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Sivertsen DM, Becker U, Andersen O, Kirk JW. Between acute medicine and municipal alcohol treatment: Cross-sectoral collaborations regarding patients with alcohol problems. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:403-425. [PMID: 39309201 PMCID: PMC11412477 DOI: 10.1177/14550725241252256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/17/2024] [Indexed: 09/25/2024] Open
Abstract
Aim: The aim was to examine cross-sectoral collaborations of a Danish emergency department (ED) and two municipal treatment centres in the uptake area regarding patients with alcohol problems. Methods: The study was a qualitative exploratory study. We conducted individual interviews with ED nurses and secretaries (n = 21) and group interviews (n = 2) in municipal alcohol treatment centres with three and four participants, respectively. Interviews were analysed, first with qualitative content analysis, then by applying the analytical concept "boundary object". Results: Three themes emerged: (1) Responsibilities in practice; (2) Professional contrasts; and (3) The social nurse in a unique position. Themes illuminated a low degree of collaboration characterising the intersectoral work. Blurred responsibilities, challenged communication and acute versus long-term focus were some of the factors not supporting cross-sector collaborations. However, the function of the social nurse was highly appreciated in both sectors and plays a central role. Nonetheless, implicit limitations of this function entail that not all patients with alcohol problems are referred and handled within an ED setting. Conclusions: Overall, we found a lack of collaborative work between healthcare professionals in ED and municipalities for patients with alcohol problems. However, the "social nurse" function was greatly valued in both sectors due to a mediating role, since healthcare professionals in both sectors experienced lack of organisational structures supporting collaborative network, perceived temporal barriers, limited knowledge exchange and differences in approaches to patients.
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Affiliation(s)
- Ditte Maria Sivertsen
- Copenhagen University Hospital, Denmark; Capital Region of Denmark Psychiatry, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ove Andersen
- Copenhagen University Hospital Amager Hvidovre, Denmark; University of Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Copenhagen University Hospital, Denmark; National Institute of Public Health, University of Southern Denmark, Denmark
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Bartels SM, Phan HTT, Hutton HE, Nhan DT, Sripaipan T, Chen JS, Rossi SL, Ferguson O, Nong HTT, Nguyen NTK, Giang LM, Bui HTM, Chander G, Sohn H, Kim S, Tran HV, Nguyen MX, Powell BJ, Pence BW, Miller WC, Go VF. Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial. Implement Sci 2024; 19:40. [PMID: 38867283 PMCID: PMC11170841 DOI: 10.1186/s13012-024-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use. METHODS Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI. PARTICIPANTS ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months. OUTCOMES We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm. DISCUSSION This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases. TRIAL REGISTRATION NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
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Affiliation(s)
- Sophia M Bartels
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Huong T T Phan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Heidi E Hutton
- Johns Hopkins Hospital University School of Medicine, Baltimore, MD, USA
| | - Do T Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jane S Chen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sarah L Rossi
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Olivia Ferguson
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Le Minh Giang
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Hao T M Bui
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Hojoon Sohn
- Seoul National University College, Seoul, Korea
| | - Sol Kim
- Seoul National University College, Seoul, Korea
| | | | - Minh X Nguyen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MI, USA
| | - Brian W Pence
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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Sapru S, Mitchell K, McFadden T. Combining Physician Expertise and Women's Lived Experience to Educate Health Professionals about Preventing Fetal Alcohol Spectrum Disorders. Matern Child Health J 2024; 28:229-239. [PMID: 37847449 DOI: 10.1007/s10995-023-03786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Physician Champions from the American College of Obstetricians and Gynecologists (ACOG) and trained women Speakers from FASD United, who have given birth to a child with a fetal alcohol spectrum disorder (FASD), co-present to healthcare providers (HCPs) in medical residency programs as part of an educational intervention. They present FASDs as a biological and social problem surrounded by stigma that prevent pregnant women from talking openly to their HCPs about their alcohol use or alcohol use disorder (AUD) and getting the medical help they need. METHODS Semi-structured interviews were conducted with 10 ACOG Champions and nine FASD United Speakers and a thematic analysis assessed how the co-presentations can enhance HCPs' understanding about FASDs and address stigma associated with alcohol use during pregnancy. RESULTS Interview findings indicated that both Champions and Speakers emphasized the need for HCPs to be nonjudgmental and create a safe space for open dialogue. They reported that residents were moved by mothers' personal stories, wanted to understand AUD better, and asked about the type of help HCPs can offer women. DISCUSSION Combining physicians' expertise with mothers' personal stories of lived experiences of FASDs directed at residents, who are more reflective and open at this phase of their careers, moved them from a fact-based to an empathy-based approach to learning that is critical to address the stigma surrounding women who may be using alcohol or struggling with an AUD during pregnancy. Collaboration between national organizations allowed this intervention to be widely implemented across the country.
