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Brandt SK, Essig S, Balthasar A. Professional beliefs of physicians and allied health professionals and their willingness to promote health in primary care: a cross-sectional survey. BMC PRIMARY CARE 2024; 25:188. [PMID: 38802787 PMCID: PMC11129482 DOI: 10.1186/s12875-024-02412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Primary care professionals could play a key role in health promotion implementation. A fundamental aspect that might affect the willingness of primary care professionals to strengthen health promotion, and about which we do not yet know much, are professional beliefs. Therefore, we conducted a quantitative survey to (1) compare professional beliefs and the willingness to work more in health promotion between five major primary care professions, and (2) investigate associations between professional beliefs and the willingness to work more in health promotion. METHODS A large-scale cross-sectional study based on a nation-wide web-based survey of primary care professionals in Switzerland was conducted from January to July 2022. The survey was addressed to pharmacists, physicians, medical practice assistants, nurses, and physiotherapists working in primary care in Switzerland. Differences between groups were tested using T-tests and Chi-square tests. Multivariable logistic regression analyses were used to evaluate the association between variables related to professional beliefs and the willingness to work more in health promotion. RESULTS The responses of 4'063 primary care professionals were used for analysis. Most primary care professionals revealed a salutogenetic attitude towards their primary care tasks. Members of all professions showed high awareness of their tasks in tackling increased risks of disease (80.2% of all participants). Especially allied health professionals wished to see a greater role of prevention in primary care (pharmacists: 72.4%, medical practice assistants: 63.9%, nurses: 75.6%, physiotherapists: 73.9% versus physicians: 46.9%). All professional groups showed a high willingness to work more in health promotion (88% of all participants). Salutogenetic beliefs of primary care professionals and their willingness to work more in health promotion are strongly associated. Participants agreeing that health promotion should play a greater role or that preventive consultations should be offered in primary care, are more willing to work more in health promotion compared to participants who disagree with these ideas. CONCLUSIONS Both affiliation to allied primary care professions and salutogenetic professional beliefs are associated with higher willingness to work more in health promotion. The high willingness provides evidence of a large, yet untapped potential. Promoting salutogenetic beliefs might further increase the willingness to engage in health promotion.
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Affiliation(s)
| | - Stefan Essig
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Interface Policy Studies Research Consulting, Lucerne, Switzerland
| | - Andreas Balthasar
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Isojima S, Yajima N, Yanai R, Miura Y, Fukuma S, Kaneko K, Fujio K, Oku K, Matsushita M, Miyamae T, Wada T, Tanaka Y, Kaneko Y, Nakajima A, Murashima A. Physician approval for pregnancy in patients with systemic lupus erythematosus showing only serological activity: A vignette survey study. Mod Rheumatol 2024; 34:509-514. [PMID: 37243689 DOI: 10.1093/mr/road049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The European League Against Rheumatism recommends that the disease activity of systemic lupus erythematosus should be stable before pregnancy because complications and disease flares increase if pregnancy occurs while disease activity is high. However, some patients have ongoing serological activity even after treatment. Herein, we investigated how physicians decide on the acceptability of pregnancy in patients showing only serological activity. METHODS A questionnaire was administered from December 2020 to January 2021. It included the characteristics of physicians, facilities, and the allowance for pregnancies of patients using vignette scenarios. RESULTS The questionnaire was distributed to 4946 physicians, and 9.4% responded. The median age of respondents was 46 years, and 85% were rheumatologists. Pregnancy allowance was significantly affected by the duration of the stable period and status of serological activity [duration: proportion difference 11.8 percentage points (p.p.), P < .001; mild activity: proportion difference -25.8 p.p., P < .001; high activity: proportion difference -65.6 p.p., P < .001]. For patients with high-level serological activity, 20.5% of physicians allowed pregnancy if there were no clinical symptoms for 6 months. CONCLUSIONS Serological activity had a significant effect on the acceptability of pregnancy. However, some physicians allowed patients with serological activity alone to become pregnant. Further observational studies are required to clarify such prognoses.
