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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [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] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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2
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Aly M, Schneider CR, Sukkar MB, Lucas C. Development of an adaptation framework to implement a new professional pharmacy service (PPS) to a new environment. Res Social Adm Pharm 2024; 20:165-169. [PMID: 38438294 DOI: 10.1016/j.sapharm.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
The effective provision of professional pharmacy services is critical to support the delivery of primary health care. Structured frameworks and theoretical strategies are required to facilitate successful service implementation processes, outcomes and sustainability. This commentary discusses the considerations of what framework (adoption versus adaptation) would be suitable when implementing a new professional pharmacy service to a new environment. Utilizing Minor Ailments Services (MASs) as an exemplar as a professional pharmacy service case study, the research that underpinned these considerations enabled the development of a sequential, phased framework. There is the potential to utilize this framework for future evolving professional pharmacy services in the new setting.
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Affiliation(s)
- Mariyam Aly
- Pharmaceutical Society of Australia, 32 Ridge St, North Sydney, New South Wales, Australia, 2060.
| | - Carl R Schneider
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Sydney New South Wales, Australia.
| | - Maria B Sukkar
- The University of Technology Sydney, School of Life Sciences, Faculty of Science, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Cherie Lucas
- The University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW, 2007, Australia; University of NSW (UNSW) Sydney, School of Population Health, Faculty of Medicine and Health, Sydney, NSW, Australia.
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3
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Ramos Salas X, Saquimux Contreras MA, Breen C, Preiss Y, Hussey B, Forhan M, Wharton S, Campbell-Scherer D, Vallis M, Brown J, Pedersen SD, Sharma AM, Woodward E, Patton I, Pearce N. Review of an international pilot project to adapt the Canadian Adult Obesity Clinical Practice Guideline. OBESITY PILLARS (ONLINE) 2023; 8:100090. [PMID: 38125658 PMCID: PMC10728699 DOI: 10.1016/j.obpill.2023.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
Background The evidence-based Canadian Adult Obesity Clinical Practice Guideline (CPG) released in August 2020 were developed through a systematic literature review and patient-oriented research process. This CPG is considered a paradigm shift for obesity care as it introduced a new obesity definition that is based on health not body size, incorporates lived experiences of people affected by obesity, and addresses the pervasive weight bias and stigma that patients face in healthcare systems. The purpose of this pilot project was to assess the feasibility of adapting the Canadian CPG in Chile and Ireland. Methods An International Clinical Practice Guideline Adaptation Committee was established to oversee the project. The project was conducted through four interrelated phases: 1) planning and preparation; 2) pilot project application process; 3) adaptation; and 4) launch, dissemination, and implementation. Ireland used the GRADE-ADAPTE framework and Chile used the GRADE-ADOLOPMENT approach. Results Chile and Ireland developed their adapted guidelines in one third of the time it took to develop the Canadian guidelines. In Ireland, 18 chapters, which underpin the 80 key recommendations, were contextually adapted. Chile adopted 18 chapters and 76 recommendations, adapted one recommendation, and developed 12 new recommendations.
. Conclusion The pilot project demonstrated it is feasible to adapt the Canadian CPG for use in other countries with different healthcare systems, languages, and cultural contexts, while retaining the Canadian CPG's key principles and values such as the treatment of obesity as a chronic disease, adoption of new clinical assessment approaches that go beyond anthropometric measurements, elimination of weight bias and stigma, shifting obesity care outcomes to improved health and well-being rather than weight loss alone, and the use of patient-centred, collaborative and shared-decision clinical care approaches.