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Affiliation(s)
| | | | - Tonya McFadden
- American College of Obstetricians and Gynecologists, Washington, DC, USA
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Sivertsen DM, Andersen KV, Becker U, Lisby M, Andersen O, Brünes N, Kirk JW. Acceptability Among Frontline Staff Toward Distributing an Anonymous Alcohol Survey in Emergency Departments: A Mixed Methods Study. J Addict Nurs 2023; 34:E53-E64. [PMID: 37669345 PMCID: PMC10510809 DOI: 10.1097/jan.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
ABSTRACT Emergency departments (EDs) serve as the front line when patients encounter the hospital system. Limited data are available of patients' alcohol habits collected during Danish ED visits, and no studies have, to our knowledge, examined frontline staffs' (registered nurses and medical secretaries) acceptability to deliver anonymous alcohol surveys to patients. We aimed at examining the proportion of survey respondents and the prevalence of patients' alcohol habits and also exploring frontline staff acceptability of the distribution of an anonymous survey regarding patients' alcohol habits in EDs. Intendedly, all eligible patients ≥18 years old entering two EDs in March 2019 should receive a survey based on the Alcohol Use Disorder Identification Test. The study was an explanatory, sequential, mixed methods design, and results were analyzed with descriptive statistics and a deductive content analysis based on the theoretical framework of acceptability. In total, 15% (n = 1,305) of the total 8,679 patients in the EDs returned the survey. Qualitative analysis of interviews (n = 31) with staff showed that they had been reluctant to distribute the survey primarily because of ethical concerns of anonymity, freedom of choice, and being nonjudgmental toward patients. Hence, patients with no obvious alcohol problems were more likely to receive the survey. Still, we found that 23% of the respondents had an Alcohol Use Disorder Identification Test score ≥ 8. Results indicate that frontline staffs' recognition of patients' alcohol use is inadequate, and findings show a low degree of acceptability among staff to deliver an anonymous survey, which is in line with earlier described barriers toward screening activities in EDs.
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Næss O, Ekeland TJ, Arnevik EA, Aarstad J, Lid TG. Governing by commissioning services - Implementing alcohol screening and brief interventions in hospital settings in Norway. EVALUATION AND PROGRAM PLANNING 2023; 98:102271. [PMID: 36921405 DOI: 10.1016/j.evalprogplan.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 05/17/2023]
Abstract
Norwegian health services have undergone marked logistical changes in organization and funding over recent decades. One significant change was the new public management-inspired commissioner's document, first issued in 2013 by the Norwegian Ministry of Health and Care Services, to establish medical and surgical departments' identification of patients with underlying substance abuse problems (Ministry of Health and Care Services, 2013). Herein, we investigate how multiple stakeholders and actors, who bear responsibility in regional and local health trusts, have responded to the commissioned services to establish routines for identifying alcohol and substance abuse problems among patients admitted to medical and surgical wards. First, an extensive literature search was conducted. Second, we conducted qualitative interviews with informants who have responsibility for applying the commissioner's document in regional health authorities and local hospitals. The study results demonstrate that responsible actors at all levels take establishing alcohol routines seriously, and that hospitals' self-assessment of their achievements on internal goals indicate that they have made satisfactory progress. Nevertheless, improvement is needed to meet the goal of discussing alcohol use with all patients admitted to medical and surgical wards within local health trusts. Recommendations for the next steps, based on these findings, include further research and training priorities.
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Affiliation(s)
- Ole Næss
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway; Volda University College, PO 500, 6101 Volda, Norway.