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Affiliation(s)
- Sakiko Isojima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoko Miura
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kayoko Kaneko
- Division of Maternal Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masakazu Matsushita
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Tsu, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Lioté F, Constantin A, Dahan É, Quiniou JB, Frazier A, Sibilia J. A prospective survey on therapeutic inertia in psoriatic arthritis (OPTI'PsA). Rheumatology (Oxford) 2024; 63:516-524. [PMID: 37261843 PMCID: PMC10836978 DOI: 10.1093/rheumatology/kead262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/27/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES Clinical inertia, or therapeutic inertia (TI), is the medical behaviour of not initiating or intensifying treatment when recommended by clinical recommendations. To our knowledge, our survey is the first to assess TI around psoriatic arthritis (PsA). METHODS Eight hundred and twenty-five French rheumatologists were contacted via email between January and March 2021 and invited to complete an online questionnaire consisting of seven clinical vignettes: five cases ('oligoarthritis', 'enthesitis', 'polyarthritis', 'neoplastic history', 'cardiovascular risk') requiring treatment OPTImization, and two 'control' cases (distal interphalangeal arthritis, atypical axial involvement) not requiring any change of treatment-according to the most recent PsA recommendations. Rheumatologists were also questioned about their routine practice, continuing medical education and perception of PsA. RESULTS One hundred and one rheumatologists completed this OPTI'PsA survey. Almost half the respondents (47%) demonstrated TI on at least one of the five vignettes that warranted treatment optimization. The complex profiles inducing the most TI were 'oligoarthritis' and 'enthesitis' with 20% and 19% of respondents not modifying treatment, respectively. Conversely, clinical profiles for which there was the least uncertainty ('polyarthritis in relapse', 'neoplastic history' and 'cardiovascular risk') generated less TI with 11%, 8% and 6% of respondents, respectively, choosing not to change the current treatment. CONCLUSION The rate of TI we observed for PsA is similar to published data for other chronic diseases such as diabetes, hypertension, gout or multiple sclerosis. Our study is the first to show marked clinical inertia in PsA, and further research is warranted to ascertain the reasons behind this inertia.
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Affiliation(s)
- Frédéric Lioté
- Université Paris Cité, UFR de Médecine, Paris, France
- Rheumatology Department & INSERM U1132 Bioscar, Viggo Petersen Centre, Lariboisière Hospital, Paris, France
| | - Arnaud Constantin
- Rheumatology Department, Pierre-Paul Riquet Hospital, Toulouse, France
- Université Toulouse III—Paul Sabatier & INSERM, 1291 Infinity, Toulouse, France
| | - Étienne Dahan
- Rheumatology Department, UF 6501, Hautepierre Hospital, CHU Strasbourg, France
| | | | - Aline Frazier
- Rheumatology Department & INSERM U1132 Bioscar, Viggo Petersen Centre, Lariboisière Hospital, Paris, France
| | - Jean Sibilia
- Rheumatology Department, National Reference Centre for Rare Systemic Auto-immune Diseases East-South-West (RESO), CHU Strasbourg, France
- Molecular Immuno-Rhumatology Laboratory, GENOMAX platform, INSERM UMR-S1109, Faculty of Medicine, Interdisciplinary Thematic Institute (ITI) of Precision Medicine of Strasbourg, Transplantex NG, Federation of Translational Medicine of Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
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Payton KSE, Gould JB. Vignette Research Methodology: An Essential Tool for Quality Improvement Collaboratives. Healthcare (Basel) 2022; 11:7. [PMID: 36611468 PMCID: PMC9818599 DOI: 10.3390/healthcare11010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, some practice variation is due to the individual preference or style of the clinicians. Quality improvement collaboratives are commonly used to disseminate quality care on a wide scale. Practice variation is a notable barrier to any quality improvement effort. A detailed and accurate understanding of practice variation can help optimize the quality improvement efforts. The traditional survey methods do not capture the complex nuances of practice variation. Vignette methods have been shown to accurately measure the actual practice variation and quality of care delivered by clinicians. Vignette methods are cost-effective relative to other methods of measuring quality of care. This review describes our experience and lessons from implementing vignette research methods in quality improvement collaboratives in California neonatal intensive care units. Vignette methodology is an ideal tool to address practice variation in quality improvement collaboratives, actively engage a large number of participants, and support more evidence-based practice to improve outcomes.
