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Gabrys L, Schaller A, Peters S, Barzel A, Berrisch-Rahmel S, Dreinhöfer KE, Eckert K, Göhner W, Geidl W, Krupp S, Lange M, Nebel R, Pfeifer K, Reusch A, Schmidt-Ohlemann M, Sewerin P, Steindorf K, Ströhle A, Sudeck G, Wäsche H, Wolf S, Wollesen B, Thiel C. [DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research]. DAS GESUNDHEITSWESEN 2024. [PMID: 39047784 DOI: 10.1055/a-2340-1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.
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Affiliation(s)
- Lars Gabrys
- ESAB Fachhochschule für Sport und Management Potsdam, Gesundheitssport und Prävention, Potsdam, Germany
| | - Andrea Schaller
- Universität der Bundeswehr München, Institut für Sportwissenschaft, Arbeitsbereich Gesundheit, Betriebliche Gesundheitsförderung und Prävention, München, Germany
| | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Hürth-Efferen, Germany
- Universität der Bundeswehr, Institut für Sportwissenschaft, Arbeitsbereich Gesundheit, Betriebliche Gesundheitsförderung und Prävention, München, Germany
| | - Anne Barzel
- Universitätsklinikum Ulm, Institut für Allgemeinmedizin, Ulm, Germany
| | - Susanne Berrisch-Rahmel
- Projektgruppe PG 05 Prävention der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e.V., Sprecherin der AG Sport und Prävention des Bundesverband niedergelassener Kardiologen e.V., Düsseldorf, Germany
| | - Karsten E Dreinhöfer
- Medical Park AG, Orthopädie und Unfallchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Eckert
- IST-Hochschule für Management GmbH, Gesundheitsmanagement & Public Health, Düsseldorf, Germany
| | - Wiebke Göhner
- Katholische Hochschule Freiburg, Bereich Gesundheitspsychologie, Freiburg, Germany
| | - Wolfgang Geidl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Erlangen, Germany
| | - Sonja Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Lübeck, Germany
| | - Martin Lange
- IST-Hochschule für Management GmbH, Fachbereich Fitness & Gesundheit, Düsseldorf, Germany
| | - Roland Nebel
- Deutsche Gesellschaft zur Prävention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR), Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, Leichlingen, Germany
| | - Klaus Pfeifer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Erlangen, Germany
| | - Andrea Reusch
- Zentrum Patientenschulung und Gesundheitsförderung, (ZePG e.V.), Würzburg, Germany
| | | | - Philipp Sewerin
- Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Karen Steindorf
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, DKFZ, Abteilung für Bewegung, Präventionsforschung und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Andreas Ströhle
- Charite Universitatsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie Campus Charité Mitte, Berlin, Germany
| | - Gorden Sudeck
- Eberhard Karls Universität Tübingen, Arbeitsbereich Bildungs- und Gesundheitsforschung im Sport, Institut für Sportwissenschaft, Tübingen, Germany
- Eberhard Karls Universität Tübingen, Interfakultäres Forschungsinstitut für Sport und körperliche Aktivität, Tübingen, Germany
| | - Hagen Wäsche
- Universität Koblenz-Landau Fachbereich 3 Mathematik/Naturwissenschaften, Institut für Sportwissenschaft, Koblenz, Germany
| | - Sebastian Wolf
- Eberhard Karls Universität Tübingen, Arbeitsbereich Bildungs- und Gesundheitsforschung im Sport, Institut für Sportwissenschaft, Tübingen, Germany
| | - Bettina Wollesen
- Universität Hamburg, Arbeitsbereich Bewegungs- und Trainingswissenschaft, Fakultät für Psychologie und Bewegungswissenschaft, Hamburg, Germany
| | - Christian Thiel
- Hochschule für Gesundheit Bochum, Studienbereich Physiotherapie, Department für Angewandte Gesundheitswissenschaften, Bochum, Germany
- Ruhr-Universität Bochum, und Forschungsbereich Trainingswissenschaft, Fakultät für Sportwissenschaft, Bochum, Germany
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Tumuhimbise W, Theuring S, Kaggwa F, Atukunda EC, Rubaihayo J, Atwine D, Sekandi JN, Musiimenta A. Enhancing the Implementation and Integration of mHealth Interventions in Resource-Limited Settings: A Scoping Review. RESEARCH SQUARE 2024:rs.3.rs-4757157. [PMID: 39070627 PMCID: PMC11275990 DOI: 10.21203/rs.3.rs-4757157/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions. Methods We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions. Results We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged. Conclusion The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.
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Affiliation(s)
- Wilson Tumuhimbise
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda
| | - Stefanie Theuring
- Institute of International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Fred Kaggwa
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda
| | - Esther C Atukunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara Uganda
| | - John Rubaihayo
- Faculty of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | | | | | - Angella Musiimenta
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara Uganda, Angels Compassion Research and Development Initiative, Mbarara Uganda
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Dong X, Zhang L, Wang Z, Zheng ZJ. Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions. Front Public Health 2024; 12:1390819. [PMID: 38993705 PMCID: PMC11236690 DOI: 10.3389/fpubh.2024.1390819] [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: 02/24/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Background Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers. Methods Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews. Results We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion. Conclusion Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.