| | | | - Espen Ajo Arnevik
- Section for clinical addiction research (Rusforsk), Oslo University Hospital, Oslo, Norway
| | - Janne Aarstad
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
| | - Torgeir Gilje Lid
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger Norway
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Sundström C, Forsström D, Berman AH, Khadjesari Z, Sundqvist K. What do we know about alcohol internet interventions aimed at employees?-A scoping review. Front Public Health 2023; 11:929782. [PMID: 36778564 PMCID: PMC9909699 DOI: 10.3389/fpubh.2023.929782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Background Internet interventions are a promising avenue for delivering alcohol prevention to employees. The objective of this scoping review was to map all research on alcohol internet interventions aimed at employees regardless of design, to gain an overview of current evidence and identify potential knowledge gaps. Methods We conducted a literature search in three data bases (PsycInfo, PubMed, and Web of Science). Eligibility criteria were that (1) the study targeted employees age ≥18 years; (2) the intervention was delivered predominantly online; (3) the study focused specifically or in part on alcohol use; and (4) the study was published in English in a peer-reviewed academic journal. Two reviewers independently screened, reviewed, and extracted data. Results Twenty studies were included, of which 10 were randomized controlled trials, five were secondary analyses, three were feasibility trials, one was a cohort study and one described the rationale and development of an intervention. No qualitative studies were found. Randomized trials tended to show effects when interventions were compared to waitlists but not when more intensive interventions were compared to less intensive ones. We identified two design-related aspects where studies differed; (1) whether all applicants were included regardless of alcohol use level and (2) whether the intervention was explicitly framed as alcohol-focused or not. Significant recruitment problems were noted in several studies. Conclusions Alcohol internet interventions hold promise in delivering alcohol prevention to employees, but heterogeneity in study design and difficulties in recruitment complicate interpretation of findings. Systematic review registration https://osf.io/25x7e/, Open Science Framework.
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Affiliation(s)
- Christopher Sundström
- Department of Psychology, Stockholm University, Stockholm, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden,*Correspondence: Christopher Sundström ✉
| | - David Forsström
- Department of Psychology, Stockholm University, Stockholm, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Anne H. Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Zarnie Khadjesari
- Behavioral and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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K S, Nattala P, B A A, Murthy P. Nurses' perspectives regarding integrated nursing interventions for psychoactive substance use cessation: A mixed methods study from South India. Perspect Psychiatr Care 2022; 58:2183-2189. [PMID: 35133648 DOI: 10.1111/ppc.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To obtain nurses' perspectives regarding integrated interventions for substance use cessation for patients in general hospital settings. DESIGN AND METHODS (a) Quantitative survey (N = 207) (nurses' knowledge, attitude, practice, confidence regarding integrated interventions; (b) Focus groups exploring nurses' perspectives regarding integrated interventions (N = 32). FINDINGS Participants' scores (mean, SD): Knowledge-112.5 (10.4) (maximum score-198); Attitude-30.99 (7.05) (maximum-52); Practice-1.66 (2.63) (maximum-28); Confidence-11.90 (3.82) (maximum-24). From the focus groups, four themes were identified: Substance use patterns among patients seeking treatment at the hospitals where the nurses are employed; Nurses' role in providing integrated interventions; Nurses' training needs for providing integrated interventions; Feasibility of providing integrated interventions. PRACTICE IMPLICATIONS Findings provide clear justification for module development to train nurses in providing integrated interventions.
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Affiliation(s)
- Sugavanaselvi K
- Department of Nursing, College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Prasanthi Nattala
- Department of Nursing, & Nursing Consultant, Center for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Arvind B A
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Department of Psychiatry, Center for Addiction Medicine, & Director, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Tan HT, Lui YS, Peh LH, Winslow RM, Guo S. Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting. Subst Abuse 2022; 16:11782218211065755. [PMID: 35035219 PMCID: PMC8753239 DOI: 10.1177/11782218211065755] [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: 01/28/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards. METHODS A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources. RESULTS About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%). CONCLUSION/DISCUSSION Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. SCIENTIFIC SIGNIFICANCE The prompt identification and treatment of patients with alcohol problems are contingent on the workers' attitudes towards them. This study's results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.