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Affiliation(s)
- Kurlen S E Payton
- Cedars-Sinai Medical Center, Department of Pediatrics, Division of Neonatology, Los Angeles, CA 90048, USA
- California Perinatal Quality Care Collaborative, Stanford, CA 94305, USA
| | - Jeffrey B Gould
- California Perinatal Quality Care Collaborative, Stanford, CA 94305, USA
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA 94305, USA
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Rousseau A, Azria E, Baumann S, Deneux‐Tharaux C, Senat MV. Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth. BJOG 2019; 127:467-476. [DOI: 10.1111/1471-0528.16039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Affiliation(s)
- A Rousseau
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
- EA 7285 Versailles Saint Quentin University Montigny le Bretonneux France
| | - E Azria
- Maternity Unit Notre Dame de Bon Secours Paris Saint Joseph Hospital Paris Descartes University Paris France
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - S Baumann
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
| | - C Deneux‐Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - MV Senat
- Department of Obstetrics and Gynaecology Bicêtre Hospital AP‐HP Kremlin Bicêtre France
- Paris Sud Paris Saclay University Le Kremlin Bicêtre France
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Rousseau A, Rozenberg P, Perrodeau E, Ravaud P. Variation in severe postpartum hemorrhage management: A national vignette-based study. PLoS One 2018; 13:e0209074. [PMID: 30543683 PMCID: PMC6292622 DOI: 10.1371/journal.pone.0209074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess variations in management of severe postpartum hemorrhage: 1) between obstetricians in the same situation 2) by the same obstetrician in different situations. STUDY DESIGN A link to a vignette-based survey was emailed to obstetricians of 215 maternity units; the questionnaire asked them to report how they would manage the PPH described in 2 previously validated case-vignettes of different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. Variations in PPH were assessed in a descriptive analysis; agreement about management and its timing between vignette 1 and vignette 2 was assessed with the Kappa coefficient. RESULTS Analysis of complete responses from 119 (43.4%) obstetricians from 53 (24.6%) maternity units showed delayed or inadequate management in both vignettes. While 82.3% and 83.2% of obstetricians (in vignettes 1 and 2, respectively) would administer oxytocin 15 minutes after PPH diagnosis, only 52.9% and 29.4% would alert other team members. Management by obstetricians of the two vignette situations was inconsistent in terms of choice of treatment and timing of almost all treatments. CONCLUSION Case vignettes demonstrated inadequate management as well as variations in management between obstetricians and in different PPH situations. Protocols or procedures are necessary in all maternity units to reduce the variations in practices that may explain a part of the delay in management that leads to PPH-related maternal mortality and morbidity.
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Affiliation(s)
- Anne Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Research Unit EA 7285, Versailles-St Quentin University, Saint Quentin en Yvelines, France
| | - Elodie Perrodeau
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - Philippe Ravaud
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Variation in the Reported Management of Canine Prolapsed Nictitans Gland and Feline Herpetic Keratitis. Vet Sci 2018; 5:vetsci5020054. [PMID: 29865183 PMCID: PMC6024657 DOI: 10.3390/vetsci5020054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/09/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022] Open
Abstract
Treatment variation in medicine may be driven by evidence gaps, clinician factors, and patient preferences. Although well-documented in human medicine, variation in clinical management is relatively unexplored in veterinary practice. Clinical vignette questionnaires were administered to a cross section of general practitioners (GPs) and veterinarians with postgraduate training in ophthalmology (PGs) to survey recommended management of canine prolapsed nictitans gland (“cherry eye”, PNG) and feline herpesvirus (FHV-1) keratitis. The majority of veterinarians (96.2%) suggested surgical replacement of cherry eye, with a pocketing technique being the most frequently nominated procedure. GPs were more likely to suggest gland excision in the event of surgical failure, while PGs more frequently nominated techniques incorporating a periosteal anchor for salvage repair. Most respondents managed FHV-1 keratitis with topical antibiotics (76.4%), with a minority suggesting topical antivirals (32.2%). GPs favoured topical acyclovir whilst PGs more frequently recommended topical trifluorothymidine. A significantly larger proportion of PGs nominated systemic famciclovir and lysine supplement for FHV-1 keratitis. This survey revealed moderate treatment variation for these conditions, both between and within practitioner groups. Additional research is needed to assess the reasons for this variation, particularly for conditions in which high quality evidence is scant.