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Affiliation(s)
- Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Lin Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Zongbin Wang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Zhi-jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Mustafa M, Hatah E, Makmor-Bakry M. Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting-An implementation testing study. PLoS One 2024; 19:e0304291. [PMID: 38870126 PMCID: PMC11175411 DOI: 10.1371/journal.pone.0304291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/04/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Medication review (MR) services are evidenced-based practices in which a systematic assessment of a patient's medication is conducted, primarily aiming to optimize drug therapy and minimize adverse drug events through pharmacist interventions. Although studies show that MR services are effective, the implementation of MR services in Malaysia has been challenging due to several barriers. An MR services blueprint was developed to be adapted to the Malaysian community pharmacy setting as part of tailoring strategies. OBJECTIVE Through utilizing the design thinking triple diamond model and implementation science principles, a powerful guide for healthcare researchers and stakeholders to assist with effective service implementation, this study aimed to evaluate the implementation testing and observe the effectiveness of the developed MR service blueprint. METHOD The study utilizes an effectiveness-implementation Type 3 hybrid implementation science framework conducted from May 2021 to April 2022. Employing a qualitative ethnographic approach, researchers observed pharmacy study sites during the implementation of MR services. Both qualitative and quantitative data were collected across exploration, preparation, testing, and operational phases. Implementation outcomes evaluated include phases, reach, fidelity, acceptability, as well as implementation barriers and strategies. MR intervention outcomes included service characteristics and the number and type of drug-related problems and interventions offered. RESULTS 17 community pharmacists were invited to pilot the MR service blueprint for six months in their setting. Of this, 78.5% (n = 11) of the pharmacies reached the testing phase, and 36% (n = 4) reached the implementation phase. Fifty-four patients were in the study, giving an implementation reach of 70%. The majority of surveyed patients expressed satisfaction with the service. The total DRP identified was 133, and 64 interventions were provided by the pharmacists. Facilitation strategies such as "Engage stakeholders by creating ownership of the change" and "Equip stakeholders with training" are needed to overcome the barriers. CONCLUSION This study marked the beginning of successful MR service implementation at Malaysian community pharmacies. Future studies with multi-level partnered strategies are required to reach full implementation and sustainability.
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Affiliation(s)
- Maali Mustafa
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, Cyberjaya, Selangor, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Martin T, Veldeman S, Großmann H, Fuchs-Frohnhofen P, Czaplik M, Follmann A. Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study. JMIR Aging 2024; 7:e55471. [PMID: 38842915 PMCID: PMC11190630 DOI: 10.2196/55471] [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: 12/13/2023] [Revised: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. OBJECTIVE This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. METHODS A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. RESULTS In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. CONCLUSIONS Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.
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Affiliation(s)
- Tobias Martin
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Sarah Veldeman
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | - Michael Czaplik
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Docs In Clouds Telecare GmbH, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Stockton DA, Fowler C, Debono D, Travaglia J. Development of a framework for the collaborative adaptation of service models for child and family health in diverse settings (CASCADES). J Child Health Care 2024; 28:329-347. [PMID: 36165065 PMCID: PMC11141087 DOI: 10.1177/13674935221129003] [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] [Indexed: 11/16/2022]
Abstract
The impact of health service access disparities has significant implications for society. The importance of addressing health and social inequities is never more critical than in the early years of a child's life. Despite advances in healthcare implementation, there is a lack of an evidence-based framework to specifically guide the adaptation of child and family health (CFH) service models for different community contexts. This paper describes the development of a framework for the adaptation of community-based CFH service models. Drawing on the findings of an integrative review and Delphi study, Participatory Action Research was used to test the framework, resulting in the Framework for Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES). The Framework uses the analogy of a waterfall to represent the iterative process of collecting information to inform each step. The framework supports a collaborative co-design approach to build a comprehensive understanding of the target community to inform the adaptation and evaluation of evidence-based interventions appropriate to the local context. The ultimate aim is to enable the delivery of services that are contextually relevant for local communities and provide greater access to effective, accessible services to support children and their families.
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Affiliation(s)
- Deborah A Stockton
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Cathrine Fowler
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Rivard M, Jacques C, Hérault É, Mello C, Abouzeid N, Saulnier G, Boulé M. An innovative and collaborative method to develop a model care and service trajectory for the assessment, diagnosis, and support of children with developmental disabilities. EVALUATION AND PROGRAM PLANNING 2024; 104:102431. [PMID: 38608392 DOI: 10.1016/j.evalprogplan.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
This paper documents an innovative research approach undertaken to co-develop an integrated assessment, diagnosis, and support service trajectory for children suspected of having a developmental disability. It employed data-driven practices and involved multiple stakeholders such as parents, professionals, managers, and researchers. It emphasized the importance of incorporating experiential knowledge adopting an integrated care and service trajectory perspective, and using an implementation science framework. The first part of this article presents the theoretical roots and the collaborative method used to co-construct the model trajectory. The second part of this article presents the results of a survey in which participating stakeholders shared their point of view on the value and impact of this approach Overall, this article provides a step-by-step operationalization of participative research in the context of public health and social services. This may help guide future initiatives to improve services for developmental disabilities in partnership with those directly concerned by these services.