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Affiliation(s)
- Ho Teck Tan
- Department of Psychological Medicine,
National University Hospital, Singapore
| | - Yit Shiang Lui
- Department of Psychological Medicine,
National University Health System, Singapore
| | - Lai Huat Peh
- Department of Psychological Medicine,
Changi General Hospital, Singapore
| | | | - Song Guo
- National Addictions Management Service,
Institute of Mental Health, Singapore
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Kools N, van de Goor I, Bovens RHLM, van de Mheen D, Rozema AD. Impeding and facilitating factors for the implementation of alcohol interventions in hospitals: a qualitative and exploratory study among Dutch healthcare professionals. BMC Health Serv Res 2022; 22:6. [PMID: 34974830 PMCID: PMC8722137 DOI: 10.1186/s12913-021-07412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-moderated alcohol use is more prevalent among hospitalized patients compared to the general population. However, many hospitals fail to find and intervene with people with alcohol problems. We aimed to conduct an exploration of impeding and facilitating factors experienced by healthcare professionals in implementation of alcohol interventions in Dutch general hospitals. In addition, we explored the alcohol interventions used in the selected hospitals and involved stakeholders. Methods Through a qualitative study, semi-structured telephone interviews were conducted with twenty healthcare professionals working in or in collaboration with six different general hospitals. Results Healthcare professionals indicated impeding and facilitating factors in the areas of motivation, knowledge and skills, patient characteristics, protocol, internal and external collaboration/support, resources, role suitability and societal support. Five different categories of approaches to identify and intervene with non-moderated alcohol use and 18 involved stakeholders from both inside and outside the hospital were found. Conclusions Implementation of alcohol interventions for patients in Dutch general hospitals still seems to be in its infancy. Respondents emphasized the importance of one clear protocol on how to tackle alcohol problems within their hospital, repeated training on alcohol-related knowledge and skills, (clinical) “champions” that support healthcare professionals and developing and maintaining collaborations with stakeholders within and outside the hospital.
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Affiliation(s)
- Nathalie Kools
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Ien van de Goor
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Rob H L M Bovens
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
| | - Andrea D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, 5000 LE, Tilburg, The Netherlands
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Lid TG, Karlsson N, Thomas K, Skagerström J, O'Donnell A, Abidi L, Nilsen P. Addressing Patients' Alcohol Consumption-A Population-Based Survey of Patient Experiences. Int J Public Health 2021; 66:1604298. [PMID: 34795555 PMCID: PMC8592895 DOI: 10.3389/ijph.2021.1604298] [Citation(s) in RCA: 3] [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: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To identify the proportion of the population that had experienced that alcohol was addressed in health care the previous year, to explore experiences and perceived effects of addressing alcohol, and to investigate the proportion of risky drinkers in the population. Methods: Cross-sectional national web-based survey with 1,208 participants. Socio-demographic data, alcohol consumption (AUDIT-C), and experiences with alcohol conversations were investigated. Results: Approximately four in five respondents had visited health care the past 12 months, and one in six reported having experienced addressing alcohol. Women and older respondents were less likely to report having experienced alcohol conversations compared to other groups. Risky drinkers were not more likely to have experienced an alcohol conversation, but reported longer duration of alcohol conversations and more frequently perceived addressing alcohol as awkward or judgmental. Almost a third of respondents were classified as risky drinkers. Conclusion: The proportion experiencing addressing alcohol in routine health care is low, also among risky drinkers, and risky drinkers more frequently experienced the conversations as judgmental. More sensitive and relevant ways of addressing alcohol in health care is needed.
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Affiliation(s)
- Torgeir Gilje Lid
- Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Nadine Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Amy O'Donnell
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Latifa Abidi
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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11
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Sivertsen DM, Becker U, Andersen O, Kirk JW. An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department. Addict Sci Clin Pract 2021; 16:60. [PMID: 34600564 PMCID: PMC8487327 DOI: 10.1186/s13722-021-00269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. Methods An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. Results 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”. Conclusions Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00269-z.
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Affiliation(s)
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
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12
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Oxholm C, Christensen AMS, Christiansen R, Nielsen AS. Can We Talk about Alcohol for a Minute? Thoughts and Opinions Expressed by Health Professionals and Patients at a Somatic Hospital. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2020.1803168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Oxholm
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
| | | | - Regina Christiansen
- Department for the Study of Culture, Faculty of Humanities, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Research Unit of Clinical Alcohol Research, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- University Function, Psychiatric Hospital, Region of Southern Denmark, Odense, Denmark
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Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res 2020; 44:2386-2400. [PMID: 33119905 DOI: 10.1111/acer.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.
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Affiliation(s)
- Kristine Lou Gargaritano
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caoimhe Murphy
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Austin B Auyeung
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Thoele K, Draucker CB, Newhouse R. Implementation of screening, brief intervention, and referral to treatment (SBIRT) by nurses on acute care units: A qualitative descriptive study. Subst Abus 2020; 42:662-671. [PMID: 33044895 DOI: 10.1080/08897077.2020.1823549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is "one more thing to do" but other nurses feel that it was a "good, simple" screening tool that does not take long to do and can "plant the seeds of change" for patients. Additionally, participants mentioned barriers and facilitators related to the patients' responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT.
