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Hopayian K, Dimosthenous S. The utility of the classification tools in National Institute of Health and Clinical Excellence's Clinical Knowledge Summaries for primary care. Fam Pract 2024; 41:194-197. [PMID: 37703115 PMCID: PMC11017775 DOI: 10.1093/fampra/cmad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The National Institute of Health and Clinical Excellence provides a web-based resource, Clinical Knowledge Summaries (CKS), whose aim is to give evidence-based guidance for primary care practitioners and students. Included in the information it provides, are tools for the classification of conditions. OBJECTIVES The objective of this study was to measure the proportion and utility of the classification tools that have implications for management. METHODS Each topic on the CKS website was screened in alphabetical order for the presence of a classification tool. The linkage to management and the strength of recommendations were extracted by 2 researchers working independently. Disagreements were resolved through discussion. RESULTS Classification tools were present for 35 conditions. There were 52 tools in all. A strong recommendation for their use was made in 37% while for a sizeable minority, 46%, the strength of recommendation was uncertain. There was a relation between strength of recommendation and linkage: for the stronger recommendation, 76% had some form of implication for management. CONCLUSION Relevance is an important feature of a guideline for general practitioners (GPs). Given that nearly half its tools have no utility in guiding management, CKS may need to consider whether extraneous information should be disposed of or retained.
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Affiliation(s)
- Kevork Hopayian
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Sotiris Dimosthenous
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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2
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Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C. Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job". BMC Geriatr 2024; 24:213. [PMID: 38424477 PMCID: PMC10905774 DOI: 10.1186/s12877-024-04830-8] [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: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. METHODS Semi-structured interviews were conducted with a range of healthcare professionals (n = 31) working in primary and community care in the South of England in 2023. Transcribed interviews were uploaded to NVivo 12, then analysed inductively and deductively using a thematic framework. RESULTS Continence-related conversations were avoided by many healthcare professionals due to lack of dementia-continence specific knowledge. Many considered that continence problems of people living with dementia were largely outside their remit once a physical cause had been ruled out. This contributed to a lack of priority and proactivity in raising the subject of continence in their consultations. Challenges to providing support included limited consultation time and lack of access to specialist services with availability to support individuals. CONCLUSION There is substantial scope to support primary and community-based healthcare professionals in their provision of continence-related support and advice to people living at home with dementia. This includes addressing knowledge deficits, enhancing confidence and instilling a sense of accomplishment.
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Affiliation(s)
- Barbara Bradbury
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK.
| | - Helen Chester
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Leanne Morrison
- Department of Psychology, Faculty of Environmental and Life Sciences, Primary Care Research Centre, Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Mandy Fader
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jane Ward
- University of Southampton, B67, West Highfield Campus, University Road, Southampton, SO17 1BJ, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK
| | - Catherine Murphy
- School of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Shirley, SO16 6YD, UK
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Workman JK, Keenan HT, Weir CR. Pediatric Septic Shock Care Pathways in General Emergency Departments: A Qualitative Study Targeting How to Really Make it Work. Pediatr Emerg Care 2023; 39:562-568. [PMID: 36688499 PMCID: PMC10363245 DOI: 10.1097/pec.0000000000002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Many academic pediatric emergency departments (PEDs) have successfully implemented pediatric septic shock care pathways. However, many general emergency departments (GEDs), who see the majority of pediatric ED visits, have not. This study aims to compare the workflow, resources, communication, and decision making across these 2 settings to inform the future implementation of a standardized care pathway for children with septic shock in the GED. METHODS We used the critical incident technique to conduct semistructured interviews with 24 ED physicians, nurses, and technicians at one PED and 2 GEDs regarding pediatric septic shock care. We performed a thematic analysis using the Framework Method to develop our coding schema through inductive and deductive analyses. We continued an iterative process of revising the schema until we reached consensus agreement and thematic saturation. RESULTS We identified the following 6 themes: (1) functioning like a "well-oiled machine" may be key to high performance; (2) experiencing the sequence of care for children with sepsis as invariant and predictable may be essential to high-quality performance; (3) resilience and flexibility are characteristic of high levels of performance; (4) believing that "the buck stops here" may contribute to more accountability; (5) continuous system learning is essential; and (6) computerized clinical decision support may not be optimized to drive decision-making at the point of care. Commentary from GED and PED participants differed across the 6 themes, providing insight into the approach for standardized care pathway implementation in GEDs. CONCLUSIONS Pediatric septic shock workflow, decision making, and system performance differ between the PED and GEDs. Implementation of a standardized care pathway in GEDs will require a tailored approach. Specific recommendations include (1) improving shared situation awareness; (2) simulation for knowledge, skill, and team-based training; and (3) promoting a culture of continuous learning.
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Affiliation(s)
| | - Heather T Keenan
- From the Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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Hatch LM, Widnall EC, Albers PN, Hopkins GL, Kidger J, de Vocht F, Kaner E, van Sluijs EMF, Fairbrother H, Jago R, Campbell RM. Conducting school-based health surveys with secondary schools in England: advice and recommendations from school staff, local authority professionals, and wider key stakeholders, a qualitative study. BMC Med Res Methodol 2023; 23:142. [PMID: 37322415 PMCID: PMC10273669 DOI: 10.1186/s12874-023-01957-x] [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: 11/29/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Improving the health and well-being of young people is a public health priority. Schools present an ideal setting to implement strategies to improve young people's health and well-being. A key strategy involves conducting surveys to assess student health needs, inform interventions, and monitor health over time. Conducting research in schools is, however, challenging. Schools can find it difficult to participate and adhere to research processes, even when they are keen to be involved in research, because of competing priorities (e.g., attendance and educational achievement), as well as time and resource constraints. There is a lack of literature on the perspectives of school staff and other key stakeholders working in young people's health on how best to work with schools to conduct health research, and in particular, health surveys. METHODS Participants (n = 26) included members of staff from 11 secondary schools (covering students aged 11-16 years), 5 local authority professionals, and 10 wider key stakeholders in young people's health and well-being (e.g., a school governor, a national government member), based in South West England. Participants took part in semi-structured interviews that were conducted either over the phone or via an online platform. Data were analysed using the Framework Method. RESULTS Three main themes were identified: Recruitment and Retention, Practicalities of Data Collection in Schools, and Collaboration from Design to Dissemination. It is important to acknowledge the role of local authorities and academy trusts in the English education system, and work closely with these when conducting school-based health surveys. School staff prefer to be contacted about research via email and in the summer term, following exams. Researchers should contact a member of staff involved in student health/well-being, as well as senior leadership, during recruitment. Data collection during the start and end of the school year is undesirable. Research should be collaborative with school staff and young people, consistent with school priorities and values, and flexible and tailored to school timetables and resources. CONCLUSIONS Overall the findings demonstrate that survey-based research methods should be school-led and tailored to each school.
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Affiliation(s)
- Lorna M Hatch
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK.
| | - Emily C Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Patricia N Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Georgina L Hopkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Rona M Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Cognitive processes associated with emotional disorders: implications for efficient psychological treatments. J Ment Health 2023; 32:54-62. [PMID: 33989506 DOI: 10.1080/09638237.2021.1922651] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Jose F Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
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Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:8. [PMID: 36717955 PMCID: PMC9885062 DOI: 10.1186/s41043-023-00348-8] [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: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. METHODS This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11. RESULTS Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions. CONCLUSION Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people's eating habits. In particular, citizens' income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach.
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Affiliation(s)
- Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Poursina Ave, Tehran, Iran.
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Heath Equity Research Center (HERC) - TUMS, Tehran, Iran.
- National Center for Health Insurance Research, The Iranian Health Insurance Organization, Tehran, Iran.
| | - Hamed Pouraram
- Ommunity Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Poursina Ave, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Amerzadeh M, Takian A, Pouraram H, Sari AA, Ostovar A. Policy analysis of nutrition stewardship for prevention and control of Non-communicable diseases in Iran. BMC Health Serv Res 2023; 23:79. [PMID: 36694184 PMCID: PMC9873537 DOI: 10.1186/s12913-023-09087-2] [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: 08/05/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% of death and 62% of DALYs globally. As an unhealthy diet is the leading behavioral risk factor of NCDs, in line with the national action plan for the prevention and control of NCD, this study explored the nutrition-related stewardship problems to reduce the burden of NCDs in Iran. METHODS This is a qualitative study. We interviewed 30 purposefully identified key informants, i.e., stakeholders, policymakers, and academics, from December 2018 to August 2019. All interviews were recorded and transcribed verbatim. We analyzed data using qualitative content analysis facilitated by MAXQDA 11 software. RESULTS Ample policies and laws were identified, most of which were not or partially implemented. Despite some plausible efforts, NCDs do not seem to be a top priority for high-level managers and decision-makers. Besides, the role of non-state actors, i.e., the private sector, is marginal in NCD's planning and management. Whereas the government, e.g., the Food and Drug Organization (FDO), is the biggest player. Worse still, many harmful products are advertised and easily distributed across the country. CONCLUSION Iran's government has created a noticeable roadmap to battle NCDs despite imposing many sanctions and related socioeconomic problems. Nevertheless, more interventions are needed to strengthen the stewardship of NCDs by various stakeholders. We recommend the government to monitor the implementation of policies and advertisement of harmful products to prioritize prevention and control of NCDs. In addition, we advocate employing the capacity of non-state actors to reduce the consumption of unhealthy food and the burden of NCDs across the country, ultimately.