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Affiliation(s)
- Mélina Rivard
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada.
| | - Claudine Jacques
- Department of Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Élodie Hérault
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada
| | - Catherine Mello
- Department of Psychology, Penn State University - Berks, Reading, PA, Canada
| | - Nadia Abouzeid
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Geneviève Saulnier
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Mélina Boulé
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montréal, QC H2X 3P2, Canada
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Chan AHY, Te Ao B, Baggott C, Cavadino A, Eikholt AA, Harwood M, Hikaka J, Gibbs D, Hudson M, Mirza F, Naeem MA, Semprini R, Chang CL, Tsang KCH, Shah SA, Jeremiah A, Abeysinghe BN, Roy R, Wall C, Wood L, Dalziel S, Pinnock H, van Boven JFM, Roop P, Harrison J. DIGIPREDICT: physiological, behavioural and environmental predictors of asthma attacks-a prospective observational study using digital markers and artificial intelligence-study protocol. BMJ Open Respir Res 2024; 11:e002275. [PMID: 38777583 PMCID: PMC11116853 DOI: 10.1136/bmjresp-2023-002275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Asthma attacks are a leading cause of morbidity and mortality but are preventable in most if detected and treated promptly. However, the changes that occur physiologically and behaviourally in the days and weeks preceding an attack are not always recognised, highlighting a potential role for technology. The aim of this study 'DIGIPREDICT' is to identify early digital markers of asthma attacks using sensors embedded in smart devices including watches and inhalers, and leverage health and environmental datasets and artificial intelligence, to develop a risk prediction model to provide an early, personalised warning of asthma attacks. METHODS AND ANALYSIS A prospective sample of 300 people, 12 years or older, with a history of a moderate or severe asthma attack in the last 12 months will be recruited in New Zealand. Each participant will be given a smart watch (to assess physiological measures such as heart and respiratory rate), peak flow meter, smart inhaler (to assess adherence and inhalation) and a cough monitoring application to use regularly over 6 months with fortnightly questionnaires on asthma control and well-being. Data on sociodemographics, asthma control, lung function, dietary intake, medical history and technology acceptance will be collected at baseline and at 6 months. Asthma attacks will be measured by self-report and confirmed with clinical records. The collected data, along with environmental data on weather and air quality, will be analysed using machine learning to develop a risk prediction model for asthma attacks. ETHICS AND DISSEMINATION Ethical approval has been obtained from the New Zealand Health and Disability Ethics Committee (2023 FULL 13541). Enrolment began in August 2023. Results will be presented at local, national and international meetings, including dissemination via community groups, and submission for publication to peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12623000764639; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
| | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Christina Baggott
- Department of Respiratory Medicine and Respiratory research unit, Waikato Hospital, Hamilton, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Amber A Eikholt
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands
| | - Matire Harwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Dianna Gibbs
- Pinnacle Midlands Health Network, Hamilton, New Zealand
| | - Mariana Hudson
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
| | - Farhaan Mirza
- Department of IT and Software Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Muhammed Asif Naeem
- Department of IT and Software Engineering, Auckland University of Technology, Auckland, New Zealand
- National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - Ruth Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Catherina L Chang
- Department of Respiratory Medicine and Respiratory research unit, Waikato Hospital, Hamilton, New Zealand
| | - Kevin C H Tsang
- University College London, London, UK
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Syed Ahmar Shah
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Aron Jeremiah
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Binu Nisal Abeysinghe
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Clare Wall
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Lisa Wood
- Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Stuart Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Hilary Pinnock
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
| | - Job F M van Boven
- University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, Netherlands
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, Netherlands
| | - Partha Roop
- Department of Electrical, Computer and Software Engineering, University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Region, New Zealand
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McKinnon K, Lentz C, Boccher-Lattimore D, Cournos F, Pather A, Sukumaran S, Thompson A, DeLorenzo L, Hager M, Remien RH, Mellins CA. Barriers and facilitators to implementing evidence-based integrated HIV and behavioral health care: perspectives from seven federal ending the HIV epidemic jurisdictions. AIDS Care 2024:1-8. [PMID: 38771971 DOI: 10.1080/09540121.2024.2354897] [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: 08/26/2023] [Accepted: 05/08/2024] [Indexed: 05/23/2024]
Abstract
The federal Ending the HIV Epidemic (EHE) initiative was created to reduce new US HIV infections, largely through pre-exposure prophylaxis and HIV treatments that reduce HIV transmissibility to zero. Behavioral health disorders (mental health and substance use) remain significant barriers to achieving EHE goals. Addressing behavioral health (BH) disorders within HIV primary care settings has been promoted as a critical EHE strategy. Implementation of efficacious HIV-BH care integration and its impact on HIV-related health outcomes is not well documented. In a federally-funded, exploratory phase implementation science study, we used the Collective Impact Framework to engage partners in seven EHE jurisdictions about the feasibility, acceptability, and sustainability of implementing HIV-BH integration interventions within local HIV settings. Partners concluded that full integration will remain the exception unless health systems invest in collaborative practice, professional training, appropriate health technology, and inter-system communication. Partners supported smaller incremental improvements including transdiagnostic approaches to reinforce each team member's sense of value in the shared endeavor. This early phase implementation science study identified research and implementation gaps that are critical to fill to end the HIV epidemic. Both the Collective Impact Framework and implementation science show promise for guiding future implementation of evidence-based HIV-BH intervention integration.