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White CN, Downes MJ, Jones G, Wigfall C, Dean RS, Brennan ML. Use of clinical vignette questionnaires to investigate the variation in management of keratoconjunctivitis sicca and acute glaucoma in dogs. Vet Rec 2017; 182:21. [PMID: 29275324 DOI: 10.1136/vr.104390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 10/17/2017] [Accepted: 11/02/2017] [Indexed: 02/03/2023]
Abstract
There is little peer-reviewed research assessing therapeutic effectiveness in canine eye disease. Current treatments used in first opinion and ophthalmology referral practices are also somewhat poorly documented. The aim of this study was to investigate the current management of canine keratoconjunctivitis sicca (KCS) and acute primary angle-closure glaucoma (PACG) by veterinary surgeons. Questionnaires using clinical vignettes were administered to a cross section of general practitioners ('GPs') and veterinarians engaged in or training for postgraduate ophthalmology practice ('PGs'). Similar treatment recommendations for KCS (topical cyclosporine, lubricant, antibiotic) were given by both groups of veterinarians with the single exception of increased topical antibiotic use by GPs. Treatment of acute glaucoma diverged between groups: PGs were much more likely to recommend topical prostaglandin analogues and a wider array of both topical and systemic treatments were recommended by both groups. Systemic ocular hypotensive agents were suggested infrequently. Our results suggest that treatments may vary substantially in ocular conditions, particularly in conditions for which neither guidelines nor high-quality evidence exists. This study highlights the need for novel strategies to address evidence gaps in veterinary medicine, as well as for better evaluation and dissemination of current treatment experience.
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Affiliation(s)
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
| | | | | | - Rachel S Dean
- School of Veterinary Medicine and Science, Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, UK
| | - Marnie L Brennan
- School of Veterinary Medicine and Science, Centre for Evidence-based Veterinary Medicine, University of Nottingham, Loughborough, UK
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Saillour-Glénisson F, Kret M, Domecq S, Sibé M, Daucourt V, Migeot V, Veillard D, Michel P. Organizational and managerial factors associated with clinical practice guideline adherence: a simulation-based study in 36 French hospital wards. Int J Qual Health Care 2017; 29:579-586. [DOI: 10.1093/intqhc/mzx074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/04/2017] [Indexed: 11/14/2022] Open
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Eskeland SL, Brunborg C, Rueegg CS, Aabakken L, de Lange T. Assessment of the effect of an Interactive Dynamic Referral Interface (IDRI) on the quality of referral letters from general practitioners to gastroenterologists: a randomised cross-over vignette trial. BMJ Open 2017; 7:e014636. [PMID: 28667208 PMCID: PMC5734248 DOI: 10.1136/bmjopen-2016-014636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We evaluated whether interactive, electronic, dynamic, diagnose-specific checklists improve the quality of referral letters in gastroenterology and assessed the general practitioners' (GPs') acceptance of the checklists. DESIGN Randomised cross-over vignette trial. SETTING Primary care in Norway. PARTICIPANTS 25 GPs. INTERVENTION The GPs participated in the trial and were asked to refer eight clinical vignettes in an internet-based electronic health record simulator. A referral support, consisting of dynamic diagnose-specific checklists, was created for the generation of referral letters to gastroenterologists. The GPs were randomised to refer the eight vignettes with or without the checklists. After a minimum of 3 months, they repeated the referral process with the alternative method. MAIN OUTCOME MEASURES Difference in quality of the referral letters between referrals with and without checklists, measured with an objective Thirty Point Score (TPS).Difference in variance in the quality of the referral letters and GPs' acceptance of the electronic dynamic user interface. RESULTS The mean TPS was 15.2 (95% CI 13.2 to 16.3) and 22.0 (95% CI 20.6 to 22.8) comparing referrals without and with checklist assistance (p<0.001), respectively. The coefficient of variance was 23.3% for the checklist group and 39.6% for the non-checklist group. Two-thirds (16/24) of the GPs thought they had included more relevant information in the referrals with checklists, and considered implementing this type of checklists in their clinical practices, if available. CONCLUSIONS Dynamic, diagnose-specific checklists improved the quality of referral letters significantly and reduced the variance of the TPS, indicating a more uniform quality when checklists were used. The GPs were generally positive to the checklists.