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Affiliation(s)
- Mohammad Amerzadeh
- grid.412606.70000 0004 0405 433XSocial Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin university of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- grid.411705.60000 0001 0166 0922Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran ,grid.411705.60000 0001 0166 0922Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran ,Heath Equity Research Center (HERC) – TUMS, Tehran, Iran ,National Center for Health Insurance Research, The Iranian Health Insurance Organization, Tehran, Iran
| | - Hamed Pouraram
- grid.411705.60000 0001 0166 0922Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- grid.411705.60000 0001 0166 0922Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Afshin Ostovar
- grid.411705.60000 0001 0166 0922Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Smith RM, Burgess C, Tahtis V, Marsden J, Seemungal BM. Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study. BMJ Open 2023; 13:e067967. [PMID: 36592999 PMCID: PMC9809272 DOI: 10.1136/bmjopen-2022-067967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Vestibular dysfunction is common in patients with acute traumatic brain injury (aTBI). Persisting vestibular symptoms (ie, dizziness and imbalance) are linked to poor physical, psychological and socioeconomic outcomes. However, routine management of vestibular dysfunction in aTBI is not always standard practice. We aimed to identify and explore any healthcare professional barriers or facilitators to managing vestibular dysfunction in aTBI. DESIGN A qualitative approach was used. Data were collected using face to face, semi-structured interviews and analysed using the Framework approach. SETTING Two major trauma centres in London, UK. PARTICIPANTS 28 healthcare professionals participated: 11 occupational therapists, 8 physiotherapists and 9 surgical/trauma doctors. RESULTS Vestibular assessment and treatment were not routinely undertaken by trauma ward staff. Uncertainty regarding responsibility for vestibular management on the trauma ward was perceived to lead to gaps in patient care. Interestingly, the term dizziness was sometimes perceived as an 'invisible' and vague phenomenon, leading to difficulties identifying or 'proving' dizziness and a tendency for making non-specific diagnoses. Barriers to routine assessment and treatment included limited knowledge and skills, a lack of local or national guidelines, insufficient training and concerns regarding the practical aspects of managing vestibular dysfunction. Of current trauma ward staff, therapists were identified as appropriate healthcare professionals to adopt new behaviours regarding management of a common form of vestibular dysfunction (benign paroxysmal positional vertigo). Strategies to support this behaviour change include heightened clarity around role, implementation of local or national guidelines, improved access to training and multidisciplinary support from experts in vestibular dysfunction. CONCLUSIONS This study has highlighted that role and knowledge barriers exist to multidisciplinary management of vestibular dysfunction in aTBI. Trauma ward therapists were identified as the most appropriate healthcare professionals to adopt new behaviours. Several strategies are proposed to facilitate such behaviour change. TRIAL REGISTRATION NUMBER ISRCTN91943864.
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Affiliation(s)
- Rebecca M Smith
- Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK
| | - Caroline Burgess
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | | | | | - Barry M Seemungal
- Brain and Vestibular Group, Centre for Vestibular Neurology, Imperial College London, London, UK
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Frantsve-Hawley J, Abt E, Carrasco-Labra A, Dawson T, Michaels M, Pahlke S, Rindal DB, Spallek H, Weyant RJ. Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. J Am Dent Assoc 2022; 153:1041-1052. [PMID: 36127176 DOI: 10.1016/j.adaj.2022.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.
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Silverberg ND, Otamendi T, Brasher PM, Brubacher JR, Li LC, Lizotte PP, Panenka WJ, Scheuermeyer FX, Archambault P. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062527. [PMID: 35728892 PMCID: PMC9214410 DOI: 10.1136/bmjopen-2022-062527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings. METHODS AND ANALYSIS We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18-69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks. ETHICS AND DISSEMINATION Study procedures were approved by the University of British Columbia's research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04704037).
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Thalia Otamendi
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope Ma Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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11
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Amerzadeh M, Takian A, Pouraram H, Sari AA, Ostovar A. Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran. BMC Nutr 2022; 8:26. [PMID: 35337385 PMCID: PMC8948451 DOI: 10.1186/s40795-022-00518-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which poor diet is the leading risk factor. It is estimated that 20% of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran. Methods This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran. Results We identified socio-cultural determents of salt, fat and sugar consumption as follows: Inadequate structure of traditional medicine and people’s desire for traditional foods, low health literacy, the global trend of nutritional transition and its impact on Iranian society, The progressive decline of people’s trust in NGOs, and Inappropriate media management. Worse still, the global trend of nutritional transition and people’s tendency towards fast foods, unhealthy diet and junk foods, partially due to establishing children’s taste mainly with salty, high-fat and sweet foods, has jeopardized their desire to eat healthily during adulthood. Conclusion Reducing salt, fat and sugar consumption is problematic in Iran, mainly due to multi-dimensional socio-cultural determinants. In line with sustainable development goal (SDG) 3.4 to reduce 30% of premature death due to NCDs and related risk factors by 2030 in Iran, various stakeholders from multiple sectors need to initiate coherent series of interventions to alter people’s approach to select food so that they may reduce the consumption of foods with excessive salt, fat and sugar. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00518-7.
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Affiliation(s)
- Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin university of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Heath Equity Research Center (HERC) - TUMS, Tehran, Iran.
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Afshin Ostovar
- Center for NCD Prevention and Management, Ministry of Health and Medical Education, Tehran, Iran.,Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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12
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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13
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Ozavci G, Bucknall T, Woodward-Kron R, Hughes C, Jorm C, Joseph K, Manias E. Knowledge and Power Relations in Older Patients' Communication About Medications Across Transitions of Care. QUALITATIVE HEALTH RESEARCH 2021; 31:2678-2691. [PMID: 34657517 DOI: 10.1177/10497323211043494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Communicating about medications across transitions of care is a challenging process for older patients. In this article, we examined communication processes between older patients, family members, and health professionals about managing medications across transitions of care, focusing on older patients' experiences. A focused ethnographic design was employed across two metropolitan hospitals. Data collection methods included interviews, observations, and focus groups. Following thematic analysis, data were analyzed using Fairclough's Critical Discourse Analysis and Medication Communication Model. Older patients' medication knowledge and family members' advocacy challenged unequal power relations between clinicians and patients and families. Doctors' use of authoritative discourse impeded older patients' participation in the medication communication. Older patients perceived that nurses' involvement in medication communication was limited due to their task-related routines. To reduce the unequal power relations, health professionals should be more proactive in sharing information about medications with older patients across transitions of care.
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Affiliation(s)
- Guncag Ozavci
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | - Tracey Bucknall
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | | | - Carmel Hughes
- Queen's University Belfast, Belfast, Northern Ireland
| | - Christine Jorm
- NSW Regional Health Partners, Newcastle, New South Wales, Australia
| | - Kathryn Joseph
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
| | - Elizabeth Manias
- Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Australia
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14
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Abelsson T, Morténius H, Karlsson AK, Bergman S, Baigi A. Evidence-based practice in primary healthcare from the managerial point of view - a national survey. BMC Health Serv Res 2021; 21:1014. [PMID: 34565349 PMCID: PMC8474930 DOI: 10.1186/s12913-021-07023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/14/2021] [Indexed: 01/10/2023] Open
Abstract
Background The vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers. Methods The study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman’s correlation coefficients. All tests were two-sided, and the significance level was set to 0.05. Results A majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %). Conclusions The study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07023-w.
