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Duda-Sikuła M, Kurpas D. Barriers and Facilitators in the Implementation of Prevention Strategies for Chronic Disease Patients-Best Practice GuideLines and Policies' Systematic Review. J Pers Med 2023; 13:jpm13020288. [PMID: 36836522 PMCID: PMC9959826 DOI: 10.3390/jpm13020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15-38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.
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Affiliation(s)
- Marta Duda-Sikuła
- Clinical Trial Department, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence:
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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Hearld LR, Kelly RJ, Tafili A. Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:384-392. [PMID: 34939603 DOI: 10.1097/phh.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. DESIGN Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. PARTICIPANTS Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. MAIN OUTCOME MEASURES Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. RESULTS In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. CONCLUSIONS While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.
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Affiliation(s)
- Larry R Hearld
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama (Dr Hearld and Ms Tafili); and Department of Health Administration and Policy, School of Health Sciences, University of New Haven, West Haven, Connecticut (Dr Kelly)
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Jacob RR, Parks RG, Allen P, Mazzucca S, Yan Y, Kang S, Dekker D, Brownson RC. How to "Start Small and Just Keep Moving Forward": Mixed Methods Results From a Stepped-Wedge Trial to Support Evidence-Based Processes in Local Health Departments. Front Public Health 2022; 10:853791. [PMID: 35570955 PMCID: PMC9096224 DOI: 10.3389/fpubh.2022.853791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Local health departments (LHDs) in the United States are charged with preventing disease and promoting health in their respective communities. Understanding and addressing what supports LHD's need to foster a climate and culture supportive of evidence-based decision making (EBDM) processes can enhance delivery of effective practices and services. Methods We employed a stepped-wedge trial design to test staggered delivery of implementation supports in 12 LHDs (Missouri, USA) to expand capacity for EBDM processes. The intervention was an in-person training in EBDM and continued support by the research team over 24 months (March 2018-February 2020). We used a mixed-methods approach to evaluate: (1) individuals' EBDM skills, (2) organizational supports for EBDM, and (3) administered evidence-based interventions. LHD staff completed a quantitative survey at 4 time points measuring their EBDM skills, organizational supports, and evidence-based interventions. We selected 4 LHDs with high contact and engagement during the intervention period to interview staff (n = 17) about facilitators and barriers to EBDM. We used mixed-effects linear regression to examine quantitative survey outcomes. Interviews were transcribed verbatim and coded through a dual independent process. Results Overall, 519 LHD staff were eligible and invited to complete quantitative surveys during control periods and 593 during intervention (365 unique individuals). A total of 434 completed during control and 492 during intervention (83.6 and 83.0% response, respectively). In both trial modes, half the participants had at least a master's degree (49.7-51.7%) and most were female (82.1-83.8%). No significant intervention effects were found in EBDM skills or in implementing evidence-based interventions. Two organizational supports scores decreased in intervention vs. control periods: awareness (-0.14, 95% CI -0.26 to -0.01, p < 0.05) and climate cultivation (-0.14, 95% CI -0.27 to -0.02, p < 0.05) but improved over time among all participants. Interviewees noted staff turnover, limited time, resources and momentum as challenges to continue EBDM work. Setting expectations, programmatic reviews, and pre-existing practices were seen as facilitators. Conclusions Challenges (e.g., turnover, resources) may disrupt LHDs' abilities to fully embed organizational processes which support EBDM. This study and related literature provides understanding on how best to support LHDs in building capacity to use and sustain evidence-based practices.
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Affiliation(s)
- Rebekah R. Jacob
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Renee G. Parks
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah Kang
- Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, United States
| | - Debra Dekker
- National Association of County and City Health Officials, Washington, DC, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Fan F, Wang Z, Yu D, Chen C, Shen D, Yu Z, Liu X, Zhou H, Shi J. General practitioners' perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China. BMC FAMILY PRACTICE 2020; 21:147. [PMID: 32698768 PMCID: PMC7375034 DOI: 10.1186/s12875-020-01212-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
Background Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. Method This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors. Result A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university. Conclusions This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.
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Affiliation(s)
- Feng Fan
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, Shanghai, 200090, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528244, China
| | - Dehua Yu
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chen Chen
- Shanghai Jing'an District Jiangning Road Community Health Service Center, Shanghai, 200041, China
| | - Delei Shen
- Shanghai Fenglin Community Health Service Center, Shanghai, 200000, China
| | - Zhaohu Yu
- Navy 971 Hospital, Qingdao, 266071, China
| | - Xin Liu
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Huining Zhou
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jianwei Shi
- Yangpu Hospital affiliated to Tongji University School of Medicine, Shanghai, 200090, China. .,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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