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Li X, Song Z, Yi Z, Qin J, Jiang D, Wang Z, Li H, Zhao R. Therapeutic drug monitoring guidelines in oncology: what do we know and how to move forward? Insights from a systematic review. Ther Adv Med Oncol 2024; 16:17588359241250130. [PMID: 38812991 PMCID: PMC11135096 DOI: 10.1177/17588359241250130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/09/2024] [Indexed: 05/31/2024] Open
Abstract
Background Compared with anti-infective drugs, immunosuppressants and other fields, the application of therapeutic drug monitoring (TDM) in oncology is somewhat limited. Objective We aimed to provide a comprehensive understanding of TDM guidelines for antineoplastic drugs and to promote the development of individualized drug therapy in oncology. Design This study type is a systematic review. Data sources and methods This study was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Databases including PubMed, Embase, the official websites of TDM-related associations and Chinese databases were comprehensively searched up to March 2023. Two investigators independently screened the literature and extracted data. The methodological and reporting quality was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT), respectively. Recommendations and quality evaluation results were presented by visual plots. This study was registered in PROSPERO (No. CRD42022325661). Results A total of eight studies were included, with publication years ranging from 2014 to 2022. From the perspective of guideline development, two guidelines were developed using evidence-based methods. Among the included guidelines, four guidelines were for cytotoxic antineoplastic drugs, three for small molecule kinase inhibitors, and one for antineoplastic biosimilars. Currently available guidelines and clinical practice provided recommendations of individualized medication in oncology based on TDM, as well as influencing factors. With regard to methodological quality based on AGREE II, the average overall quality score was 55.21%. As for the reporting quality by RIGHT evaluation, the average reporting rate was 53.57%. Conclusion From the perspective of current guidelines, TDM in oncology is now being expanded from cytotoxic antineoplastic drugs to newer targeted treatments. Whereas, the types of antineoplastic drugs involved are still small, and there is still room for quality improvement. Furthermore, the reflected gaps warrant future studies into the exposure-response relationships and population pharmacokinetics models.
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Affiliation(s)
- Xinya Li
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Zhanmiao Yi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Jiguang Qin
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhitong Wang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Huibo Li
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
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Quist-Nelson J, Hannenberg A, Ruymann K, Stover A, Baxter JK, Smith S, Angle H, Gupta N, Lopez CM, Hunt E, Tully KP. Institution-Specific Perinatal Emergency Checklists: Multicenter Report on Development, Implementation, and Sustainability. Am J Perinatol 2024; 41:e1099-e1106. [PMID: 36452973 DOI: 10.1055/a-1990-2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States. STUDY DESIGN A qualitative study was conducted individually with clinicians from three health care systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research. RESULTS The study sites included two health care systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all 10 participants approached. Checklists for 19 perinatal emergencies were developed at the three health care systems. Ten of the checklist topics were the same at all three institutions. Participants described the checklists as improving patient care during crises. The tools were viewed as opportunities to promote a shared mental model across clinical roles, to reduce redundancy and coordinate obstetric crisis management. Checklist were developed in small groups. Implementation was facilitated by those who developed the checklists. Participants agreed that simulation was essential for checklist refinement and effective use by response teams. Barriers to implementation included limited clinician availability. There was also an opportunity to strengthen integration of checklists workflow early in perinatal emergencies. Participants articulated that culture change took time, active practice, persistence, reinforcement, and process measurement. CONCLUSION This study outlines processes to develop, implement, and sustain perinatal emergency checklists at three institutions. Participants agreed that multiple, parallel implementation tactics created the culture shift for integration. The overview and specific Consolidated Framework for Implementation Research components may be used to inform adaptation and sustainability for others considering implementing perinatal emergency checklists. KEY POINTS · Perinatal emergency checklists reduce redundancy and coordinate obstetric crisis management.. · Perinatal emergency simulation is essential for checklist refinement and effective team use.. · Integrations of perinatal emergency checklists requires culture change and process measurement..
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Affiliation(s)
- Johanna Quist-Nelson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | | | - Kathryn Ruymann
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Angela Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Jason K Baxter
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen Smith
- Department of Obstetrics and Gynecology, Jefferson Abington Hospital, Abington, Pennsylvania
| | - Heidi Angle
- Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Neeru Gupta
- Department of Obstetrics and Gynecology, Kaiser Permanente, Northern California, San Francisco, California
| | - Connie M Lopez
- Department of Obstetrics and Gynecology, Kaiser Permanente, Northern California, San Francisco, California
| | - Eric Hunt
- Department of Obstetrics and Gynecology, Kaiser Permanente, Northern California, San Francisco, California
| | - Kristin P Tully
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
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Neher M, Petersson L, Nygren JM, Svedberg P, Larsson I, Nilsen P. Innovation in healthcare: leadership perceptions about the innovation characteristics of artificial intelligence-a qualitative interview study with healthcare leaders in Sweden. Implement Sci Commun 2023; 4:81. [PMID: 37464420 DOI: 10.1186/s43058-023-00458-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Despite the extensive hopes and expectations for value creation resulting from the implementation of artificial intelligence (AI) applications in healthcare, research has predominantly been technology-centric rather than focused on the many changes that are required in clinical practice for the technology to be successfully implemented. The importance of leaders in the successful implementation of innovations in healthcare is well recognised, yet their perspectives on the specific innovation characteristics of AI are still unknown. The aim of this study was therefore to explore the perceptions of leaders in healthcare concerning the innovation characteristics of AI intended to be implemented into their organisation. METHODS The study had a deductive qualitative design, using constructs from the innovation domain in the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with 26 leaders in healthcare. RESULTS Participants perceived that AI could provide relative advantages when it came to care management, supporting clinical decisions, and the early detection of disease and risk of disease. The development of AI in the organisation itself was perceived as the main current innovation source. The evidence base behind AI technology was questioned, in relation to its transparency, potential quality improvement, and safety risks. Although the participants acknowledged AI to be superior to human action in terms of effectiveness and precision in some situations, they also expressed uncertainty about the adaptability and trialability of AI. Complexities such as the characteristics of the technology, the lack of conceptual consensus about AI, and the need for a variety of implementation strategies to accomplish transformative change in practice were identified, as were uncertainties about the costs involved in AI implementation. CONCLUSION Healthcare leaders not only saw potential in the technology and its use in practice, but also felt that AI's opacity limits its evidence strength and that complexities in relation to AI itself and its implementation influence its current use in healthcare practice. More research is needed based on actual experiences using AI applications in real-world situations and their impact on clinical practice. New theories, models, and frameworks may need to be developed to meet challenges related to the implementation of AI in healthcare.
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Affiliation(s)
- Margit Neher
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden.
| | - Lena Petersson
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
| | - Per Nilsen
- School of Health and Welfare, Halmstad University, Box 823, SE-30118, Halmstad, Sweden
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Smits G, Romeijnders A, Rozema H, Wijnands C, Hollander M, van Doorn S, Bots M. Stepwise implementation of a cardiovascular risk management care program in primary care. BMC PRIMARY CARE 2022. [PMCID: PMC8746647 DOI: 10.1186/s12875-021-01602-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Primary care plays a pivotal role in sustainable cardiovascular risk management (CVRM) but little is known about the organizational process of implementing the guidelines. The aim of the study was to describe the approach taken by a primary care group to implement the CVRM guideline. Methods Stepwise introduction and implementation of a programmatic CVRM care program was organized and facilitated by the care group between April 2010 and January 2013 in 137 affiliated general practices with 188 general practitioners (GPs), in the vicinity of Eindhoven, Netherlands. Care group support comprised sufficient staff, support with data extraction based on ICPC and ATC codes and with identification of eligible patients by scrutinizing patient health records and adequate coding of disease conditions. Results Patient selection based on availability of structured information on ICPC codes and risk factor levels from the electronic health records, led to 38,675 eligible patients in 2013. December 2019, the CVRM program was still running in 151 practices with 51,416 patients receiving programmatic CVRM care. Linking problems between 8 different electronic health record systems and the multidisciplinary information system for integrated care delayed adequate data collection until the beginning of 2013. Conclusion Commitment of affiliated GPs, a structured approach with adequate coding of diagnoses and risk factors, central data registration and additional funding for sufficient staff support are important conditions for the introduction and implementation of successful and sustainable programmatic CVRM care. This approach constitutes the basis for long-term follow up and annual evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01602-w.