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Affiliation(s)
- Tobias Abelsson
- Department of Research and Development, Region Halland, Region Halland, R&D, Box 517, 301 80, Halmstad, Sweden. .,Primary Healthcare Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Helena Morténius
- Primary Healthcare Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Healthcare, Region Halland, Halmstad, Sweden
| | - Ann-Kristin Karlsson
- Department of Research and Development, Region Halland, Region Halland, R&D, Box 517, 301 80, Halmstad, Sweden
| | - Stefan Bergman
- Primary Healthcare Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Spenshult, Halmstad, Sweden
| | - Amir Baigi
- Department of Research and Development, Region Halland, Region Halland, R&D, Box 517, 301 80, Halmstad, Sweden.,Primary Healthcare Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Bazyar M, Yazdi-Feyzabadi V, Rashidian A, Behzadi A. The experiences of merging health insurance funds in South Korea, Turkey, Thailand, and Indonesia: a cross-country comparative study. Int J Equity Health 2021; 20:66. [PMID: 33637090 PMCID: PMC7913450 DOI: 10.1186/s12939-021-01382-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fragmentation in health insurance system may lead to inequity in financial access to and utilization of health care services. One possible option to overcome this challenge is merging the existing health insurance funds together. This article aims to review and compare the experience of South Korea, Turkey, Thailand and Indonesia regarding merging their health insurance funds. METHODS This was a cross-country comparative study. The countries of the study were selected purposefully based on the availability of data to review their experience regarding merging health insurance funds. To find the most relevant documents about the subject, different sources of information including books, scientific papers, dissertations, reports, and policy documents were studied. Research databases including PubMed, Scopus, Google Scholar, Science Direct and ProQuest were used to find relevant articles. Documents released by international organizations such as WHO and World Bank were analyzed as well. The content of documents was analyzed using a data-driven conventional content analysis approach and all details regarding the subject were extracted. The extracted information was reviewed by all authors several times and nine themes emerged. RESULTS The findings show that improving equity in health financing and access to health care services among different groups of population was one of the main triggers to merge health insurance funds. Resistance by groups enjoying better benefit package and concerns of workers and employers about increasing the contribution rates were among challenges ahead of merging health insurance funds. Improving equity in the health care financing; reducing inequity in access to and utilization of health care services; boosting risk pooling; reducing administrative costs; higher chance to control total health care expenditures; and enhancing strategic purchasing were the main advantages of merging health insurance funds. The experience of these countries also emphasizes that political commitment and experiencing a reliable economic growth to enhance benefit package and support the single national insurance scheme financially after merging are required to facilitate implementation of merging health insurance funds. CONCLUSIONS Other contributing health reforms should be implemented simultaneously or sequentially in both supply side and demand side of the health system if merging is going to pave the way reaching universal health coverage.
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Affiliation(s)
- Mohammad Bazyar
- Department of Health Promotion, Faculty of health, Ilam University of Medical Sciences, Ilam, Iran
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Vahid Yazdi-Feyzabadi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Arash Rashidian
- Evidence and Research Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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16
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Silverberg ND, Panenka WJ, Lizotte PP, Bayley MT, Dance D, Li LC. Promoting early treatment for mild traumatic brain injury in primary care with a guideline implementation tool: a pilot cluster randomised trial. BMJ Open 2020; 10:e035527. [PMID: 33082178 PMCID: PMC7577038 DOI: 10.1136/bmjopen-2019-035527] [Citation(s) in RCA: 4] [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] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES New clinical practice guidelines for the management of mild traumatic brain injury (mTBI) emphasise that family physicians should proactively screen and initiate treatment for depression/anxiety, insomnia and headaches. This study aimed to evaluate the feasibility of delivering an implementation intervention to family physicians. DESIGN Pilot cluster randomised controlled trial. SETTING Specialty outpatient clinic (recruitment) and primary care (implementation). PARTICIPANTS 114 primary care clinics were randomised. These clinics were associated with 137 unique family physicians caring for 148 adult patients who sustained an mTBI within the previous 3 months and were seeking care for persistent symptoms. INTERVENTIONS Patients completed self-report screening measures for depression/anxiety, insomnia and headaches. A tailored letter that incorporates the patient's screening test results and associated treatment algorithms was sent to their family physician (or walk-in clinic). Physicians at clinics assigned to the control condition received a generic letter, without the screening test results. PRIMARY OUTCOME MEASURES Feasibility outcomes included the frequency of primary care follow-up, retention rates and reliability of patient recall of their physicians' actions (primary mechanistic outcome). The primary efficacy outcome was the Rivermead Post-Concussion Symptom Questionnaire (RPQ). RESULTS Most patients (97.8%; 128 of 131) followed up at the primary care clinic they planned to. Retention rates were 88% (131 of 148) and 78% (116 of 148) at the 1-month and 3-month assessments, respectively. Agreement between patient recall of their physicians' actions and medical chart audits was moderate (intraclass correlation coefficient=0.48-0.65). Patients in the experimental group reported fewer symptoms on the RPQ compared with those in the control group, whose physician received a general letter (B=-4.0, 95% CI: -7.3 to -0.7). CONCLUSIONS A larger trial will need to address minor feasibility challenges to evaluate the effectiveness of this guideline implementation tool for improving mTBI clinical outcomes and confirm the mechanism(s) of intervention benefit. TRIAL REGISTRATION NUMBER NCT03221218.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
- BC Neuropsychiatry Program, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Research Center, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Derry Dance
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Acquired Brain Injury Program, GF Strong Rehabilitation Hospital, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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17
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Tudball J, Reddel HK, Laba TL, Jan S, Flynn A, Goldman M, Lembke K, Roughead E, Marks GB, Zwar N. General practitioners' views on the influence of cost on the prescribing of asthma preventer medicines: a qualitative study. AUST HEALTH REV 2020; 43:246-253. [PMID: 29754592 DOI: 10.1071/ah17030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 01/19/2018] [Indexed: 12/25/2022]
Abstract
Objective Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS) alone, but in Australia most are prescribed combination ICS-long-acting β2-agonists (LABA), which cost more to patients and government. The present qualitative study among general practitioners (GPs) explored the acceptability, and likely effect on prescribing, of lower patient copayments for ICS alone. Methods Semistructured telephone interviews were conducted with 15 GPs from the greater Sydney area; the interviews were transcribed and thematically analysed. Results GPs reported that their main criteria for selecting medicines were appropriateness and effectiveness. They did not usually discuss costs with patients, had low awareness of out-of-pocket costs and considered that these were seldom prohibitive for asthma patients. GPs strongly believed that patient care should not be compromised to reduce cost to government. They favoured ICS-LABA combinations over ICS alone because they perceived that ICS-LABA combinations enhanced adherence and reduced costs for patients. GPs did not consider that lower patient copayments for ICS alone would affect their prescribing. Conclusion The results suggest that financial incentives, such as lower patient copayments, would be unlikely to encourage GPs to preferentially prescribe ICS alone, unless accompanied by other strategies, including evidence for clinical effectiveness. GPs should be encouraged to discuss cost barriers to treatment with patients when considering treatment choices. What is known about the topic? Australian guidelines recommend that most patients with asthma should be treated with low-dose ICS alone to minimise symptom burden and risk of flare ups. However, most patients in Australian general practice are instead prescribed combination ICS-LABA preventers, which are indicated if asthma remains uncontrolled despite treatment with ICS alone. It is not known whether GPs are aware that the combination preventers have a higher patient copayment and a higher cost to government. What does this paper add? This qualitative study found that GPs favoured combination ICS-LABA inhalers over ICS alone because they perceived ICS-LABA combinations to have greater effectiveness and promote patient adherence. This aligned with GPs' views that their primary responsibility was patient care rather than generating cost savings for government. However, it emerged that GPs rarely discussed medicine costs with patients, had low knowledge of medicine costs to patients and the health system and reported that patients rarely volunteered cost concerns. GPs believed that lower patient copayments for asthma preventer medicines would have little effect on their prescribing practices. What are the implications for practitioners? This study suggests that, when considering asthma treatment choices, GPs should empathically explore with the patient whether cost-related medication underuse is an issue, and should be aware of the option of lower out-of-pocket costs with guideline-recommended ICS alone treatment. Policy makers must be aware that differential patient copayments for ICS preventer medicines are unlikely to act as an incentive for GPs to preferentially prescribe ICS alone preventers, unless the position of these preventers in guidelines and evidence for their clinical effectiveness are also reiterated.
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Affiliation(s)
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Rd, Glebe, NSW 2037, Australia. Email
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street, Newtown NSW 2042, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street, Newtown NSW 2042, Australia.
| | - Anthony Flynn
- Asthma Australia Ltd, Level 13, 799 Pacific Hwy, Chatswood NSW 2067, Australia.
| | - Michele Goldman
- Asthma Australia Ltd, Level 13, 799 Pacific Hwy, Chatswood NSW 2067, Australia.