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Affiliation(s)
- Sigrun Losada Eskeland
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Corina Silvia Rueegg
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Lars Aabakken
- Department of Transplantation Medicine, Section of GI Endoscopy, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Departement of Bowel Cancer Screening, Cancer Registry of Norway, Majorstuen, Oslo, Norway
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Rousseau A, Rozenberg P, Perrodeau E, Deneux-Tharaux C, Ravaud P. Variations in Postpartum Hemorrhage Management among Midwives: A National Vignette-Based Study. PLoS One 2016; 11:e0152863. [PMID: 27043439 PMCID: PMC4820253 DOI: 10.1371/journal.pone.0152863] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess variations in adherence to guidelines for management of postpartum hemorrhage (PPH) among midwives. METHODS A multicentre vignette-based study was e-mailed to a random sample of midwives from 145 maternity units in France. They were asked to describe how they would manage the PPH described in 2 case-vignettes. These previously validated case-vignettes described 2 different scenarios for severe PPH. Vignette 1 described a typical immediate, severe PPH and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. An expert consensus defined 14 criteria for assessing adherence to guidelines issued by the French College of Obstetricians and Gynecologists in 2004 in the midwives' responses. We analyzed the number of errors among the 14 criteria to quantify the level of adherence. RESULTS We obtained 450 complete responses from midwives from 87 maternity units. The rate of complete adherence (no error for any of the 14 criteria) was low: 25.1% in vignette 1 and 4.2% in vignette 2. The error rate was higher for pharmacological management, especially oxytocin use, than for non-pharmacological management and communication-monitoring-investigation. Adherence to guidelines varied substantially between and within maternity units, as well as between the vignettes for the same midwives. CONCLUSION Reponses to case-vignettes demonstrated substantial variations in PPH management and especially individual variations in adherence to guidelines. Midwives should participate in continuous and individualized training.
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Affiliation(s)
- A. Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - P. Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Research unit EA 7285, Versailles-St Quentin University, Saint Quentin en Yvelines, France
| | - E. Perrodeau
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - C. Deneux-Tharaux
- INSERM U1153, EPOPé (Epidémiologie Obstétricale, Périnatale et Pédiatrique) Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - P. Ravaud
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Rousseau A, Rozenberg P, Perrodeau E, Deneux-Tharaux C, Ravaud P. Staff and Institutional Factors Associated with Substandard Care in the Management of Postpartum Hemorrhage. PLoS One 2016; 11:e0151998. [PMID: 27010407 PMCID: PMC4806984 DOI: 10.1371/journal.pone.0151998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/06/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE to identify staff and institutional factors associated with substandard care by midwives managing postpartum hemorrhage (PPH). METHODS A multicenter vignette-based study was e-mailed to a random sample of midwives at 145 French maternity units that belonged to 15 randomly selected perinatal networks. Midwives were asked to describe how they would manage two case-vignettes about PPH and to complete a short questionnaire about their individual (e.g., age, experience, and full- vs. part-time practice) and institutional (private or public status and level of care) characteristics. These previously validated case-vignettes described two different scenarios: vignette 1, a typical immediate, severe PPH, and vignette 2, a severe but gradual hemorrhage. Experts consensually defined 14 criteria to judge adherence to guidelines. The number of errors (possible range: 0 to 14) for the 14 criteria quantified PPH guideline adherence, separately for each vignette. RESULTS 450 midwives from 87 maternity units provided complete responses. Perfect adherence (no error for any of the 14 criteria) was low: 25.1% for vignette 1 and 4.2% for vignette 2. After multivariate analysis, midwives' age remained significantly associated with a greater risk of error in guideline adherence in both vignettes (IRR 1.19 [1.09; 1.29] for vignette 1, and IRR 1.11 [1.05; 1.18] for vignette 2), and the practice of mortality and morbidity reviews in the unit with a lower risk (IRR 0.80 [0.64; 0.99], IRR 0.78 [0.66; 0.93] respectively). Risk-taking scores (IRR 1.41 [1.19; 1.67]) and full-time practice (IRR 0.83 [0.71; 0.97]) were significantly associated with adherence only in vignette 1. CONCLUSIONS Both staff and institutional factors may be associated with substandard care in midwives' PPH management.
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Affiliation(s)
- A. Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - P. Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Research unit EA 7285, Versailles-St Quentin University, Saint Quentin en Yvelines, France
| | - E. Perrodeau
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - C. Deneux-Tharaux
- INSERM U1153, EPOPé (Epidémiologie Obstétricale, Périnatale et Pédiatrique) Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - P. Ravaud
- INSERM U1153, METHODS (Méthodes en évaluation thérapeutique des maladies chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Rousseau A, Rozenberg P, Ravaud P. Assessing Complex Emergency Management with Clinical Case-Vignettes: A Validation Study. PLoS One 2015; 10:e0138663. [PMID: 26383261 PMCID: PMC4575125 DOI: 10.1371/journal.pone.0138663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another obstetrician would be the same as the actual management. Methods A multicenter vignette-based study was used in 7 French maternity units. We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other obstetricians’ cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the obstetricians previously managed and the cases of others. Results Thirty obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62–0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other obstetricians’ cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12–0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p<0.001). Conclusions Dynamic case-vignettes accurately reflect actual practices in complex emergency situations. Therefore, they can be used to assess the quality of management in these situations.