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Affiliation(s)
- Karen McKinnon
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Daria Boccher-Lattimore
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | - Francine Cournos
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ariana Pather
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Stephen Sukumaran
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Adam Thompson
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, New York, NY, USA
| | | | | | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Ritchie MJ, Smith JL, Kim B, Woodward EN, Kirchner JE. Building a sharable literature collection to advance the science and practice of implementation facilitation. FRONTIERS IN HEALTH SERVICES 2024; 4:1304694. [PMID: 38784706 PMCID: PMC11111980 DOI: 10.3389/frhs.2024.1304694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
Background Implementation science seeks to produce generalizable knowledge on strategies that promote the adoption and sustained use of evidence-based innovations. Literature reviews on specific implementation strategies can help us understand how they are conceptualized and applied, synthesize findings, and identify knowledge gaps. Although rigorous literature reviews can advance scientific knowledge and facilitate theory development, they are time-consuming and costly to produce. Improving the efficiency of literature review processes and reducing redundancy of effort is especially important for this rapidly developing field. We sought to amass relevant literature on one increasingly used evidence-based strategy, implementation facilitation (IF), as a publicly available resource. Methods We conducted a rigorous systematic search of PubMed, CINAHL, and Web of Science citation databases for peer-reviewed, English-language articles with "facilitation" and a combination of other terms published from January 1996 to December 2021. We searched bibliographies of articles published from 1996 to 2015 and identified articles during the full text review that reported on the same study. Two authors screened 3,168 abstracts. After establishing inter-rater reliability, they individually conducted full-text review of 786 relevant articles. A multidisciplinary team of investigators provided recommendations for preparing and disseminating the literature collection. Findings The literature collection is comprised of 510 articles. It includes 277 empirical studies of IF and 77 other articles, including conceptual/theoretical articles, literature reviews, debate papers and descriptions of large-scale clinical initiatives. Over half of the articles were published between 2017 and 2021. The collection is publicly available as an Excel file and as an xml file that can be imported into reference management software. Conclusion We created a publicly accessible collection of literature about the application of IF to implement evidence-based innovations in healthcare. The comprehensiveness of this collection has the potential to maximize efficiency and minimize redundancy in scientific inquiry about this strategy. Scientists and practitioners can use the collection to more rapidly identify developments in the application of IF and to investigate a wide range of compelling questions on its use within and across different healthcare disciplines/settings, countries, and payer systems. We offer several examples of how this collection has already been used.
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Affiliation(s)
- Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jeffrey L. Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Ogrin R, Rushford MA, Fallon J, Mannix R, Quinn B, Lewis A. Describing the development and implementation of a novel collaborative multidisciplinary approach to deliver foot health supports for individuals experiencing homelessness and its outcomes. PLoS One 2024; 19:e0302572. [PMID: 38687771 PMCID: PMC11060552 DOI: 10.1371/journal.pone.0302572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.
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Affiliation(s)
- Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Mary-Anne Rushford
- Bolton Clarke Homeless Persons Program, West Melbourne, Victoria, Australia
| | - Joseph Fallon
- Bolton Clarke Homeless Persons Program, West Melbourne, Victoria, Australia
| | | | - Ben Quinn
- cohealth, Melbourne, Victoria, Australia
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Tait D, Davis D, Roche MA, Paterson C. Nurse/midwife-to-patient ratios: A scoping review. Contemp Nurse 2024; 60:257-269. [PMID: 38408182 DOI: 10.1080/10376178.2024.2318361] [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: 10/04/2022] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND A significant body of work has linked high nurse or midwife workload to negative patient outcomes. Anecdotal reports suggest that mandated ratio models enhance patient care and improve nurse job satisfaction. However, there is limited focused research. OBJECTIVE To identify key outcomes, implementation processes, and research needs regarding nurse/midwife-to-patient ratios in the Australian healthcare context. DESIGN Scoping review. METHODS Data sources were CINAHL, Open Dissertations, Medline, and Scopus. 289 articles screened, and 53 full text documents independently assessed against criteria by two reviewers and conflicts resolved by a third reviewer, using Covidence™. Three studies were included in this review. RESULTS Studies focused on nurse (job satisfaction, burnout), patient (mortality, readmission, length of stay) and system (costs) outcomes with limited information on implementation processes and no midwifery research. CONCLUSIONS Ratios provide benefits for patients, nurses, and hospitals although there is limited research in Australia. Implementation was poorly reported..