| | - Kirsty Lembke
- NPS MedicineWise, PO Box 1147 Strawberry Hills NSW 2012. Email
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, CEA-19, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Email
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, 431 Glebe Point Rd, Glebe, NSW 2037, Australia. Email
| | - Nick Zwar
- School of Public Health and Community Medicine, University of New South Wales Sydney, NSW 2052, Australia
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18
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Gulliford MC, Juszczyk D, Prevost AT, Soames J, McDermott L, Sultana K, Wright M, Fox R, Hay AD, Little P, Moore M, Yardley L, Ashworth M, Charlton J. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Health Technol Assess 2020; 23:1-70. [PMID: 30900550 DOI: 10.3310/hta23110] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. OBJECTIVES To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). INTERVENTIONS A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. DESIGN A parallel-group, cluster randomised controlled trial. SETTING The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS All registered patients were included. MAIN OUTCOME MEASURES The primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period. COHORT STUDY A separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014. RESULTS There were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99; p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15-84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices. LIMITATIONS The research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended. CONCLUSIONS This study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15-84 years, but not for children or the senior elderly. FUTURE WORK Strategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN95232781. 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. 23, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dorota Juszczyk
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Toby Prevost
- School of Population Health and Environmental Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Jamie Soames
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Lisa McDermott
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Kirin Sultana
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Mark Wright
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | | | - Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Research Group, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Judith Charlton
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Gatta R, Vallati M, Fernandez-Llatas C, Martinez-Millana A, Orini S, Sacchi L, Lenkowicz J, Marcos M, Munoz-Gama J, Cuendet MA, de Bari B, Marco-Ruiz L, Stefanini A, Valero-Ramon Z, Michielin O, Lapinskas T, Montvila A, Martin N, Tavazzi E, Castellano M. What Role Can Process Mining Play in Recurrent Clinical Guidelines Issues? A Position Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6616. [PMID: 32932877 PMCID: PMC7557817 DOI: 10.3390/ijerph17186616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 01/28/2023]
Abstract
In the age of Evidence-Based Medicine, Clinical Guidelines (CGs) are recognized to be an indispensable tool to support physicians in their daily clinical practice. Medical Informatics is expected to play a relevant role in facilitating diffusion and adoption of CGs. However, the past pioneering approaches, often fragmented in many disciplines, did not lead to solutions that are actually exploited in hospitals. Process Mining for Healthcare (PM4HC) is an emerging discipline gaining the interest of healthcare experts, and seems able to deal with many important issues in representing CGs. In this position paper, we briefly describe the story and the state-of-the-art of CGs, and the efforts and results of the past approaches of medical informatics. Then, we describe PM4HC, and we answer questions like how can PM4HC cope with this challenge? Which role does PM4HC play and which rules should be employed for the PM4HC scientific community?
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Affiliation(s)
- Roberto Gatta
- Dipartimento di Scienze Cliniche e Sperimentali dell’Università degli Studi di Brescia, 25128 Brescia, Italy;
| | - Mauro Vallati
- School of Computing and Engineering, University of Huddersfield, Huddersfield HD13DH, UK;
| | - Carlos Fernandez-Llatas
- PM4Health-SABIEN-ITACA, Universitat Politècnica de València, 46022 València, Spain; (C.F.-L.); (A.M.-M.); (Z.V.-R.)
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Antonio Martinez-Millana
- PM4Health-SABIEN-ITACA, Universitat Politècnica de València, 46022 València, Spain; (C.F.-L.); (A.M.-M.); (Z.V.-R.)
| | - Stefania Orini
- Alzheimer Operative Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25128 Brescia, Italy;
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, Università di Pavia, 27100 Pavia, Italy;
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy;
| | - Mar Marcos
- Department of Computer Engineering and Science, Universitat Jaume I, 12071 Castelló de la Plana, Spain;
| | - Jorge Munoz-Gama
- Human & Process Research Lab (HAPLAB), Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, 3580000 Santiago, Chile;
| | - Michel A. Cuendet
- Department of Oncology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (M.C.); (O.M.); (E.T.)
- Swiss Institute of Bioinformatics, UNIL Sorge, 1015 Lausanne, Switzerland
| | - Berardino de Bari
- Radiation Oncology, Réseau Hospitalier Neuchâtelois, 2000 La Chaux-de-Fonds, Switzerland;
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1015 Lausanne, Switzerland
| | - Luis Marco-Ruiz
- Norwegian Centre for E-health Research, University Hospital of North Norway, 7439 Tromsø, Norway;
| | - Alessandro Stefanini
- Dipartimento di Ingegneria dell’energia dei sistemi del territorio e delle costruzioni, Università degli Studi di Pisa, 56126 Pisa, Italy;
| | - Zoe Valero-Ramon
- PM4Health-SABIEN-ITACA, Universitat Politècnica de València, 46022 València, Spain; (C.F.-L.); (A.M.-M.); (Z.V.-R.)
| | - Olivier Michielin
- Department of Oncology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (M.C.); (O.M.); (E.T.)
- Swiss Institute of Bioinformatics, UNIL Sorge, 1015 Lausanne, Switzerland
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Antanas Montvila
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Niels Martin
- Data Analytics Laboratory, Vrije Universiteit Brussel, 1050 Ixelles, Belgium;
- Research Foundation Flanders (FWO), 1000 Brussel, Belgium
- Hasselt University, 3500 Hasselt, Belgium
| | - Erica Tavazzi
- Department of Oncology, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (M.C.); (O.M.); (E.T.)
- Department of Information Engineering, Università degli Studi di Padova, 35122 Padova, Italy
| | - Maurizio Castellano
- Dipartimento di Scienze Cliniche e Sperimentali dell’Università degli Studi di Brescia, 25128 Brescia, Italy;
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Bazyar M, Yazdi-Feyzabadi V, Rahimi N, Rashidian A. What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran. BMC Public Health 2020; 20:1315. [PMID: 32867732 PMCID: PMC7457517 DOI: 10.1186/s12889-020-09417-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. METHODS In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. RESULTS The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization's unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. CONCLUSION Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents' objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.
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Affiliation(s)
- Mohammad Bazyar
- Health Policy, Department of Health Promotion, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahid Yazdi-Feyzabadi
- Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haftbagh Highway, Kerman, Iran.
| | | | - Arash Rashidian
- Information, Evidence, and Research Department, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Ramezanian M, Haghdoost AA, Mehrolhassani MH, Abolhallaje M, Dehnavieh R, Poursheikhali A. Effective factors and drivers of Iran's health care financing system. Med J Islam Repub Iran 2020; 34:104. [PMID: 33315996 PMCID: PMC7722973 DOI: 10.34171/mjiri.34.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran's financing system.
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Affiliation(s)
- Maryam Ramezanian
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Research institute for Endocrine Science, Shahid Beheshti university of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Atousa Poursheikhali
- Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Asgari N, Hessam S, Masoudi Asl I, Vahdat S. Determining Core Components in Accreditation of Limited Surgery Facilities in Iran. Galen Med J 2020; 9:e1729. [PMID: 34466579 PMCID: PMC8343499 DOI: 10.31661/gmj.v9i0.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/14/2019] [Accepted: 01/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Limited surgery facilities, or day-care centers, have been expanding in recent years with the approach of reducing the number of patients referred to hospitals for treatment in relation to limited and ambulatory surgeries. This study was conducted to perform a comparative review of accreditation models for limited surgery facilities of selected countries and to obtain expert opinions in the field of policymaking and accreditation in Iran. Materials and Methods: This applied and qualitative study was carried out by a comparative method in 2019. The accreditation standards of limited surgery facilities in nine selected countries/states were assessed. Semi-structured interviews were then held with 25 Iranian experts in policymaking as well as accreditation authorities. Results: Evaluation of the core components of accreditation standards for limited surgery facilities in selected countries showed that the main concepts of care and treatment, human resource management, patient safety, drug management, patient education, health information management, quality improvement, service recipient rights, infection prevention and control, physical structure, management and leadership, and general facilities were among the key recurring concepts in all models. In the study of factors affecting the accreditation model of limited surgery facilities in Iran, 5 main topics and 43 subtopics were identified. Conclusion: Although the current assessment model of limited surgery facilities is an appropriate tool for evaluation, it still needs to be improved because of the uncertainty of evaluation model, training of accreditors and the content of standards.
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Affiliation(s)
- Nader Asgari
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Somayeh Hessam
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
- Correspondence to: Somayeh Hessam, Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran Telephone Number: 09122268534 Email Address:
| | - Irvan Masoudi Asl
- Department of Health Services Management, School of Management and Information, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Vahdat
- Department of Health Services Administration, South Tehran Branch, Islamic Azad University, Tehran, Iran
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Bucknall TK, Hutchinson AM, Botti M, McTier L, Rawson H, Hitch D, Hewitt N, Digby R, Fossum M, McMurray A, Marshall AP, Gillespie BM, Chaboyer W. Engaging patients and families in communication across transitions of care: An integrative review. PATIENT EDUCATION AND COUNSELING 2020; 103:1104-1117. [PMID: 32029297 DOI: 10.1016/j.pec.2020.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the current evidence about patient and family engagement in communication with health professionals during transitions of care to, within and from acute care settings. METHODS An integrative review using seven international databases was conducted for 2003-2017. Forty eligible studies were analysed and synthesised using framework synthesis. RESULTS Four themes: 1) Partnering in care: patients and families should be partners in decision-making and care; 2) Augmenting communication during transitions: intrinsic and extrinsic factors supported transition communication between patients, families and health professionals; 3) Impeding information exchange: the difficulties faced by patients and families taking an active role in transition; and 4) Outcomes of communication during transitions: reported experiences for patients, families and health professionals. CONCLUSION While attitudes towards engaging patients and family in transition communication in acute settings are generally positive, current practices are variable. Structural supports for practice are not always present. PRACTICE IMPLICATIONS Organisational strategies to improve communication must incorporate an understanding of patient needs. A structured approach which considers timing, privacy, location and appropriateness for patients and families is needed. Communication training is required for patients, families and health professionals. Health professionals must respect a patient's right to be informed by regularly communicating.
