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Wangler J, Jansky M. Primary care involvement in clinical research - prerequisites, motivators, and barriers: results from a study series. Arch Public Health 2024; 82:41. [PMID: 38504310 PMCID: PMC10953082 DOI: 10.1186/s13690-024-01272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now. METHODS The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research. RESULTS Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project. CONCLUSIONS Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany
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Wangler J, Jansky M. Experiences with Innovation Fund healthcare models in primary care: a qualitative study amongst German general practitioners. Wien Med Wochenschr 2024; 174:53-60. [PMID: 35503146 PMCID: PMC10896771 DOI: 10.1007/s10354-022-00935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
The Innovation Fund was set up in 2015 with the aim of improving medical care in the German statutory health insurance system. Primary care needs to be involved in testing interventions and new forms of care for effectiveness and inclusion in standard care. There has so far been hardly any research on how far Innovation Fund models accommodate the primary care setting, or on the experience general practitioners have had with these models. Between September 2021 and January 2022, 36 semi-standardized individual interviews were performed with general practitioners who had already participated in Innovation Fund projects. Eleven regional physician networks in Rhineland-Palatinate, Hesse, North Rhine-Westphalia, and Schleswig-Holstein were involved in the recruitment process. Most of the interviewees associated the Innovation Fund with potential and opportunity including intensification of application-oriented healthcare research, independent financing, and general healthcare involvement. Even so, many general practitioners were unsure as to how far primary care in particular would stand to benefit from the Innovation Fund in the long term. A mostly positive balance was drawn from participation in care models-benefit of intervention as well as cost-benefit ratio. However, some also reported hurdles and stress factors such as documentation requirements and disruption in everyday office routine. Innovation Fund projects will need to be suitable for general practitioners especially regarding medical decision-making leeway, limits to documentation requirements, preserving established office routine, greater involvement in research planning, and improvements to the primary care setting to encourage willingness to participate in Innovation Fund projects amongst general practitioners.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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Tranberg K, Jønsson A, Due T, Siersma V, Brodersen JB, Bissenbakker K, Martiny F, Davidsen A, Kjellberg PK, Doherty K, Mercer SW, Nielsen MH, Reventlow S, Møller A, Rozing M. The SOFIA pilot study: assessing feasibility and fidelity of coordinated care to reduce excess mortality and increase quality of life in patients with severe mental illness in a general practice setting; a cluster-randomised pilot trial. BMC PRIMARY CARE 2023; 24:188. [PMID: 37715123 PMCID: PMC10504748 DOI: 10.1186/s12875-023-02141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To evaluate the feasibility and fidelity of implementing and assessing the SOFIA coordinated care program aimed at lowering mortality and increasing quality of life in patients with severe mental illness by improving somatic health care in general practice. DESIGN A cluster-randomised, non-blinded controlled pilot trial. SETTING General Practice in Denmark. INTERVENTION The SOFIA coordinated care program comprised extended structured consultations carried out by the GP, group-based training of GPs and staff, and a handbook with information on signposting patients to relevant municipal, health, and social initiatives. PATIENTS Persons aged 18 years or older with a diagnosis of psychotic, bipolar, or severe depressive disorder. MAIN OUTCOME MEASURES We collected quantitative data on the delivery, recruitment and retention rates of practices and patients, and response rates of questionnaires MMQ and EQ-5D-5 L. RESULTS From November 2020 to March 2021, nine practices were enrolled and assigned in a 2:1 ratio to the intervention group (n = 6) or control group (n = 3). Intervention group practices included 64 patients and Control practices included 23. The extended consultations were delivered with a high level of fidelity in the general practices; however, thresholds for collecting outcome measures, and recruitment of practices and patients were not reached. CONCLUSION Our findings suggest that delivering the coordinated care program in a fully powered trial in primary care is likely feasible. However, the recruitment methodology requires improvement to ensure sufficient recruitment and minimize selective inclusion. TRIAL REGISTRATION The date of pilot trial protocol registration was 05/11/2020, and the registration number is NCT04618250.
