1
|
Otero-Ketterer E, Peñacoba-Puente C, Ortega-Santiago R, Galán-Del-Río F, Valera-Calero JA. Consideration of Psychosocial Factors in Acute Low Back Pain by Physical Therapists. J Clin Med 2023; 12:jcm12113865. [PMID: 37298060 DOI: 10.3390/jcm12113865] [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: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Clinical guidelines consistently recommend screening psychosocial (PS) factors in patients with low back pain (LBP), regardless of its mechanical nature, as recognized contributors to pain chronicity. However, the ability of physiotherapists (PTs) in identifying these factors remains controversial. This study aimed to assess the current identification of psychosocial risk factors by physical therapists (PTs) and which characteristics of PTs are associated with the identification of the main risk for chronicity (physical or psychosocial). A cross-sectional descriptive study surveying Spanish PTs in public and private health services was conducted, including questions on PT characteristics and three low back pain (LBP) patient vignettes with different biopsychosocial (BPS) clinical presentations. From 484 respondents, the majority of PTs agreed regarding the main risk for chronicity for each vignette (PS 95.7% for vignette A, PS and physical 83.5% for vignette B and PS 66% for vignette C). Female PTs were more likely to rate psychosocial compared with males (p < 0.05). PTs with higher levels of social and emotional intelligence (both, p < 0.05) were more likely to identify the main risk for chronicity. However, only gender and social information processing for vignette A (p = 0.024) and emotional clarity for vignette B (p = 0.006) were able to predict the identification of psychosocial and physical risk, respectively. The main risk for chronicity was correctly identified by a large majority of PTs through patient vignettes. Gender, social and emotional intelligence played a relevant role in the recognition of psychosocial risk and biopsychosocial factors.
Collapse
Affiliation(s)
- Emilia Otero-Ketterer
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Physiotherapy Department, Mutua Universal Mugenat, 28801 Alcalá de Henares, Spain
| | | | - Ricardo Ortega-Santiago
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Fernando Galán-Del-Río
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| |
Collapse
|
2
|
Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [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: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
Collapse
Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
3
|
Evans BJW, Parmar K, Dickinson C. Reply to: Mallett unit or fully fusionable images for prisms against asthenopia? JOURNAL OF OPTOMETRY 2022; 15:186-187. [PMID: 34670731 PMCID: PMC9068569 DOI: 10.1016/j.optom.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Ketan Parmar
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christine Dickinson
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
4
|
Parkins DJ, Shah B, Benwell MJ, Evans BJW, Edgar DF. Design and use of vignettes to investigate referral decision-making by optometrists. JOURNAL OF OPTOMETRY 2021; 14:346-354. [PMID: 33967018 PMCID: PMC8569393 DOI: 10.1016/j.optom.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care. METHODS Twenty computerised vignettes were developed to assess clinical and referral management decisions taken in primary care optometry. The online system was specifically designed to present vignettes (ten pre-CET and ten post-CET) that avoided prompting correct answers. The main study group was qualified optometrists (N = 31) who chose any CET options available to United Kingdom optometrists over six months. Participants submitted a record of the CET undertaken, which was compared with an anonymised General Optical Council (GOC) reference sample. The vignettes were also completed by newly-qualified (N = 18) and pre-registration (N = 11) groups. RESULTS CET had no significant correlation (p = 0.37) with improvement in optometric clinical decision-making and referral practice (qualified group). Selection bias affected this group who had more CET points (p = 0.008) and peer discussion points (p = 0.003) than the GOC reference sample. Results were indicative due to small sample sizes. Newly-qualified practitioners were significantly more likely to refer than the qualified group (p = 0.004). Number of referrals decreased with time since qualification (p = 0.006). CONCLUSION Computerised vignettes are a useful tool for comparing referral decisions between groups. Recruiting clinicians for time-consuming vignette studies is challenging. Strategies to reduce unwarranted variation in optometry, including support for newly-qualified optometrists, require further investigation.