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Affiliation(s)
- Tracey K Bucknall
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia.
| | | | - Mari Botti
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Lauren McTier
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Helen Rawson
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Danielle Hitch
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Nicky Hewitt
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Robin Digby
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Mariann Fossum
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Anne McMurray
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Andrea P Marshall
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Brigid M Gillespie
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
| | - Wendy Chaboyer
- Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia
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Bazyar M, Rashidian A, Alipouri Sakha M, Vaez Mahdavi MR, Doshmangir L. Combining health insurance funds in a fragmented context: what kind of challenges should be considered? BMC Health Serv Res 2020; 20:26. [PMID: 31915003 PMCID: PMC6950996 DOI: 10.1186/s12913-019-4858-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/22/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. METHODS A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. RESULTS This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. CONCLUSIONS Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.
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Affiliation(s)
- Mohammad Bazyar
- Department of Health Promotion, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Alipouri Sakha
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Leila Doshmangir
- Department of Health Policy and Management,Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Dekkers-Sánchez PM, de Wind AE. Enhancing medical evaluations of sick-listed employees: an educational intervention to improve professional practice of physicians performing work ability assessments of employees on long-term sick leave. Int Arch Occup Environ Health 2019; 92:729-738. [PMID: 30673838 DOI: 10.1007/s00420-019-01409-4] [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: 05/24/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Long-term sick leave (LTSL) is a complex phenomenon. Medical and non-medical factors can delay return-to-work (RTW); therefore, the assessment of work ability is complicated. A checklist for identifying factors associated with delayed RTW was developed in a prior study to facilitate the exploration of barriers and facilitators for RTW. The purpose of the present study was to determine if use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and whether the reporting of work ability assessments improved when using the checklist in the routinely practice-based context. METHODS An educational intervention study was performed using qualitative framework analysis. Thirty-five Dutch physicians were asked to identify and report the barriers and facilitators for RTW and the consequences for the work ability and for the prognosis regarding work reintegration using the checklist. A pre-post qualitative analysis of the medical records was performed using a gradual classification of the reporting of the work ability to evaluate the change in reporting following the educational intervention. RESULTS A total of 337 work ability assessments were performed using the checklist. The identification of factors influencing RTW and the comprehensiveness of the medical records increased when compared with the reporting before the educational intervention. The reporting of the work ability assessments improved after the educational intervention. Most physicians reported at least one of the factors of the checklist. 72% participants reported and described adequately at least one factor. 48% participants reported how the factors influenced the work ability, 20% participants reported how the factors influenced the prognosis regarding RTW and 12% participants reported which advice was provided by the physician to influence the barriers for RTW. CONCLUSIONS Use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and is associated with increased identification of barriers and facilitators for RTW. The use of the checklist should be considered to improve professional practice of physicians performing work ability assessments.
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Affiliation(s)
- Patricia M Dekkers-Sánchez
- Department of Social Medical Affairs, Dutch Employee Insurance Agency (UWV), Rotterdam, The Netherlands.
| | - Annette E de Wind
- Department of Social Medical Affairs, Dutch Employee Insurance Agency (UWV), Rotterdam, The Netherlands.,Environment and Health, Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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Ikdahl E, Rollefstad S, Wibetoe G, Salberg A, Krøll F, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Gjesdal CG, Gulseth C, Haugeberg G, Semb AG. Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project. RMD Open 2018; 4:e000737. [PMID: 30305931 PMCID: PMC6173264 DOI: 10.1136/rmdopen-2018-000737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 01/01/2023] Open
Abstract
Objective The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits. Methods The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures. Results Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres. Conclusion Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.
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Affiliation(s)
- Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Grunde Wibetoe
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Anne Salberg
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Frode Krøll
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Drammen Hospital, Drammen, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansen's Hospital, Bærum, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
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Levay AV, Chapman GE, Seed B, Wittman H. It's just the right thing to do: Conceptualizing a theory of change for a school food and beverage sales environment interv ention and implications for implementation evaluation. EVALUATION AND PROGRAM PLANNING 2018; 70:73-82. [PMID: 29866404 DOI: 10.1016/j.evalprogplan.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 04/02/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
School food environments are the target of nutrition interventions and evaluations across the globe. Yet little work to-date has articulated the importance of developing a theory of change upon which to base evaluation of both implementation and outcomes. This paper undertakes an interpretive approach to develop a retrospective theory of change for an implementation evaluation of British Columbia's school food and beverage sales Guidelines. This study contributes broadly to a nuanced conceptualization of this type of public health intervention and provides a methodological contribution on how to develop a retrospective theory of change with implications for effective evaluation. Data collection strategies included document analysis, semi-structured interviews with key stakeholders, and participant observation. Developing the logic model revealed that, despite the broad population health aims of the intervention, the main focus of implementation is to change behaviors of adults who create school food environments. Derived from the analysis and interpretation of the data, the emergent program theory focuses on the assumption that if adults are responsibilized through information and education campaigns and provided implementation tools, they will be 'convinced' to implement changes to school food environments to foster broader public health goals. These findings highlight the importance of assessing individual-level implementation indicators as well as the more often evaluated measures of food and beverage availability.
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Affiliation(s)
- Adrienne V Levay
- Integrated Studies in Land and Food Systems, Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Gwen E Chapman
- College of Social and Applied Human Sciences, University of Guelph, Canada.
| | - Barbara Seed
- Independent Consultant in Food and Nutrition Policy, Canada
| | - Hannah Wittman
- Center for Sustainable Food Systems, Faculty of Land and Food Systems, University of British Columbia, Canada
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Masoud A, Noori Hekmat S, Dehnavieh R, Haj-Akbari N, Poursheikhali A, Abdi Z. An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran. Int J Health Policy Manag 2018; 7:818-827. [PMID: 30316230 PMCID: PMC6186487 DOI: 10.15171/ijhpm.2018.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/17/2018] [Indexed: 11/12/2022] Open
Abstract
Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015.
Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase.
Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend.
Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.
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Affiliation(s)
- Ali Masoud
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Haj-Akbari
- Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Atousa Poursheikhali
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
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Doctors' Knowledge of Hypertension Guidelines Recommendations Reflected in Their Practice. Int J Hypertens 2018; 2018:8524063. [PMID: 29721335 PMCID: PMC5867602 DOI: 10.1155/2018/8524063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/25/2022] Open
Abstract
Aim To evaluate doctors' knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008). Methods Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors' knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis. Results Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines' recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15 ± 1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5–20). Statistically significant correlation (rs = 0.635, P < 0.001) was observed between doctors' knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P = 0.008), left ventricular hypertrophy (OR = 0.091, P = 0.001) and heart failure (OR = 1.923, P = 0.039) were significantly associated with guidelines adherence. Conclusion Doctors' knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.
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Brennan C, Greenhalgh J, Pawson R. Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. J Eval Clin Pract 2018; 24:105-116. [PMID: 28370699 DOI: 10.1111/jep.12734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by "a guideline" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries. METHODS This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, "thematic reviews," which aggregate and enumerate the "barriers and facilitators" to guideline implementation. It then outlines a "realist synthesis," focussing on testing the "programme theories" that practitioners have devised to improve guideline uptake. RESULTS Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change. CONCLUSIONS Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
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Affiliation(s)
- Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, Bohren MA, Tunçalp Ö, Colvin CJ, Garside R, Carlsen B, Langlois EV, Noyes J. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci 2018; 13:2. [PMID: 29384079 PMCID: PMC5791040 DOI: 10.1186/s13012-017-0688-3] [Citation(s) in RCA: 489] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The GRADE-CERQual ('Confidence in the Evidence from Reviews of Qualitative research') approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Information, Evidence and Research Department, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | | | - Etienne V. Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
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Nekoei‐Moghadam M, Amiresmaili M, Iranemansh M, Iranmanesh M. Hospital accreditation in Iran: A qualitative case study of Kerman hospitals. Int J Health Plann Manage 2018; 33:426-433. [DOI: 10.1002/hpm.2480] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mahmood Nekoei‐Moghadam
- Research Center for Health Services AdministrationInstitute of Future Studies in Health, Health Services Administration, Kerman University of Medical Sciences Kerman Iran
| | - Mohammadreza Amiresmaili
- Department of Management, Economics, and Health PolicyKerman University of Medical Sciences Kerman Iran
| | - Mohammadhosein Iranemansh
- Research Center for Health Services AdministrationInstitute of Future Studies in Health, Health Services Administration, Kerman University of Medical Sciences Kerman Iran
| | - Mahla Iranmanesh
- Research Center for Health Services AdministrationInstitute of Future Studies in Health, Health Services Administration, Kerman University of Medical Sciences Kerman Iran
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Esfandiari A, Salari H, Rashidian A, Masoumi Asl H, Rahimi Foroushani A, Akbari Sari A. Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders' Views. Int J Health Policy Manag 2018; 7:27-34. [PMID: 29325400 PMCID: PMC5745865 DOI: 10.15171/ijhpm.2017.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/13/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although preventable, healthcare-associated infections (HAIs) continue to pose huge health and economic burdens on countries worldwide. Some studies have indicated the numerous causes of HAIs, but only a tiny literature exists on the multifaceted measures that can be used to address the problem. This paper presents stakeholders' opinions on measures for controlling HAIs in Iran. METHODS We used the qualitative research method in studying the phenomenon. Through a purposive sampling approach, we conducted 24 face-to-face interviews using a semi-structured interview guide. Participants were mainly key informants, including policy-makers, health professionals, and technical officers across the national and subnational levels, including the Ministry of Health (MoH), medical universities, and hospitals in Iran. We performed thematic framework analysis using the software MAXQDA10. RESULTS Four main interdisciplinary themes emerged from our study of measures of controlling HAIs: strengthening governance and stewardship; strengthening human resources policies; appropriate prescription and usage of antibiotics; and environmental sanitation and personal hygiene. CONCLUSION According to our findings, elimination of HAIs demands multifactorial interventions. While the ultimate recommendation of policy-makers is to have HAIs among the priorities of the national agenda, financial commitment and the creation of an enabling work environment in which both patients and healthcare workers can practice personal hygiene could lead to a significant reduction in HAIs in Iran.