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Affiliation(s)
- Kelli Thoele
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | | | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, Indiana, USA
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Snowden C, Lynch E, Avery L, Haighton C, Howel D, Mamasoula V, Gilvarry E, McColl E, Prentis J, Gerrand C, Steel A, Goudie N, Howe N, Kaner E. Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32131964 DOI: 10.3310/hta24120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. OBJECTIVES To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. DESIGN A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. SETTING The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. PARTICIPANTS Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. INTERVENTIONS The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. MAIN OUTCOME MEASURES Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. RESULTS The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. CONCLUSIONS The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. TRIAL REGISTRATION Current Controlled Trials ISRCTN36257982. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Christopher Snowden
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Valentina Mamasoula
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Newcastle Addictions Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - James Prentis
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Brief video intervention to teach firefighters the neurobiological basis of high risk alcohol use: A pilot study. Arch Psychiatr Nurs 2019; 33:377-382. [PMID: 31280783 DOI: 10.1016/j.apnu.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Evidence-based information related to the neurobiological bases of alcohol use disorders has not been widely disseminated to individuals affected by alcohol use. The feasibility, acceptability, and effectiveness of the video, Alcohol and the Brain was assessed, guided by the three constructs of the transtheoretical model: processes of change, decisional balance, and self-efficacy. METHODS This study examined the feasibility and acceptability of a brief video intervention and change in alcohol-related knowledge in a sample of urban firefighters (n = 11). The 20 min video was shown in a 45-min session of a Self-Management Wellness Program. A 10-item knowledge test was administered prior to and after the video and analyzed using a paired t-tests. RESULTS This brief intervention was feasibly delivered with sufficient time for questions and answers in the firehouse. There was a high level of acceptability as reflected in the positive comments and the highly interactive discussion. There was a significant increase in knowledge from pre- to post-test (t = 7.7; p < 0.001). IMPLICATIONS FOR PRACTICE Complex neuroscience can be translated for patients in the form of a video that is feasible and acceptable with significant increase in knowledge. The efficacy of this brief video intervention on alcohol-related and treatment-related outcomes needs to be established.
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Thørrisen MM, Skogen JC, Kjeken I, Jensen I, Aas RW. Current practices and perceived implementation barriers for working with alcohol prevention in occupational health services: the WIRUS OHS study. Subst Abuse Treat Prev Policy 2019; 14:30. [PMID: 31242911 PMCID: PMC6595559 DOI: 10.1186/s13011-019-0217-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities. METHODS In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses. RESULTS Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS' organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS' organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees' alcohol consumption constitute a public health challenge, and that OHS' should focus more on alcohol prevention targeting employees. CONCLUSIONS Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.
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Affiliation(s)
- Mikkel Magnus Thørrisen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- Presenter – Making Sense of Science, PO box 8118, NO-4068 Stavanger, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, PO box 973, NO-5808 Bergen, Norway
- Center for Alcohol & Drug Research, Stavanger University Hospital, PO box 8100, NO-4068 Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PO box 8600, Forus, NO-4036 Stavanger, Norway
| | - Ingvild Kjeken
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO box 23, Vindern, NO-0319 Oslo, Norway
| | - Irene Jensen
- Institute of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
- Presenter – Making Sense of Science, PO box 8118, NO-4068 Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PO box 8600, Forus, NO-4036 Stavanger, Norway
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Thompson C, McLeod SL, Perelman V, Lee S, Carver S, Dear T, Borgundvaag B. Evaluation of a Web-based Educational Program to Teach the Identification and Management of Alcohol Withdrawal in the Emergency Department. AEM EDUCATION AND TRAINING 2019; 3:50-57. [PMID: 30680347 PMCID: PMC6339544 DOI: 10.1002/aet2.10202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom-driven approach, where patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised [CIWA-Ar]) and treated according to severity. Accurate administration of the CIWA-Ar requires experience, yet there is no training program to teach this competency. The objective of this study was to develop and evaluate a curriculum to teach clinicians how to accurately assess and treat AWS. METHODS This was a three-phase education program consisting of a series of e-learning modules containing core competency material, an in-person seminar to orient learners to high-fidelity simulation, and a summative evaluation in an objective structured clinical examination setting using a standardized patient. To determine the impact of the AWS curriculum, we recorded how often the CIWA-Ar was appropriately applied in the emergency department (ED) before and after training. A CIWA-Ar protocol breach was defined as inappropriate administration of benzodiazepines (CIWA-Ar < 10) and failure to administer benzodiazepines when required (CIWA-Ar ≥ 10). ED length of stay, amount of benzodiazepines administered in the ED, discharge prescriptions, and unit doses (take-away bottle of four tablets) of benzodiazepine given were recorded. RESULTS Seventy-four ED nurses completed the curriculum over an 8-week period. In the 5 months prior to the educational program delivery, we identified 144 of 565 (25.5%) CIWA-Ar protocol breaches, compared to 64 of 547 (11.7%) in the 5 months after training (∆13.8%, 95% confidence interval [CI] = 9.3%-18.3%). Program completion resulted in a reduction in the median total dose of diazepam administered in the ED (40 mg vs. 30 mg, ∆10 mg, 95% CI = 0-20 mg) and no change was detected in ED length of stay and benzodiazepines prescribed. CONCLUSIONS Completion of this curriculum resulted in better compliance with the CIWA-Ar protocol by those who administer the CIWA-Ar; however, changes in inappropriate benzodiazepine prescribing practice will require future interdisciplinary initiatives.