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Affiliation(s)
- Darcy Tait
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Watson, Australian Capital Territory, Australia
| | - Deborah Davis
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
| | - Michael A Roche
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- University of Technology Sydney, School of Nursing and Midwifery, Faculty of Health, Ultimo, New South Wales, Australia
| | - Catherine Paterson
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, School of Nursing, Midwifery & Paramedic Practice, Garthdee, UK
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Kumari R, Chander S. Improving healthcare quality by unifying the American electronic medical report system: time for change. Egypt Heart J 2024; 76:32. [PMID: 38489094 PMCID: PMC10942963 DOI: 10.1186/s43044-024-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In recent years, innovation in healthcare technology has significantly improved the efficiency of the healthcare system. Advancements have led to better patient care and more cost-effective services. The electronic medical record (EMR) system, in particular, has enhanced interoperability and collaboration across healthcare departments by facilitating the exchange and utilization of patient data. The COVID-19 pandemic further accelerated this trend, leading to a surge in telemedicine services, which rely on electronic communication to deliver healthcare remotely. MAIN BODY Integrating artificial intelligence (AI) and machine learning (ML) in healthcare have been instrumental in analyzing vast data sets, allowing for identifying patterns and trends that can improve care delivery and pinpoint potential issues. The proposal of a unified EMR system in the USA aims to capitalize on these technological advancements. Such a system would streamline the sharing of patient information among healthcare providers, improve the quality and efficiency of care, and minimize the likelihood of errors in patient treatment. CONCLUSION A unified electronic medical record system represents a promising avenue for enhancing interoperability within the US healthcare sector. By creating a more connected and accessible network of patient information, it sets the stage for a transformation in healthcare delivery. This change is imperative for maintaining the momentum of progress in healthcare technology and realizing the full potential of recent advancements in patient care and system efficiency.
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Affiliation(s)
- Roopa Kumari
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA
| | - Subhash Chander
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA.
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Schaller A, Stassen G, Baulig L, Lange M. Physical activity interventions in workplace health promotion: objectives, related outcomes, and consideration of the setting-a scoping review of reviews. Front Public Health 2024; 12:1353119. [PMID: 38406496 PMCID: PMC10884305 DOI: 10.3389/fpubh.2024.1353119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background The workplace is a recognized setting for promoting health among adults, and physical activity (PA) interventions are an integral part of workplace health promotion (WHP). Objectives The present review of reviews aims to provide an overview of the main objectives and related outcomes addressed in WHP-related PA interventions, as well as the setting-specific aspects considered in the research field. Methods A scoping review of reviews was conducted. Reviews were included if they were peer-reviewed, written in English, and focused on PA interventions conducted in the context of WHP. A literature search was conducted in PubMed, SPORTDiscus, and Web of Science. Reviews were included if they had been published after the year 2000. Information on the following dimensions was extracted: author, region, number of primary studies included, target group(s), PA interventions included, main objective(s), related outcomes, and setting-specific aspects. Results A total of 17 reviews were included. Six reviews aimed at solely identifying the effectiveness of promoting daily PA and reducing sedentary behavior. Eleven reviews showed a combined approach considering physical activity behavior and/or health and job-related outcomes. Outcomes in the primary studies were heterogeneous. None of the reviews had an explicit definition of WHP and setting-specific information was very general and sparse. The reported setting-specific information was referred to the general importance of the workplace setting, the specific importance as an access route to target groups, and implementation aspects. Regarding the additional characteristics of the reviews, the selection of primary studies was restricted to a specific region in 2 of the 17 reviews in advance. Three reviews restricted the target group (sedentary workers, women, desk-based workers), while eleven reviews included working adults in general and, three reviews gave no information about the target group. Eleven intervention approaches of the reviews were behaviorally oriented, two focused solely on environmental interventions, and four reviews can be attributed to a combined approach considering behavioral and environmental interventions. Conclusion For sustainable future developments, the present results indicate a strong need for conceptual consolidation of WHP in the research field of PA interventions. Therefore, both WHP and health-related PA interventions need to take a comprehensive approach comprising behavioral and environmental interventions.