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Affiliation(s)
| | | | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Masoumi Asl
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Research Center of Pediatric Infectious Diseases, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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White CN, Downes MJ, Jones G, Wigfall C, Dean RS, Brennan ML. Use of clinical vignette questionnaires to investigate the variation in management of keratoconjunctivitis sicca and acute glaucoma in dogs. Vet Rec 2017; 182:21. [PMID: 29275324 DOI: 10.1136/vr.104390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 10/17/2017] [Accepted: 11/02/2017] [Indexed: 02/03/2023]
Abstract
There is little peer-reviewed research assessing therapeutic effectiveness in canine eye disease. Current treatments used in first opinion and ophthalmology referral practices are also somewhat poorly documented. The aim of this study was to investigate the current management of canine keratoconjunctivitis sicca (KCS) and acute primary angle-closure glaucoma (PACG) by veterinary surgeons. Questionnaires using clinical vignettes were administered to a cross section of general practitioners ('GPs') and veterinarians engaged in or training for postgraduate ophthalmology practice ('PGs'). Similar treatment recommendations for KCS (topical cyclosporine, lubricant, antibiotic) were given by both groups of veterinarians with the single exception of increased topical antibiotic use by GPs. Treatment of acute glaucoma diverged between groups: PGs were much more likely to recommend topical prostaglandin analogues and a wider array of both topical and systemic treatments were recommended by both groups. Systemic ocular hypotensive agents were suggested infrequently. Our results suggest that treatments may vary substantially in ocular conditions, particularly in conditions for which neither guidelines nor high-quality evidence exists. This study highlights the need for novel strategies to address evidence gaps in veterinary medicine, as well as for better evaluation and dissemination of current treatment experience.
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Affiliation(s)
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
| | | | | | - Rachel S Dean
- School of Veterinary Medicine and Science, Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, UK
| | - Marnie L Brennan
- School of Veterinary Medicine and Science, Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, UK
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Mehrtak M, Farzaneh E, Habibzadeh S, Kamran A, Zandian H, Mahdavi A. Explaining the role of organizational culture on succession-planning at the Ministry of Health and Medical Education: A qualitative study. Electron Physician 2017; 9:5806-5813. [PMID: 29403623 PMCID: PMC5783132 DOI: 10.19082/5806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
Background Developing and guiding new knowledge are futile unless the organizational culture can also be transformed. Future leaders cannot emerge out of an organizational environment that is not conducive to the accumulation of experiences. Objective The aim of this study was to explore the role of organizational culture in creating a succession-planning system at the Ministry of Health and Medical Education in 2014. Methods The present qualitative framework analysis held interviews with 23 director generals, administrative directors and deputies from the headquarters of the Iranian Ministry of Health and Medical Education in 2014 who were selected through snowball sampling. The data obtained were analyzed in MAXQDA-10. Codes were extracted using inductive techniques. Results The cultural factors affecting succession-planning at the Ministry of Health and Medical Education were identified and classified under three main areas, including the cultural factors related to the directors with four themes (Directors’ job security, Constructive competition, Transparency and trust development, Creating opportunities), to the personnel with four themes (Organizational identity and loyalty, Trust in the organization, Talent and merit, Peer envy) and to the system with two themes (Values and beliefs, Politicization). Conclusion Findings of the study show that establishment and institutionalization of the succession planning to the Ministry of Health and Medical Education is deeply affected by the components of organizational culture. Accordingly, unprofessional organization culture can deprive the organization of numerous advantages in multiple-succession planning.
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Affiliation(s)
- Mohammad Mehrtak
- Ph.D. Assistant Professor, Department of Health Information Management, Faculty of Paramedical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Esmaeil Farzaneh
- M.D. Associate Professor, Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shahram Habibzadeh
- M.D. Associate Professor, Department of Infectious Diseases, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aziz Kamran
- Ph.D. Assistant Professor, Department of Public Health, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Ph.D. Assistant Professor, Department of Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Abdollah Mahdavi
- Ph.D. Assistant Professor, Department of Health Information Management, Faculty of Paramedical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
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Rubber stamp templates for improving clinical documentation: A paper-based, m-Health approach for quality improvement in low-resource settings. Int J Med Inform 2017; 114:121-129. [PMID: 29107565 DOI: 10.1016/j.ijmedinf.2017.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/16/2017] [Accepted: 10/13/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The United Nations' Sustainable Development Goal #3.8 targets 'access to quality essential healthcare services'. Clinical practice guidelines are an important tool for ensuring quality of clinical care, but many challenges prevent their use in low-resource settings. Monitoring the use of guidelines relies on cumbersome clinical audits of paper records, and electronic systems face financial and other limitations. Here we describe a unique approach to generating digital data from paper using guideline-based templates, rubber stamps and mobile phones. INTERVENTION The Guidelines Adherence in Slums Project targeted ten private sector primary healthcare clinics serving informal settlements in Nairobi, Kenya. Each clinic was provided with rubber stamp templates to support documentation and management of commonly encountered outpatient conditions. Participatory design methods were used to customize templates to the workflows and infrastructure of each clinic. Rubber stamps were used to print templates into paper charts, providing clinicians with checklists for use during consultations. Templates used bubble format data entry, which could be digitized from images taken on mobile phones. Besides rubber stamp templates, the intervention included booklets of guideline compilations, one Android phone for digitizing images of templates, and one data feedback/continuing medical education session per clinic each month. In this paper we focus on the effect of the intervention on documentation of three non-communicable diseases in one clinic. METHODS Seventy charts of patients enrolled in the chronic disease program (hypertension/diabetes, n=867; chronic respiratory diseases, n=223) at one of the ten intervention clinics were sampled. Documentation of each individual patient encounter in the pre-intervention (January-March 2016) and post-intervention period (May-July) was scored for information in four dimensions - general data, patient assessment, testing, and management. Control criteria included information with no counterparts in templates (e.g. notes on presenting complaints, vital signs). Documentation scores for each patient were compared between both pre- and post-intervention periods and between encounters documented with and without templates (post-intervention only). RESULTS The total number of patient encounters in the pre-intervention (282) and post-intervention periods (264) did not differ. Mean documentation scores increased significantly in the post-intervention period on average by 21%, 24% and 17% for hypertension, diabetes and chronic respiratory diseases, respectively. Differences were greater (47%, 43% and 27%, respectively) when documentation with and without templates was compared. Changes between pre- vs.post-intervention, and with vs.without template, varied between individual dimensions of documentation. Overall, documentation improved more for general data and patient assessment than in testing or management. CONCLUSION The use of templates improves paper-based documentation of patient care, a first step towards improving the quality of care. Rubber stamps provide a simple and low-cost method to print templates on demand. In combination with ubiquitously available mobile phones, information entered on paper can be easily and rapidly digitized. This 'frugal innovation' in m-Health can empower small, private sector facilities, where large numbers of urban patients seek healthcare, to generate digital data on routine outpatient care. These data can form the basis for evidence-based quality improvement efforts at large scale, and help deliver on the SDG promise of quality essential healthcare services for all.
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Walthouwer MJL, Oenema A, Soetens K, Lechner L, de Vries H. Implementation of web-based interventions by Dutch occupational health centers. Health Promot Int 2017; 32:818-830. [PMID: 27020573 DOI: 10.1093/heapro/daw014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this qualitative study was to identify barriers and facilitators to the adoption and particularly the implementation of a web-based computer-tailored obesity prevention intervention by occupational health centers. Participants were directors of Dutch occupational health centers who had adopted and implemented the intervention for the corresponding efficacy study (n = 8) as well as non-adopters (n = 12). Individual semi-structured interviews were carried out to study barriers and facilitators related to the intervention, the user, the organization, and the socio-political environment. All interviews were carried out by telephone, audio-recorded and transcribed verbatim. The transcripts were analyzed using a directed-content approach and coded by two persons. There were important differences in perceptions between adopters and non-adopters, particularly on barriers and facilitators related to the intervention and the personal beliefs of the implementer. The relative advantages of the intervention were considered to be most important. Participants also indicated that their personal attitudinal and self-efficacy beliefs influenced their implementation efforts. Regarding the organization, the possibilities to increase profits and integrate the intervention within the organization were considered to be important facilitators for the implementation. Participants mentioned few implementation barriers and facilitators related to the socio-political environment. Strategies to improve the implementation of web-based computer-tailored interventions by occupational health centers should be tailored to implementers' unique perceptions and particularly address the perceived advantages and disadvantages of the intervention, attitudinal and self-efficacy beliefs, and the potential to increase organizations' profits and competitiveness.