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Murphy DJ, Lane-Fall MB. Leveraging Robust Mixed Methodologies to Advance Implementation Research and Practice. Crit Care Med 2022; 50:1159-1161. [PMID: 35726982 DOI: 10.1097/ccm.0000000000005551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David J Murphy
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine; Department of Medicine; Emory University, Atlanta, GA
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Wiggin DA, Timmons S, Rukundo A, Walsh KA. Improving the appropriateness of psychotropic prescribing for nursing home residents with dementia: an overview of reviews. Aging Ment Health 2022; 26:1087-1094. [PMID: 33982608 DOI: 10.1080/13607863.2021.1922601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Psychotropic medications are commonly inappropriately prescribed for people with dementia (PwD) residing in nursing homes. This population is often multi-morbid, receiving multiple medications and therefore at an increased risk of mortality. This overview aimed to collate all synthesised quantitative, qualitative, and mixed-method evidence pertaining to the effectiveness of interventions aimed at reducing inappropriate psychotropic prescribing for nursing home residents with dementia; the perceived barriers and facilitators to the implementation of these interventions; and the attitudes and experiences of stakeholders toward prescribing. Method: An overview of reviews was conducted (PROSPERO protocol registration CRD42020187288). Five databases were systematically searched from January 2010 through June 2020, supplemented by grey literature searching. Reviews presenting evidence pertaining to either randomised controlled trials (RCT) aiming to reduce inappropriate prescribing or qualitative/mixed method studies of stakeholder views, were included. RESULTS Of 273 records identified, 11 systematic reviews were included. The quality of reviews ranged from critically low to moderate. There was mixed evidence for the use of education-only interventions. Multicomponent interventions (typically staff education combined with organisational and structural components), medication review, and interventions aimed at cultural change were evidenced as effective compared to care as usual. Stakeholders cited the importance of multidisciplinary collaboration and targeting organisational climate in changing psychotropic prescribing behaviours. CONCLUSIONS The inappropriate use of psychotropic medications in nursing homes for PwD is a complex issue with many contextual factors. The evidence suggests a comprehensive approach, targeting organisational climate and multidisciplinary collaboration, along with staff education and training, may be an effective strategy.
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Affiliation(s)
- Daisy A Wiggin
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Aphie Rukundo
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Kieran A Walsh
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Development and delivery of an allied health team intervention for older adults in the emergency department: A process evaluation. PLoS One 2022; 17:e0269117. [PMID: 35617330 PMCID: PMC9135235 DOI: 10.1371/journal.pone.0269117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background There is encouraging evidence that interdisciplinary teams of Health and Social Care Professionals (HSCPs) can enhance patient care in the Emergency Department (ED), especially for older adults with complex needs. However, no formal process evaluations of implementations of ED-based HSCP interventions are available. The study aimed to evaluate the development and delivery of a HSCP team intervention for older adults in the ED of a large Irish teaching hospital. Methods Using the Medical Research Council (MRC) Framework for process evaluations, we investigated implementation and delivery, mechanisms of impact, and contextual influences on implementation by analysing the HSCP team’s activity notes and participant recruitment logs, and by carrying out six interviews and four focus groups with 26 participants (HSCP team members, ED doctors and nurses, hospital staff). Qualitative insights were analysed thematically. Results The implementation process had three phases (pre-implementation, piloting, and delivery), with the first two described as pivotal to optimise care procedures and build positive stakeholders’ involvement. The team’s motivation and proactive communication were key to promote acceptability and integration in the ED (Theme 1); also, their specialised skills and interdisciplinary approach enhanced patient and staff’s ED experience (Theme 2). The investment and collaboration of multiple stakeholders were described as essential contextual enablers of implementation (Theme 4). Delivering the intervention within a randomised controlled trial fostered credibility but caused frustration among patients and staff (Theme 3). Discussion This process evaluation is the first to provide in-depth and practical insights on the complexities of developing and delivering an ED-based HSCP team intervention for older adults. Our findings highlight the importance of establishing a team of HSCPs with a strong interdisciplinary ethos to ensure buy-in and integration in the ED processes. Also, actively involving relevant stakeholders is key to facilitate implementation. Trial registration ClinicalTrials.gov, NCT03739515; registered on 12th November 2018.
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Choi KE(A, Lindert L, Schlomann L, Pfaff H. "I'll leave that to the case managers." Healthcare Service Providers' Perceptions of Organizational Readiness for Change in a Randomized Controlled Trial-A Qualitative Analysis Exploring Implementation Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095782. [PMID: 35565177 PMCID: PMC9104361 DOI: 10.3390/ijerph19095782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Abstract
Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive-inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner's model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.
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Affiliation(s)
- Kyung-Eun (Anna) Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
- Health Services Research, MIAAI group, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstr. 124, 3500 Krems an der Donau, Austria
- Correspondence: ; Tel.: +49-(0)33638-83987
| | - Lara Lindert
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Lara Schlomann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
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O'Dwyer C, Tarzia L, Fernbacher S, Hegarty K. Health Professionals' Experiences of Providing Trauma-Informed Care in Acute Psychiatric Inpatient Settings: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:1057-1067. [PMID: 32027227 DOI: 10.1177/1524838020903064] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Trauma-informed care is increasingly recognized as the ideal model of care for acute psychiatric inpatient units; however, it continues to be a challenge to implement. The aims of this review are (1) to synthesize the research exploring health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient settings and (2) to examine these experiences through a gender lens, particularly relating to gender-based violence. This research will provide additional insights to facilitate implementation of trauma-informed care in acute psychiatric inpatient care. METHOD A comprehensive scoping review methodology was adopted. English-language, peer-reviewed articles published between January 1998 and March 2018 were identified from seven databases. Inclusion criteria included a qualitative or mixed-method study design. RESULTS Eight full-text articles were found. This review highlights the importance for health professionals to have a reflective environment and a multilayered level of collaboration to adopt trauma-informed care. However, negative attitudes toward female consumers and inconsistent implementation strategies continue to hold back implementation of trauma-informed care in acute psychiatric inpatient units. Overall, limited consideration for gendered issues and gender-based violence in the implementation of trauma-informed care in acute psychiatric inpatient settings was found. CONCLUSION AND IMPLICATIONS There is a lack of research on health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient units, with even less research considerating gender-based violence. We argue that more research is needed to gain a better understanding of the experience of health professionals from acute psychiatric inpatient settings to inform future implementation of trauma-informed care.
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Affiliation(s)
- Carol O'Dwyer
- Department of General Practice, The University of Melbourne, Victoria, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Centre for Family Violence Prevention, Melbourne, Victoria, Australia
| | | | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Centre for Family Violence Prevention, Melbourne, Victoria, Australia
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Latulippe K, LeBlanc A, Gagnon MP, Boivin K, Lavoie P, Dufour J, Raynard EP, Richard E, Lamontagne MÈ. Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol. Syst Rev 2021; 10:255. [PMID: 34556170 PMCID: PMC8461924 DOI: 10.1186/s13643-021-01793-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is an important means of improving the health service quality. Most research on the effectiveness of KT strategies has focused on individual strategies, i.e., those directly targeting the modification of allied health professionals' knowledge, attitudes, and behaviors, for example. In general, these strategies are moderately effective in changing practices (maximum 10% change). Effecting change in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) is part of a promising new avenue to service quality improvement through the implementation of evidence-based practices. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings. METHODS This is a realist review protocol involving four iterative steps: (1) Initial theory formulation, (2) search for Evidence search, (3) knowledge extraction and synthesis, and (4) recommendations. We will search electronic databases such as PubMed, Embase, CINHAL, Cochrane Library, and Conference Proceedings Citation Index - Science. The studies included will be those relating to the use of organizational KT strategies in trauma settings, regardless of study designs, published between January 1990 and October 2020, and presenting objective measures that demonstrate change in allied health professionals' knowledge, attitudes, and clinical behaviors. Two independent reviewers will select, screen, and extract the data related to all relevant sources in order to refine or refute the context-mechanism-outcome (CMO) configurations developed in the initial theory and identify new CMO configurations. DISCUSSION Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020216105.
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Affiliation(s)
- Karine Latulippe
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Pavillon Lindsay de l'IURDPM, 6363, Chemin Hudson, Montréal, Québec, H3S 1M9, Canada
| | - Annie LeBlanc
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Pavillon Ferdinand-Vandry, Université Laval, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Marie-Pierre Gagnon
- Chaire de recherche du Canada en technologies et pratiques en santé, Faculté des sciences infirmières, Pavillon Ferdinand-Vandry, Université Laval, Canada, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Katia Boivin
- Direction de l'enseignement et des affaires universitaires, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
| | - Pascale Lavoie
- Direction de l'enseignement et des affaires universitaires, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525, boul. Wilfrid Hamel, Québec, Québec, G1M 2S8, Canada
| | - Joëlle Dufour
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada
| | | | - Eve Richard
- Bibliothèque de l'Université Laval, 2345, allée des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada.