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Affiliation(s)
- Katrine Tranberg
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Alexandra Jønsson
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, Faculty of Health Sciences, The Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tina Due
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- The Mental health services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Volkert Siersma
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, Faculty of Health Sciences, The Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
- The Primary Health Care Research Unit, Region Zealand, Zealand, Denmark
| | - Kristine Bissenbakker
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Martiny
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Annette Davidsen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | - Kevin Doherty
- Copenhagen Center for Health Technology (CACHET), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Stewart W Mercer
- Old Medical School, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Haahr Nielsen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
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Buckley D, McHugh SM, Riordan F. What works to recruit general practices to trials? A rapid review. HRB Open Res 2023; 6:13. [PMID: 37753269 PMCID: PMC10518848 DOI: 10.12688/hrbopenres.13650.1] [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] [Accepted: 11/04/2022] [Indexed: 09/28/2023] Open
Abstract
Background: Recruitment challenges are a barrier to the conduct of trials in general practice, yet little is known about which recruitment strategies work best to recruit practices for randomised controlled trials (RCTs). We aimed to describe the types of strategies used to recruit general practices for trials and synthesize any available evidence of effectiveness. Methods: We conducted a rapid evidence review in line with guidance from Tricco et al. Eligible studies reported or evaluated any strategy to improve practice recruitment to participate in clinical or implementation RCTs. PubMed, Embase, and Cochrane Central Library were searched from inception to June 22 nd, 2021. Reference lists of included studies were screened. Data were synthesized narratively. Results: Over 9,162 articles were identified, and 19 studies included. Most (n=13, 66.7%) used a single recruitment strategy. The most common strategies were: in-person practice meetings/visits by the research team (n=12, 63.2%); phone calls (n=10, 52.6%); financial incentives (n=9, 47.4%); personalised emails (n=7, 36.8%) or letters (n=6, 52.6%) (as opposed to email 'blasts' or generic letters); targeting practices that participated in previous studies or with which the team had existing links (n=6, 31.6%) or targeting of practices within an existing practice or research network (n=6, 31.6%). Three studies reporting recruitment rates >80%, used strategies such as invitation letters with a follow-up phone call to non-responders, presentations by the principal investigator and study coordinator, or in-person meetings with practices with an existing affiliation with the University or research team. Conclusions: Few studies directly compared recruitment approaches making it difficult to draw conclusions about their comparative effectiveness. However, the role of more personalised letter/email, in-person, or phone contact, and capitalising on existing relationships appears important. Further work is needed to standardise how recruitment methods are reported and to directly compare different recruitment strategies within one study . PROSPERO registration: CRD42021268140 (15/08/2021).
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Affiliation(s)
- Daire Buckley
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
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Horstmannshoff C, Skudlik S, Petermann J, Kiesel T, Döringer T, Crispin A, Hermsdörfer J, Köberlein-Neu J, Jahn K, Schädler S, Bauer P, Voigt K, Müller M. Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial. Trials 2023; 24:91. [PMID: 36747256 PMCID: PMC9902065 DOI: 10.1186/s13063-022-07017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. METHODS For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. DISCUSSION With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. TRIAL REGISTRATION DRKS, DRKS00028524 retrospectively registered on March 24, 2022.