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Affiliation(s)
- Michel Jean Louis Walthouwer
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, Maastricht 6200 MD, the Netherlands
| | - Anke Oenema
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, Maastricht 6200 MD, the Netherlands
| | - Katja Soetens
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, Maastricht 6200 MD, the Netherlands
| | - Lilian Lechner
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Department of Psychology, Open University of the Netherlands, PO Box 2960, Heerlen 6419 AT, the Netherlands
| | - Hein de Vries
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, Maastricht 6200 MD, the Netherlands
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Use of theory to plan or evaluate guideline implementation among physicians: a scoping review. Implement Sci 2017; 12:26. [PMID: 28241771 PMCID: PMC5327520 DOI: 10.1186/s13012-017-0557-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/14/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians. METHODS A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed. RESULTS A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes. CONCLUSIONS While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided scant details about how theory was used. This limits interpretation and replication of those interventions, and seems to result in multifaceted interventions, which may not be feasible outside of scientific investigation. Further research is needed to better understand how to employ theory in guideline implementation planning or evaluation.
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Bullock A, Barnes E, Morris ZS, Fairbank J, de Pury J, Howell R, Denman S. Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundKnowledge and innovation transfer (KIT) is recognised internationally as a complex, dynamic process that is difficult to embed in organisations. There is growing use of health service–academic–industry collaborations in the UK, with knowledge brokers linking producers with the users of knowledge and innovation.AimFocusing on KIT ‘agent’ roles within Academic Health Science Networks in England and Partnerships in Wales, we show how individual dispositions, processes and content contribute to desired outcomes.MethodsWe studied the KIT intentions of all Academic Health Science Networks in England, and the South East Wales Academic Health Science Partnership. Using a qualitative case study design, we studied the work of 13 KIT agents purposively sampled from five networks, by collecting data from observation of meetings, documentation, KIT agent audio-diaries, and semistructured interviews with KIT agents, their line managers and those they supported (‘Links’). We also used a consensus method in a meeting of experts (nominal group technique) to discuss the measurement of outcomes of KIT agent activity.FindingsThe case study KIT agents were predominantly from a clinical background with differing levels of experience and expertise, with the shared aim of improving services and patient care. Although outside of recognised career structures, the flexibility afforded to KIT agents to define their role was an enabler of success. Other helpful factors included (1) time and resources to devote to KIT activity; (2) line manager support and a team to assist in the work; and (3) access and the means to use data for improvement projects. The organisational and political context could be challenging. KIT agents not only tackled local barriers such as siloed working, but also navigated shifting regional and national policies. Board-level support for knowledge mobilisation together with a culture of reflection (listening to front-line staff), openness to challenges and receptivity to research all enabled KIT agents to achieve desired outcomes. Nominal group findings underscored the importance of relating measures to specific intended outcomes. However, the case studies highlighted that few measures were employed by KIT agents and their managers. Using social marketing theory helped to show linkages between processes, outcomes and impact, and drew attention to how KIT agents developed insight into their clients’ needs and tailored work accordingly.LimitationsLevel of KIT agent participation varied; line managers and Links were interviewed only once; and outcomes were self-reported.ConclusionsSocial marketing theory provided a framework for analysing KIT agent activity. The preparatory work KIT agents do in listening, understanding local context and building relationships enabled them to develop ‘insight’ and adapt their ‘offer’ to clients to achieve desired outcomes.Future workThe complexity of the role and the environment in which it is played out justifies more research on KIT agents. Suggestions include (1) longitudinal study of career pathways; (2) how roles are negotiated within teams and how competing priorities are managed; (3) how success is measured; (4) the place of improvement methodologies within KIT work; (5) the application of social marketing theory to comparative study of similar roles; and (6) patients as KIT agents.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Bullock
- The Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, Cardiff, UK
| | - Emma Barnes
- The Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, Cardiff, UK
| | | | | | | | - Rosamund Howell
- Aneurin Bevan University Health Board, Clinical Research and Innovation Centre, St Woolos Hospital, Newport, UK
| | - Susan Denman
- School of Medicine, Cardiff University, Cardiff, UK
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Esfandiari A, Rashidian A, Masoumi Asl H, Rahimi Foroushani A, Salari H, Akbari Sari A. Prevention and control of health care-associated infections in Iran: A qualitative study to explore challenges and barriers. Am J Infect Control 2016; 44:1149-1153. [PMID: 27307179 DOI: 10.1016/j.ajic.2016.03.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Globally, the health and economic burden posed by health care-associated infections (HAIs) remains wide and severe. To curb the burden associated with HAIs, countries, including Iran, aim at HAI prevention and control. This study explores the challenges faced by the Iranian health system in addressing the issues associated with the prevention and control of HAIs. METHODS A qualitative research method was adopted in exploring the phenomenon. We used the purposive sampling approach in reaching 24 key informants at the national and subnational levels. The thematic framework analysis was conducted for analyzing the interviews. RESULTS Five main themes emerged from our study demonstrating the obstacles toward the prevention and control of HAIs. They include governance and stewardship, resources, safety culture, monitoring and surveillance systems, and inappropriate prescription of antibiotics. CONCLUSIONS Strengthening of reporting and surveillance systems for HAIs coupled with proper governance and stewardship are crucial in order to improve the health and safety of patients. However, the availability of resources, through an intersectoral approach, is essential to achieve sustained output.
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Moreno EM, Moriana JA. User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources. Health Res Policy Syst 2016; 14:61. [PMID: 27507569 PMCID: PMC4979121 DOI: 10.1186/s12961-016-0135-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. METHODS The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. RESULTS A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. CONCLUSIONS The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.
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Affiliation(s)
- Eliana M Moreno
- Department of Psychology, University of Cordoba, Calle San Alberto Magno S/N, 14071, Cordoba, Spain. .,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Avda Menéndez Pidal s/n, 14004, Cordoba, Spain.
| | - Juan Antonio Moriana
- Department of Psychology, University of Cordoba, Calle San Alberto Magno S/N, 14071, Cordoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Avda Menéndez Pidal s/n, 14004, Cordoba, Spain
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Czarnawska-Iliev I, Robinson N. General Practitioners’ use of and attitudes to acupuncture in relation to the UK’s National Institute for Health and Care Excellence (NICE) clinical guidelines—A pilot study. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gvozdenović E, Allaart CF, van der Heijde D, Ferraccioli G, Smolen JS, Huizinga TWJ, Landewé R. When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS). RMD Open 2016; 2:e000221. [PMID: 27175294 PMCID: PMC4860861 DOI: 10.1136/rmdopen-2015-000221] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction The European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treat-to-target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice. Objective To investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice. Methods The International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5–10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1–2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists. Results In total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that disease-modifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were composite scores actually recorded in ≥50% of patient visits. Conclusion Reporting to be compliant with EULAR recommendations and T2T principles, even after dedicated education does not mean they actually comply with it in clinical practice.
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Affiliation(s)
- Emilia Gvozdenović
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Gianfranco Ferraccioli
- Division of Rheumatology , on behalf of GISEA, Catholic University of the Sacred Heart , Rome , Italy
| | - Josef S Smolen
- Division of Rheumatology , Medical University of Vienna , Vienna , Austria
| | - Tom W J Huizinga
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Robert Landewé
- Rheumatology Department , Academic Medical Center, Amsterdam & Atrium Medical Center , Heerlen , The Netherlands
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Doshmangir L, Rashidian A, Jafari M, Ravaghi H, Takian A. Fail to prepare and you can prepare to fail: the experience of financing path changes in teaching hospitals in Iran. BMC Health Serv Res 2016; 16:138. [PMID: 27102262 PMCID: PMC4841059 DOI: 10.1186/s12913-016-1405-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/18/2016] [Indexed: 11/21/2022] Open
Abstract
Background In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called “hospital autonomy” policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals’ performance, hoping to reduce government’s costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. Methods We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. Results We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals’ organization, feasibility of policy implementation, actors and stakeholders’ support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Conclusions Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result.
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Affiliation(s)
- Leila Doshmangir
- Iranian Center of Excellence in Health Management, School of Health Services Management, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Management Research Center (NPMC), Tabriz University of Medical sciences, Tabriz, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari
- School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Health Management and Economics Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Health Management and Economics Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,College of Health & Life Sciences, Brunel University London, Uxbridge, UK.