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Evaluation of two strategies to implement physical cancer rehabilitation guidelines for survivors of abdominopelvic cavity tumors: a controlled before-and-after study. J Cancer Surviv 2021; 16:497-513. [PMID: 34519980 PMCID: PMC9142440 DOI: 10.1007/s11764-021-01045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022]
Abstract
Purpose This study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies. Methods We tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility. Results In total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies. Conclusion Implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations. Implications for Cancer Survivors Using implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01045-3.
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Gyamfi N, Bhullar N, Islam MS, Usher K. A systematic review of measures assessing mental health professionals' perspectives of recovery. Int J Ment Health Nurs 2021; 30:847-874. [PMID: 34129745 DOI: 10.1111/inm.12895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
Recovery is internationally recognized as a concept to improve the well-being of consumers. Compared with the numerous measures assessing consumer perspectives of recovery, only a few measures have been developed to assess Mental Health Professionals' (MHPs) perspectives of recovery to inform practice. The present study aims to systematically review the literature to identify existing measures designed to assess MHPs' perspectives of recovery and evaluate their psychometric properties, and the methodological considerations of the design and use of these measures. We searched literature across eight electronic databases: MEDLINE, Web of Science, PsycINFO, PsyArticles, CINAHL, Scopus, EMBASE, and Google scholar. We identified 2631 articles across all databases. Of these, 40 articles met the inclusion criteria, which comprised 14 original measures assessing mental health recovery and 26 articles reassessing the psychometric properties of the original 14 measures. Our results suggested that while there are existing measures for assessing MHPs' perspectives of recovery, only a few of these measures met standard evaluation criteria for psychometric properties. Specifically, the validation of the identified measures is still in its infancy. For example, the easiness of applying the measures differs among the studies, and only a few of the measures fully involved consumers in the scale development phase. The implication of the findings for future use and development of recovery measures in mental health practice and research are discussed and recommended.
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Affiliation(s)
- Naomi Gyamfi
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Kim Usher
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1129] [Impact Index Per Article: 376.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Peven K, Bick D, Purssell E, Rotevatn TA, Nielsen JH, Taylor C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review. Health Policy Plan 2020; 35:ii47-ii65. [PMID: 33156939 PMCID: PMC7646733 DOI: 10.1093/heapol/czaa122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/02/2023] Open
Abstract
Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3-31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1-4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, 57 Waterloo Road, London SE1 8WA, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Hyldgaard Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
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Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Physiotherapists' perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality - a qualitative study. BMC Geriatr 2020; 20:432. [PMID: 33121434 PMCID: PMC7596977 DOI: 10.1186/s12877-020-01846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Falls in older adults are an increasingly important public-health concern. Despite abundant research, fall rates have not been reduced, because implementation of evidence-based fall-prevention measures has been slow and limited. This study aims to explore physiotherapists' perceptions on external factors, such as public policy, organisation and leadership, regarding the relation between knowledge translation and the three elements of evidence-based practice (EBP) to effectively address barriers and facilitate the uptake of EBP in fall prevention. METHODS We conducted semi-structured interviews with 18 physiotherapists (men = 7; women = 11) working with fall prevention in the primary healthcare system. The physiotherapists ranged in age from 27 to 60 years (median 36 years) and had worked as a physiotherapist from 1 to 36 years (median 7 years). Data are analysed using thematic analysis. RESULTS The analysis revealed one main theme and four sub-themes. The main theme was 'Environmental empowerment enhances physiotherapists' capabilities for using EBP'. A resourceful work environment facilitates EBP, having access to information about research-based knowledge, supportive leadership, enough human resources and opportunities to learn and grow at work. The four sub-themes were as follows: 1) 'Tension between attributes of research-based knowledge and organisational routines and practices'; 2) 'Evidence must be informed by policymakers-What works?'; 3) 'Empowering culture and work environment-A steppingstone to EBP' and 4) 'Organisation readiness for EBP, managerial and clinical relations'. Success in environmental empowerment depends on the leader's role in creating preconditions at the workplace that may lead to important positive personal and organisational outcomes for EBP. Two-way communication and transfer-of-information are also key factors in the development of positive work engagement when using EBP. CONCLUSION The findings of this study outline tension between policy, leadership, organisational facilitators and EBP. Leadership is influenced by policy with ripple effects for the organisation and clinicians. Organisational facilitators form structural empowerment, which is the foundation for creating an EBP environment. TRIAL REGISTRATION 2018/2227/REC south-east C. Registered 19 December 2018, Norwegian Ethics Committee for Medical and Health Research Ethics.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Cassarino M, Quinn R, Boland F, Ward ME, McNamara R, O'Connor M, McCarthy G, Ryan D, Galvin R, Robinson K. Stakeholders' perspectives on models of care in the emergency department and the introduction of health and social care professional teams: A qualitative analysis using World Cafés and interviews. Health Expect 2020; 23:1065-1073. [PMID: 32841463 PMCID: PMC7696138 DOI: 10.1111/hex.13033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background There is some evidence that health and social care professional (HSCP) teams contribute to enhanced patient and process outcomes in increasingly crowded emergency departments (EDs), but the views of service users and providers on this model of care need investigation to optimize implementation. Objective This qualitative study investigated the perspectives of key ED stakeholders about HSCP teams working in the ED. Methods Using a participatory design, we conducted World Café focus groups and individual interviews in two Irish hospital sites with 65 participants (purposive sampling) including ED patients and carers/relatives, ED doctors and nurses, HSCPs and pre‐hospital staff. Data were thematically analysed using NVivo software. Results Participants reported that ED‐based HSCP teams could improve quality and integration of care and staff experience (Theme 1) and would be appropriate for older adults with complex needs and non‐urgent complaints (Theme 2). Concerns were raised about operational and relational barriers to implementation (Theme 3), and changes in processes and culture were considered necessary for HSCPs to work successfully in the ED (Theme 4). In contrast to service providers, service users’ concerns centred on the importance of positive communication and relations (Theme 5). Conclusions Our study indicates potential acceptability of HSCP teams working in the ED, especially to care for older adults; however, operational and relational aspects, particularly developing interdisciplinary and integrated care, need addressing to ensure successful implementation. Differences in priorities between service users and providers (relational vs operational) highlighted the usefulness of gathering views from multiple stakeholders to understand ED processes.
