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Suttels V, Guedes Da Costa S, Garcia E, Brahier T, Hartley MA, Agodokpessi G, Wachinou P, Fasseur F, Boillat-Blanco N. Barriers and facilitators to implementation of point-of-care lung ultrasonography in a tertiary centre in Benin: a qualitative study among general physicians and pneumologists. BMJ Open 2023; 13:e070765. [PMID: 37369423 DOI: 10.1136/bmjopen-2022-070765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Owing to its ease-of-use and excellent diagnostic performance for the assessment of respiratory symptoms, point-of-care lung ultrasound (POC-LUS) has emerged as an attractive skill in resource-low settings, where limited access to specialist care and inconsistent radiology services erode health equity.To narrow down the research to practice gap, this study aims to gain in-depth insights in the perceptions on POC-LUS and computer-assisted POC-LUS for the diagnosis of lower respiratory tract infections (LRTIs) in a low-income and middle-income country (LMIC) of sub-Saharan Africa. DESIGN AND SETTING Qualitative study using face-to-face semi-structured interviews with three pneumologists and five general physicians in a tertiary centre for pneumology and tuberculosis in Benin, West Africa. The center hosts a prospective cohort study on the diagnostic performance of POC-LUS for LRTI. In this context, all participants started a POC-LUS training programme 6 months before the current study. Transcripts were coded by the interviewer, checked for intercoder reliability by an independent psychologist, compared and thematically summarised according to grounded theory methods. RESULTS Various barriers- and facilitators+ to POC-LUS implementation were identified related to four principal categories: (1) hospital setting (eg, lack of resources for device renewal or maintenance-, need for POC tests+), (2) physician's perceptions (eg, lack of opportunity to practice-, willingness to appropriate the technique+), (3) tool characteristics (eg, unclear lifespan-, expedited diagnosis+) and (4) patient's experience (no analogous image to keep-, reduction in costs+). Furthermore, all interviewees had positive attitudes towards computer-assisted POC-LUS. CONCLUSIONS There is a clear need for POC affordable lung imaging techniques in LMIC and physicians are willing to implement POC-LUS to optimise the diagnostic approach of LRTI with an affordable tool. Successful integration of POC-LUS into clinical routine will require adequate responses to local challenges related to the lack of available maintenance resources and limited opportunity to supervised practice for physicians.
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Affiliation(s)
| | - Sofia Guedes Da Costa
- Research Center for Psychology of Health, Aging and Sport Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Elena Garcia
- Emergency Department, CHUV, Lausanne, Switzerland
| | | | - Mary-Anne Hartley
- Digital Global Health Department, University of Lausanne, Lausanne, Switzerland
- Intelligent Global Health Research Group, Swiss Institute of Technology (EPFL), Lausanne, Switzerland
| | - Gildas Agodokpessi
- National Hospital Center of Pneumology, University of Abomey-Calavi, Cotonou, Benin
| | - Prudence Wachinou
- National Hospital Center of Pneumology, University of Abomey-Calavi, Cotonou, Benin
| | - Fabienne Fasseur
- Research Center for Psychology of Health, Aging and Sport Examination (PHASE), University of Lausanne, Lausanne, Switzerland
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Stevenson K, Smith P, Ryan S, Dziedzic K. Mobilizing physiotherapy knowledge: Understanding the best evidence and barriers to implementation of hydrotherapy for musculoskeletal disease. Physiother Theory Pract 2023; 39:343-350. [PMID: 34856858 DOI: 10.1080/09593985.2021.2010847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To explore two linked strategies to highlight the best current available evidence for hydrotherapy and to explore the barriers and enablers to mobilizing this evidence into practice. METHOD Phase 1: The best published evidence for hydrotherapy was collated using a Critically Appraised Topic (CAT) methodology. The focus was the best available research evidence for hydrotherapy in musculoskeletal conditions (i.e. osteoarthritis (OA), juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and low back pain (LBP)). Once evaluated for quality, a summary of the evidence was produced in a Clinical Bottom Line (CBL). Phase 2: A Focus Group explored the: CBL, the barriers and facilitators of embedding the best evidence for hydrotherapy into practice. RESULTS Phase 1: The CAT identified seven studies that indicated hydrotherapy had beneficial, although short term, effects for common musculoskeletal conditions. Phase 2: Six participants from primary, secondary care, private practice, and education discussed the evidence identified. They highlighted issues such as: understanding the value of hydrotherapy, an overuse of quantitative methodologies and the quality of existing research as being barriers to this knowledge being actively mobilized into clinical care. CONCLUSIONS These two linked enquiries (CAT and Focus Group) identified the best evidence and the basis for discussion to explore barriers and facilitators of evidence use in practice. This gave an understanding of the reasons for the research to practice gap and thereby allows planning of knowledge mobilization strategies to reduce this.