Collapse
Affiliation(s)
- David J Parkins
- London South Bank University, School of Health and Social Care, 103 Borough Road, London SE1 0AA, UK; Institute of Optometry, 56-62 Newington Causeway, London SE1 6DS, UK.
| | - Beju Shah
- Institute of Optometry, 56-62 Newington Causeway, London SE1 6DS, UK
| | - Martin J Benwell
- London South Bank University, School of Health and Social Care, 103 Borough Road, London SE1 0AA, UK
| | - Bruce J W Evans
- London South Bank University, School of Health and Social Care, 103 Borough Road, London SE1 0AA, UK; Institute of Optometry, 56-62 Newington Causeway, London SE1 6DS, UK; Division of Optometry & Visual Sciences, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - David F Edgar
- Division of Optometry & Visual Sciences, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| |
Collapse
|
5
|
Moore PA, Wolffsohn JS, Sheppard AL. Attitudes of optometrists in the UK and Ireland to Digital Eye Strain and approaches to assessment and management. Ophthalmic Physiol Opt 2021; 41:1165-1175. [PMID: 34545597 PMCID: PMC9291543 DOI: 10.1111/opo.12887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the attitudes and understanding of optometrists in the UK and Ireland towards Digital Eye Strain (DES), and to examine related practice patterns. METHODS An anonymous online questionnaire was developed, covering attitude and understanding of DES, examination of patients who may be experiencing DES and approaches to management options. The questionnaire was promoted to UK and Ireland optometrists via professional bodies and local and area optometric committees. RESULTS 406 responses were included in the analysis. Most respondents agreed that DES was an important concern for optometrists (88.9%). 91.4% reported they felt confident in discussing possible symptoms of DES and management options; this was weakly and negatively associated with number of years qualified (rs = -0.198, p ≤ 0.001). Estimations of the proportion of patients affected by DES were lower than reports in the literature (median 25%, IQR 10%-50%). Most respondents always (60.6%) or frequently (21.9%) inquired about device usage in routine case history taking, and also asked follow-up questions, although 29.3% only asked about the presence of symptoms half the time or less. Advising on regular breaks (84.0%), lubricants (55.7%) and environment/set up (69.2%) were felt to be extremely or very important by most respondents. Advising on specialist spectacle lenses, specifically blue filtering designs, was considered extremely or very important by 34.2% and 15.2%, respectively. CONCLUSION Given the agreement that DES is a significant issue causing frequent and persistent symptoms, and practitioners reported high levels of confidence in discussing DES, patients can expect to receive advice on symptoms and management from their optometrist. Simple management strategies were felt to be most important to advise on, with more uncertainty linked to specialist spectacle lenses.
Collapse
Affiliation(s)
- Patrick A Moore
- Optometry and Vision Sciences Research Group, Aston University, Birmingham, UK
| | - James S Wolffsohn
- Optometry and Vision Sciences Research Group, Aston University, Birmingham, UK
| | - Amy L Sheppard
- Optometry and Vision Sciences Research Group, Aston University, Birmingham, UK
| |
Collapse
|
6
|
Sheringham J, Kuhn I, Burt J. The use of experimental vignette studies to identify drivers of variations in the delivery of health care: a scoping review. BMC Med Res Methodol 2021; 21:81. [PMID: 33888077 PMCID: PMC8061048 DOI: 10.1186/s12874-021-01247-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Identifying how unwarranted variations in healthcare delivery arise is challenging. Experimental vignette studies can help, by isolating and manipulating potential drivers of differences in care. There is a lack of methodological and practical guidance on how to design and conduct these studies robustly. The aim of this study was to locate, methodologically assess, and synthesise the contribution of experimental vignette studies to the identification of drivers of unwarranted variations in healthcare delivery. Methods We used a scoping review approach. We searched MEDLINE, Embase, Web of Science and CINAHL databases (2007–2019) using terms relating to vignettes and variations in healthcare. We screened title/abstracts and full text to identify studies using experimental vignettes to examine drivers of variations in healthcare delivery. Included papers were assessed against a methodological framework synthesised from vignette study design recommendations within and beyond healthcare. Results We located 21 eligible studies. Study participants were almost exclusively clinicians (18/21). Vignettes were delivered via text (n = 6), pictures (n = 6), video (n = 6) or interactively, using face-to-face, telephone or online simulated consultations (n = 3). Few studies evaluated the credibility of vignettes, and many had flaws in their wider study design. Ten were of good methodological quality. Studies contributed to understanding variations in care, most commonly by testing hypotheses that could not be examined directly using real patients. Conclusions Experimental vignette studies can be an important methodological tool for identifying how unwarranted variations in care can arise. Flaws in study design or conduct can limit their credibility or produce biased results. Their full potential has yet to be realised. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01247-4.