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Affiliation(s)
- Anne Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- INSERM U1153 Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
- * E-mail:
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Research unit EA 7285, Versailles-St Quentin University, Saint Quentin en Yvelines, France
| | - Philippe Ravaud
- INSERM U1153 Research Unit, Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Converse L, Barrett K, Rich E, Reschovsky J. Methods of Observing Variations in Physicians' Decisions: The Opportunities of Clinical Vignettes. J Gen Intern Med 2015; 30 Suppl 3:S586-94. [PMID: 26105672 PMCID: PMC4512963 DOI: 10.1007/s11606-015-3365-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To support their efforts to promote high quality and efficient care, policymakers need to better understand the key factors associated with variations in physicians' decisions, and in particular, physician deviations from evidence-based care. Clinical vignette survey instruments hold potential for research in this area as an approach that both allows for practical, large-scale study and overcomes the data quality challenges posed by analysis of clinical data. These surveys present respondents with a narrative description of a hypothetical patient case and solicit responses to one or more questions regarding the care of the patient. In this review, we describe various methods for measuring variations in physicians' decisions and highlight a range of design features researchers should consider when developing a clinical vignette survey. We conclude by identifying areas for future research.
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Pittet V, Maillard MH, Lauvergeon S, Timmer M, Michetti P, Froehlich F, Burnand B, Vader JP, Mottet C. Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings: do practicing gastroenterologists agree with experts? J Crohns Colitis 2015; 9:132-9. [PMID: 25518062 DOI: 10.1093/ecco-jcc/jju021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Appropriateness criteria for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC) have been developed by expert panels. Little is known about the acceptance of such recommendations by care providers. The aim was to explore how treatment decisions of practicing gastroenterologists differ from those of experts, using a vignette case study and a focus group. METHODS Seventeen clinical vignettes were drawn from clinical indications evaluated by the expert panel. A vignette case questionnaire asking for treatment options in 9 or 10 clinical situations was submitted to 26 practicing gastroenterologists. For each vignette case, practitioners’ answers on treatments deemed appropriate were compared with panel decisions. Qualitative analysis was performed on focus group discussion to explore acceptance and divergence reasons. RESULTS Two hundred thirty-nine clinical vignettes were completed, 98 for CD and 141 for UC.Divergence between proposed treatments and panel recommendations was more frequent for CD (34%) than for UC (27%). Among UC clinical vignettes, the main divergences with the panel were linked to 5-aminosalicylate (5-ASA) failure assessment and to situations in which stopping treatment was the main decision. For CD, the propositions of care providers diverged from the panel in mild to moderate active disease, for which practitioners were more prone to an accelerated step-up than the panel’s recommendations. CONCLUSIONS In about one-third of vignette cases, inflammatory bowel disease treatment propositions made by practicing gastroenterologists diverged from expert recommendations. Practicing gastroenterologists may experience difficulty in applying recommendations in daily practice.
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Corkery MB, Edgar KL, Smith CE. A survey of physical therapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD). J Man Manip Ther 2014; 22:75-89. [PMID: 24976750 PMCID: PMC4017798 DOI: 10.1179/2042618613y.0000000048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore the clinical practice of physical therapists and examine adherence to clinical guidelines for treating patients with whiplash associated disorders (WAD). METHODS A cross-sectional electronic survey was sent to 1484 licensed physical therapists from the Orthopedic Section of the American Physical Therapy Association and the American Academy of Orthopedic Manual Physical Therapists. The survey included demographic data and two clinical vignettes describing patients with acute and chronic WAD. The chi-square test was used to analyze responses. RESULTS There were 291(19.6%) responses to the survey. Of those, 237 (81.4%) provided data for vignette 1 and 204 (70.1%) for vignette 2. One hundred and eighty (76.6%) respondents reported familiarity with evidence-based or clinical practice guidelines for treating patients with WAD. Of those, 71.5% (n = 128) indicated that they followed them more than 50% of the time. Therapists with an advanced certification were more likely to be familiar with clinical guidelines than those who were not certified (P<0.01). Responses indicated overall adherence to guidelines; however, there was a low utilization of quantitative sensory assessment, screening for psychological distress and some outcome measures. Significant differences in clinical practice (P<0.01) were found between therapists who were and were not familiar with guidelines and those with and without an advanced certification. DISCUSSION Advanced certification and knowledge of guidelines appeared to play a role in the clinical practice of physical therapists treating patients with WAD. Further research is needed to explore factors affecting knowledge translation from research to clinical practice and to evaluate the outcomes of patients with WAD when clinical guidelines are applied in practice.