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Affiliation(s)
- Caren Horstmannshoff
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Jenny Petermann
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Theresia Kiesel
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119 Wuppertal, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistraße 15, 81377 Munich, Germany
- Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043 Bad Aibling, Germany
| | - Stefan Schädler
- Physiotherapie im Schloss, Schloss 88, 3454, Sumiswald, Switzerland
| | - Petra Bauer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Department of Primary Care and Health Services Research, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Shikany JM, Safford MM, Cherrington AL, Halladay JR, Anabtawi M, Richman EL, Adams AD, Holt C, Oparil S, Soroka O, Cummings DM. Recruitment and retention of primary care practices in the Southeastern Collaboration to Improve Blood Pressure Control. Contemp Clin Trials Commun 2023; 32:101059. [PMID: 36718176 PMCID: PMC9883192 DOI: 10.1016/j.conctc.2023.101059] [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: 09/01/2022] [Revised: 11/28/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Racial disparities related to hypertension prevalence and control persist, with Black persons continuing to have both high prevalence and suboptimal control. The Black Belt region of the US Southeast is characterized by multiple critical priority populations: rural, low-income, and minority (Black). Methods In a cluster-randomized, controlled, pragmatic implementation trial, the Southeastern Collaboration to Improve Blood Pressure Control evaluated two multi-component, multi-level functional interventions - peer coaching (PC) and practice facilitation (PF) (separately and combined) - as adjuncts to usual care to improve blood pressure control in the Black Belt. The overall goal was to randomize 80 primary care practices (later reduced to 69 practices) in Alabama and North Carolina to one of four interventions: 1) enhanced usual care (EUC); 2) EUC plus PC; 3) EUC plus PF; or 4) EUC plus both PC and PF. Several measures to facilitate recruitment and retention of practices were employed, including practice readiness assessment. Results Contact was initiated with 248 practices during the study enrollment period. Of these, 99 declined participation, 39 were ineligible, and 41 were being evaluated for inclusion when the target number of practices was reached. The remaining 69 practices eventually were enrolled, with 18 practices randomized to EUC, 19 to PC, 16 to PF, and 16 to PC plus PF. Only two practices (2.9%) were withdrawn during the study. Several facilitators of and barriers to practice recruitment and retention were identified. Conclusion Our findings underscore the importance of a structured approach to recruiting primary care practices in a pragmatic implementation trial.ClinicalTrials.gov registration number NCT02866669.
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Affiliation(s)
- James M. Shikany
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,Corresponding author. MT 619, 1720 2nd Ave S, Birmingham, AL, 35294-4410, USA.
| | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andrea L. Cherrington
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacqueline R. Halladay
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Muna Anabtawi
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erica L. Richman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alyssa D. Adams
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Charlotte Holt
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Orysya Soroka
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Doyle M. Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Wangler J, Jansky M. [The German Innovation Fund and primary care-What expectations and experiences do general practitioners have with regard to participating in innovative care models?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:697-705. [PMID: 35476151 PMCID: PMC9132806 DOI: 10.1007/s00103-022-03533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2015, the German Innovation Fund was established to promote improvements in the quality of medical care. In order for new care models and interventions to be tested and incorporated into standard care in the future, primary care must be included. OBJECTIVES The study explores general practitioners' (GPs') attitudes, participation-relevant expectations, and experiences with regard to Innovation Fund projects. METHODS Between July and October 2021, all 13,170 general practitioners in Baden-Württemberg, Hesse, and Rhineland-Palatinate were invited to take part in an online survey. Included in the evaluation were 3556 completed questionnaires (response rate: 27%). In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of the respondents, 83% were familiar with the Innovation Fund. Most of the respondents associate it with opportunities and potential (including intensification of application-oriented healthcare research, independent financing, and inclusion of primary care). Nevertheless, many GPs are unsure to what extent primary care can benefit from the Innovation Fund in the longer term. When it comes to willingness to participate in Innovation Fund studies, the respondents are divided. Respondents who have already participated in such projects (24%) draw a positive balance (benefit of the intervention, cost-benefit ratio). However, hurdles and stress factors are also reported, such as documentation requirements and interventions in practice processes. CONCLUSIONS In order to increase the attractiveness of the Innovation Fund for GPs, it is important to ensure that projects are fully compliant with primary care, especially with regard to the scope of medical decision-making, the limitation of documentation obligations, the guarantee of practice routines, a greater involvement in research planning, and an upgrading of the GP setting.