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Piggott KL, Leis JA. When urine testing to rule out infection does more harm than good. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:551-554. [PMID: 39271226 PMCID: PMC11407598 DOI: 10.46747/cfp.7009551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Affiliation(s)
- Katrina L Piggott
- Staff geriatrician at Sunnybrook Health Sciences Centre in Toronto, Ont, Assistant Professor of Medicine in the Department of Medicine at the University of Toronto in Ontario, and Assistant Professor of Quality Improvement and Patient Safety at the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Jerome A Leis
- Infectious disease physician, Medical Director of Infection Prevention and Control at Sunnybrook Health Sciences Centre, and Associate Professor in the Department of Medicine at the University of Toronto
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Piggott KL, Leis JA. Quand les tests d’urine pour exclure une infection causent plus de torts que de bien. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:e129-e133. [PMID: 39271210 PMCID: PMC11407605 DOI: 10.46747/cfp.7009e129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Affiliation(s)
- Katrina L Piggott
- Gériatre membre du personnel au Centre des sciences de la santé Sunnybrook à Toronto (Ontario), professeure adjointe de médecine au Département de médecine de l'Université de Toronto et professeure adjointe en amélioration de la qualité et en sécurité des patients à l'Institute of Health Policy, Management and Evaluation de l'Université de Toronto
| | - Jerome A Leis
- Infectiologue, directeur médical de la prévention et du contrôle des infections au Centre des sciences de la santé Sunnybrook, et professeur agrégé au Département de médecine de l'Université de Toronto
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3
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Lim K, Broom A, Olsen A, Seale H. Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100212. [PMID: 36582997 PMCID: PMC9793303 DOI: 10.1016/j.rcsop.2022.100212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Community pharmacists, as primary care providers, are an underutilised resource in antimicrobial stewardship (AMS). Primary care plays an important role in tackling antimicrobial resistance (AMR) as the principle of balancing access to antimicrobials while ensuring optimal use is agnostic to health setting. Understanding the sector's perceptions and practices towards AMS involvement is a continuing focus area of research. However, there is an opportunity to understand the sociological factors which influence the profession's contribution to stewardship practice, particularly across a broader spectrum of sector stakeholders at the individual, practice, system, and policy levels. Objective To explore stakeholders' perceptions of the Australian community pharmacy sector's AMS involvement. Methods Semi-structured interviews were conducted with fifteen key informants from the Australian community pharmacy sector. Participants' insights were invited across three broad areas: (1) understanding of AMR and AMS; and the (2) current and (3) future state of community pharmacy's AMS involvement. Interviews were audio-recorded, transcribed verbatim and analyzed using a combined method of inductive (informed by the Theoretical Domains Framework) and deductive thematic analysis. Results Perceptions on promoting community pharmacists' AMS involvement within their existing role in promoting the quality use of medicines were heard. Adopting an antimicrobial guardian or gatekeeper role was perceived as influenced by the timing of their interaction with a patient either prior to, or post-consultation with a general practitioner (GP). Suggestions that the profession's potential and actual role in AMS could be challenged or even delimited due to lack of access to completeness of clinical information, and perceived consequences from a clinical and professional engagement perspective were also heard. Conclusion Collaborative partnerships between GPs and community pharmacists, framing stewardship within a quality use of medicines agenda, and highlighting connections between pharmacists' professional services such as minor ailments are key elements enabling community pharmacist's antimicrobial gatekeeper and guardian role.
