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Kenis I, Van Hecke A, Foulon V. The impact of a patient-centred care pathway for patients treated with oral anticancer drugs: A multicentre pre-posttest study in Flanders. J Eval Clin Pract 2024. [PMID: 38818713 DOI: 10.1111/jep.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/30/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
RATIONALE In the Collaborative Network To Take Responsibility for Oral Anticancer Therapy (CONTACT) project, an evidence-based and patient-centred care(PCC) pathway was implemented in 12 oncology departments in Flanders. The care pathway was developed in cocreation by an interdisciplinary project team, and tailored to the local hospital context. AIMS AND OBJECTIVES In this study, the impact of the care pathways on quality of PCC and other patient outcomes was investigated. METHOD A pre-posttest study was performed in nine of the participating oncology departments. The primary outcome was quality of PCC. Furthermore, level of patient self-management, medication adherence, satisfaction with information about the oral anticancer drug and quality of life were measured as secondary outcomes. Linear mixed models were used to investigate differences in outcomes between the pre- and posttest group. RESULTS Quality of PCC, as well as all secondary outcomes improved after implementation of the care pathway. However, the changes in pre- and posttest scores were not significant. The overall quality of PCC increased from 3.72 to 3.88, measured on a five-point Likert scale (p = 0.124). CONCLUSION This study showed small, however, no significant improvements in the quality of PCC and other patient outcomes. The lack of significant changes can be attributed to the complexity of the care pathway development, poor or unstable implementation of the care pathway and limited changes in follow-up care. More insight in the actual implementation of the care pathway and potential contextual factors influencing its effect is needed to help understand the outcomes of this pre-posttest study.
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Affiliation(s)
- Ilyse Kenis
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Gukova X, Hazlewood GS, Arbillaga H, MacMullan P, Zimmermann GL, Barnabe C, Choi MY, Barber MRW, Charlton A, Job B, Osinski K, Hartfeld NMS, Knott MW, Pirani P, Barber CEH. Development of an interdisciplinary early rheumatoid arthritis care pathway. BMC Rheumatol 2022; 6:35. [PMID: 35751106 PMCID: PMC9233314 DOI: 10.1186/s41927-022-00267-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management. Methods Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4). Results Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators. Conclusion The ‘Calgary Early RA Care Pathway’ emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00267-x.
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Affiliation(s)
- Xenia Gukova
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Hector Arbillaga
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Learning Health System, Alberta SPOR SUPPORT Unit, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - May Y Choi
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | - Becky Job
- Alberta Health Services, Calgary, Canada
| | | | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | | | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Arthritis Research Canada, Vancouver, Canada.
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