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Affiliation(s)
- Kay Stevenson
- Impact Accelerator Unit, School of Medicine, David Weatherall Building Keele University, Keele, UK.,Haywood Rheumatology Centre, Midlands Partnership NHS Trust, High Lane, Burslem, UK
| | - Pam Smith
- Haywood Rheumatology Centre, Midlands Partnership NHS Trust, High Lane, Burslem, UK
| | - Sarah Ryan
- Haywood Rheumatology Centre, Midlands Partnership NHS Trust, High Lane, Burslem, UK
| | - Krysia Dziedzic
- Haywood Rheumatology Centre, Midlands Partnership NHS Trust, High Lane, Burslem, UK
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Kumah EA, McSherry R, Bettany‐Saltikov J, van Schaik P, Hamilton S, Hogg J, Whittaker V. Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of UG student. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1233. [PMID: 36911346 PMCID: PMC9013402 DOI: 10.1002/cl2.1233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND To produce graduates with strong knowledge and skills in the application of evidence into healthcare practice, it is imperative that all undergraduate health and social care students are taught, in an efficient manner, the processes involved in applying evidence into practice. The two main concepts that are linked to the application of evidence into practice are "evidence-based practice" and "evidence-informed practice." Globally, evidence-based practice is regarded as the gold standard for the provision of safe and effective healthcare. Despite the extensive awareness of evidence-based practice, healthcare practitioners continue to encounter difficulties in its implementation. This has generated an ongoing international debate as to whether evidence-based practice should be replaced with evidence-informed practice, and which of the two concepts better facilitate the effective and consistent application of evidence into healthcare practice. OBJECTIVES The primary objective of this systematic review was to evaluate and synthesize literature on the effectiveness of evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior of undergraduate health and social care students toward the application of evidence into practice. Specifically, we planned to answer the following research questions: (1) Is there a difference (i.e., difference in content, outcome) between evidence-informed practice and evidence-based practice educational interventions? (2) Does participating in evidence-informed practice educational interventions relative to evidence-based practice educational interventions facilitate the application of evidence into practice (as measured by, e.g., self-reports on effective application of evidence into practice)? (3) Do both evidence-informed practice and evidence-based practice educational interventions targeted at undergraduate health and social care students influence patient outcomes (as measured by, e.g., reduced morbidity and mortality, absence of nosocomial infections)? (4) What factors affect the impact of evidence-informed practice and evidence-based practice educational interventions (as measured by, e.g., course content, mode of delivery, multifaceted interventions, standalone intervention)? SEARCH METHODS We utilized a number of search strategies to identify published and unpublished studies: (1) Electronic databases: we searched Academic Search Complete, Academic search premier, AMED, Australian education index, British education index, Campbell systematic reviews, Canada bibliographic database (CBCA Education), CINAHL, Cochrane Library, Database of Abstracts of Reviews on Effectiveness, Dissertation Abstracts International, Education Abstracts, Education complete, Education full text: Wilson, ERIC, Evidence-based program database, JBI database of systematic reviews, Medline, PsycInfo, Pubmed, SciELO (Scientific Electronic Library Online), and Scopus; (2) A web search using search engines such as Google and Google scholar; (3) Grey literature search: we searched OpenGrey (System for Information on Grey Literature in Europe), System for information on Grey Literature, the Society for Research on Educational Effectiveness, and Virginia Henderson Global Nursing e-Repository; (4) Hand searching of journal articles; and (5) Tracking bibliographies of previously retrieved studies. The searches were conducted in June 2019. SELECTION CRITERIA We planned to include both quantitative (including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies) and qualitative primary studies (including, case series, individual case reports, and descriptive cross-sectional studies, focus groups, and interviews, ethnography, phenomenology, and grounded theory), that evaluate and compare the effectiveness of any formal evidence-informed practice educational intervention to evidence-based practice educational intervention. The primary outcomes were evidence-informed practice and evidence-based practice knowledge, attitudes, understanding, and behavior. We planned to include, as participants, undergraduate pre-registration health and social care students from any geographical area. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full-text of selected articles. Discrepancies were resolved through discussion or consultation with a third author. We found no article eligible for inclusion in this review. MAIN RESULTS No studies were found which were eligible for inclusion in this review. We evaluated and excluded 46 full-text articles. This is because none of the 46 studies had evaluated and compared the effectiveness of evidence-informed practice educational interventions with evidence-based practice educational interventions. Out of the 46 articles, 45 had evaluated solely, the effectiveness of evidence-based practice educational interventions and 1 article was on evidence-informed practice educational intervention. Hence, these articles were excluded as they did not meet the inclusion criteria. AUTHORS' CONCLUSIONS There is an urgent need for primary studies evaluating the relative effectiveness of evidence-informed practice and evidence-based practice educational interventions targeted at improving undergraduate healthcare students' competencies regarding the application of evidence into practice. Such studies should be informed by current literature on the concepts (i.e., evidence-informed practice and evidence-based practice) to identify the differences, similarities, as well as appropriate content of the educational interventions. In this way, the actual effect of each of the concepts could be determined and their effectiveness compared.
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Affiliation(s)
| | - Robert McSherry
- Faculty of Health and Social CareUniversity of ChesterChesterUK
| | | | - Paul van Schaik
- School of Social Sciences, Humanities and LawTeesside UniversityMiddlesbroughUK
| | - Sharon Hamilton
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Julie Hogg
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Vicki Whittaker
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
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The Challenge of Conducting Research in the Neonatal and Pediatric Age and of Translating Results Into Clinical Practice. Crit Care Med 2022; 50:165-168. [PMID: 34914650 DOI: 10.1097/ccm.0000000000005192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Howie AH, Klar N, Nash DM, Reid JN, Zwarenstein M. Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651]. BMC FAMILY PRACTICE 2021; 22:243. [PMID: 34895165 PMCID: PMC8666060 DOI: 10.1186/s12875-021-01592-9] [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: 07/14/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022]
Abstract
Background Printed educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications. Methods A pragmatic, 2 × 2 factorial, cluster randomized controlled trial was designed to ascertain the effect of two PEM formats on physician prescribing: a postcard-sized message (“outsert”) or a longer narrative article (“insert”). Ontario family physician practices (clusters) were randomly allocated to receive the insert, outsert, both or neither. Physicians were eligible if they were in active practice and their patients were included if they were over 65 years with a diabetes diagnosis; both were unaware of the trial. Administrative databases at ICES (formerly the Institute for Clinical Evaluative Sciences) were used to link patients to their physician and to analyse prescribing patterns at baseline and 1 year following PEM mailout. The primary outcome was intensification defined as the addition of a new antihypertensive or cholesterol-lowering agent, or dose increase of a current drug, measured at the patient level. Analyses were by intention-to-treat and accounted for the clustering of patients to physicians. Results We randomly assigned 4231 practices (39% of Ontario family physicians) with a total population of 185,526 patients (20% of patients with diabetes in Ontario primary care) to receive the insert, outsert, both, and neither; among these, 4118 practices were analysed (n = 1025, n = 1037, n = 1031, n = 1025, respectively). No significant treatment effect was found for the outsert (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.98 to 1.04) or the insert (OR 0.99, 95% CI 0.96 to 1.02). Percent of intensification in the four arms was similar (approximately 46%). Adjustment for physician characteristics (e.g., age, sex, practice location) had no impact on these findings. Conclusions PEMs have no effect on physician’s adherence to recommendations for the management of diabetes-related complications in Ontario. Further research should investigate the effect of other strategies to narrow this evidence-to-practice gap. Trial registration ISRCTN72772651. Retrospectively registered 21 July 2005. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01592-9.