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Gupta S, Rai N, Bhattacharrya O, Cheng AYY, Connelly KA, Boulet LP, Kaplan A, Brouwers MC, Kastner M. Optimizing the language and format of guidelines to improve guideline uptake. CMAJ 2016; 188:E362-E368. [PMID: 27091799 DOI: 10.1503/cmaj.151102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Samir Gupta
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
| | - Navjot Rai
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Onil Bhattacharrya
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Alice Y Y Cheng
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Kim A Connelly
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Louis-Philippe Boulet
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Alan Kaplan
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Melissa C Brouwers
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Monika Kastner
- Departments of Medicine (Gupta, Cheng, Connelly) and of Family and Community Medicine (Bhattacharrya), University of Toronto, Toronto, Ont.; Divisions of Respirology (Gupta) and Cardiology (Connelly), St. Michael's Hospital; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gupta, Rai, Connelly, Kastner), Toronto, Ont.; Department of Family and Community Medicine (Bhattacharrya), Women's College Hospital, Toronto, Ont.; Division of Endocrinology (Cheng), Trillium Health Partners and St. Michael's Hospital; Institut universitaire de cardiologie et de pneumologie de Québec (Boulet), Université Laval, Québec, Que.; Family Physician Airways Group of Canada (Kaplan), Richmond Hill, Ont.; Escarpment Cancer Research Institute (Brouwers), McMaster University, Hamilton, Ont.; Division of Epidemiology (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
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Mounesan L, Sayarifard A, Haghjou L, Ghadirian L, Rajabi F, Nedjat S. A Manual for Prioritizing the Topics of Clinical Practice Guidelines for Family Physicians. Int J Prev Med 2016; 7:64. [PMID: 27141283 PMCID: PMC4837793 DOI: 10.4103/2008-7802.180407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 02/17/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Development of a manual or well-defined criterion for prioritizing the topics of clinical practice guidelines (CPGs) will help validate and organize this process evermore. This study was conducted to design an applicable manual that would prioritize the CPG topics for family physicians. METHODS This study was a multi-stage method using a qualitative approach that was conducted for the manual developing. The manual development process took place in four steps, as follows: Literature review, interviews with ten experts, preparing a list of criteria and determining its appropriateness by applying the RAND/UCLA Appropriateness method, and development of the final draft of the manual and pilot study. RESULTS Interview transcripts went under content analysis and were classified into eight main groups, 12 subgroups, and 85 themes. A comprehensive list consisting of fifty preliminary criteria were extracted. After summarizing and classifying the criteria, 12 appropriate criteria were evaluated using the RAND appropriateness method. Eventually, based on the literature review and our own results of the interview analysis, a manual consisting of five main sections and one clause on ethics was developed. Later, a pilot study was conducted on ten family physician topics, and prioritized by nine experts. CONCLUSIONS The manual can be eyed as a tool ensuring the quality of the process of prioritizing CPG topics for family physicians, as it takes into account the issues involved in priority-setting. Selecting informed stakeholders for rating the criteria and ranking the topics was an issue that was greatly emphasized by the experts. Eventually, the application of this manual can be the first step toward systematizing the process of prioritizing CPG topics in the country.
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Affiliation(s)
- Leila Mounesan
- Center for Academic and Health Policy, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sayarifard
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Haghjou
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Ghadirian
- Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, and Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajabi
- Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, Knowledge Utilization Research Centre, School of Public Health, Tehran, Iran
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Bastani P, Dinarvand R, SamadBeik M, Pourmohammadi K. Pharmaceutical strategic purchasing requirements in Iran: Price interventions and the related effective factors. J Res Pharm Pract 2016; 5:35-42. [PMID: 26985434 PMCID: PMC4776545 DOI: 10.4103/2279-042x.176553] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Pharmaceutical access for the poor is an essential factor in developing countries that can be improved through strategic purchasing. This study was conducted to identify the elements affecting price in order to enable insurance organizations to put strategic purchasing into practice. METHODS This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis (familiarization, identifying a thematic framework, indexing, mapping, and interpretation). Data analysis was started right after transcribing each interview applying ATLAS.ti. Data were saturated after 32 semi-structured interviews by experts. These key informants were selected purposefully and through snowball sampling. FINDINGS Findings showed that there are four main themes as Pharmaceutical Strategic Purchasing Requirements in Iran as follows essential and structural factors, international factors, economical factors, and legal factors. Moreover, totally 14 related sub-themes were extracted in this area as the main effective variables. CONCLUSION It seems that paying adequate attention to the four present themes and 14 sub-themes affecting price can enable health system policy-makers of developing countries like Iran to make the best decisions through strategic purchasing of drugs by the main insurers in order to improve access and health in the country.
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Affiliation(s)
- Peivand Bastani
- Department of Health Service Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasoul Dinarvand
- Department of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz SamadBeik
- Department of Health Information Technology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kimia Pourmohammadi
- Department of Health Service Management, Shiraz University of Medical Sciences, Shiraz, Iran
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Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e23782. [PMID: 27340558 PMCID: PMC4916528 DOI: 10.5812/ircmj.23782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 10/08/2014] [Accepted: 10/25/2014] [Indexed: 11/17/2022]
Abstract
Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model.
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Affiliation(s)
- Reza Esmaeili
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hadian
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohammad Hadian, Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Shariati
- Community Medicine Department, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossien Ghaderi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
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Bazyar M, Rashidian A, Kane S, Vaez Mahdavi MR, Akbari Sari A, Doshmangir L. Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran. Int J Health Policy Manag 2016; 5:253-8. [PMID: 27239868 DOI: 10.15171/ijhpm.2016.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/03/2016] [Indexed: 11/09/2022] Open
Abstract
There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.
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Affiliation(s)
- Mohammad Bazyar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sumit Kane
- Department of Development Policy and Practice, Royal Tropical Institute, Amsterdam, The Netherlands
| | | | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Department of Health Services Management, School of Management and Medical Informatics, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
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Pawson R, Greenhalgh J, Brennan C. Demand management for planned care: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BackgroundThe task of matching fluctuating demand with available capacity is one of the basic challenges in all large-scale service industries. It is a particularly pressing concern in modern health-care systems, as increasing demand (ageing populations, availability of new treatments, increased patient knowledge, etc.) meets stagnating supply (capacity and funding restrictions on staff and services, etc.). As a consequence, a very large portfolio of demand management strategies has developed based on quite different assumptions about the source of the problem and about the means of its resolution.MethodsThis report presents a substantial review of the effectiveness of main strategies designed to alleviate demand pressures in the area of planned care. The study commences with an overview of the key ideas about the genesis of demand and capacity problems for health services. Many different diagnoses were uncovered: fluctuating demand meeting stationary capacity; turf protection between different providers; social rather than clinical pressures on referral decisions; self-propelling diagnostic cascades; supplier-induced demand; demographic pressures on treatment; and the informed patient and demand inflation. We then conducted a review of the key ideas (programme theories) underlying interventions designed to address demand imbalance. We discovered that there was no close alignment between purported problems and advocated solutions. Demand management interventions take their starting point in seeking reforms at the levels of strategic decision-making, organisational re-engineering, procedural modifications and behavioural change. In mapping the ideas for reform, we also noted a tendency for programme theories to become ‘whole-system’ models; over time policy-makers have advocated the need for concerted action on all of these fronts.FindingsThe remainder and core of the report contains a realist synthesis of the empirical evidence on the effectiveness on a spanning subset of four major demand management interventions: referral management centres (RMCs); using general practitioners with special interests (GPwSIs) at the interface between primary and secondary care; general practitioner (GP) direct access to clinical tests; and referral guidelines. In all cases we encountered a chequered pattern of success and failure. The primary literature is replete with accounts of unanticipated problems and unintended effects. These programmes ‘work’ only in highly circumscribed conditions. To give brief examples, we found that the success of RMCs depends crucially on the balance of control in their governance structures; GPwSIs influence demand only after close negotiations on an agreed and intermediate case mix; significant efficiencies are created by direct GP access to tests mainly when there is low diagnostic yield and high ‘rule-out’ rates; and referral guidelines are more likely to work when implemented by staff with responsibility for their creation.ConclusionsThe report concludes that there is no ‘preferred intervention’ that has the capacity to outperform all others. Instead, the review found many, diverse, hard-won, local and adaptive solutions. Whatever the starting point, success in demand management depends on synchronising a complex array of strategic, organisational, procedural and motivational changes. The final chapter offers practitioners some guidance on how they might ‘think through’ all of the interdependencies, which bring demand and capacity into equilibrium. A close analysis of the implementation of different configurations of demand management interventions in different local contexts using mixed methods would be valuable to understand the processes through which such interventions are tailored to local circumstances. There is also scope for further evidence synthesis. The substitution theory is ubiquitous in health and social care and a realist synthesis to compare the fortunes of different practitioners placed at different professional boundaries (e.g. nurses/doctors, dentists/dental care practitioners, radiologists/radiographers and so on) would be valuable to identify the contexts and mechanisms through which substitution, support or short-circuit occurs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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