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Affiliation(s)
- Andrea Schaller
- Department of Human Sciences, Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Gerrit Stassen
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - Lukas Baulig
- University of Police and Public Administration of North Rhine-Westphalia, Cologne, Germany
| | - Martin Lange
- Department of Fitness and Health, IST University of Applied Sciences, Düsseldorf, Germany
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von Peter S, Kraemer UM, Cubellis L, Fehler G, Ruiz-Pérez G, Schmidt D, Ziegenhagen J, Kuesel M, Ackers S, Mahlke C, Nugent L, Heuer I. Implementing peer support work in mental health care in Germany: The methodological framework of the collaborative, participatory, mixed-methods study (ImpPeer-Psy5). Health Expect 2024; 27:e13938. [PMID: 39102703 DOI: 10.1111/hex.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Starting in the 1990s in the United States, individuals with lived experience of mental health crises and recovery have been employed as peer support workers (PSWs) internationally. However, the implementation of PSW in clinical contexts remains challenging. METHODS This manuscript presents and discusses the methodological framework of the ImpPeer-Psy5 study on the PSW implementation in the German mental healthcare sector. This study used a mixed-methods and collaborative research approach, as well as participatory research strategies. After describing the study design, populations, teamwork and assessments, the epistemic challenges of its methodological framework will be critically discussed and how it has iteratively shaped the object of study. DISCUSSION AND PRACTICAL IMPLICATIONS The healthcare, policy and funding context of PSW implementation as well as the study's methodological framework have differently influenced the ways in which the implementation of PSW has been conceived in this study. The choice of a collaborative or participatory methodological framework is advised to better align research questions and procedures to the specific needs and challenges of PSWs and other stakeholders concerned with PSW implementation. PATIENT AND PUBLIC CONTRIBUTION The research team of the ImpPeer-Psy5 study was collaboratively staffed by a portion of researchers who also identify as users or survivors of psychiatric services. A nonprofit organization for the training of PSWs served as a practice partner throughout the research process. Different participatory formats involve a significant number of diverse stakeholders relevant to PSW implementation.
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Affiliation(s)
- Sebastian von Peter
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Ute Maria Kraemer
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Lauren Cubellis
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Georgia Fehler
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Guillermo Ruiz-Pérez
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Daniela Schmidt
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Jenny Ziegenhagen
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | - Madeleine Kuesel
- Brandenburg Medical School, Centre of Mental HealtPsychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Neuruppin, Germany
| | | | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Nugent
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Imke Heuer
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Smith MY, Gaglio B, Anatchkova M. The use of implementation science theories, models, and frameworks in implementation research for medicinal products: A scoping review. Health Res Policy Syst 2024; 22:17. [PMID: 38287407 PMCID: PMC10823700 DOI: 10.1186/s12961-024-01102-0] [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: 09/20/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The uptake, adoption and integration of new medicines and treatment regimens within healthcare delivery can take a decade or more. Increasingly, implementation science (IS) research is being used to bridge this gap between the availability of new therapeutic evidence and its actual application in clinical practice. Little is known, however, about the quality of IS research in this area, including the degree to which theories, models and frameworks (TMFs) are being used. The objective of this study was to conduct a scoping review of the use of TMFs in implementation research involving medicinal products. METHODS A search was conducted for English language abstracts and manuscripts describing the application of TMFs in IS studies for medicinal products. Eligible publications were those published between 1 January 1974 and 12 December 2022. All records were screened at the title and abstract stage; included full-text papers were abstracted using data extraction tables designed for the study. Study quality was appraised using the Implementation Research Development Tool. RESULTS The initial scoping search identified 2697 publications, of which 9 were ultimately eligible for inclusion in the review. Most studies were published after 2020 and varied in their objectives, design and therapeutic area. Most studies had sample sizes of fewer than 50 participants, and all focused on the post-marketing phase of drug development. The TMF most frequently used was the Consolidated Framework for Implementation Research (CFIR). Although most studies applied all TMF domains, TMF use was limited to instrument development and/or qualitative analysis. Quality appraisals indicated the need for engaging patients and other stakeholders in the implementation research, reporting on the cost of implementation strategies, and evaluating the unintended consequences of implementation efforts. CONCLUSIONS We found that few IS studies involving medicinal products reported using TMFs. Those that did encompassed a wide variety of therapeutic indications and medicinal products; all were in the post-marketing phase and involved limited application of the TMFs. Researchers should consider conducting IS in earlier phases of drug development and integrating the TMFs throughout the research process. More consistent and in-depth use of TMFs may help advance research in this area.
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Affiliation(s)
- Meredith Y Smith
- Evidera, Inc., Bethesda, MD, United States of America.
- Department of Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America.
