID: PMC8281683 DOI: 10.1186/s12906-021-03371-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. METHODS The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. RESULTS Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. CONCLUSIONS While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.
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Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, East Lismore, NSW 2480 Australia
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Chung VCH, Ho LTF, Leung TH, Wong CHL. Designing delivery models of traditional and complementary medicine services: a review of international experiences. Br Med Bull 2021; 137:70-81. [PMID: 33681965 DOI: 10.1093/bmb/ldaa046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The World Health Organization advocates integration of traditional and complementary medicine (T&CM) into the conventional health services delivery system. Integrating quality services in a patient-centred manner faces substantial challenges when T&CM is delivered within a health system dominated by conventional medicine. This review has synthesized international experiences of integration strategies across different contexts. SOURCES OF DATA Publications describing international experiences of delivering T&CM service in conventional healthcare settings were searched. Backward and forward citation chasing was also conducted. AREAS OF AGREEMENT Capable leaders are crucial in seeking endorsement from stakeholders within the conventional medicine hierarchy and regulatory bodies. However, patient demands for integrative care can be successful as demonstrated by cases included in this review, as can the promotion of the use of T&CM for filling effectiveness gaps in conventional medicine. Safeguarding quality and safety of the services is a priority. AREAS OF CONTROVERSY Different referral mechanisms between conventional and T&CM practitioners suit different contexts, but at a minimum, general guideline on responsibilities across the two professionals is required. Evidence-based condition-specific referral protocols with detailed integrative treatment planning are gaining in popularity. GROWING POINTS Interprofessional education is critical to establishing mutual trust and understanding between conventional clinicians and T&CM practitioners. Interprofessional communication is key to a successful collaboration, which can be strengthened by patient chart sharing, instant information exchange, and dedicated time for face-to-face interactions. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed on the optimal methods for financing integrated care to ensure equitable access, as well as in remuneration of T&CM practitioners working in integrative healthcare.
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Affiliation(s)
- Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong.,School of Chinese Medicine, The Chinese University of Hong Kong
| | - Leonard T F Ho
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
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Braun T, Ehrenbrusthoff K, Bahns C, Happe L, Kopkow C. What's a true change? - Interpreting change scores in measurement instruments of evidence-based practice: A comment. Complement Ther Med 2020; 54:102454. [PMID: 33183656 DOI: 10.1016/j.ctim.2020.102454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany.
| | - Katja Ehrenbrusthoff
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Carolin Bahns
- Institute of Occupational Medicine, University of Lübeck, Lübeck, Germany
| | - Lisa Happe
- Department for Health Services Research, Assistance Systems and Medical Devices, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Christian Kopkow
- Department of Therapy Science I, Brandenburg Technical University Cottbus-Senftenberg, Senftenberg, Germany
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Wong CH, Chung VCH. Letter to the Editor: Response to “What’s a true change? – Interpreting change scores in measurement instruments of evidence-based practice: A comment”. Complement Ther Med 2020; 52:102492. [DOI: 10.1016/j.ctim.2020.102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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