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Affiliation(s)
- Cameron Thompson
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Shelley L. McLeod
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Vsevolod Perelman
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Shirley Lee
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Sally Carver
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Taylor Dear
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine InstituteUniversity of TorontoTorontoOntarioCanada
- Sinai Health SystemUniversity of TorontoTorontoOntarioCanada
- Division of Emergency MedicineDepartment of Family & Community MedicineUniversity of TorontoTorontoOntarioCanada
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Taylor G, McMahon C, Reeves L, Hickman M. 'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation. J Public Health (Oxf) 2018; 40:381-388. [PMID: 28977388 PMCID: PMC6053838 DOI: 10.1093/pubmed/fdx090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/18/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs' perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
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Affiliation(s)
- J Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - F Fox
- University Hospital Bristol, NHS Foundation Trust, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Kaner
- Institute of Health & Society, University of Newcastle, Newcastle upon Tyne, UK
| | - G Taylor
- Department for Health, University of Bath, Bath, UK
| | - C McMahon
- B&NES Council Public Health, Bath, UK
| | | | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Pedersen MS, Landheim A, Møller M, Lien L. Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Serv Res 2018; 18:71. [PMID: 29386020 PMCID: PMC5793343 DOI: 10.1186/s12913-018-2862-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. METHODS This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. RESULTS The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. CONCLUSION Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
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Affiliation(s)
- Monica Stolt Pedersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway.,Inland Norway University of Applied Sciences, Campus Elverum, Elverum, Norway
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Gleason KT, Davidson PM, Tanner EK, Baptiste D, Rushton C, Day J, Sawyer M, Baker D, Paine L, Himmelfarb CRD, Newman-Toker DE. Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action. Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractNurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.
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Mitchell AM, Kane I, Lindsay DL, Hagle H, Puskar K, Aiello J, Boucek L, Knapp E. Educating Emergency Department Registered Nurses (EDRNs) in screening, brief intervention, and referral to treatment (SBIRT): Changes in attitudes and knowledge over time. Int Emerg Nurs 2017; 33:32-36. [DOI: 10.1016/j.ienj.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/07/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022]
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Hickman M. Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review. BMC Public Health 2017; 17:562. [PMID: 28599632 PMCID: PMC5466741 DOI: 10.1186/s12889-017-4476-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people. METHODS This review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis. RESULTS From a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs. CONCLUSIONS There remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.
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Affiliation(s)
- Jane Derges
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Judi Kidger
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Fiona Fox
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Rona Campbell
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Matthew Hickman
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
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Sánchez-Solís A, de San Jorge X. Experiencias del personal de enfermería con pacientes hospitalizados por abuso de alcohol. ENFERMERÍA UNIVERSITARIA 2017. [DOI: 10.1016/j.reu.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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O'Neill G, Masson S, Bewick L, Doyle J, McGovern R, Stoker E, Wright H, Newbury-Birch D. Can a theoretical framework help to embed alcohol screening and brief interventions in an endoscopy day-unit? Frontline Gastroenterol 2016; 7:47-53. [PMID: 26834957 PMCID: PMC4717435 DOI: 10.1136/flgastro-2014-100519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/04/2015] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION AND AIMS The National Institute for Health Care and Excellence recommend that alcohol screening and brief intervention (ASBI) should be routinely implemented in secondary care. This study used theoretical frameworks to understand how health professionals can be supported to adapt their behaviour and clinical practice. DESIGN AND METHODS Staff training and support was conducted using theoretical frameworks. A 12-week study, delivering ASBI was carried out as part of routine practice in an endoscopy day-unit. Anonymised patient data were collected using the Alcohol Use Disorders Identification Tool (AUDIT) and whether patients received a brief intervention. Staff completed the Shortened Alcohol and Alcohol Problems Perceptions Questionnaire at three time points and took part in a focus group both pre and post study. RESULTS For staff, levels or role adequacy, role legitimacy, motivation to discuss alcohol, security in their role, job satisfaction and commitment to working with patients who drink increased during the time of the study. 1598 individual patients were seen in the department in the timeframe. Of these, 1180 patients were approached (74%); 18% (n=207) of patients were AUDIT positive. DISCUSSION This study has shown that it is possible to reach a high number of patients in a busy hospital out-patient department and deliver ASBI by working with staff using theoretical frameworks for training. Embedding evidence-based public health interventions into routine clinical environments is complex. The social system in which professionals operate requires consideration alongside individual professionals' real and perceived barriers and facilitators to change.