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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Foley L, Hynes L, Murphy AW, Molloy GJ. 'Just keep taking them, keep hoping they'll work': A qualitative study of adhering to medications for multimorbidity. Br J Health Psychol 2021; 27:691-715. [PMID: 34719079 DOI: 10.1111/bjhp.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Compared to single diseases, health psychology reflects many areas of medical research by affording relatively less attention to the experiences of people self-managing multiple co-occurring conditions and, in particular, the experience of managing the associated complex medication regimens. This study aimed to explore the experience of self-managing multimorbidity among older adults, with a focus on medication adherence. DESIGN A qualitative approach was taken, using individual semi-structured interviews. METHODS Sixteen people with complex multimorbidity aged 65 years or older were recruited through general practice to take part in semi-structured interviews. Data were analysed following guidelines for reflexive thematic analysis. RESULTS Two themes were generated, with each theme comprising three subthemes. Theme one represents the amplified burden arising from multimorbidity that leads to unique challenges for self-management, such as integrating multiple medications into daily life, accumulating new symptoms and treatments, and managing evolving medication regimens. Theme two represents pathways towards relief that reduce this burden and promote medication adherence, such as prioritising certain conditions and treatments, resigning to the need for multiple medications, and identifying and utilising adherence supports. CONCLUSIONS We identified factors relevant to medication adherence for older adults with multimorbidity that go beyond single-disease influences and account for the amplified experience of chronic disease that multimorbidity can produce for some people. While evidence of single-disease influences remains fundamental to tailoring behavioural interventions to individuals, the impact of multimorbidity on medication adherence should be accounted for in research and practice.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Hynes
- Croí Heart and Stroke Centre, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Ireland.,HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Ireland
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9
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Linehan C, Benson A, Gunko A, Christensen J, Sun Y, Tomson T, Marson A, Forsgren L, Trinka E, Iliescu C, Althoehn Sonderup J, Werenberg Dreier J, Sandu C, Leanca M, Rainer L, Kobulashvili T, Granbichler CA, Delanty N, Doherty C, Staines A, Shahwan A. Exploring the prevalence and profile of epilepsy across Europe using a standard retrospective chart review: Challenges and opportunities. Epilepsia 2021; 62:2651-2666. [PMID: 34472627 DOI: 10.1111/epi.17057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence of epilepsy in four European countries (Austria, Denmark, Ireland, and Romania) employing a standard methodology. The study was conducted under the auspices of ESBACE (European Study on the Burden and Care of Epilepsy). METHODS All hospitals and general practitioners serving a region of at least 50 000 persons in each country were asked to identify patients living in the region who had a diagnosis of epilepsy or experienced a single unprovoked seizure. Medical records were accessed, where available, to complete a standardized case report form. Data were sought on seizure frequency, seizure type, investigations, etiology, comorbidities, and use of antiseizure medication. Cases were validated in each country, and the degree of certainty was graded as definite, probable, or suspect cases. RESULTS From a total population of 237 757 in the four countries, 1988 (.8%) patients were identified as potential cases of epilepsy. Due to legal and ethical issues in the individual countries, medical records were available for only 1208 patients, and among these, 113 had insufficient clinical information. The remaining 1095 cases were classified as either definite (n = 706, 64.5%), probable (n = 191, 17.4%), suspect (n = 153, 14.0%), or not epilepsy (n = 45, 4.1%). SIGNIFICANCE Although a precise prevalence estimate could not be generated from these data, the study found a high validity of epilepsy classification among evaluated cases (95.9%). More generally, this study highlights the significant challenges facing epidemiological research methodologies that are reliant on patient consent and retrospective chart review, largely due to the introduction of data protection legislation during the study period. Documentation of the epilepsy diagnosis was, in some cases, relatively low, indicating a need for improved guidelines for assessment, follow-up, and documentation. This study highlights the need to address the concerns and requirements of recruitment sites to engage in epidemiological research.