Collapse
Affiliation(s)
- Jessica Sheringham
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Isla Kuhn
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Jenni Burt
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| |
Collapse
|
7
|
Evans BJW, Edgar DF, Jessa Z, Yammouni R, Campbell P, Soteri K, Hobby A, Khatoon A, Beg A, Harsum S, Aggarwal R, Shah R. Referrals from community optometrists to the hospital eye service in England. Ophthalmic Physiol Opt 2020; 41:365-377. [PMID: 33354812 DOI: 10.1111/opo.12772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES. METHODS Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De-identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. RESULTS A total of 459 de-identified referrals were extracted. The RR ranged from 3.6%-8.7%. The proportion of referred patients who were seen in the HES unit was 63%-76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%-49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%-62%. Patients received a copy of the reply in 3%-21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%-97% and were accurate in 81%-98% of cases. The referral reply addressed the reason for the referral in 93%-97% and was meaningful in 94%-99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR. CONCLUSIONS In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.
Collapse
Affiliation(s)
- Bruce J W Evans
- Institute of Optometry, London, UK.,Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | | | | | - Peter Campbell
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK.,Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | - Steven Harsum
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | | | - Rakhee Shah
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
8
|
Ho KC, Stapleton F, Wiles L, Hibbert P, Alkhawajah S, White A, Jalbert I. Systematic review of the appropriateness of eye care delivery in eye care practice. BMC Health Serv Res 2019; 19:646. [PMID: 31492128 PMCID: PMC6731572 DOI: 10.1186/s12913-019-4493-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/29/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts' practice and to describe the methods used to measure appropriateness of eye care. METHODS A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts' practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. RESULTS Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2-100% for glaucoma, 0-100% for diabetic retinopathy and 0-100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. CONCLUSIONS These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.
Collapse
Affiliation(s)
- Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.,Eye Health, Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louise Wiles
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.,Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Hibbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.,Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sally Alkhawajah
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.,Optometry and Vision Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Andrew White
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.,Save Sight Institute, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.,Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, 2052, Australia.
| |
Collapse
|
9
|
Ho KC, Rahardjo D, Stapleton F, Wiles L, Hibbert PD, White AJR, Hayen A, Jalbert I. Can the appropriateness of eye care be measured through cross-sectional retrospective patient record review in eye care practices in Australia? The iCareTrack feasibility study. BMJ Open 2019; 9:e024298. [PMID: 30837251 PMCID: PMC6429871 DOI: 10.1136/bmjopen-2018-024298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery. DESIGN Cross-sectional feasibility study. SETTING AND PARTICIPANTS Two hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation sampling. METHODS Retrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines. PRIMARY OUTCOME MEASURE Number of eligible patient records, sampling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner-patient encounters at which appropriate eye care was received. RESULTS A median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective sampling strategy involved random letter generation followed by sequential sampling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care. CONCLUSIONS Appropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.
Collapse
Affiliation(s)
- Kam Chun Ho
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Dian Rahardjo
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Wiles
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Andrew J R White
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
- Centre for Vision Research, Westmead Millennium Institute, Sydney, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Liao J, Chen Y, Cai Y, Zhan N, Sylvia S, Hanson K, Wang H, Wasserheit JN, Gong W, Zhou Z, Pan J, Wang X, Tang C, Zhou W, Xu D. Using smartphone-based virtual patients to assess the quality of primary healthcare in rural China: protocol for a prospective multicentre study. BMJ Open 2018; 8:e020943. [PMID: 29997138 PMCID: PMC6089284 DOI: 10.1136/bmjopen-2017-020943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Valid and low-cost quality assessment tools examining care quality are not readily available. The unannounced standardised patient (USP), the gold standard for assessing quality, is costly to implement while the validity of clinical vignettes, as a low-cost alternative, has been challenged. Computerised virtual patients (VPs) create high-fidelity and interactive simulations of doctor-patient encounters which can be easily implemented via smartphone at low marginal cost. Our study aims to develop and validate smartphone-based VP as a quality assessment tool for primary care, compared with USP. METHODS AND ANALYSIS The study will be implemented in primary health centres (PHCs) in rural areas of seven Chinese provinces, and physicians practicing at township health centres and village clinics will be our study population. The development of VPs involves three steps: (1) identifying 10 VP cases that can best represent rural PHCs' work, (2) designing each case by a case-specific development team and (3) developing corresponding quality scoring criteria. After being externally reviewed for content validity, these VP cases will be implemented on a smartphone-based platform and will be tested for feasibility and face validity. This smartphone-based VP tool will then be validated for its criterion validity against USP and its reliability (ie, internal consistency and stability), with 1260 VP/USP-clinician encounters across the seven study provinces for all 10 VP cases. ETHICS AND DISSEMINATION Sun Yat-sen University: No. 2017-007. Study findings will be published and tools developed will be freely available to low-income and middle-income countries for research purposes.