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Affiliation(s)
| | - Miguel Alejandro Saquimux Contreras
- Universidade Estadual de Campinas - UNICAMP, Centro de Pesquisas em Saúde Reprodutiva de Campinas – CEMICAMP, Rua Vital Brasil, 200 Cidade Universitária, Campinas, SP, 13083-888, Brazil
| | - Cathy Breen
- Association for the Study of Obesity on the island of Ireland, Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Yudith Preiss
- Sociedad Chilena de Cirugía Bariátrica y Metabólica, Centro Medico Novamed, Lo Fontecilla 101, oficina 201-202, Las Condes, RM, Chile
| | - Brad Hussey
- Replica Communications, 156 Melville Street, Dundas, Ontario, L9H 2A8, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160 – 500 University Ave., 9th floor, Toronto, ON, M5G 1V7, Canada
| | - Sean Wharton
- McMaster University, Wharton Medical Clinic, 2951 Walkers Line, Burlington, Ontario, L7M 4Y1, Canada
| | - Denise Campbell-Scherer
- University of Alberta, 2-590B Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Michael Vallis
- Dalhousie University Family Medicine, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Jennifer Brown
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Sue D. Pedersen
- C-ENDO Diabetes and Endocrinology Clinic, Rockyview Health Centre II, Suite 210, 1016-68 Avenue SW, Calgary, Alberta, T2V 4J2, Canada
| | - Arya M. Sharma
- University of Alberta, Faculty of Medicine & Dentistry, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Euan Woodward
- European Association for the Study of Obesity, Level 2, 8 Waldergrave Road, Teddington, Middlesex, TW11 8GT, United Kingdom
| | - Ian Patton
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Nicole Pearce
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
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Al Zoubi FM, Wong AYL, Cheing GLY, Cheung JPY, Fu SN, Tsang HHL, Law RKY, So BCL, Tsang R, Tsang S, Wen C, Wong M, Yau YC, Bussières AE. Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists. Healthcare (Basel) 2023; 11:2964. [PMID: 37998457 PMCID: PMC10671134 DOI: 10.3390/healthcare11222964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient's feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.
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Affiliation(s)
- Fadi M. Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Gladys L. Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Jason P. Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China;
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Helen H. L. Tsang
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Rainbow K. Y. Law
- Physiotherapy Centre, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
| | - Billy Chun Lung So
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Raymond Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
- Hong Kong Physiotherapy Association, Hong Kong SAR, China
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong SAR, China
| | - Sharon Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.L.W.); (G.L.Y.C.)
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Michael Wong
- Rehabilitation Clinic, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Yim Ching Yau
- Nursing Mixed Surgical Ward, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China;
| | - André E. Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada;
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
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5
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O'Brien E, Duffy S, Harkins V, Smith SM, O'Herlihy N, Walsh A, Clyne B, Wallace E. A scoping review of evidence-based guidance and guidelines published by general practice professional organizations. Fam Pract 2023:cmad015. [PMID: 36812366 DOI: 10.1093/fampra/cmad015] [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] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making. OBJECTIVE To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination. METHODS Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed. RESULTS Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies. CONCLUSION The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization. PROTOCOL REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Duffy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin Ireland
| | | | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations. HRB Open Res 2022; 4:53. [PMID: 35233505 PMCID: PMC8866908 DOI: 10.12688/hrbopenres.13268.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/09/2023] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner's clinical decision making to benefit patient care.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Noirin O'Herlihy
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
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7
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations. HRB Open Res 2022; 4:53. [PMID: 35233505 PMCID: PMC8866908 DOI: 10.12688/hrbopenres.13268.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner’s clinical decision making to benefit patient care.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Noirin O'Herlihy
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
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8
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance published by general practitioner professional organisations. HRB Open Res 2021; 4:53. [DOI: 10.12688/hrbopenres.13268.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centred approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will identify the role of GP professional organisations in generating, endorsing and/or disseminating evidence-based guidance for supporting general practitioner’s clinical decision making to benefit patient care.
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9
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Wang Z, Norris SL, Bero L. The advantages and limitations of guideline adaptation frameworks. Implement Sci 2018; 13:72. [PMID: 29843737 PMCID: PMC5975671 DOI: 10.1186/s13012-018-0763-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline. This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation. ANALYSIS Recent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries. CONCLUSION Despite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.
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Affiliation(s)
- Zhicheng Wang
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
| | | | - Lisa Bero
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
- Charles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales Australia
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10
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Ayhan Baser D, Kahveci R, Baydar Artantas A, Yasar İ, Aksoy H, Koc EM, Kasim İ, Kunnamo I, Özkara A. Exploring guideline adaptation strategy for Turkey: Is "ADAPTE" feasible or does it need adaptation as well? J Eval Clin Pract 2018; 24:97-104. [PMID: 28449396 DOI: 10.1111/jep.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, OBJECTIVES Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation. METHODS The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts. RESULTS The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit. CONCLUSION This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools.