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Affiliation(s)
- Marica Cassarino
- Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Rosie Quinn
- Emergency Department, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie E Ward
- School of Psychology, Trinity College, the University of Dublin, Dublin 2, Ireland
| | - Rosa McNamara
- Emergency Department, St. Vincent University Hospital, Dublin, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.,Faculty of Education and Health Sciences, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Gerard McCarthy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Damien Ryan
- Faculty of Education and Health Sciences, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
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Eldh AC, Holmefur M, Luhr K, Wenemark M. Assessing and reporting patient participation by means of patient preferences and experiences. BMC Health Serv Res 2020; 20:702. [PMID: 32727451 PMCID: PMC7391651 DOI: 10.1186/s12913-020-05574-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation. METHODS With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested. RESULTS Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures. CONCLUSIONS Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE751 22 Uppsala, Sweden
| | - Marie Holmefur
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Kristina Luhr
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, S701 82 Örebro, Sweden
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Unit of Public Health and Statistics, Region Östergötland, S581 85 Linköping, Sweden
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Hill J, Garvin S, Chen Y, Cooper V, Wathall S, Bartlam B, Saunders B, Lewis M, Protheroe J, Chudyk A, Birkinshaw H, Dunn KM, Jowett S, Oppong R, Hay E, van der Windt D, Mallen C, Foster NE. Computer-Based Stratified Primary Care for Musculoskeletal Consultations Compared With Usual Care: Study Protocol for the STarT MSK Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17939. [PMID: 32442141 PMCID: PMC7381066 DOI: 10.2196/17939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) pain is a major cause of pain and disability. We previously developed a prognostic tool (Start Back Tool) with demonstrated effectiveness in guiding primary care low back pain management by supporting decision making using matched treatments. A logical next step is to determine whether prognostic stratified care has benefits for a broader range of common MSK pain presentations. OBJECTIVE This study seeks to determine, in patients with 1 of the 5 most common MSK presentations (back, neck, knee, shoulder, and multisite pain), whether stratified care involving the use of the Keele Start MSK Tool to allocate individuals into low-, medium-, and high-risk subgroups, and matching these subgroups to recommended matched clinical management options, is clinical and cost-effective compared with usual nonstratified primary care. METHODS This is a pragmatic, two-arm parallel (stratified vs nonstratified care), cluster randomized controlled trial, with a health economic analysis and mixed methods process evaluation. The setting is UK primary care, involving 24 average-sized general practices randomized (stratified by practice size) in a 1:1 ratio (12 per arm) with blinding of trial statistician and outcome data collectors. Randomization units are general practices, and units of observation are adult MSK consulters without indicators of serious pathologies, urgent medical needs, or vulnerabilities. Potential participant records are tagged and individuals invited using a general practitioner (GP) point-of-consultation electronic medical record (EMR) template. The intervention is supported by an EMR template (computer-based) housing the Keele Start MSK Tool (to stratify into prognostic subgroups) and the recommended matched treatment options. The primary outcome using intention-to-treat analysis is pain intensity, measured monthly over 6 months. Secondary outcomes include physical function and quality of life, and an anonymized EMR audit to capture clinician decision making. The economic evaluation is focused on the estimation of incremental quality-adjusted life years and MSK pain-related health care costs. The process evaluation is exploring a range of potential factors influencing the intervention and understanding how it is perceived by patients and clinicians, with quantitative analyses focusing on a priori hypothesized intervention targets and qualitative approaches using focus groups and interviews. The target sample size is 1200 patients from 24 general practices, with >5000 MSK consultations available for anonymized medical record data comparisons. RESULTS Trial recruitment commenced on May 18, 2018, and ended on July 15, 2019, after a 14-month recruitment period in 24 GP practices. Follow-up and interview data collection was completed in February 2020. CONCLUSIONS This trial is the first attempt, as far as we know, at testing a prognostic stratified care approach for primary care patients with MSK pain. The results of this trial should be available by the summer of 2020. TRIAL REGISTRATION ISRCTN Registry ISRCTN15366334; http://www.isrctn.com/ISRCTN15366334. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17939.
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Affiliation(s)
- Jonathan Hill
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Stefannie Garvin
- Keele Clinical Trials Unit, Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Ying Chen
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Vincent Cooper
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Simon Wathall
- Keele Clinical Trials Unit, Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | | | - Benjamin Saunders
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Martyn Lewis
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Joanne Protheroe
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Adrian Chudyk
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Hollie Birkinshaw
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Kate M Dunn
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Raymond Oppong
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Elaine Hay
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Danielle van der Windt
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Christian Mallen
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Nadine E Foster
- Institute for Primary, Community and Social Care, Keele University, Stoke-on-Trent, United Kingdom
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Bechini A, Lorini C, Zanobini P, Mandò Tacconi F, Boccalini S, Grazzini M, Bonanni P, Bonaccorsi G. Utility of Healthcare System-Based Interventions in Improving the Uptake of Influenza Vaccination in Healthcare Workers at Long-Term Care Facilities: A Systematic Review. Vaccines (Basel) 2020; 8:vaccines8020165. [PMID: 32260594 PMCID: PMC7348755 DOI: 10.3390/vaccines8020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Healthcare workers (HCWs) in long-term care facilities (LTCFs) can represent a source of influenza infection for the elderly. While flu vaccination coverage (VC) is satisfactory in the elderly, HCWs are less likely to be vaccinated. There is no definitive evidence on which types of healthcare system-based interventions at LTCFs would be more useful in improving the vaccination uptake among HCWs. We performed a systematic review in different databases (Pubmed, Cochrane Database of Systematic Reviews, Health Evidence, Web of Science, Cinahl) to provide a synthesis of the available studies on this topic. Among the 1177 articles screened by their titles and abstracts, 27 were included in this review. Most of the studies reported multiple interventions addressed to improve access to vaccination, eliminate individual barriers, or introduce policy interventions. As expected, mandatory vaccinations seem to be the most useful intervention to increase the vaccination uptake in HCWs. However, our study suggests that better results in the vaccination uptake in HCWs were obtained by combining interventions in different areas. Educational campaigns alone could not have an impact on vaccination coverage. LTCFs represent an ideal setting to perform preventive multi-approach interventions for the epidemiological transition toward aging and chronicity.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
- Correspondence: ; Tel.: +39-366-343-5179
| | - Francesco Mandò Tacconi
- Nuovo Ospedale delle Apuane, North-West Tuscany LHU, Via Enrico Mattei, 21, 54100 Massa, Italy;
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Maddalena Grazzini
- Careggi, University Hospital, Largo G. Alessandro Brambilla, 3, 50134 Florence, Italy;
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (A.B.); (C.L.); (S.B.); (P.B.); (G.B.)
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Lamontagne ME, Best KL, Clarke T, Dumont FS, Noreau L. Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 25:303-315. [PMID: 31844382 DOI: 10.1310/sci19-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessment and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.
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Affiliation(s)
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | | | - Frederic S Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Luc Noreau
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
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Francis-Coad J, Etherton-Beer C, Burton E, Naseri C, Hill AM. Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review. ACTA ACUST UNITED AC 2019; 16:973-1002. [PMID: 29634516 DOI: 10.11124/jbisrir-2017-003485] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available evidence for the effectiveness of complex falls prevention interventions delivered at two or more of the following levels: resident, facility or organization, on fall rates in the residential aged care (RAC) population. INTRODUCTION Preventing falls in the high risk RAC population is a common global goal with acknowledged complexity. Previous meta-analyses have not specifically addressed complexity, described as falls prevention intervention delivery at multiple levels of a RAC organization, to determine its effect on fall outcomes. INCLUSION CRITERIA The current review considered studies that included participants who were aged 65 years and over residing in long-term care settings providing 24-hour supervision and/or care assistance.Studies that evaluated complex falls prevention interventions delivered by single discipline or multidisciplinary teams across at least two or all of the following levels: residents, RAC facility and RAC organization were eligible. Experimental study designs including randomized controlled trials, controlled clinical trials and quasi-experimental trials that reported on measures related to fall incidence were considered, namely, rate of falls (expressed as the number of falls per 1000 occupied bed days), the number of participants who became fallers (expressed as the number of participants who fell once or more) and the rate of injurious falls (expressed as the number of falls with injury per 1000 occupied bed days). METHODS A three-step search strategy was undertaken, commencing with an initial scoping search of MEDLINE and CINAHL databases prior to an extensive search of all relevant published literature, clinical trial registries and gray literature. Two independent reviewers assessed selected studies for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted from the selected studies using the standardized data extraction tool from JBI SUMARI. Quantitative data were pooled in statistical meta-analysis for rate of falls, the number of participants who became fallers and the rate of injurious falls. Meta-analysis was conducted using a random-effect model with heterogeneity assessed using the standard Chi-squared and I index. Where statistical pooling was not possible, study findings were presented in narrative form. RESULTS Twelve studies were included in this review with seven being eligible for meta-analysis. Complex falls prevention interventions delivered at multiple levels in RAC populations did not show a significant effect in reducing fall rates (MD = -1.29; 95% CI [-3.01, 0.43]), or the proportion of residents who fell (OR = 0.76; 95% CI [0.42, 1.38]). However, a sensitivity analysis suggested complex falls prevention interventions delivered with additional resources at multiple levels had a significant positive effect in reducing fall rates (MD = -2.26; 95% CI [-3.72, -0.80]). CONCLUSIONS Complex falls prevention interventions delivered at multiple levels in the RAC population may reduce fall rates when additional staffing, expertise or resources are provided. Organizations may need to determine how resources can be allocated to best address falls prevention management. Future research should continue to investigate which combinations of multifactorial interventions are effective.