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Affiliation(s)
- G O'Neill
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - S Masson
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK,Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - L Bewick
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - J Doyle
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - R McGovern
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - E Stoker
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - H Wright
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - D Newbury-Birch
- School of Health & Social Care, Teesside University, Middlesbrough, UK
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Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial. Addict Sci Clin Pract 2015; 10:13. [PMID: 25968121 PMCID: PMC4480647 DOI: 10.1186/s13722-015-0033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders. These performance measures have been controversial due to the limited and equivocal evidence for the efficacy of BI among hospitalized individuals. The few BI trials conducted with hospital inpatients vary widely in methodological quality. While the majority of these studies indicate limited to no effects of BI in this population, none have been designed to account for the most pervasive methodological issue in BI studies presumed to drive study findings towards the null: assessment reactivity (AR). METHODS/DESIGN This is a three-arm, single-site, randomized controlled trial of BI for hospitalized patients at a large academic medical center affiliated with the U.S. Department of Veterans Affairs who use alcohol at hazardous levels but do not have an alcohol use disorder. Participants are randomized to one of three study conditions. Study Arm 1 receives a three-part alcohol BI. Study Arm 2 receives attention control. To account for potential AR, Study Arm 3 receives AC with limited assessment. Primary outcomes will include the number of standard drinks/week and binge drinking episodes reported in the 30-day period prior to a final measurement visit obtained 6 months after hospital discharge. Additional outcomes will include readiness to change drinking behavior and number of adverse consequences of alcohol use. To assess differences in primary outcomes across the three arms, we will use mixed-effects regression models that account for a patient's repeated measures over the timepoints and clustering within medical units. Intervention implementation will be assessed by: a) review of intervention audio recordings to characterize barriers to intervention fidelity; and b) feasibility of participant recruitment, enrollment, and follow-up. DISCUSSION The results of this methodologically rigorous trial will provide greater justification for or against the use of BI performance measures in the inpatient setting and inform organizational responses to BI-related hospital accreditation and performance measures. TRIAL REGISTRATION NCT01602172.
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Affiliation(s)
- Lauren M Broyles
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Melissa E Wieland
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Andrea L Confer
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Monica M DiNardo
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Barbara H Hanusa
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Ada O Youk
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
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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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Kara B. The efficacy of an educational intervention on health behaviors in a sample of Turkish female nursing students: a longitudinal, quasi-experimental study. NURSE EDUCATION TODAY 2015; 35:146-151. [PMID: 25263072 DOI: 10.1016/j.nedt.2014.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 08/21/2014] [Accepted: 08/28/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Unhealthy behaviors are a key factors leading to health problems. It remains unclear whether an educational intervention has a long term effect on health behaviors of nursing students. OBJECTIVES The aim of this study was to evaluate the long term effect of an educational intervention on the health behaviors and examine predictors of change in these behaviors in Turkish female baccalaureate nursing students. DESIGN Quasi-experimental design with one-group, pre- and posttest, and 3-year follow-up. SETTING The study was conducted in a school of nursing in Turkey. PARTICIPANTS One hundred-eight students participated in this study. METHODS Data were collected before and after the implementation of the educational intervention by using the Health-Promoting Lifestyle Profile-I (HPLP-I). Descriptive statistics, the one-way analysis of variance for repeated measures and multiple linear regression analysis were used. RESULTS There were significant differences among the three time points in terms of the HPLP-I total and subscales scores (self-actualization, health responsibility, exercise, nutrition and stress management), except for interpersonal support (p<.05). The positive effect of intervention on the HPLP-I total and health responsibility subscale scores was maintained during the 3-year follow-up period (p<.05). The amount of change from pretest to posttest in the total HPLP-I score was the only predictor of the 3-year change in the total scale score (unstandardized β=0.538; p<.001), after adjustment for the potential confounding factors. CONCLUSIONS The educational intervention was partially effective in improving all health behaviors of the nursing students over the long term. Nursing students who demonstrated higher levels of benefit from the intervention were more likely to have more positive health behaviors at the 3-year point. The findings of this study highlight the importance of the integration of health behaviors within the nursing curriculum.