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Ziam S, Lanoue S, McSween-Cadieux E, Gervais MJ, Lane J, Gaid D, Chouinard LJ, Dagenais C, Ridde V, Jean E, Fleury FC, Hong QN, Prigent O. A scoping review of theories, models and frameworks used or proposed to evaluate knowledge mobilization strategies. Health Res Policy Syst 2024; 22:8. [PMID: 38200612 PMCID: PMC10777658 DOI: 10.1186/s12961-023-01090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Evaluating knowledge mobilization strategies (KMb) presents challenges for organizations seeking to understand their impact to improve KMb effectiveness. Moreover, the large number of theories, models, and frameworks (TMFs) available can be confusing for users. Therefore, the purpose of this scoping review was to identify and describe the characteristics of TMFs that have been used or proposed in the literature to evaluate KMb strategies. METHODS A scoping review methodology was used. Articles were identified through searches in electronic databases, previous reviews and reference lists of included articles. Titles, abstracts and full texts were screened in duplicate. Data were charted using a piloted data charting form. Data extracted included study characteristics, KMb characteristics, and TMFs used or proposed for KMb evaluation. An adapted version of Nilsen (Implement Sci 10:53, 2015) taxonomy and the Expert Recommendations for Implementing Change (ERIC) taxonomy (Powell et al. in Implement Sci 10:21, 2015) guided data synthesis. RESULTS Of the 4763 search results, 505 were retrieved, and 88 articles were eligible for review. These consisted of 40 theoretical articles (45.5%), 44 empirical studies (50.0%) and four protocols (4.5%). The majority were published after 2010 (n = 70, 79.5%) and were health related (n = 71, 80.7%). Half of the studied KMb strategies were implemented in only four countries: Canada, Australia, the United States and the United Kingdom (n = 42, 47.7%). One-third used existing TMFs (n = 28, 31.8%). According to the adapted Nilsen taxonomy, process models (n = 34, 38.6%) and evaluation frameworks (n = 28, 31.8%) were the two most frequent types of TMFs used or proposed to evaluate KMb. According to the ERIC taxonomy, activities to "train and educate stakeholders" (n = 46, 52.3%) were the most common, followed by activities to "develop stakeholder interrelationships" (n = 23, 26.1%). Analysis of the TMFs identified revealed relevant factors of interest for the evaluation of KMb strategies, classified into four dimensions: context, process, effects and impacts. CONCLUSIONS This scoping review provides an overview of the many KMb TMFs used or proposed. The results provide insight into potential dimensions and components to be considered when assessing KMb strategies.
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Affiliation(s)
- Saliha Ziam
- School of Business Administration, Université TÉLUQ, Montreal, Canada.
| | - Sèverine Lanoue
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
| | - Esther McSween-Cadieux
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Julie Lane
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Dina Gaid
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | | | - Valéry Ridde
- Université Paris Cité, IRD (Institute for Research on Sustainable Development, CEPED, Paris, France
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Emmanuelle Jean
- Public Health Intelligence and Knowledge Translation Division, Public Health Agency of Canada, Ottawa, Canada
| | - France Charles Fleury
- Coordinator of the Interregional Consortium of Knowledge in Health and Social Services (InterS4), Rimouski, Canada
| | - Quan Nha Hong
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Ollivier Prigent
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
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Misra R, Kirk B, Shawley-Brzoska S, Totzkay D, Morton C, Kuhn S, Harris M, McMillion M, Darling E. Educational Intervention to Increase COVID-19 Vaccine Uptake in Rural Patients with Chronic Diseases: Lessons Learned from An Innovative Academic-Community Partnership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:71. [PMID: 38248535 PMCID: PMC10815710 DOI: 10.3390/ijerph21010071] [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: 11/09/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The pandemic has disproportionately impacted rural communities with a higher burden of chronic disease and COVID-19 infection. West Virginia is a rural state with a high rate of diabetes, hypertension, and COPD, which are known risk factors for severe COVID-19 and long COVID. Yet, there is a significant hesitancy regarding COVID-19 vaccination uptake in the state. The purpose of this study was to use an educational intervention to increase vaccine knowledge and vaccine acceptance in rural patients with chronic disease(s) in West Virginia. This project used an academic-community partnership comprised of researchers, practitioners, community organizations, community-engaged partners, and patient stakeholders to increase COVID-19 health literacy and increase vaccine acceptance among rural West Virginians with chronic conditions. MATERIALS AND METHODS A quasi-experimental study design was used to deliver an educational intervention by trained Health Navigators using short videos to increase COVID-19 health literacy and address participants' vaccine concerns. Eligibility included adults (18 years and older) who have at least one chronic condition. A statewide community advisory board (CAB) guided the development of the educational training curriculum and implementation strategies. An adapted version of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework guided the development of the intervention. Health Navigators (n = 45) delivered the educational intervention in their local communities between November 2022 and October 2023 (project implementation is still ongoing). Intervention fidelity checks, an adaptable script, and a flow chart allowed tailoring of brief videos to address participants' specific COVID-19 questions and vaccine concerns. A validated online survey, monitored by an online Research Electronic Data Capture (REDCap) database, assessed participants' knowledge, perceived susceptibility, and vaccine intention. RESULTS Health Navigators delivered the intervention to 1368 West Virginians in 52 counties (59.2% women; 61.8% without a college degree). Participants reported living with an average of 2.1 ± 1.4 chronic conditions. The mean age was 43.5 ± 18.8 years. The majority of participants (81.2%) had received the primary vaccination series, and 63.1% had at least one booster. However, 18% were unvaccinated or did not complete the primary COVID-19 vaccine series. Discussions to improve vaccine literacy focused on how the vaccine was so quickly developed and protects against variants, addressing concerns related to the safety, short- and long-term side effects, and importance of vaccine uptake for immunocompromised individuals. Participants with higher concerns were more likely to be unvaccinated and to have not completed their primary series or boosters (p < 0.001). However, the educational intervention improved the willingness of individuals who were either unvaccinated or did not complete their primary vaccine series to get vaccinated (11.4%). DISCUSSION Our findings highlight the importance of vaccine literacy in increasing vaccination rates among rural patients with chronic diseases. Using the EPIS framework allowed us to reflect upon the challenges, ensure resilience during changing local contexts, and plan and implement a promising, cost-effective intervention in rural areas. CONCLUSIONS This study provides insights into the need for tailored educational interventions based on disease status, which has implications for public health and patient care in rural and underserved communities. Academic-community partnerships can be useful for successful knowledge transfer for vaccine acceptance to reduce rural health disparities.