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Affiliation(s)
| | | | - Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Chiara Naseri
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
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Will KK, Johnson ML, Lamb G. Team-Based Care and Patient Satisfaction in the Hospital Setting: A Systematic Review. J Patient Cent Res Rev 2019; 6:158-171. [PMID: 31414027 DOI: 10.17294/2330-0698.1695] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Limited research examining the relationship between team-based models of care and patient satisfaction in the hospital setting is available. The purpose of this literature review was to explore this relationship as well as the relationships between team composition, team-based interventions, patient satisfaction, and other outcomes of care when measured as part of the study. Methods A systematic appraisal of research studies published through February 2017 was conducted using PubMed, Cochrane Library, CINAHL, Embase, Ovid, gray literature and Google Scholar. Inclusion criteria were 1) experimental (randomized control trials), quasi-experimental, or non-experimental (cross-sectional) study design; 2) team-based care interventions; 3) hospital setting; 4) patient satisfaction measured as an outcome; and 5) published in English. Results The literature search yielded 15,247 citations. In total, 142 articles were retrieved for full-text screening; 21 studies met inclusion criteria. Overall, 57% of the studies identified a statistically significant improvement in patient satisfaction associated with team-based care. Team-based care interventions ranged from single team activities such as multidisciplinary rounds to comprehensive team-based models of care. Patient satisfaction scores were greater with teams that had more than two professions and more comprehensive team-based models. About one-quarter of studies that measured patient satisfaction and at least one additional outcome demonstrated improvement in both. Conclusions Team-based care may positively affect patient satisfaction. Team composition and type of team intervention appears to influence the strength of the relationship. Improvements in satisfaction are not consistently accompanied by improvements in other outcomes.
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Affiliation(s)
- Kristen K Will
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | | | - Gerri Lamb
- Center for Advancing Interprofessional Practice, Education and Research, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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Nakrem S, Stensvik GT, Skjong RJ, Ostaszkiewicz J. Staff experiences with implementing a case conferencing care model in nursing homes: a focus group study. BMC Health Serv Res 2019; 19:191. [PMID: 30917815 PMCID: PMC6438011 DOI: 10.1186/s12913-019-4034-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background A majority of nursing home residents have dementia, and many develop neuropsychiatric symptoms. These symptoms are often caused by neuropathological changes in the brain, but modifiable factors related to quality of care also have an impact. A team-based approach to care that include comprehensive geriatric assessments to facilitate clinical decision-making and structured case conference meetings could improve quality of care and quality of life for the residents. Despite recommendations to adopt this approach, dementia care does not reach standards of evidence-based practice. Better implementation strategies are needed to improve care. A cluster randomised controlled trial with a 12-month intervention was conducted, and the experiences of staff from the intervention nursing homes were explored in a qualitative study after the trial was completed. The aim of the present study was to describe: (i) staff’s experiences with the intervention consisting of comprehensive geriatric assessments of nursing home residents and case conferencing, and (ii) enablers and barriers to implementing and sustaining the intervention. Methods Four focus groups with a total of 19 healthcare staff were interviewed, representing four out of eight intervention nursing homes. Thematic content analysis was used to interpret the transcribed data. Results Two major themes emerged: 1) learning experiences and 2) enablers and barriers to implementation. The participants had experienced learning both on an organisational level: improvements in care and an organisation that could adjust and facilitate change; and on an individual level: becoming more conscious of residents’ needs and acquiring skills in resident assessments. Participants described important enabling factors such as managerial support, drivers for change, and feasibility of the intervention for the local nursing home. Barriers to implementing and sustaining the intervention were time constraints, lack of staff training, unsuitable electronic patient record system for care planning and high complexities of care and instabilities that are present in nursing homes. Conclusions Quality improvements in nursing homes are difficult to sustain. In order to offer residents high quality of care that meet their individual needs, it is important for management and nursing home staff to be aware of and understand factors that enable or constrain change.
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Affiliation(s)
- Sigrid Nakrem
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.
| | - Geir-Tore Stensvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway
| | - Rickard Johan Skjong
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.,Work Environment Unit in Trondheim kommune, Postboks 2300 Torgarden, 7004, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research- Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, 3125, Australia
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Saengsuwan J, Suangpho P. Self-perceived and Actual Risk of Further Stroke in Patients with Recurrent Stroke or Recurrent Transient Ischemic Attack in Thailand. J Stroke Cerebrovasc Dis 2019; 28:632-639. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 01/30/2023] Open
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Dawson A, Henriksen B, Cortvriend P. Guideline Implementation in Standardized Office Workflows and Exam Types. J Prim Care Community Health 2019; 10:2150132719836898. [PMID: 30900500 PMCID: PMC6431766 DOI: 10.1177/2150132719836898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) in medicine are recommendations supported by systematic review of evidence to facilitate optimal patient outcomes. Primary care practices are expected to implement more than 200 CPGs, overwhelming many practices. This qualitative study elucidated the perspectives and priorities of family medicine physicians and office managers in grouping CPGs to facilitate implementation. METHODS A qualitative study was performed using individual, semistructured interviews. During the interviews the participants completed an open card-sort exercise grouping 20 CPGs. Purposive sampling was used to identify family medicine physicians and office managers practicing in medically underserved zip codes listed in the local medical society directory. Seven physicians and 6 office managers were interviewed. The interviews were transcribed and analyzed using thematic analysis and compared with the card-sort results. RESULTS Thematic content analysis identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for implementation: delegation, personalization, triggers, and change management. The card sort exercise revealed grouping by standardized preventive care visit, standardized rooming and discharge processes, and chronic illness. Chronic illness-based groupings and personalization of guidelines were recognized as presenting barriers to delegation of CPGs to the care team. Development of standardized preventive exams, standard rooming and discharge processes and chronic disease management were identified as promoting CPG adherence through team-based care. Standardized workflows provided opportunities for task delegation through predicable roles. Medicalization of CPG implementation relied heavily on the physician alone to remember to adhere to CPGs and inhibited task sharing by not giving office staff clear disease-based protocols to follow. CONCLUSIONS This study identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for concomitant implementation: delegation, personalization, triggers, and change management. Successful implementation was perceived to be associated with standardized preventive exams, standard rooming and discharge processes, and chronic disease management.
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Affiliation(s)
- Amy Dawson
- Fort Wayne Medical Education Program, Fort Wayne, IN, USA
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Walther F, Kuester D, Schmitt J. Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019884182. [PMID: 31746255 PMCID: PMC6868575 DOI: 10.1177/0046958019884182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023]
Abstract
Quality of care and the increasing strategies to its promotion, especially in inpatient settings, led to the question which quality-interventions work best and which do not. The aim was to summarize and critically appraise the evidence on the effects of structure- and/or process-related quality-interventions on patient outcome in predominantly controlled and inpatient settings. A systematic overview of systematic reviews after electronic searches in Medline, Embase, Cinahl, and PsycINFO, supplemented by hand search and expert survey, was conducted. From a total of 1559 identified records, 37 reviews fulfilled the inclusion criteria. 26 reviews assessed process-related quality-interventions, 6 structure-related quality-interventions, and 5 combined structure- and process-related quality-interventions. In all, 19 reviews reported pooled effect estimates (meta-analysis). Based on the evidence of this systematic overview, stroke units and pathways can be recommended. Although patient-relevant improvements for interprofessional approaches and discharge planning have been reported, pooled effect estimated evidence are currently missing for these and other quality-interventions.
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Affiliation(s)
- Felix Walther
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Denise Kuester
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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Sanson-Fisher R, Hobden B, Watson R, Turon H, Carey M, Bryant J, Freund M. The new challenge for improving psychosocial cancer care: shifting to a system-based approach. Support Care Cancer 2018; 27:763-769. [PMID: 30543048 DOI: 10.1007/s00520-018-4568-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is a need to improve the psychosocial well-being of cancer patients. To date, intervention research has primarily focussed on improving psychosocial well-being through targeting singular aspects of care at the individual patient level. Sustainable, high-quality psychosocial care should address the issues faced by people diagnosed with cancer throughout the care pathway using a system-based approach. AIMS To examine the number of intervention trials attempting to improve psychosocial cancer care that have implemented a system-based approach. METHOD Five journals were selected and relevant studies across all years were extracted. Four criteria, argued to be essential characteristics of system-based change, were assessed: (1) establishing a culture change within the healthcare system/organisation, through designated leaders who endorse organisational goals; (2) adopting a multidisciplinary approach to change; (3) mapping the system and identifying points of leverage; and (4) measuring the impact of change and adapting establish feedback loops. RESULTS The search strategy returned 1174 citations, of which five met the inclusion criteria. Of the intervention studies identified, three met none of the four defined criteria for a systems-based intervention, one study met criterion 2 only, and one study met all four criteria, however, was not a rigorous study design. CONCLUSIONS This review of published psychosocial intervention trials in top-ranking psychosocial cancer care journals only found one study that met our criteria for evaluating system-based change. This is likely to be a consequence of the significant pragmatic and political barriers to conducting system-based intervention research.