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Affiliation(s)
- Belgüzar Kara
- Department of Internal Medicine Nursing, School of Nursing, Gulhane Military Medical Academy, Turkey.
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Stoner SA, Mikko AT, Carpenter KM. Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs. J Subst Abuse Treat 2014; 47:362-70. [PMID: 25115136 PMCID: PMC4196703 DOI: 10.1016/j.jsat.2014.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/20/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022]
Abstract
This project evaluated a Web-based multimedia training for primary care providers in screening, brief intervention, and referral to treatment (SBIRT) for unhealthy use of alcohol, tobacco, and other drugs. Physicians (n = 37), physician assistants (n = 35), and nurse practitioners (n = 20) were recruited nationally by email and randomly assigned to online access to either the multimedia training or comparable reading materials. At baseline, compared to non-physicians, physicians reported lower self-efficacy for counseling patients regarding substance use and doing so less frequently. All provider types in both conditions showed significant increases in SBIRT-related knowledge, self-efficacy, and clinical practices. Although the multimedia training was not superior to the reading materials with regard to these outcomes, the multimedia training was more likely to be completed and rated more favorably. Findings indicate that SBIRT training does not have to be elaborate to be effective. However, multimedia training may be more appealing to the target audiences.
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Affiliation(s)
- Susan A Stoner
- Talaria, Inc., Seattle, Washington; The Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington.
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Finnell DS, Nowzari S, Reimann B, Fischer L, Pace E, Goplerud E. Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an Integral Part of Nursing Practice. Subst Abus 2014; 35:114-8. [DOI: 10.1080/08897077.2014.888384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mdege ND, Raistrick D, Johnson G. Medical specialists' views on the impact of reducing alcohol consumption on prognosis of, and risk of, hospital admission due to specific medical conditions: results from a Delphi survey. J Eval Clin Pract 2014; 20:100-10. [PMID: 24118631 DOI: 10.1111/jep.12092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To find consensus, or lack thereof, on the impact of reducing alcohol consumption on prognosis and the risk of hospital admissions for a number of alcohol-attributable disorders. METHODS A modified two-round Delphi survey utilizing web-based questionnaires to collect quantitative and qualitative data was used. Alcohol treatment experts from cardiology, emergency medicine, gastroenterology and oncology in the United Kingdom were invited to participate. The main outcomes were median impact ratings (on a scale of 1-9) and consensus (unanimous, strong, moderate, weak or no consensus). RESULTS Of 192 experts invited to participate, 59 completed first questionnaires. The overall retention rate to the second questionnaires was about 51% (30/59). There was strong support that reducing alcohol consumption could result in improvement in prognosis for gastroenterology and emergency medicine patients; but uncertainty on the benefits for cardiology and oncology patients. Overall, the responses from the expert panel did not reflect the assumption that reducing alcohol consumption would result in benefits on hospital admissions for any of the specialties. The specialists viewed the severity of disorders as important when considering the impact of reducing alcohol consumption. CONCLUSIONS The highest impact of treatment for problem drinking in hospitals is considered to be for alcohol-related disorders associated with gastroenterology and emergency medicine. At policy level, if targeted screening for alcohol problems by presenting disease or condition is the strategy of choice, it would be logical to implement screening and easily accessible interventions or addiction specialists within these areas where alcohol treatment is considered as having a high impact.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
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Makdissi R, Stewart SH. Care for hospitalized patients with unhealthy alcohol use: a narrative review. Addict Sci Clin Pract 2013; 8:11. [PMID: 23738519 PMCID: PMC3679958 DOI: 10.1186/1940-0640-8-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/24/2013] [Indexed: 12/31/2022] Open
Abstract
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
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Affiliation(s)
- Regina Makdissi
- Division of General Internal Medicine, University at Buffalo State University of New York, Buffalo, NY, USA
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