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Affiliation(s)
- Alison H Howie
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada
| | - Danielle M Nash
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.,ICES, Toronto, ON, Canada
| | | | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, 1465 Richmond St., London, ON, N6G 2M1, Canada.,ICES, Toronto, ON, Canada.,Department of Family Medicine, Western Centre for Public Health and Family Medicine, 1465 Richmond St, London, ON, N6G 2M1, Canada
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Melchiorre MG, Papa R, Quattrini S, Lamura G, Barbabella F. Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9025326. [PMID: 32337283 PMCID: PMC7168691 DOI: 10.1155/2020/9025326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/07/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. MATERIALS AND METHODS In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). RESULTS 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. CONCLUSIONS Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.
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Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Roberta Papa
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Sabrina Quattrini
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - on behalf of ICARE4EU Consortium
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
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Foster A, Croot L, Brazier J, Harris J, O'Cathain A. The facilitators and barriers to implementing patient reported outcome measures in organisations delivering health related services: a systematic review of reviews. J Patient Rep Outcomes 2018; 2:46. [PMID: 30363333 PMCID: PMC6170512 DOI: 10.1186/s41687-018-0072-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background There is increasing interest in using Patient Reported Outcome Measures (PROMs) within organisations delivering health related services. However, organisations have had mixed success in implementing PROMs and there is little understanding about why this may be. Thus, the purpose of this study was to identify the facilitators and barriers to implementing PROMs in organisations. Method A systematic review of reviews was undertaken. Searches were conducted of five electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews, during the week of the 20th February 2017. Additional search methods included website searching and reference checking. To be included, a publication had to be a review of the literature, describe its methods and include information related to implementing PROMs. The reviews were extracted using a standardised form and assessed for their risk of bias using the Risk of Bias in Systematic Reviews tool. The findings were synthesised using the Consolidated Framework for Implementation Research. The protocol was registered on the International Prospective Register of Systematic Reviews database (PROSPERO) (CRD42017057491). Results Initially 2047 records were identified. After assessing eligibility, six reviews were included. These reviews varied in their review type and focus. Different issues arose at distinct stages of the implementation process. Organisations needed to invest time and resources in two key stages early in the implementation process: ‘designing’ the processes for using PROMs within an organisation; and ‘preparing’ an organisation and its staff. The ‘designing’ stage involved organisations planning not just which PROMs to use and how to administer them, but also how the data would be used for clinical purposes. The ‘preparing’ stage involved getting an organisation and its staff ready to use PROMs, particularly persuading clinicians of the validity and value of PROMs, delivering training, and developing electronic systems. Having an implementation lead overseeing the process and developing the process based on feedback were also identified as facilitating implementation. Conclusion Organisations implementing PROMs need to invest time and resources in ‘designing’ the PROMs strategy and ‘preparing’ the organisation to use PROMs. Focusing on these earlier stages may prevent problems arising when PROMs are used in practice. Electronic supplementary material The online version of this article (10.1186/s41687-018-0072-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexis Foster
- School of Health and Related Research, University of Sheffield, Regents Court, Regents Street, S1 4DA, Sheffield, UK
| | - Liz Croot
- School of Health and Related Research, University of Sheffield, Regents Court, Regents Street, S1 4DA, Sheffield, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Regents Court, Regents Street, S1 4DA, Sheffield, UK
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Regents Court, Regents Street, S1 4DA, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Regents Court, Regents Street, S1 4DA, Sheffield, UK