Collapse
Affiliation(s)
- Jing Liao
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Nan Zhan
- Department of Health Management, School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kara Hanson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hong Wang
- Health Economics, Financing & Systems, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Judith N Wasserheit
- Departments of Global Health, Medicine, and Epidemiology, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jay Pan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, China
| | - Dong Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University
| |
Collapse
|
11
|
Artus M, van der Windt DA, Afolabi EK, Buchbinder R, Chesterton LS, Hall A, Roddy E, Foster NE. Management of shoulder pain by UK general practitioners (GPs): a national survey. BMJ Open 2017; 7:e015711. [PMID: 28637737 PMCID: PMC5734284 DOI: 10.1136/bmjopen-2016-015711] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/13/2017] [Accepted: 05/03/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Studies in Canada, the USA and Australia suggested low confidence among general practitioners (GPs) in diagnosing and managing shoulder pain, with frequent use of investigations. There are no comparable studies in the UK; our objective was to describe the diagnosis and management of shoulder pain by GPs in the UK. METHODS A national survey of a random sample of 5000 UK GPs collected data on shoulder pain diagnosis and management using two clinical vignettes that described primary care presentations with rotator cuff tendinopathy (RCT) and adhesive capsulitis (AdhC). RESULTS Seven hundred and fourteen (14.7%) responses were received. 56% and 83% of GPs were confident in their diagnosis of RCT and AdhC, respectively, and a wide range of investigations and management options were reported. For the RCT presentation, plain radiographs of the shoulder were most common (60%), followed by blood tests (42%) and ultrasound scans (USS) (38%). 19% of those who recommended a radiograph and 76% of those who recommended a USS did so 'to confirm the diagnosis'. For the AdhC presentation, the most common investigations were blood tests (60%), plain shoulder radiographs (58%) and USS (31%). More than two-thirds of those recommending a USS did so 'to confirm the diagnosis'. The most commonly recommended treatment for both presentations was physiotherapy (RCT 77%, AdhC 71%) followed by non-steroidal anti-inflammatory drugs (RCT 58%, AdhC 74%). 17% opted to refer the RCT to secondary care (most often musculoskeletal interface service), compared with 31% for the AdhC. CONCLUSIONS This survey of GPs in the UK highlights reliance on radiographs and blood tests in the management of common shoulder pain presentations. GPs report referring more than 7 out of 10 patients with RCT and AdhC to physiotherapists. These findings need to be viewed in the context of low response to the survey and, therefore, potential non-response bias.
Collapse
Affiliation(s)
- Majid Artus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Ebenezer K Afolabi
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Linda S Chesterton
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Alison Hall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| |
Collapse
|
12
|
Lohela TJ, Nesbitt RC, Manu A, Vesel L, Okyere E, Kirkwood B, Gabrysch S. Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana. BMJ Open 2016; 6:e010963. [PMID: 27297010 PMCID: PMC4916610 DOI: 10.1136/bmjopen-2015-010963] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities. DESIGN Cross-sectional Health Facility Assessment linked to population-based surveillance data. SETTING 7 districts in Brong Ahafo region, Ghana. PARTICIPANTS Most experienced delivery care providers in all 64 delivery facilities in the 7 districts. PRIMARY OUTCOME MEASURES Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant. RESULTS Vignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p<0.001). Competence varied significantly by facility type: hospital respondents, who were mainly doctors and midwives, achieved highest scores (70% correct) and clinic respondents scored lowest (45% correct). There was a lack of inexpensive key drugs and equipment to carry out vignette actions, and more often, lack of competence to use available items in clinical situations. The average annual workload was very unevenly distributed among facilities, ranging from 0 to 184 deliveries per skilled birth attendant, with higher workload associated with higher vignette scores. CONCLUSIONS Lack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care. TRIAL REGISTRATION NUMBER NCT00623337.