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Affiliation(s)
- Kathryn Lim
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Australia
| | - Anna Olsen
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, Australia
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McNicholas M, Hooper G. Effects of patient education to reduce antibiotic prescribing rates for upper respiratory infections in primary care. Fam Pract 2022; 39:1-5. [PMID: 34173645 DOI: 10.1093/fampra/cmab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic stewardship programs in primary care are necessary to reduce the estimated 30% of inappropriately written antibiotic prescriptions and reduce the spread of microbial resistance. Most programs focus on educating prescribers, but this intervention focused on educating patients. OBJECTIVES To develop and implement an antibiotic stewardship program in a primary care clinic to educate patients with upper respiratory infections (URIs) about antibiotic use and to assess the effectiveness of the program through antibiotic prescribing rates. METHODS Using materials from the Centers for Disease Control and Prevention (CDC) Be Antibiotics Aware program, posters on antibiotic use were placed in the exam rooms, graphic interchange formats (GIFs) and memes were displayed on exam room monitors, patient-provider discussions on antibiotic use were held, and written information for symptom management of URIs was provided. Retrospective chart reviews were conducted to assess antibiotic prescribing rates by four prescribers in a primary care clinic for September and October 2020 and compared to the same time period for 2019. RESULTS The rate of total antibiotic prescriptions decreased by 12.6% (P = 0.044) and the rate of repeat consultation antibiotic prescriptions decreased by 12.2% (P = 0.007), whereas the rate of antibiotics prescribed at the time of the visit remained unchanged (P = 0.937). All providers had decreased rates of antibiotic prescribing after the intervention. CONCLUSION Results of this study indicate that providing education about antibiotics to patients in need of treatment for URIs may reduce the rate of antibiotics prescribed in primary care; however, further research is warranted.
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Affiliation(s)
| | - Gwendolyn Hooper
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
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Crosby M, von den Baumen TR, Chu C, Gomes T, Schwartz KL, Tadrous M. Interprovincial variation in antibiotic use in Canada, 2019: a retrospective cross-sectional study. CMAJ Open 2022; 10:E262-E268. [PMID: 35318250 PMCID: PMC8946648 DOI: 10.9778/cmajo.20210095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Geographic trends in antibiotic prescribing show regional variation in antibiotic overuse and antimicrobial resistance, posing a threat to global health care systems. This study's objective was to examine interprovincial variation in outpatient antibiotic dispensing in Canada in 2019. METHODS We conducted a cross-sectional study of antibiotic prescriptions dispensed in Canadian provinces in 2019, leveraging the IQVIA Geographic Prescription Monitor database. We report annual rates of overall antibiotic dispensing, broad-spectrum antibiotic dispensing and age-specific antibiotic dispensing as prescriptions per 1000 population in each province and nationally. RESULTS A total of 23 406 640 antibiotic prescriptions were dispensed nationally in 2019, at a rate of 627.3 prescriptions per 1000 population. Overall antibiotic dispensing rates in Newfoundland and Labrador (920.5 prescriptions per 1000 population) and Saskatchewan (713.7 prescriptions per 1000 population) significantly exceeded the national rate, whereas the rate in British Columbia (543.3 prescriptions per 1000 population) was significantly below the national rate. We observed additional variation when provincial rates of antibiotic dispensing were stratified by drug class and age group. INTERPRETATION We identified interprovincial variation in antibiotic use in Canadian provinces in 2019. These findings highlight the need for provincial targets for antibiotic use to reduce overuse and antimicrobial resistance.
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Affiliation(s)
- Michael Crosby
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Teagan Rolf von den Baumen
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Cherry Chu
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Kevin L Schwartz
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont.
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6
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Rolf von den Baumen T, Crosby M, Tadrous M, Schwartz KL, Gomes T. Measuring the impacts of the Using Antibiotics Wisely campaign on Canadian community utilization of oral antibiotics for respiratory tract infections: a time-series analysis from 2015 to 2019. J Antimicrob Chemother 2021; 76:2472-2478. [PMID: 34223899 DOI: 10.1093/jac/dkab205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND On 1 November 2018, Choosing Wisely Canada launched their Using Antibiotics Wisely primary care campaign, which aimed to reduce unnecessary antibiotic prescriptions for respiratory tract infections (RTIs) through educational tools for patients and providers. OBJECTIVES We explored the impact of this campaign on antibiotic utilization in Canada. METHODS We conducted a population-based study in Canada between January 2015 and December 2019. We used interventional autoregressive integrated moving average models to study the impact of the Using Antibiotics Wisely campaign on the prescribing rate (prescriptions per 1000 population) of RTI-indicated antibiotics. We analysed prescription rates overall and stratified by age group, drug class and province, in each month over the study period. RESULTS There was a 1.5% reduction in the annual prescribing rate of RTI-indicated antibiotics over the study period, which was generally consistent across age groups and provinces. Following the 2018 Using Antibiotics Wisely clinician toolkit release, we observed no significant change in RTI-indicated antibiotic prescribing rates nationally (P = 0.13). This was consistent by age group (children, P = 0.91; adults, P = 0.58; and older adults, P = 0.67) and drug class (narrow-spectrum penicillins, P = 0.88; macrolides, P = 0.85; broad-spectrum penicillins, P = 0.60; cephalosporins, P = 0.45; tetracyclines, P = 0.55; and fluoroquinolones, P = 0.98). In our secondary analysis of prescription rates in provinces that self-identified as prioritizing Using Antibiotics Wisely, we observed no significant change following the launch of the campaign. CONCLUSIONS The introduction of the Using Antibiotics Wisely campaign in Canada has not caused a significant change in short-term antibiotic prescribing patterns. Community antibiotic stewardship campaigns that include components beyond education may be more impactful.