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Cowie J, Campbell P, Dimova E, Nicoll A, Duncan EAS. Improving the sustainability of hospital-based interventions: a study protocol for a systematic review. BMJ Open 2018; 8:e025069. [PMID: 30185584 PMCID: PMC6129084 DOI: 10.1136/bmjopen-2018-025069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sustaining effective interventions in hospital environments is essential to improving health outcomes, and reducing research waste. Current evidence suggests many interventions are not sustained beyond their initial delivery. The reason for this failure remains unclear. Increasingly research is employing theoretical frameworks and models to identify critical factors that influence the implementation of interventions. However, little is known about the value of these frameworks on sustainability. The aim of this review is to examine the evidence regarding the use of theoretical frameworks to maximise effective intervention sustainability in hospital-based settings in order to better understand their role in supporting long-term intervention use. METHODS AND ANALYSIS Systematic review. We will systematically search the following databases: Medline, AMED, CINAHL, Embase and Cochrane Library (CENTRAL, CDSR, DARE, HTA). We will also hand search relevant journals and will check the bibliographies of all included studies. Language and date limitations will be applied. We will include empirical studies that have used a theoretical framework (or model) and have explicitly reported the sustainability of an intervention (or programme). One reviewer will remove obviously irrelevant titles. The remaining abstracts and full-text articles will be screened by two independent reviewers to determine their eligibility for inclusion. Disagreements will be resolved by discussion, and may involve a third reviewer if required. Key study characteristics will be extracted (study design, population demographics, setting, evidence of sustained change, use of theoretical frameworks and any barriers or facilitators data reported) by one reviewer and cross-checked by another reviewer. Descriptive data will be tabulated within evidence tables, and key findings will be brought together within a narrative synthesis. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data will be collected. Dissemination of results will be through peer-reviewed journal publications, presentation at an international conference and social media. PROSPERO REGISTRATION NUMBER CRD42017081992.
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Affiliation(s)
- Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHPRU), Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHPRU), Glasgow Caledonian University, Glasgow, UK
| | - Elena Dimova
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Avril Nicoll
- Nursing Midwifery and Allied Health Professions Research Unit (NMAHPRU), University of Stirling, Stirling, UK
| | - Edward A S Duncan
- Nursing Midwifery and Allied Health Professions Research Unit (NMAHPRU), University of Stirling, Stirling, UK
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Lansbury LN, Roberts HC, Clift E, Herklots A, Robinson N, Sayer AA. Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care. Br J Gen Pract 2017; 67:e751-e756. [PMID: 28947622 PMCID: PMC5647918 DOI: 10.3399/bjgp17x693089] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/14/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Identifying frailty is key to providing appropriate treatment for older people at high risk of adverse health outcomes. Screening tools proposed for primary care often involve additional workload. The electronic Frailty Index (eFI) has the potential to overcome this issue. AIM To assess the feasibility and acceptability of using the eFI in primary care. DESIGN AND SETTING Pilot study in one suburban primary care practice in southern England in 2016. METHOD Use of the eFI on the primary care TPP SystmOne database was explained to staff at the practice where a comprehensive geriatric assessment (CGA) clinic was being trialled. The practice data manager ran an eFI report for all patients (n = 6670). Date of birth was used to identify patients aged ≥75 years (n = 589). The eFI was determined for patients attending the CGA clinic (n = 18). RESULTS Practice staff ran the eFI reports in 5 minutes, which they reported was feasible and acceptable. The eFI range was 0.03 to 0.61 (mean 0.23) for all patients aged ≥75 years (mean 83 years, range 75 to 102 years). For CGA patients (mean 82 years, range 75 to 94 years) the eFI range was 0.19 to 0.53 (mean 0.33). Importantly, the eFI scores identified almost 12% of patients aged ≥75 years in this practice to have severe frailty. CONCLUSION It was feasible and acceptable to use the eFI in this pilot study. A higher mean eFI in the CGA patients demonstrated construct validity for frailty identification. Practice staff recognised the potential for the eFI to identify the top 2% of vulnerable patients for avoiding unplanned admissions.