Collapse
Affiliation(s)
- Terhi Johanna Lohela
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | | | - Alexander Manu
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Linda Vesel
- Innovations for Maternal, Newborn and Child Health, Concern Worldwide US, New York, New York, USA
- Health Section, Programme Division, UNICEF Headquarters, New York, New York, USA
| | - Eunice Okyere
- Department of Public Health, Flinders University, Adelaide, South Australia, Australia
- Ghana Health Service, Kintampo Health Research Centre, Kintampo, Ghana
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
13
|
Shneor E, Evans BJW, Fine Y, Shapira Y, Gantz L, Gordon-Shaag A. A survey of the criteria for prescribing in cases of borderline refractive errors. JOURNAL OF OPTOMETRY 2016; 9:22-31. [PMID: 26520884 PMCID: PMC4705315 DOI: 10.1016/j.optom.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/09/2015] [Accepted: 09/12/2015] [Indexed: 05/26/2023]
Abstract
PURPOSE This research investigated the reported optometric prescribing criteria of Israeli optometrists. METHODS An online questionnaire based on previous studies was distributed via email and social networking sites to optometrists in Israel. The questionnaire surveyed the level of refractive error at which respondents would prescribe for different types of refractive error at various ages with and without symptoms. RESULTS 124 responses were obtained, yielding a response rate of approximately 12-22%, 92% of whom had trained in Israel. For all refractive errors, the presence of symptoms strongly influenced prescribing criteria. For example, for 10-20 year old patients the degree of hyperopia for which 50% of practitioners would prescribe is +0.75 D in the presence of symptoms but twice this value (+1.50 D) in the absence of symptoms. As might be expected, optometrists prescribed at lower degrees of hyperopia for older compared with younger patients. There was a trend for more experienced practitioners to be less likely to prescribe for lower degrees of myopia and presbyopia. Practitioner gender, country of training, the type of practice environment, and financial incentives were not strongly related to prescribing criteria. CONCLUSIONS The prescribing criteria found in this study are broadly comparable with those in previous studies and with published prescribing guidelines. Subtle indications suggest that optometrists may become more conservative in their prescribing criteria with experience.
Collapse
Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel.
| | | | - Yael Fine
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
| | - Yehudit Shapira
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
| | - Liat Gantz
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
| | | |
Collapse
|
14
|
Wolffsohn JS, Naroo SA, Christie C, Morris J, Conway R, Maldonado-Codina C, Retalic N, Purslow C. History and symptom taking in contact lens fitting and aftercare. Cont Lens Anterior Eye 2015; 38:258-65. [DOI: 10.1016/j.clae.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/20/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
|
15
|
Halvorsen PA, Aasland OG, Kristiansen IS. Decisions on statin therapy by patients' opinions about survival gains: cross sectional survey of general practitioners. BMC FAMILY PRACTICE 2015; 16:79. [PMID: 26139240 PMCID: PMC4490724 DOI: 10.1186/s12875-015-0288-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
Abstract
Background Guidelines for primary prevention of cardiovascular disease provide little guidance on how patients’ preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to patient preferences regarding survival gains from statin therapy. Methods In a cross sectional, online survey 3,270 Norwegian GPs were presented with a 55 year old patient with an unfavourable cardiovascular risk profile. He expressed preferences for statin therapy by indicating a minimum survival gain that would be considered a substantial benefit. This survival gain varied across six versions of the vignette: 8, 4 and 2 years, and 12, 6 and 3 months, respectively. Participants were randomly allocated to one version only. We asked whether the GPs would recommend the patient to take a statin. Subsequently we asked the GPs to estimate the average survival gain of life long simvastatin therapy for patients with a similar risk profile. Results We received 1,296 responses (40 %). Across levels of survival gains (8 years to 3 months) the proportion of GPs recommending statin therapy did not vary significantly (OR per level 1.07, 95 % CI 0.99 to 1.16). The GP’s own estimate of survival gain was a statistically significant predictor of recommending therapy (OR per year adjusted for the GPs’ age, sex, speciality attainment and number of patients listed 3.07, CI 2.55 to 3.69). Conclusion GPs were insensitive to patient preferences regarding survival gain when recommending statin therapy. The GPs' recommendations were strongly associated with their own estimates of survival gain.