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Affiliation(s)
- Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton, NSW, Australia.
| | - Rochelle Watson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton, NSW, Australia
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Menichetti J, Pitacco G, Graffigna G. Exploring the early-stage implementation of a patient engagement support intervention in an integrated-care context-A qualitative study of a participatory process. J Clin Nurs 2018; 28:997-1009. [PMID: 30362643 DOI: 10.1111/jocn.14706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore: (a) the usual patient education in different care services of an integrated-care organisation, (b) the healthcare professionals' experiences with adding a patient engagement support intervention called PHEinAction in the patient education practice and (c) the co-designed activities to assist the implementation. BACKGROUND Including individual support for engaging patients in care into patient education practice is a key effort of integrated-care organisations. However, there is a paucity of studies exploring the implementation of similar efforts. DESIGN AND METHODS We conducted a qualitative study of a participatory process with 26 healthcare professionals-mostly nurses (n = 22) with leading roles (n = 12)-of different care services in one Italian integrated-care organisation. Data were collected through multiple sources (observations and shadowing; interviews; documents/artefacts; workshops) during the first 6 months of the implementation of PHEinAction. A thematic analysis using a hybrid approach was performed. COREQ guidelines were followed. RESULTS The existing patient education practice of hospital, ambulatory and community healthcare services of the organisation differed in contents, perceived responsibility and focus area. These key aspects of patient education influenced the healthcare professionals' experiences with the implementation. The experiences informed the activities enacted during the participatory process to assist the implementation, from the co-creation of artefacts to the deployment of peer group supervision. CONCLUSION The implementation of a brief intervention for patient engagement support required a process of adjustment to the single settings and a continuous support to healthcare professionals. It also required performing complementary activities to assist the implementation and its adoption in new care services. RELEVANCE TO CLINICAL PRACTICE This qualitative study contributes to the understanding of the pitfalls and strategies that may surround embedding patient engagement support in the educational practice of complex organisations, potentially facilitating the deployment to other care settings.
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Affiliation(s)
- Julia Menichetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Giuliana Pitacco
- Nursing Direction, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2018; 5:CD009103. [PMID: 29734470 PMCID: PMC6494626 DOI: 10.1002/14651858.cd009103.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. MAIN RESULTS The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. AUTHORS' CONCLUSIONS We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
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Affiliation(s)
- Bernadeta Bridgwood
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK, LE1 7RH
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Dal Molin A, Gatta C, Boggio Gilot C, Ferrua R, Cena T, Manthey M, Croso A. The impact of primary nursing care pattern: Results from a before-after study. J Clin Nurs 2018; 27:1094-1102. [PMID: 29076592 DOI: 10.1111/jocn.14135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the effect of "Primary Nursing" on nursing-sensitive patient outcomes, staff-related outcomes and organisation-related outcomes. BACKGROUND Primary nursing is one example of a care pattern that has recently been implemented in many countries. DESIGN Before-after study. METHODS This study was conducted in an Italian hospital. We observed patient-related outcomes (pressure ulcers, falls, urinary tract infection and venous catheter infection) in 2,857 inpatients before the implementation of primary nursing and in 3,169 inpatients after its implementation. Staff-related outcomes (nursing competence and diagnostic thinking) and organisation-related outcomes (empowerment and team climate) were collected from 369 nurses. From a subgroup of inpatients, we collected data regarding their satisfaction with the care provided. RESULTS After the implementation of primary nursing, some nursing competencies and diagnostic thinking were improved, so were organisation-related outcomes. Our data showed that the number of inpatients with urinary catheter infections (5.5% vs. 4.3%) and venous catheter infections (peripheral: 2.2% vs. 1%; central: 5.6% vs. 1%) was significantly decreased; also, the numbers of falls (2.4% vs. 1.9%) and pressure ulcers (4.8% vs. 4%) decreased, although these decreases were not statistically significant. Overall, the implementation of primary nursing increased patient satisfaction with nursing care (193.57 vs. 210.21). CONCLUSIONS Primary nursing improved staff-related outcomes, nursing-sensitive patient outcomes and organisation outcomes. RELEVANCE TO CLINICAL PRACTICE Our results show that primary nursing has the potential to positively impact on inpatients, nurses and organisations. Moreover, the implementation of this care pattern is feasible.
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Affiliation(s)
- Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Nursing School, Biella Hospital, Biella, Italy
| | | | | | - Rachele Ferrua
- Centro Studi Professioni Sanitarie (CESPI), Torino, Italy
| | - Tiziana Cena
- Unit of Medical Statistics and Cancer Epidemiology, Center of Oncological Prevention (CPO), University of Piemonte Orientale, Novara, Italy
| | - Marie Manthey
- Creative Health Care Management, Minneapolis, MN, USA
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Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, Rada G, Wiysonge CS, Bastías G, Dudley L, Flottorp S, Gagnon M, Garcia Marti S, Glenton C, Okwundu CI, Peñaloza B, Suleman F, Oxman AD. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011083. [PMID: 28901005 PMCID: PMC5621087 DOI: 10.1002/14651858.cd011083.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. AUTHORS' CONCLUSIONS A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies.
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Affiliation(s)
- Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Tomas Pantoja
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | | | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Gabriel Bastías
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Signe Flottorp
- Norwegian Institute of Public HealthDepartment for Evidence SynthesisPO Box 4404 NydalenOsloNorway0403
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Fatima Suleman
- University of KwaZulu‐NatalDiscipline of Pharmaceutical Sciences, School of Health SciencesPrivate Bag X54001DurbanKZNSouth Africa4000
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, Herrera CA, Rada G, Peñaloza B, Dudley L, Gagnon M, Garcia Marti S, Oxman AD. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011086. [PMID: 28895659 PMCID: PMC5621088 DOI: 10.1002/14651858.cd011086.pub2] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories - strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support. AUTHORS' CONCLUSIONS Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | | | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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McKillop A, Shaw J, Sheridan N, Gray CS, Carswell P, Wodchis WP, Connolly M, Denis JL, Baker GR, Kenealy T. Understanding the Attributes of Implementation Frameworks to Guide the Implementation of a Model of Community-based Integrated Health Care for Older Adults with Complex Chronic Conditions: A Metanarrative Review. Int J Integr Care 2017; 17:10. [PMID: 28970751 PMCID: PMC5624227 DOI: 10.5334/ijic.2516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best. METHODS We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. RESULTS Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Five metanarratives emerged 1) theoretical constructs; 2) multiple influencing factors; 3) development of new frameworks; 4) application of existing frameworks; and 5) effectiveness of interventions within frameworks/models. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone. DISCUSSION The research identified perspectives central to integrated CBPHC that were missing in the literature. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible. CONCLUSIONS All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.
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Schmidhauser M, Regamey J, Pilon N, Pascual M, Rotman S, Banfi C, Prêtre R, Meyer P, Antonietti JP, Hullin R. The impact of multidisciplinary care on early morbidity and mortality after heart transplantation. Interact Cardiovasc Thorac Surg 2017; 25:384-390. [DOI: 10.1093/icvts/ivx151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
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Pin S, Spini D. Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge. J Aging Soc Policy 2017; 28:218-31. [PMID: 27110727 DOI: 10.1080/08959420.2016.1181972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and their families but also individuals of all ages. We conclude that the development of suitable policies addressing the needs of the very old will benefit from future investigation of cross-cultural similarities and differences in centenarians' characteristics, available services, as well as life conditions they encounter in communities and institutional contexts.
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Affiliation(s)
- Stephanie Pin
- a Institute of Social Sciences, University of Lausanne , Lausanne , Switzerland
| | - Dario Spini
- a Institute of Social Sciences, University of Lausanne , Lausanne , Switzerland
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Costa DK, White MR, Ginier E, Manojlovich M, Govindan S, Iwashyna TJ, Sales AE. Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review. Chest 2017; 152:304-311. [PMID: 28438605 DOI: 10.1016/j.chest.2017.03.054] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improved outcomes are associated with the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE); however, implementation issues are common. As yet, no study has integrated the barriers to ABCDE to provide an overview of reasons for less successful efforts. The purpose of this review was to identify and catalog the barriers to ABCDE delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation. METHODS We searched MEDLINE via PubMed, CINAHL, and Scopus for original research articles from January 1, 2007, to August 31, 2016, that identified barriers to ABCDE implementation for adult patients in the ICU. Two reviewers independently reviewed studies, extracted barriers, and conducted thematic content analysis of the barriers, guided by the Consolidated Framework for Implementation Research. Discrepancies were discussed, and consensus was achieved. RESULTS Our electronic search yielded 1,908 articles. After applying our inclusion/exclusion criteria, we included 49 studies. We conducted thematic content analysis of the 107 barriers and identified four classes of ABCDE barriers: (1) patient-related (ie, patient instability and safety concerns); (2) clinician-related (ie, lack of knowledge, staff safety concerns); (3) protocol-related (ie, unclear protocol criteria, cumbersome protocols to use); and, not previously identified in past reviews, (4) ICU contextual barriers (ie, interprofessional team care coordination). CONCLUSIONS We provide the first, to our knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors. Our analysis offers a differential diagnosis checklist for clinicians planning ABCDE implementation to improve patient care and outcomes.