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Affiliation(s)
- Lynn N Lansbury
- Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton
| | - Helen Clare Roberts
- Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, and University Hospital Southampton NHS Foundation Trust, Southampton
| | - Esther Clift
- Health Education England (Wessex), Faculty of Health Sciences, University of Southampton, Southampton
| | | | | | - Avan A Sayer
- National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre, and professor of geriatric medicine, Academic Geriatric Medicine, NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, Ageing, Geriatrics and Epidemiology, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, and National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle upon Tyne NHS Foundation Trust and Newcastle University, Newcastle upon Tyne
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Mauco KL, Scott RE, Mars M. Critical analysis of e-health readiness assessment frameworks: suitability for application in developing countries. J Telemed Telecare 2016; 24:110-117. [PMID: 28008790 DOI: 10.1177/1357633x16686548] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction e-Health is an innovative way to make health services more effective and efficient and application is increasing worldwide. e-Health represents a substantial ICT investment and its failure usually results in substantial losses in time, money (including opportunity costs) and effort. Therefore it is important to assess e-health readiness prior to implementation. Several frameworks have been published on e-health readiness assessment, under various circumstances and geographical regions of the world. However, their utility for the developing world is unknown. Methods A literature review and analysis of published e-health readiness assessment frameworks or models was performed to determine if any are appropriate for broad assessment of e-health readiness in the developing world. A total of 13 papers described e-health readiness in different settings. Results and Discussion Eight types of e-health readiness were identified and no paper directly addressed all of these. The frameworks were based upon varying assumptions and perspectives. There was no underlying unifying theory underpinning the frameworks. Few assessed government and societal readiness, and none cultural readiness; all are important in the developing world. While the shortcomings of existing frameworks have been highlighted, most contain aspects that are relevant and can be drawn on when developing a framework and assessment tools for the developing world. What emerged is the need to develop different assessment tools for the various stakeholder sectors. This is an area that needs further research before attempting to develop a more generic framework for the developing world.
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Affiliation(s)
- Kabelo Leonard Mauco
- 1 Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,2 Boitekanelo College, Gaborone, Botswana
| | - Richard E Scott
- 1 Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,3 NT Consulting, Global e-Health Inc, Calgary, AB, Canada
| | - Maurice Mars
- 1 Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa
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Hurley DA, Murphy LC, Hayes D, Hall AM, Toomey E, McDonough SM, Lonsdale C, Walsh NE, Guerin S, Matthews J. Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS). Implement Sci 2016; 11:56. [PMID: 27113575 PMCID: PMC4845501 DOI: 10.1186/s13012-016-0418-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/05/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice. This study describes the use of intervention mapping (IM) in the design of a theory-driven, group-based complex intervention to support self-management (SM) of patients with osteoarthritis (OA) and chronic low back pain (CLBP) in Ireland's primary care health system. METHODS The six steps of the IM protocol were systematically applied to develop the self-management of osteoarthritis and low back pain through activity and skills (SOLAS) intervention through adaptation of the Facilitating Activity and Self-management in Arthritis (FASA) intervention. A needs assessment including literature reviews, interviews with patients and physiotherapists and resource evaluation was completed to identify the programme goals, determinants of SM behaviour, consolidated definition of SM and required adaptations to FASA to meet health service and patient needs and the evidence. The resultant SOLAS intervention behavioural outcomes, performance and change objectives were specified and practical application methods selected, followed by organised programme, adoption, implementation and evaluation plans underpinned by behaviour change theory. RESULTS The SOLAS intervention consists of six weekly sessions of 90-min education and exercise designed to increase participants' physical activity level and use of evidence-based SM strategies (i.e. pain self-management, pain coping, healthy eating for weight management and specific exercise) through targeting of individual determinants of SM behaviour (knowledge, skills, self-efficacy, fear, catastrophizing, motivation, behavioural regulation), delivered by a trained physiotherapist to groups of up to eight individuals using a needs supportive interpersonal style based on self-determination theory. Strategies to support SOLAS intervention adoption and implementation included a consensus building workshop with physiotherapy stakeholders, development of a physiotherapist training programme and a pilot trial with physiotherapist and patient feedback. CONCLUSIONS The SOLAS intervention is currently being evaluated in a cluster randomised controlled feasibility trial. IM is a time-intensive collaborative process, but the range of methods and resultant high level of transparency is invaluable and allows replication by future complex intervention and trial developers.