Collapse
Affiliation(s)
- Peder A Halvorsen
- Department of Community Medicine, UiT - The Arctic University of Norway, P.o. box 6050 Langnes, N-9037, Tromsø, Norway.
| | - Olaf Gjerløw Aasland
- LEFO - Institute for Studies of the Medical Profession, The Norwegian Medical Association, P. box 1152 Sentrum, N-0107, Oslo, Norway. .,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P. box 1089 Blindern, N-0318, Oslo, Norway.
| | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P. box 1089 Blindern, N-0318, Oslo, Norway.
| |
Collapse
|
16
|
Dabasia PL, Edgar DF, Garway-Heath DF, Lawrenson JG. A survey of current and anticipated use of standard and specialist equipment by UK optometrists. Ophthalmic Physiol Opt 2015; 34:592-613. [PMID: 25160893 DOI: 10.1111/opo.12150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate current and anticipated use of equipment and information technology (IT) in community optometric practice in the UK, and to elicit optometrists' views on adoption of specialist equipment and IT. METHODS An anonymous online questionnaire was developed, covering use of standard and specialist diagnostic equipment, and IT. The survey was distributed to a random sample of 1300 UK College of Optometrists members. RESULTS Four hundred and thirty-two responses were received (response rate = 35%). Enhanced (locally commissioned) or additional/separately contracted services were provided by 73% of respondents. Services included glaucoma repeat measures (30% of respondents), glaucoma referral refinement (22%), fast-track referral for wet age-related macular degeneration (48%), and direct cataract referral (40%). Most respondents (88%) reported using non-contact/pneumo tonometry for intra-ocular pressure measurement, with 81% using Goldmann or Perkins tonometry. The most widely used item of specialist equipment was the fundus camera (74% of respondents). Optical Coherence Tomography (OCT) was used by 15% of respondents, up from 2% in 2007. Notably, 43% of those anticipating purchasing specialist equipment in the next 12 months planned to buy an OCT. 'Paperless' records were used by 39% of respondents, and almost 80% of practices used an electronic patient record/practice management system. Variations in responses between parts of the UK reflect differences in the provision of the General Ophthalmic Services contract or community enhanced services. There was general agreement that specialised equipment enhances clinical care, permits increased involvement in enhanced services, promotes the practice and can be used as a defence in clinico-legal cases, but initial costs and ongoing maintenance can be a financial burden. Respondents generally agreed that IT facilitates administrative flow and secure exchange of health information, and promotes a state-of-the-art practice image. However, use of IT may not save examination time; its dynamic nature necessitates frequent updates and technical support; the need for adequate training is an issue; and security of data is also a concern. CONCLUSION UK optometrists increasingly employ modern equipment and IT services to enhance patient care and for practice management. While the clinical benefits of specialist equipment and IT are appreciated, questions remain as to whether the investment is cost-effective, and how specialist equipment and IT may be used to best advantage in community optometric practice.
Collapse
Affiliation(s)
- Priya L Dabasia
- Centre for Public Health Research, School of Health Sciences, City University London, London, UK
| | | | | | | |
Collapse
|
17
|
Mohan D, Angus DC, Ricketts D, Farris C, Fischhoff B, Rosengart MR, Yealy DM, Barnato AE. Assessing the validity of using serious game technology to analyze physician decision making. PLoS One 2014; 9:e105445. [PMID: 25153149 PMCID: PMC4143260 DOI: 10.1371/journal.pone.0105445] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
Background Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity. Methods We created a serious game and evaluated its construct validity. We used the decision context of trauma triage in the Emergency Department of non-trauma centers, given widely accepted guidelines that recommend the transfer of severely injured patients to trauma centers. We designed cases with the premise that the representativeness heuristic influences triage (i.e. physicians make transfer decisions based on archetypes of severely injured patients rather than guidelines). We randomized a convenience sample of emergency medicine physicians to a control or cognitive load arm, and compared performance (disposition decisions, number of orders entered, time spent per case). We hypothesized that cognitive load would increase the use of heuristics, increasing the transfer of representative cases and decreasing the transfer of non-representative cases. Findings We recruited 209 physicians, of whom 168 (79%) began and 142 (68%) completed the task. Physicians transferred 31% of severely injured patients during the game, consistent with rates of transfer for severely injured patients in practice. They entered the same average number of orders in both arms (control (C): 10.9 [SD 4.8] vs. cognitive load (CL):10.7 [SD 5.6], p = 0.74), despite spending less time per case in the control arm (C: 9.7 [SD 7.1] vs. CL: 11.7 [SD 6.7] minutes, p<0.01). Physicians were equally likely to transfer representative cases in the two arms (C: 45% vs. CL: 34%, p = 0.20), but were more likely to transfer non-representative cases in the control arm (C: 38% vs. CL: 26%, p = 0.03). Conclusions We found that physicians made decisions consistent with actual practice, that we could manipulate cognitive load, and that load increased the use of heuristics, as predicted by cognitive theory.