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Affiliation(s)
- Christine Linehan
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Ailbhe Benson
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Alex Gunko
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Yuelian Sun
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,National Center for Register-Based Research, Department of Economics and Business Economics, Business, and Social Science, Aarhus University, Aarhus, Denmark
| | - Torbjorn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Anthony Marson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umea University, Umea, Sweden
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria.,EpiCARE European Reference Network, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.,Department of Public Health, Health Services Research, and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Catrinel Iliescu
- Clinical Neurosciences Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Pediatric Neurology Department, Expertise Center for Rare Diseases in Pediatric Neurology, Prof Dr Alexandru Obregia Clinical Hospital, Bucharest, Romania.,EpiCARE European Reference Network, Bucharest, Romania
| | | | - Julie Werenberg Dreier
- National Center for Register-Based Research, Department of Economics and Business Economics, Business, and Social Science, Aarhus University, Aarhus, Denmark
| | - Carmen Sandu
- Clinical Neurosciences Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Madalina Leanca
- Clinical Neurosciences Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucas Rainer
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria
| | - Claudia A Granbichler
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University and Center for Cognitive Neuroscience, Salzburg, Austria.,Department of Neurology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Norman Delanty
- Beaumont Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Ireland
| | - Colin Doherty
- FutureNeuro Research Centre for Rare and Chronic Diseases, Royal College of Surgeons in Ireland, Dublin, Ireland.,Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Amre Shahwan
- Temple Street Children's University Hospital, Dublin, Ireland
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10
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Mackenzie L, Liddle J, Clemson LM, Tan ACW, Lovarini M, Pit SW, Poulos RG, Roberts C, Pond CD, Willis K. Perspectives of Australian GPs on tailoring fall risk management: a qualitative study. Aust J Prim Health 2021; 27:409-415. [PMID: 34384518 DOI: 10.1071/py21022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
Falls among older people are highly prevalent, serious and costly, and translation of evidence about falls prevention needs to occur urgently. GPs can identify older people at risk of falling and put preventative measures in place before a fall. Because GPs are key to identifying older people at risk of falls and managing falls risk, this study explored how GPs adapted to the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) process to embed evidence-based falls prevention strategies within primary care, and whether and how they changed their practice. A theoretically informed qualitative study using normalisation process theory was conducted in parallel to the iSOLVE trial to elicit GPs' views about the iSOLVE process. Data were coded and a thematic analysis of interview transcripts was conducted using constant comparison between the data and themes as they developed. In all, 24 of 32 eligible GPs (75%) from general practices located in the North Sydney Primary Health Network, Australia, were interviewed. Six themes were identified: (1) making it easy to ask the iSOLVE questions; (2) internalising the process; (3) integrating the iSOLVE into routine practice; (4) addressing assumptions about patients and fall prevention; (5) the degree of change in practice; and (6) contextual issues influencing uptake. The iSOLVE project focused on practice change, and the present study indicates that practice change is possible. How GPs addressed falls prevention in their practice determined the translation of evidence into everyday practice. Support tools for falls prevention must meet the needs of GPs and help with decision making and referral. Fall prevention can be integrated into routine GP practice through the iSOLVE process to tailor fall risk management.Trial Registry.This trial was registered with the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au; Trial ID: ACTRN12615000401550).
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Affiliation(s)
- Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia; and Corresponding author.
| | - Jeannine Liddle
- Ageing Work and Health Research Unit, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Lindy M Clemson
- Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Amy C W Tan
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Sabrina W Pit
- School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia; and University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Roslyn G Poulos
- School of Public Health and Community Medicine, UNSW, Sydney, NSW 2052, Australia
| | - Chris Roberts
- Discipline of General Practice, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Constance D Pond
- Discipline of General Practice, Faculty of Health, University of Newcastle, NSW 2308, Australia
| | - Karen Willis
- School of Allied Health, Human Services and Sport, La Trobe University, Vic. 3086, Australia
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11
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Riordan F, Murphy K, Bradley C, Kearney PM, Smith SM, McHugh SM. Acceptability and feasibility of conducting a pilot trial in Irish primary care: lessons from the IDEAs study. HRB Open Res 2021; 4:73. [PMID: 35136854 PMCID: PMC8804907 DOI: 10.12688/hrbopenres.13306.