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Affiliation(s)
| | | | - Emily Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI
| | | | - Sushant Govindan
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Anne E Sales
- VA Center for Clinical Management Research, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
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Woods C, Carlisle K, Larkins S, Thompson SC, Tsey K, Matthews V, Bailie R. Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services. Front Public Health 2017; 5:45. [PMID: 28393064 PMCID: PMC5364947 DOI: 10.3389/fpubh.2017.00045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. METHODS High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. RESULTS High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. CONCLUSION Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.
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Affiliation(s)
- Cindy Woods
- School of Health, University of New England , Armidale, NSW , Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Sandra Claire Thompson
- Western Australian Centre for Rural Health, University of Western Australia , Geraldton, WA , Australia
| | - Komla Tsey
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia; Cairns Institute and College of Art, Society and Education, James Cook University, Cairns, QLD, Australia
| | | | - Ross Bailie
- University Centre for Rural Health , Lismore, NSW , Australia
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Frakes KA, Brownie S, Davies L, Thomas JB, Miller ME, Tyack Z. Capricornia Allied Health Partnership (CAHP): a case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic. AUST HEALTH REV 2016; 38:483-6. [PMID: 25099212 DOI: 10.1071/ah13177] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/20/2014] [Indexed: 11/23/2022]
Abstract
Faced with significant health and workforce challenges, the Central Queensland Hospital and Health Service commenced an innovative student-assisted clinical model of care. The Capricornia Allied Health Partnership (CAHP) in 2010. The clinic supports pre-entry allied health student clinical placements to: (1) address service delivery gaps for previously underserved people with chronic disease; (2) facilitate hospital avoidance and early discharge from the local hospital; (3) provide an attractive clinical placement opportunity for allied health students that will potentially lead to future recruitment success, and (4) demonstrate leadership in developing interprofessional skills of future health workforce trainees. This case study details the conceptual background of the initial model, the key features of the clinical placement and service delivery model, and discusses the current and future evaluation of the clinic.
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Affiliation(s)
- Kerrie-anne Frakes
- Central Queensland Hospital and Health Services, Canning St, Rockhampton, Qld 4700, Australia
| | - Sharon Brownie
- Griffith Health Institute, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus, Griffith University, Qld 4222, Australia.
| | - Lauren Davies
- Siggins Miller Consultants, PO BOX 1143, Kenmore, Qld 4069, Australia.
| | - Janelle B Thomas
- Royal Brisbane and Women's Hospital, Butterfield St, Herston, Qld 4029, Australia.
| | - Mary-Ellen Miller
- Siggins Miller Consultants, PO BOX 1143, Kenmore, Qld 4069, Australia.
| | - Zephanie Tyack
- School of Health and Rehabilitation Sciences, Therapies Annexe Building 84, Level 8, Room 805, St Lucia Campus, The University of Queensland, Qld 4072, Australia.
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Salamonsen A, Kiil MA, Kristoffersen AE, Stub T, Berntsen GR. "My cancer is not my deepest concern": life course disruption influencing patient pathways and health care needs among persons living with colorectal cancer. Patient Prefer Adherence 2016; 10:1591-600. [PMID: 27574408 PMCID: PMC4994880 DOI: 10.2147/ppa.s108422] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The concept of "patient pathways" in cancer care is most commonly understood as clinical pathways, operationalized as standardized packages of health care based on guidelines for the condition in question. In this understanding, patient pathways do not address multimorbidity or patient experiences and preferences. This study explored patient pathways understood as the individual and cultural life course, which includes both life and health events. The overall aim was to contribute to supportive and targeted cancer care. MATERIALS AND METHODS Nine Norwegian patients recently diagnosed with rectal cancer Tumor-Node-Metastasis stage I-III participated in qualitative interviews, five times over 1 year. Five patients later participated in a workshop where they made illustrations of and discussed patient pathways. RESULTS Patient pathways including both health and life events were illustrated and described as complex and circular. Stress, anxiety, and depression caused by life events had significant disruptive effects and influenced patient-defined health care needs. The participants experienced the Norwegian public health service as focused on hospital-based standardized cancer care. They expressed unmet health care needs in terms of emotional and practical support in their everyday life with cancer, and some turned to complementary and alternative medicine. CONCLUSION This study suggests that acknowledging life course disruption before cancer diagnosis may have significant relevance for understanding complex patient pathways and individual health care needs. Approaching patient pathways as individual and socially constructed may contribute important knowledge to support targeted cancer care.
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Affiliation(s)
- Anita Salamonsen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Mona A Kiil
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Agnete Egilsdatter Kristoffersen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Trine Stub
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Gro R Berntsen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Norwegian Center for eHealth Research, University Hospital of Northern Norway, Tromsø, Norway
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Sirois FM, Salamonsen A, Kristoffersen AE. Reasons for continuing use of Complementary and Alternative Medicine (CAM) in students: a consumer commitment model. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:75. [PMID: 26911133 PMCID: PMC4765033 DOI: 10.1186/s12906-016-1059-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/16/2016] [Indexed: 12/23/2022]
Abstract
Background Research on continued CAM use has been largely atheoretical and has not considered the broader range of psychological and behavioral factors that may be involved. The purpose of this study was to test a new conceptual model of commitment to CAM use that implicates utilitarian (trust in CAM) and symbolic (perceived fit with CAM) in psychological and behavioral dimensions of CAM commitment. Methods A student sample of CAM consumers, (N = 159) completed a survey about their CAM use, CAM-related values, intentions for future CAM use, CAM word-of-mouth behavior, and perceptions of being an ongoing CAM consumer. Results Analysis revealed that the utilitarian, symbolic, and CAM commitment variables were significantly related, with r’s ranging from .54 to .73. A series hierarchical regression analyses controlling for relevant demographic variables found that the utilitarian and symbolic values uniquely accounted for significant and substantial proportion of the variance in each of the three CAM commitment indicators (R2 from .37 to .57). Conclusions The findings provide preliminary support for the new model that posits that CAM commitment is a multi-dimensional psychological state with behavioral indicators. Further research with large-scale samples and longitudinal designs is warranted to understand the potential value of the new model.
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Sirois FM, Salamonsen A, Kristoffersen AE. Reasons for continuing use of Complementary and Alternative Medicine (CAM) in students: a consumer commitment model. Altern Ther Health Med 2016. [PMID: 26911133 DOI: 10.1186/s12906-016-1059-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research on continued CAM use has been largely atheoretical and has not considered the broader range of psychological and behavioral factors that may be involved. The purpose of this study was to test a new conceptual model of commitment to CAM use that implicates utilitarian (trust in CAM) and symbolic (perceived fit with CAM) in psychological and behavioral dimensions of CAM commitment. METHODS A student sample of CAM consumers, (N = 159) completed a survey about their CAM use, CAM-related values, intentions for future CAM use, CAM word-of-mouth behavior, and perceptions of being an ongoing CAM consumer. RESULTS Analysis revealed that the utilitarian, symbolic, and CAM commitment variables were significantly related, with r's ranging from .54 to .73. A series hierarchical regression analyses controlling for relevant demographic variables found that the utilitarian and symbolic values uniquely accounted for significant and substantial proportion of the variance in each of the three CAM commitment indicators (R(2) from .37 to .57). CONCLUSIONS The findings provide preliminary support for the new model that posits that CAM commitment is a multi-dimensional psychological state with behavioral indicators. Further research with large-scale samples and longitudinal designs is warranted to understand the potential value of the new model.
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Affiliation(s)
- Fuschia M Sirois
- Department of Psychology, University of Sheffield, Sheffield, UK.,Department of Psychology, University of Windsor, Windsor, Canada
| | - Anita Salamonsen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Larkins S, Woods CE, Matthews V, Thompson SC, Schierhout G, Mitropoulos M, Patrao T, Panzera A, Bailie RS. Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives. Front Public Health 2016; 3:288. [PMID: 26835442 PMCID: PMC4720733 DOI: 10.3389/fpubh.2015.00288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/25/2015] [Indexed: 11/13/2022] Open
Abstract
Background Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. Setting and participants PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Methods/design Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Results Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. Conclusion The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to improvement.