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Affiliation(s)
- Deirdre A. Hurley
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Laura Currie Murphy
- Breast-Predict-Collaborative Cancer Research Centre, Pharmacology and Therapeutics, Trinity College Dublin, St James’s Hospital, Dublin 8, Ireland
| | - David Hayes
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Amanda M. Hall
- The George Institute for Global Health, Oxford Martin School, Oxford University, Oxford, UK
| | - Elaine Toomey
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Suzanne M. McDonough
- Institute of Nursing and Health Research, Jordanstown Campus, Ulster University, Antrim, BT37 0QB UK
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, 25A Barker Road, Strathfield, NSW 2135 Australia
| | - Nicola E. Walsh
- Faculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, BS16 1DD UK
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | - James Matthews
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E. Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci 2016; 11:40. [PMID: 27001107 PMCID: PMC4802575 DOI: 10.1186/s13012-016-0396-4] [Citation(s) in RCA: 280] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background This study is to identify, summarise and synthesise literature on the causes of the evidence to practice gap for complex interventions in primary care. Design This study is a systematic review of reviews. Methods MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from inception to December 2013. Eligible reviews addressed causes of the evidence to practice gap in primary care in developed countries. Data from included reviews were extracted and synthesised using guidelines for meta-synthesis. Results Seventy reviews fulfilled the inclusion criteria and encompassed a wide range of topics, e.g. guideline implementation, integration of new roles, technology implementation, public health and preventative medicine. None of the included papers used the term “cause” or stated an intention to investigate causes at all. A descriptive approach was often used, and the included papers expressed “causes” in terms of “barriers and facilitators” to implementation. We developed a four-level framework covering external context, organisation, professionals and intervention. External contextual factors included policies, incentivisation structures, dominant paradigms, stakeholders’ buy-in, infrastructure and advances in technology. Organisation-related factors included culture, available resources, integration with existing processes, relationships, skill mix and staff involvement. At the level of individual professionals, professional role, underlying philosophy of care and competencies were important. Characteristics of the intervention that impacted on implementation included evidence of benefit, ease of use and adaptability to local circumstances. We postulate that the “fit” between the intervention and the context is critical in determining the success of implementation. Conclusions This comprehensive review of reviews summarises current knowledge on the barriers and facilitators to implementation of diverse complex interventions in primary care. To maximise the uptake of complex interventions in primary care, health care professionals and commissioning organisations should consider the range of contextual factors, remaining aware of the dynamic nature of context. Future studies should place an emphasis on describing context and articulating the relationships between the factors identified here. Systematic review registration PROSPERO CRD42014009410 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0396-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosa Lau
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Fiona Stevenson
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Anne Rogers
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | | | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E. Achieving change in primary care--effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews. BMJ Open 2015; 5:e009993. [PMID: 26700290 PMCID: PMC4691771 DOI: 10.1136/bmjopen-2015-009993] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care. DESIGN Systematic review of reviews. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from first publication until December 2013; the bibliographies of relevant articles were screened for additional reports. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligible reviews had to (1) examine effectiveness of single or multifaceted implementation strategies, (2) measure health professional practice or process outcomes and (3) include studies from predominantly primary care in developed countries. Two reviewers independently screened titles/abstracts and full-text articles of potentially eligible reviews for inclusion. DATA SYNTHESIS Extracted data were synthesised using a narrative approach. RESULTS 91 reviews were included. The most commonly evaluated strategies were those targeted at the level of individual professionals, rather than those targeting organisations or context. These strategies (eg, audit and feedback, educational meetings, educational outreach, reminders) on their own demonstrated a small to modest improvement (2-9%) in professional practice or behaviour with considerable variability in the observed effects. The effects of multifaceted strategies targeted at professionals were mixed and not necessarily more effective than single strategies alone. There was relatively little review evidence on implementation strategies at the levels of organisation and wider context. Evidence on cost-effectiveness was limited and data on costs of different strategies were scarce and/or of low quality. CONCLUSIONS There is a substantial literature on implementation strategies aimed at changing professional practices or behaviour. It remains unclear which implementation strategies are more likely to be effective than others and under what conditions. Future research should focus on identifying and assessing the effectiveness of strategies targeted at the wider context and organisational levels and examining the costs and cost-effectiveness of implementation strategies. PROSPERO REGISTRATION NUMBER CRD42014009410.