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Understanding primary care practices’ ‘readiness’ to engage in trials and their experience is important to inform trial procedures and supports. Few studies report on the feasibility of study procedures though this is a central part of pilot trials. We explored the acceptability and feasibility of study procedures of a cluster randomised pilot trial of an intervention in primary care to improve uptake of Ireland’s national diabetic retinopathy programme. Methods As part of the embedded mixed-methods process evaluation, quantitative and qualitative data were gathered across four general practices participating in the intervention. Interviews were conducted with a purposive sample of staff. Research logs on time spent on intervention delivery, staff assignment, resources, problems/changes, and reasons for drop-outs, were maintained over the course of intervention rollout, and practice audit data were analysed. Quantitative outcomes included recruitment, retention, completion, and data quality and completeness. Qualitative data on perceptions and experience of the pilot trial procedures were analysed using the Framework Method. Findings Nine staff (3 GPs, 4 nurses, 2 administrators) were interviewed. An interest in the topic area or in research motivated practices to take part in the trial. Reimbursement meant they could ‘afford’ to participate. Staff valued the researcher briefing at the start of the trial, to avoid ‘going in slightly blind’. While staff varied in audit skills and confidence, and some found this aspect of data collection challenging, a ‘step-by-step’ audit manual and regular researcher contact, helped them stay on track and troubleshoot during data collection. Audit quality was acceptable overall, however there were some issues, incorrect assignment of patient status being most common. Conclusion The IDEAs trial procedures were acceptable and feasible for primary care staff, however, challenges with conducting the audit may reflect staff skills gaps and the need for greater guidance and support from researchers.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Katie Murphy
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Zimansky M, Hofmann B, Schneider N, Stiel S. [Implications for health services research in GP practices using the example of an intervention study on palliative care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 164:44-50. [PMID: 34215530 DOI: 10.1016/j.zefq.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION So far there has been little evidence of the extent to which project steps can affect the timing and successful implementation of research projects in general practitioner (GP) practices. Using the example of an intervention study on palliative care, the aim of this article is to report a) how the overall course of the project turned out compared to the original planning, and b) what recommendations can be derived to promote efficient implementation of intervention studies in GP practices. METHODS In two workshops each, GP practice teams selected specific measures to improve their palliative care and tested them during a four-month implementation phase. In order to track the progress of the project, the times at which the practice teams reported their participation in the study, the individual project steps and the contacts were documented and descriptively analysed using Microsoft Excel. RESULTS Due to a high willingness of practice teams to participate in the intervention study, recruitment was completed on time. The overall duration of the project was extended due to an increased workload for the preparation of an unexpectedly high number of selected measures to improve palliative care. DISCUSSION Conducting intervention studies in GP practices is promising if practice teams take an active and co-determining role during the entire research process. Research projects can best be implemented if they involve minimal time commitment for the practice teams, and if continuous personal support from the study team is ensured. CONCLUSION When planning future intervention studies with a high participatory share of GP practice teams, it is advisable to take into account potential additional work for the preparation and further development of intervention measures.
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Affiliation(s)
- Manuel Zimansky
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Birte Hofmann
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
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13
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Lech S, O'Sullivan JL, Wellmann L, Supplieth J, Döpfmer S, Gellert P, Kuhlmey A, Nordheim J. Recruiting general practitioners and patients with dementia into a cluster randomised controlled trial: strategies, barriers and facilitators. BMC Med Res Methodol 2021; 21:61. [PMID: 33784967 PMCID: PMC8008594 DOI: 10.1186/s12874-021-01253-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background Recruitment of general practitioners (GPs) and their patients is reported as one of the most challenging steps when undertaking primary care research. The present paper describes the recruitment process of a cluster randomised controlled trial (cRCT) aiming to improve dementia care in the primary care setting. Methods Recruitment data was analysed descriptively using frequency tables to investigate comparisons of recruitment rates and results of different recruitment strategies as well as reasons for participation and non-participation of GPs, patients with dementia (PwD) and their caregivers. Results Over a period of 23 months, N = 28 GPs were successfully included in the cRCT. This represents an overall recruitment rate of 4.6%. The most efficient strategy in terms of high response and low labour-intensity involved the dissemination of calls for participation in a GP research network. Most frequently reported reasons for GP’s participation were Improvement of patient’s well-being (n = 22, 79%) followed by Interest in dementia research (n = 18, 64%). The most common reasons for non-participation were Lack of time (n = 71, 34%) followed by Not interested in participation (n = 63, 30%). On a patient level, N = 102 PwD were successfully recruited. On average, each GP referred about n = 7 PwD (range: 1–17; mdn = 6; IQR = 3.5) and successfully recruited about n = 4 PwD (range: 1–11; mdn = 3; IQR = 3.5). Conclusion First, our findings propose GP research networks as a promising strategy to promote recruitment and participation of GPs and their patients in research. Second, present findings highlight the importance of including GPs and their interests in specific research topics in early stages of research in order to ensure a successful recruitment. Finally, results do not support cold calls as a successful strategy in the recruitment of GPs. Trial registration The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019.
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Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julie L O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Leonard Wellmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Juliana Supplieth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Susanne Döpfmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Adelheid Kuhlmey
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Nordheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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