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Affiliation(s)
| | - Rabia Kahveci
- Family Medicine, TC Saglik Bakanligi Ankara Numune, Egitim ve Arastirma, Hastanesi, Ankara, Turkey
| | - Aylin Baydar Artantas
- Family Medicine, TC Saglik Bakanligi Ankara Numune, Egitim ve Arastirma, Hastanesi, Ankara, Turkey
| | - İlknur Yasar
- Yenimahalle Public Health Center, Ankara, Turkey
| | - Hilal Aksoy
- Pamukkale Pelitlibağ Family Health Center, Denizli, Turkey
| | | | - İsmail Kasim
- Family Medicine, Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd., Helsinki, Finland
| | - Adem Özkara
- Department, Hitit University, Ankara, Turkey
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11
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Lala D, Houghton P, Holyoke P, Wolfe D. Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury. Rehabil Process Outcome 2017. [DOI: 10.1177/1179572717745836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To apply a modified ADAPTE process to adapt best practices to a local context for successful implementation of electrical stimulation therapy (EST) for treating pressure injuries in persons with spinal cord injury (SCI). Participants: An expert team of health care professionals and a consumer participated in a 2-day workshop to assist in the development of the locally adapted EST document in Southwest Ontario, Canada. Results: A process map illustrating the flow of activities to initiate EST for treating pressure injuries in persons with SCI based on the challenges and opportunities existing within this region was created. The team also developed a summary of roles and responsibilities delineating tasks specific to providing EST and identified a set of challenges likely to be encountered. Conclusions: The modified ADAPTE process provided a clear and flexible structure to adaptation when used for implementation planning. This article shares some challenges associated with using this process for local adaptation and shares strategies of improvement for future studies aimed at adapting a practice to their local environment.
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Affiliation(s)
- Deena Lala
- Faculty of Health & Rehabilitation Sciences, Western University, London, ON, Canada
| | - Pamela Houghton
- Faculty of Health & Rehabilitation Sciences, Western University, London, ON, Canada
- School of Physical Therapy, Western University, London, ON, Canada
| | - Paul Holyoke
- Saint Elizabeth Research Centre, Markham, ON, Canada
| | - Dalton Wolfe
- Aging, Rehabilitation and Geriatric Care Research Centre (ARGC), Parkwood Institute Research, London, ON, Canada
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Altokhais TI, Al-Obaid OA, Kattan AE, Amer YS. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. J Eval Clin Pract 2017; 23:156-164. [PMID: 27807920 DOI: 10.1111/jep.12658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical practice guidelines (CPGs) for SAP have been published. The aim of this study was to adapt a CPG for SAP and to assess its implementability. METHODS The methodology was based on two validated tools for CPGs, namely, the ADAPTE and the Guideline Implementability Appraisal (GLIA). RESULTS The ADAPTE CPG adaptation process methodology was utilized to produce an adapted CPG for SAP based on the American Society of Health System Pharmacists 2013 CPG. The finalized CPG was then assessed to identify any possible intrinsic barriers for implementation. CONCLUSIONS In conclusion, the ADAPTE tool is a practical and successful tool for production of CPGs. The GLIA tool is useful for assessing and preparing the finalized adapted CPG for the transition from the production stage to the implementation stage. GLIA could be added to the ADAPTE process either as a final step or to check the draft of the CPG before finalization.
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Affiliation(s)
- Tariq I Altokhais
- Division of Pediatric Surgery, Department of Surgery, Surgery Departmental CPG Committee, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omar A Al-Obaid
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah E Kattan
- Division of Plastic Surgery, Department of Surgery, Surgery Departmental Quality Team, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Quality Management Department, CPG Steering Committee, Research Chair for Evidence-based Health Care and Knowledge Translation, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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- King Saud University Medical City, Riyadh, Saudi Arabia
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Linkov F, Valappil B, McAfee J, Goughnour SL, Hildrew DM, McCall AA, Linkov I, Hirsch B, Snyderman C. Development of an evidence-based decision pathway for vestibular schwannoma treatment options. Am J Otolaryngol 2017; 38:57-64. [PMID: 27780583 DOI: 10.1016/j.amjoto.2016.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). METHODS This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. RESULTS Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. DISCUSSION The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. CONCLUSIONS Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways.
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