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Affiliation(s)
| | - Michael Crosby
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario, Canada
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7
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Wu JHC, Khalid F, Langford BJ, Beahm NP, McIntyre M, Schwartz KL, Garber G, Leung V. Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective. Can Pharm J (Ott) 2021; 154:179-192. [PMID: 34104272 PMCID: PMC8165883 DOI: 10.1177/1715163521999417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Pharmacist prescribing authority is expanding, while antimicrobial resistance is an increasing global concern. We sought to synthesize the evidence for antimicrobial prescribing by community pharmacists to identify opportunities to advance antimicrobial stewardship in this setting. Methods: We conducted a systematic review to characterize the existing literature on community pharmacist prescribing of systemic antimicrobials. We searched MEDLINE, EMBASE and International Pharmaceutical Abstracts for English-language articles published between 1999 and June 20, 2019, as well as hand-searched reference lists of included articles and incorporated expert suggestions. Results: Of 3793 articles identified, 14 met inclusion criteria. Pharmacists are most often prescribing for uncomplicated urinary tract infection (UTI), acute pharyngitis and cold sores using independent and supplementary prescribing models. This was associated with high rates of clinical improvement (4 studies), low rates of retreatment and adverse effects (3 studies) and decreased health care utilization (7 studies). Patients were highly satisfied (8 studies) and accessed care sooner or more easily (7 studies). Seven studies incorporated antimicrobial stewardship into study design, and there was overlap between study outcomes and those relevant to outpatient antimicrobial stewardship. Pharmacist intervention reduced unnecessary prescribing for acute pharyngitis (2 studies) and increased the appropriateness of prescribing for UTI (3 studies). Conclusion: There is growing evidence to support the role of community pharmacists in antimicrobial prescribing. Future research should explore additional opportunities for pharmacist antimicrobial prescribing and ways to further integrate advanced antimicrobial stewardship strategies in the community setting. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | | | | | - Nathan P Beahm
- the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Mark McIntyre
- the Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto
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8
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Petruschke I, Salm F, Kaufmann M, Freytag A, Gensichen J, Behnke M, Kramer TS, Hanke R, Gastmeier P, Schneider S. Evaluation of a multimodal intervention to promote rational antibiotic use in primary care. Antimicrob Resist Infect Control 2021; 10:66. [PMID: 33823926 PMCID: PMC8025382 DOI: 10.1186/s13756-021-00908-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs. Methods The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale). Results The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior. Conclusions The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00908-9.
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Affiliation(s)
- Inga Petruschke
- Institute of General Practice and Family Medicine, Faculty of Medicine, Friedrich-Schiller-University, Bachstrasse 18, 07743, Jena, Germany.