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Affiliation(s)
- Marie B Corkery
- Department of Physical Therapy, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115
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Stacey D, Brière N, Robitaille H, Fraser K, Desroches S, Légaré F. A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making. J Interprof Care 2014; 28:453-9. [PMID: 24766619 DOI: 10.3109/13561820.2014.911157] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n = 6), good (n = 20), fair (n = 0) or weak (n = 3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p < 0.0001). Our video vignette development process resulted in a product that was true-to-life and as part of a multifaceted workshop it appears to improve knowledge among health professionals. This could be used to create and appraise vignettes targeting IP-SDM in other contexts.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, Ottawa Hospital Research Institute, University of Ottawa , Ontario , Canada
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Martinez V, Attal N, Vanzo B, Vicaut E, Gautier JM, Bouhassira D, Lantéri-Minet M. Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey. PLoS One 2014; 9:e93855. [PMID: 24747826 PMCID: PMC3991574 DOI: 10.1371/journal.pone.0093855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Background and aims The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later. Methods We used “e” case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight “e” case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive “e” case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment. Results From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed. Conclusions The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.
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Affiliation(s)
- Valéria Martinez
- Anesthésiologie-Réanimation, Hôpital Raymond-Poincaré, Garches, France
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- * E-mail:
| | - Nadine Attal
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
| | | | - Eric Vicaut
- Unité de Recherche Clinique - Hôpital Fernand Widal, Paris, France
| | - Jean Michel Gautier
- Réseau InterCLUD Languedoc Roussillon, CHRU Montpellier, Montpellier, France
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
| | - Michel Lantéri-Minet
- CHU de Nice, Centre d'Evaluation et Traitement de la Douleur, Nice, France
- INSERM/UdA, U1107, Neuro-Dol, Université de Clermont-Ferrand, Clermont-Ferrand, France
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Swennen MHJ, Rutten FH, Kalkman CJ, van der Graaf Y, Sachs APE, van der Heijden GJMG. Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study. BMJ Open 2013; 3:e002982. [PMID: 24041845 PMCID: PMC3780330 DOI: 10.1136/bmjopen-2013-002982] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors' characteristics are related to their decisions. DESIGN Cross-sectional vignette study. SETTING Continuing Medical Education meeting. PARTICIPANTS 451 Dutch GPs. MAIN OUTCOME MEASURES Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions. RESULTS Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated β-blocker treatment at a low-dose and 4% doubled the β-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued β-blocker therapy even when they considered prescribing a long-acting β2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the β-blocker in the up-titration phase. CONCLUSIONS GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a β-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions.
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Affiliation(s)
- Maartje H J Swennen
- Department of Clinical Epidemiology, Division Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Bramley H, Kroft C, Polk D, Newberry T, Silvis M. Do youth hockey coaches allow players with a known concussion to participate in a game? Clin Pediatr (Phila) 2012; 51:283-7. [PMID: 21937746 DOI: 10.1177/0009922811422434] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ice hockey is a high-risk sport for concussion. It is important that coaches have an understanding of concussion, although previous studies have demonstrated poor knowledge of concussion recognition and management by youth coaches. A cross-sectional survey with 7 case scenarios was completed by 314 youth hockey coaches. Each case scenario described a player with a concussion during a game, and scores reflected how the coach would respond to each scenario. Although most coaches would not allow a player to continue participating in a game after suffering a concussion, there was a small percentage that would. Statistical analysis found an inverse relationship between the coaches' age and consideration of continued participation. This places athletes at significant risk for further injury and is not consistent with current concussion guidelines. USA Hockey should provide additional concussion training for their coaches as well as mandatory health care clearance following a concussion.
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Affiliation(s)
- Harry Bramley
- Department of Pediatrics, Penn State Milton S.Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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