Collapse
Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- * E-mail:
| | - Derek C. Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Daniel Ricketts
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Coreen Farris
- RAND Corporation, Pittsburgh, PA, United States of America
| | - Baruch Fischhoff
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Matthew R. Rosengart
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Donald M. Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Amber E. Barnato
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| |
Collapse
|
18
|
Myint J, Edgar DF, Murdoch IE, Lawrenson JG. The impact of postgraduate training on UK optometrists’ clinical decision-making in glaucoma. Ophthalmic Physiol Opt 2014; 34:376-84. [DOI: 10.1111/opo.12126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/19/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Joy Myint
- Department of Vision and Hearing Sciences; Anglia Ruskin University; Cambridge UK
| | - David F. Edgar
- Division of Optometry and Visual Science; Henry Wellcome Laboratories for Vision Sciences; City University London; London UK
| | | | - John G. Lawrenson
- Division of Optometry and Visual Science; Henry Wellcome Laboratories for Vision Sciences; City University London; London UK
| |
Collapse
|
19
|
Collinge WR, Gross DP, Bostick GP, Cutforth GS, Rutten GM, Maroun C, Oostendorp RAB. Evaluating physical therapy students' knowledge of and adherence to the ambassador low back pain guideline. Physiother Can 2014; 65:384-95. [PMID: 24396169 DOI: 10.3138/ptc.2012-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine a process for evaluating physiotherapy (PT) students' knowledge of and adherence to the Ambassador Low Back Pain (LBP) guideline using vignettes. METHODS The study used a cross-sectional survey design. Participants were PT students who had received information related to the guideline as part of their curriculum. Primary measures were responses to questions about the management of four clinical vignettes. Adherence to guideline recommendations was measured by comparing participant scores to a "guideline-based" set of responses from a physiotherapist involved in developing the Ambassador guideline, which was considered a criterion standard. RESULTS A total of 74 respondents provided complete data, for a response rate of 89%; 65 (88%) reported no knowledge of the guideline. Overall consistency with the criterion standard was high (>70%). Respondents demonstrated high adherence when identifying red flags and deciding whether to refer to another provider. CONCLUSION Despite known exposure, knowledge of the guideline was low in this sample of Canadian PT students. Nevertheless, in several key areas, unconscious adherence was high relative to the guideline-based criterion standard. With minor modifications, the vignettes are suitable for evaluating the Ambassador LBP guidelines in a larger study.
Collapse
Affiliation(s)
| | | | | | | | - Geert M Rutten
- NUTRIM, Department of Health Promotion, Maastricht University, The Netherlands
| | - Claude Maroun
- American University of Beirut Medical Center, Physical Therapy Department, Lebanon
| | - Rob A B Oostendorp
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
20
|
Talungchit P, Liabsuetrakul T, Lindmark G. Multifaceted intervention to implement indicators of quality of care for severe pre-eclampsia/eclampsia. Int J Gynaecol Obstet 2013; 124:106-11. [DOI: 10.1016/j.ijgo.2013.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/06/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
|
21
|
Mohan D, Fischhoff B, Farris C, Switzer GE, Rosengart MR, Yealy DM, Saul M, Angus DC, Barnato AE. Validating a vignette-based instrument to study physician decision making in trauma triage. Med Decis Making 2013; 34:242-52. [PMID: 24125789 DOI: 10.1177/0272989x13508007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. METHODS We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the retest reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of undertriage (the proportion of severely injured patients not transferred to trauma centers) and overtriage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. RESULTS Physicians made similar transfer decisions for cases (κ = 0.42, P < 0.01) on 2 administrations of the instrument. Responses were internally consistent (Kuder-Richardson, 0.71-0.91). Surgeons had lower rates of undertriage than emergency physicians (13% v. 70%, P < 0.01). No correlation existed between individual rates of under- or overtriage on the vignettes and in practice (r = -0.17, P = 0.4; r = -0.03, P = 0.85). CONCLUSIONS The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However, it did not predict individual physician performance.