| | - Florian Salm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Michelle Kaufmann
- Institute of General Practice and Family Medicine, Faculty of Medicine, Friedrich-Schiller-University, Bachstrasse 18, 07743, Jena, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Faculty of Medicine, Friedrich-Schiller-University, Bachstrasse 18, 07743, Jena, Germany
| | - Jochen Gensichen
- Institute for General Practice and Family Medicine, Ludwig-Maximilians-University/University Hospital, Pettenkoferstrasse 8/10, 80336, Munich, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Tobias Siegfried Kramer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Regina Hanke
- Lindgrün GmbH, Cuxhavener Strasse 12, 10555, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Sandra Schneider
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany
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9
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Madani Larijani M, Dumba C, Thiessen H, Palen A, Carr T, Vanstone JR, Fourney DR, Hartness C, Parker R, Groot G. Development of a Patient-Oriented Intervention to Support Patient-Provider Conversations about Unnecessary Lower Back Pain Imaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052786. [PMID: 33803431 PMCID: PMC7967489 DOI: 10.3390/ijerph18052786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
Background: despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to develop an intervention that addresses lower back pain imaging overuse. Methods: to develop this intervention, we collaborated with a multidisciplinary advisory team, including two patient partners with lower back pain, researchers, clinicians, healthcare administrators, and the Choosing Wisely Canada lead for Saskatchewan. For this qualitative study, data were collected through two advisory team meetings, two individual interviews with lower back pain patient partners, and three focus groups with lower back pain patient participants. A lower back pain prescription pad was developed as an outcome of these consultations. Results: participants reported a lack of interactive and informative communication was a significant barrier to receiving appropriate care. The most cited content information for inclusion in this intervention was treatments known to work, including physical activity, useful equipment, and reliable sources of educational material. Participants also suggested it was important that benefits and risks of imaging were explained on the pad. Three key themes derived from the data were also used to guide development of the intervention: (a) the role of imaging in LBP diagnosis; (b) the impact of the patient-physician relationship on LBP diagnosis and treatment; and (c) the lack of patient awareness of Choosing Wisely Canada and their recommendations. Conclusions: the lower back pain patient-developed prescription pad may help patients and clinicians engage in informed conversations and shared decision making that could support reduce unnecessary lower back pain imaging.
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Affiliation(s)
- Maryam Madani Larijani
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
| | - Cindy Dumba
- Patient and Public Partner of Choosing Wisely Canada, Regina, SK S4S 4V4, Canada;
| | - Heather Thiessen
- Saskatchewan Patient & Family Leadership Council, Saskatoon, SK S7K 7P8, Canada;
| | - Angie Palen
- Choosing Wisely Saskatchewan, Saskatoon, SK S7K 1P3, Canada;
| | - Tracey Carr
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
| | - Jason R. Vanstone
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Daryl R. Fourney
- Division of Neurosurgery, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada;
| | - Collin Hartness
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Robert Parker
- Saskatchewan Health Authority, Regina, SK S4P 0W5, Canada; (J.R.V.); (C.H.); (R.P.)
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (M.M.L.); (T.C.)
- Correspondence: ; Tel.: +1-(306)-966-1670
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10
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Patey AM, Grimshaw JM, Francis JJ. Changing behaviour, 'more or less': do implementation and de-implementation interventions include different behaviour change techniques? Implement Sci 2021; 16:20. [PMID: 33632274 PMCID: PMC7905859 DOI: 10.1186/s13012-021-01089-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. METHODS Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson's chi-squared (χ2), Yates' continuity correction and Fisher's exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. RESULTS Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation (Χ2(2, n=178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution (Χ2(2, n=178) = 14.561, p = .0001; Yates' continuity correction); Monitoring of behaviour by others without feedback (Χ2(2, n=178) = 16.187, p = .000057; Yates' continuity correction); and Restructuring social environment (p = .000273; Fisher's 2-sided exact test). CONCLUSIONS There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.
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Affiliation(s)
- Andrea M. Patey
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Jeremy M. Grimshaw
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Jill J. Francis
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- School of Health Sciences, University of Melbourne, Melbourne, Victoria 3010 Australia
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11
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Leis JA, Born KB, Theriault G, Ostrow O, Grill A, Johnston KB. Using antibiotics wisely for respiratory tract infection in the era of covid-19. BMJ 2020; 371:m4125. [PMID: 33187951 DOI: 10.1136/bmj.m4125] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jerome A Leis
- Division of Infectious Diseases and General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Karen B Born
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guylene Theriault
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Allan Grill
- Department of Family Medicine, Markham Stouffville Hospital, Markham, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K Brian Johnston
- Quality of Care NL/Choosing Wisely NL, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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