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Affiliation(s)
- Rosa Lau
- eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care Sciences and Health Sciences, Keele University, Keele, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Scotland, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton,UK
| | - Anne Kennedy
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Derby, UK
| | - Anne Rogers
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | | | - Elizabeth Murray
- eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
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Martín Cantera C, Puigdomènech E, Ballvé JL, Arias OL, Clemente L, Casas R, Roig L, Pérez-Tortosa S, Díaz-Gete L, Granollers S. Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review. BMJ Open 2015; 5:e008807. [PMID: 26428333 PMCID: PMC4606220 DOI: 10.1136/bmjopen-2015-008807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. DESIGN A systematic review of randomised and non-randomised controlled trials was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. METHODS We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. RESULTS Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. CONCLUSIONS Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.
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Affiliation(s)
- Carlos Martín Cantera
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Puigdomènech
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jose Luis Ballvé
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Lucía Arias
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ramon Casas
- Centre d'Atenció Primària (CAP) Sant Antoni, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Lydia Roig
- Centre d'Atenció Primària (CAP) La Garriga, Institut Català de la Salut (ICS), La Garriga, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Spain
| | - Santiago Pérez-Tortosa
- Centre d'Atenció Primària (CAP) La Llagosta, Institut Català de la Salut (ICS), La Llagosta, Spain
| | - Laura Díaz-Gete
- Centre d'Atenció Primària (CAP) la Sagrera, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sílvia Granollers
- Centre d'Atenció Primària (CAP) Esplugues de Llobregat, Institut Català de la Salut (ICS), Esplugues de Llobregat, Spain
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Ross J, Stevenson F, Lau R, Murray E. Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews. BMJ Open 2015; 5:e006773. [PMID: 25869685 PMCID: PMC4401858 DOI: 10.1136/bmjopen-2014-006773] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is great potential for e-health to deliver cost-effective, quality healthcare and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, the literature often describes problematic and unsuccessful attempts to implement these new technologies into routine clinical practice. To understand and address the challenges of implementing e-health, a systematic review was conducted in 2009, which identified several conceptual barriers and facilitators to implementation. As technology is rapidly changing and new e-health solutions are constantly evolving to meet the needs of current practice, an update of this review is deemed necessary to understand current challenges to the implementation of e-health. This research aims to identify, summarise and synthesise currently available evidence, by undertaking a systematic review of reviews to explore the barriers and facilitators to implementing e-health across a range of healthcare settings. METHODS AND ANALYSIS This is a protocol for an update of a systematic review of reviews. We will search MEDLINE, EMBASE, CINAHL, PSYCINFO and The Cochrane Library for studies published between 2009 and 2014. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on the implementation of e-health technologies. Data from eligible reviews will be extracted using a data abstraction form. A thematic analysis of barriers and facilitators to e-health implementation will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required. The permission of the original authors to update the review was sought and granted. TRIAL REGISTRATION NUMBER PROSPERO CRD42015017661.
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Affiliation(s)
- Jamie Ross
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rosa Lau
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, UK
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