Collapse
Affiliation(s)
- Deepika Mohan
- The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DM, MRR, DCA).,Department ofSurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DM, MRR)
| | - Baruch Fischhoff
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania (BF)
| | | | - Galen E Switzer
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania (GES),Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (GES, AEB),Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (GES),Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (GES)
| | - Matthew R Rosengart
- Department ofSurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DM, MRR)
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DMY)
| | - Melissa Saul
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (MS)
| | - Derek C Angus
- The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (DM, MRR, DCA)
| | - Amber E Barnato
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (GES, AEB)
| |
Collapse
|
22
|
Griffin LM, Denburg MR, Shults J, Furth SL, Salusky IB, Hwang W, Leonard MB. Nutritional vitamin D use in chronic kidney disease: a survey of pediatric nephrologists. Pediatr Nephrol 2013; 28:265-75. [PMID: 23086591 PMCID: PMC4052461 DOI: 10.1007/s00467-012-2307-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/16/2012] [Accepted: 08/16/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vitamin D deficiency may contribute to risk of cardiovascular disease, diabetes, and infections, in addition to known effects on mineral metabolism. Controversy remains regarding the use of nutritional vitamin D supplementation in chronic kidney disease (CKD), and the supplementation practices of pediatric nephrologists are unknown. METHODS An electronic survey containing eight vignettes was sent to physician members of the International Pediatric Nephrology Association in 2011 to identify physician and patient characteristics that influence nephrologists to supplement CKD patients with nutritional vitamin D. Vignettes contained patient characteristics including light vs dark skin, CKD stage, cause of renal disease, parathyroid hormone (PTH), and 25(OH) vitamin D levels. Multivariate logistic generalized estimating equation regression was used to identify predictors of supplementation. RESULTS Of 1,084 eligible physicians, 504 (46%) completed the survey. Supplementation was recommended in 73% of cases overall (ranging from 91% of those with vitamin D levels <10 ng/mL to 35% with levels >30). Greater CKD severity was associated with greater recommendation of supplementation, especially for patients with higher vitamin D levels (test for interaction p < 0.0001). PTH level above target for CKD stage was associated with greater recommendation to supplement in pre-dialysis CKD, but did not have an impact on recommendations in dialysis patients (test for interaction p < 0.0001). Skin color, cause of CKD, and albumin levels were not associated with supplementation recommendation. CONCLUSIONS Recommending nutritional vitamin D is common worldwide, driven by CKD stage and vitamin D and PTH levels. Future studies are needed to establish the risks and benefits of supplementation.
Collapse
Affiliation(s)
- Lindsay M Griffin
- Department of Pediatrics, Children's Hospital of Philadelphia, 3535 Market Street, Room 868, Philadelphia, PA, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Mohan D, Rosengart MR, Farris C, Fischhoff B, Angus DC, Barnato AE. Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study. Implement Sci 2012; 7:103. [PMID: 23098291 PMCID: PMC3503726 DOI: 10.1186/1748-5908-7-103] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 10/22/2012] [Indexed: 02/03/2023] Open
Abstract
Background United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. Methods We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). Results We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds. Conclusions On a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians’ cognitive processes contributed to the under-triage of trauma patients.
Collapse
Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, The CRISMA Center-Clinical Research, Investigation, and Systems Modeling of Acute Illness, University of Pittsburgh, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, USA.
| | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Howell-Duffy C, Scally AJ, Elliott DB. Spectacle prescribing II: practitioner experience is linked to the likelihood of suggesting a partial prescription. Ophthalmic Physiol Opt 2011; 31:155-67. [PMID: 21309802 DOI: 10.1111/j.1475-1313.2010.00803.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE A follow up study to investigate whether UK optometrists partially prescribe significant changes in refractive correction to assist patient adaptation and whether various aspects of practitioner profiles are linked to the nature of these prescribing decisions. METHOD A case scenario type questionnaire was distributed by post and via the internet to UK optometrists. Five case scenarios were described that included information on patient age, symptoms, habitual refractive correction (if any), subjective refraction and any other relevant clinical information. In each case respondents were asked to indicate and justify what refractive correction they would prescribe. RESULTS A total of 592 questionnaires were completed. Between 41% and 84% prescribed the subjective refraction result depending on the scenario. The likelihood of partial prescribing increased by 34% for every 10 years following qualification and thus after a typical 40 year career, respondents were now over three times more likely to partially prescribe. There were no other links with the propensity to partially prescribe. CONCLUSION The subjective refraction result exerted a strong hold on the reported prescribing outcome, particularly for newly qualified optometrists. Partial prescribing was increasingly proposed the greater the number of years the respondent had been qualified. This suggests that with increasing exposure to patients who return dissatisfied with their spectacles, a greater appreciation of partial prescribing is gained. This link seems to be an important finding that provides significant support for the prescribing rules suggested by textbooks, which are not yet supported by research evidence.
Collapse
Affiliation(s)
- Chris Howell-Duffy
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | | | | |
Collapse
|