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Martínez C, Camarelles Guillem F, González-Viana A, Sánchez Á, Tigova O, Fernández E. [From evidence to practice: The Disemination and Implementation Science in primary care]. Aten Primaria 2024; 57:103077. [PMID: 39265319 DOI: 10.1016/j.aprim.2024.103077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 09/14/2024] Open
Abstract
Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.
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Affiliation(s)
- Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Salut Pública, Materno Infantil y Salud Mental, Facultad de Enfermería, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, EE. UU..
| | - Francisco Camarelles Guillem
- Centro de Salud Infanta Mercedes, Programa Actividades Preventivas y Promoción de la Salud PAPPS de semFYC, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Angelina González-Viana
- Servicio Catalán de la Salud - CatSalut, España; Grup d'Atenció Primària Orientada a la Comunitat (APOC) de CAMFIC, Barcelona, España
| | - Álvaro Sánchez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General OSAKIDETZA, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biobizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Sanchez A, Pijoan JI, Sainz de Rozas R, Lekue I, San Vicente R, Quindimil JA, Rotaeche R, Etxeberria A, Mozo C, Martinez-Cengotitabengoa M, Monge M, Gómez-Ramírez C, Samper R, Ogueta Lana M, Celorrio S, Merino-Inda N, Llarena M, Gonzalez Saenz de Tejada M, García-Alvarez A, Grandes G. De-imFAR phase II project: a study protocol for a cluster randomised implementation trial to evaluate the effectiveness of de-implementation strategies to reduce low-value statin prescribing in the primary prevention of cardiovascular disease. BMJ Open 2024; 14:e078692. [PMID: 38631840 PMCID: PMC11029292 DOI: 10.1136/bmjopen-2023-078692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This study aims to reduce potentially inappropriate prescribing (PIP) of statins and foster healthy lifestyle promotion in cardiovascular disease (CVD) primary prevention in low-risk patients. To this end, we will compare the effectiveness and feasibility of several de-implementation strategies developed following the structured design process of the Behaviour Change Wheel targeting key determinants of the clinical decision-making process in CVD prevention. METHODS AND ANALYSIS A cluster randomised implementation trial, with an additional control group, will be launched, involving family physicians (FPs) from 13 Integrated Healthcare Organisations (IHOs) of Osakidetza-Basque Health Service with non-zero incidence rates of PIP of statins in 2021. All FPs will be exposed to a non-reflective decision assistance strategy based on reminders and decision support tools. Additionally, FPs from two of the IHOs will be randomly assigned to one of two increasingly intensive de-implementation strategies: adding a decision information strategy based on knowledge dissemination and a reflective decision structure strategy through audit/feedback. The target population comprises women aged 45-74 years and men aged 40-74 years with moderately elevated cholesterol levels but no diagnosed CVD and low cardiovascular risk (REGICOR<7.5%), who attend at least one appointment with any of the participating FPs (May 2022-May 2023), and will be followed until May 2024. We use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes. The main outcome will be the change in the incidence rate of PIP of statins and healthy lifestyle counselling in the study population 12 and 24 months after FPs' exposure to the strategies. Moreover, FPs' perception of their feasibility and acceptability, and patient experience regarding the quality of care received will be evaluated. ETHICS AND DISSEMINATION The study was approved by the Basque Country Clinical Research Ethics Committee and was registered in ClinicalTrials.gov (NCT04022850). Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04022850.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Jose Ignacio Pijoan
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Clinical Epidemiology Unit, Osakidetza-Basque Health Service, Barakaldo, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Rita Sainz de Rozas
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Itxasne Lekue
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo San Vicente
- Zumarraga Health Center, Goierri-Alto Urola Integrated Health Organization, Osakidetza-Basque Health Service, Zumarraga, Spain
| | - Jose Antonio Quindimil
- Sestao Health Center, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Sestao, Spain
| | - Rafael Rotaeche
- Primary Care Research Unit of Gipuzkoa, Organization of Integrated Health Services of Gipuzkoa, Osakidetza-Basque Health Service, Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Spain
| | - Arritxu Etxeberria
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Carmela Mozo
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Monica Martinez-Cengotitabengoa
- School of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
- Primary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Monica Monge
- Muskiz Health Center, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Muskiz, Spain
| | - Cristina Gómez-Ramírez
- Cardiology Department, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo Samper
- Corporate Pharmacy Service, Directorate of Healthcare Assistance, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Mikel Ogueta Lana
- Subdirectorate of Quality and Health Information Systems, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Sara Celorrio
- Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | | | - Marta Llarena
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Marta Gonzalez Saenz de Tejada
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Arturo García-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
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Withers TM, Garner NJ, Thorley CS, Kellett J, Price L, Auckland S, Sheldon J, Howe A, Pascale M, Smith JR, Sampson MJ, Greaves CJ. Intervention fidelity assessment: A sub-study of the Norfolk Diabetes Prevention Study (NDPS). Br J Health Psychol 2023; 28:740-752. [PMID: 36775261 DOI: 10.1111/bjhp.12651] [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: 05/10/2022] [Accepted: 01/20/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Previous research has shown that lifestyle modification can delay or prevent the onset of type 2 diabetes in high-risk individuals. The Norfolk Diabetes Prevention Study (NDPS) was a parallel, three-arm, randomized controlled trial with up to 46 months follow-up that tested a group-delivered, theory-based lifestyle intervention to reduce the incidence of type 2 diabetes in high-risk groups. The current study aimed to evaluate if the NDPS intervention was delivered to an acceptable standard and if any part(s) of the delivery required improvement. METHODS A sub-sample of 30, 25 for inter-rater reliability and audio-recordings of the NDPS intervention education sessions were assessed independently by two reviewers (CT, TW) using a 12-item checklist. Each item was scored on a 0-5 scale, with a score of 3 being defined as 'adequate delivery'. Inter-rater reliability was assessed. Analysis of covariance (ANCOVA) was used to assess changes in intervention fidelity as the facilitators gained experience. RESULTS Inter-rater agreement was acceptable (86%). A mean score of 3.47 (SD = .38) was achieved across all items of the fidelity checklist and across all intervention facilitators (n = 6). There was an apparent trend for intervention fidelity scores to decrease with experience; however, this trend was non-significant (p > .05) across all domains in this small sample. CONCLUSION The NDPS was delivered to an acceptable standard by all Diabetes Prevention Facilitators. Further research is needed to better understand how the intervention's delivery characteristics can be optimized and how they might vary over time.
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Affiliation(s)
- Thomas M Withers
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nikki J Garner
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- University of Exeter Medical School, Exeter, UK
| | - Chris S Thorley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jo Kellett
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Lucy Price
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Sara Auckland
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jo Sheldon
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Melanie Pascale
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Mike J Sampson
- Elsie Bertram Diabetes Centre, Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Sanchez A, Pablo S, Garcia-Alvarez A, Dominguez S, Grandes G. Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy-the PVS-PREDIAPS strategy-to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial. Implement Sci 2021; 16:58. [PMID: 34044869 PMCID: PMC8161614 DOI: 10.1186/s13012-021-01127-x] [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: 12/24/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. METHODS A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process-the PVS-PREDIAPS implementation strategy-to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. RESULTS After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). DISCUSSION Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03254979 . Registered 16 August 2017-retrospectively registered.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
| | - Susana Pablo
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Arturo Garcia-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Silvia Dominguez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Basque Healthcare Service - Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain
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