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Affiliation(s)
- Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute for Tropical Health and Medicine, Townsville, QLD, Australia
| | - Cindy E Woods
- College of Medicine and Dentistry, James Cook University , Cairns, QLD , Australia
| | | | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), The University of Western Australia , Crawley, WA , Australia
| | - Gill Schierhout
- Menzies School of Health Research , Brisbane, QLD , Australia
| | | | - Tania Patrao
- Menzies School of Health Research , Brisbane, QLD , Australia
| | - Annette Panzera
- College of Medicine and Dentistry, James Cook University , Cairns, QLD , Australia
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IJsbrandy C, Ottevanger PB, Groen WG, Gerritsen WR, van Harten WH, Hermens RPMG. Study protocol: an evaluation of the effectiveness, experiences and costs of a patient-directed strategy compared with a multi-faceted strategy to implement physical cancer rehabilitation programmes for cancer survivors in a European healthcare system; a controlled before and after study. Implement Sci 2015; 10:128. [PMID: 26345182 PMCID: PMC4562188 DOI: 10.1186/s13012-015-0312-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/12/2015] [Indexed: 12/04/2022] Open
Abstract
Background The need for physical cancer rehabilitation programmes (PCRPs), addressing adverse effects from cancer, is growing. Implementing these programmes into daily practice is still a challenge. Since barriers for successful implementation often arise at different levels in healthcare, multi-faceted strategies focusing on multiple levels are likely more effective than single-faceted strategies. Nevertheless, most studies implementing PCRPs used strategies directed at patients only. The aim of this study is to develop and identify the most effective strategy to implement PCRPs into daily care. We want to assess the added value of a multi-faceted strategy compared with a single-faceted patient-directed strategy. Methods/design We will conduct a clustered controlled before and after study (CBA) in the Netherlands that compares two strategies to implement PCRPs. The patient-directed (PD) strategy (five hospitals) will focus on change at the patient level. The multi-faceted (MF) strategy (five hospitals) will focus on change at the patient, professional and organizational levels. Eligibility criteria are as follows: (A) patients: adults; preferably (history of) cancer in the gastro-intestinal, reproductive and/or urological system; successful primary treatment; and without recurrence/metastases. (B) Healthcare professionals: involved in cancer care. A stepwise approach will be followed:Step 1: Analysis of the current implementation of PCRPs and the examination of barriers and facilitators for implementation, via a qualitative study with patients (four focus groups n = 10–12) and their healthcare workers (four focus groups n = 10–12 and individual interviews n = 30–40) and collecting data on adherence to quality indicators (n = 500 patients, 50 per hospital). Step 2: Selection and development of interventions to create a PD and MF strategy during expert roundtable discussions, using the knowledge gained in step 1 and a literature search of the effect of strategies for implementing PCRPs. Step 3: Test and compare both strategies with a clustered CBA (effectiveness, process evaluation and costs), by data extraction from existing registration systems, questionnaires and interviews. For the effectiveness and cost-effectiveness, n = 500 patients, 50 per hospital. For the process evaluation, n = 50 patients, 5 per hospital, and n = 40 healthcare professionals, 4 per hospital. Main outcome measures: % screened patients, % referrals to PCRPs, incremental costs and incremental cost-effectiveness ratios (ICERs).
Trail registration NCT02205853 (ClinicalTrials.gov)
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim G Groen
- Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim H van Harten
- Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Health Technology and Services Research, MB-HTSR, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre Nijmegen, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
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Le Boutillier C, Chevalier A, Lawrence V, Leamy M, Bird VJ, Macpherson R, Williams J, Slade M. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implement Sci 2015; 10:87. [PMID: 26059397 PMCID: PMC4464128 DOI: 10.1186/s13012-015-0275-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. METHODS A systematic review of empirical primary research was conducted. Data sources were online databases (n = 8), journal table of contents (n = 5), internet, expert consultation (n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. RESULTS A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. CONCLUSIONS Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. TRIAL REGISTRATION The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942 ).
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Affiliation(s)
- Clair Le Boutillier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Agnes Chevalier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Vanessa Lawrence
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mary Leamy
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Victoria J Bird
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Julie Williams
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, Marr S, Giangregorio LM, Morin SN, Crilly RG, Josse RG, Lohfeld L, Pickard LE, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Trials 2015; 16:214. [PMID: 25962885 PMCID: PMC4431601 DOI: 10.1186/s13063-015-0720-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/13/2015] [Indexed: 01/02/2023] Open
Abstract
Background Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months. Methods We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes. Results At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively. Conclusions Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement. Trial Registration ClinicalTrials.gov: NCT01398527. Registered: 19 July 2011.
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Affiliation(s)
- Courtney C Kennedy
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - George Ioannidis
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lehana Thabane
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Jonathan D Adachi
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Sharon Marr
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lora M Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Suzanne N Morin
- McGill University, 845Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada.
| | - Richard G Crilly
- Western University, Parkwood Hospital, 801 Commissioners Road East, London, ON, N6C 5 J1, Canada.
| | - Robert G Josse
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Lynne Lohfeld
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Laura E Pickard
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | | | - Glenda Campbell
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Crt, Pickering, ON, L1W 3X6, Canada.
| | - Lisa Dolovich
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Anna M Sawka
- University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Ravi Jain
- Osteoporosis Canada, Suite 301, 1090 Don Mills Road, Toronto, ON, M3C 3R6, Canada.
| | - Lynn Nash
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Alexandra Papaioannou
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Division of Geriatrics, Department of Medicine, McMaster University, Geriatric Education and Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, Room 151, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada.
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Joosen MCW, van Beurden KM, Terluin B, van Weeghel J, Brouwers EPM, van der Klink JJL. Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy. BMC MEDICAL EDUCATION 2015; 15:82. [PMID: 25903280 PMCID: PMC4469464 DOI: 10.1186/s12909-015-0364-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 04/14/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. METHODS OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. RESULTS The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). CONCLUSIONS The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.
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Affiliation(s)
- Margot C W Joosen
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Karlijn M van Beurden
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
| | - Jaap van Weeghel
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
- Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.
- Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900, AH, Castricum, The Netherlands.
| | - Evelien P M Brouwers
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Jac J L van der Klink
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
- Department of Health Sciences, Division of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands.
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Abstract
BACKGROUND Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. DISCUSSION Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited "how-to" support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.
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Affiliation(s)
- Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Åsprang AF, Frich JC, Braut GS. Organizational impact of governmental audit of blood transfusion services in Norway: A qualitative study. Transfus Apher Sci 2015; 53:228-32. [PMID: 25935295 DOI: 10.1016/j.transci.2015.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
Little is known about the organizational impact of supervisory activities in blood banks. We did a study with the aim to explore health professional's experiences with the external audit of blood transfusion services in Norway. The audit and supervision brought attention to deficiencies in systems and practices, and had been a catalyst for quality improvement. We identify facilitators and barriers to change. While audits can bring attention to known deficiencies, and trigger improvement processes which previously have not been prioritized, involvement of senior management is important to secure change across departments.
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Affiliation(s)
| | - Jan C Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Geir Sverre Braut
- Norwegian Board of Health Supervision, Oslo, Norway; Stavanger University Hospital, Stavanger, Norway.
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Lehnbom EC, Boxall AM, Russell LM, Brien JAE. Management of Medicines in Chronic Illness: Views of Community Pharmacists in New South Wales. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00454.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Elin C Lehnbom
- Faculty of Pharmacy; The University of Sydney, and Therapeutics Centre, St Vincent's Hospital
| | | | | | - Jo-anne E Brien
- Faculty of Pharmacy; The University of Sydney, and Therapeutics Centre, St Vincent's Hospital; Darlinghurst New South Wales
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50
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Tsiachristas A, Wallenburg I, Bond CM, Elliot RF, Busse R, van Exel J, Rutten-van Mölken MP, de Bont A. Costs and effects of new professional roles: Evidence from a literature review. Health Policy 2015; 119:1176-87. [PMID: 25899880 DOI: 10.1016/j.healthpol.2015.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs. A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985-2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies. Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8). Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.
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Affiliation(s)
- A Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
| | - I Wallenburg
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - C M Bond
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - R F Elliot
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - R Busse
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - J van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - A de Bont
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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