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Affiliation(s)
- Ranjita Misra
- West Virginia University School of Public Health, Morgantown, WV 26505, USA; (B.K.); (S.S.-B.)
| | - Brenna Kirk
- West Virginia University School of Public Health, Morgantown, WV 26505, USA; (B.K.); (S.S.-B.)
| | | | - Daniel Totzkay
- Department of Communication Studies, Eberly College of Art and Sciences, West Virginia University, Morgantown, WV 26506, USA;
| | - Catherine Morton
- Health Sciences and Technology Academy, Morgantown, WV 26506, USA; (C.M.); (S.K.); (M.H.); (M.M.)
| | - Summer Kuhn
- Health Sciences and Technology Academy, Morgantown, WV 26506, USA; (C.M.); (S.K.); (M.H.); (M.M.)
| | - Misty Harris
- Health Sciences and Technology Academy, Morgantown, WV 26506, USA; (C.M.); (S.K.); (M.H.); (M.M.)
| | - Mary McMillion
- Health Sciences and Technology Academy, Morgantown, WV 26506, USA; (C.M.); (S.K.); (M.H.); (M.M.)
| | - Elaine Darling
- The Center for Rural Health Development Inc., 75 Chase Dr, Hurricane, WV 25526, USA;
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Skogrand E, Sharpe J, Englander H. Dispensing Methadone at Hospital Discharge: One Hospital's Approach to Implementing the "72-hour Rule" Change. J Addict Med 2024; 18:71-74. [PMID: 37994453 PMCID: PMC10873107 DOI: 10.1097/adm.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Methadone for opioid use disorder treatment in ambulatory settings is restricted to federally licensed opioid treatment programs (OTPs) in the United States. However, these restrictions do not apply during hospitalization. A recent change to the rule governing methadone in non-OTP settings created an opportunity to dispense methadone at hospital discharge for up to 72 hours. METHODS Here, we describe one hospital's approach to dispensing methadone at discharge in alignment with the "72-hour rule," including implementation challenges and considerations for other hospitals planning on adopting this practice. Implementation included creating a workflow and detailed documents outlining dispensing procedure, educating interprofessional staff, and coordinating with local OTPs. RESULTS Our experiences highlight the importance of pharmacy champions to support implementation and interdisciplinary staff education, the need to consider electronic health record capabilities, and the importance of having policies and practices that support appropriate interpretation of the "72-hour rule" renewal timeline. CONCLUSIONS Exceptions to federal regulations allow greater flexibility in discharge planning for patients with opioid use disorder; however, dispensation workflow falls outside standard hospital care and may be challenging to implement.
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Affiliation(s)
- Emily Skogrand
- Department of Pharmacy, Oregon Health & Science University, Portland Oregon
| | - Jackie Sharpe
- Department of Pharmacy, Oregon Health & Science University, Portland Oregon
| | - Honora Englander
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland Oregon
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Crowther D, Curran J, Somerville M, Sinclair D, Wozney L, MacPhee S, Rose AE, Boulos L, Caudrella A. Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review. PLoS One 2023; 18:e0294804. [PMID: 38100469 PMCID: PMC10723714 DOI: 10.1371/journal.pone.0294804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. METHODS A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. FINDINGS The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. CONCLUSION This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.
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Affiliation(s)
- Daniel Crowther
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Doug Sinclair
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shannon MacPhee
- Quality and Patient Safety, IWK Health, Halifax, Nova Scotia, Canada
| | | | - Leah Boulos
- The Maritime Strategy for Patient Oriented Research SUPPORT Unit, Halifax, NS, Canada
| | - Alexander Caudrella
- Mental Health and Addictions Service, St Michael’s Hospital, Toronto, Ontario, Canada
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Davidson TM, Espeleta HC, Ridings LE, Witcraft S, Bravoco O, Higgins K, Houchins R, Kitchens D, Manning B, Jones S, Crookes B, Hanson R, Ruggiero KJ. Implementation of a Stepped Care Program to Address Emotional Recovery among Traumatic Injury Patients. J Am Coll Surg 2023; 237:810-825. [PMID: 37815166 PMCID: PMC10914157 DOI: 10.1097/xcs.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Annually, over 600,000 adults served in US trauma centers (≥20%) develop posttraumatic stress disorder (PTSD) and/or depression in the first year after injury. American College of Surgeons guidelines include screening and addressing mental health recovery in trauma centers. Yet, many trauma centers do not monitor and address mental health recovery, and it is a priority to learn how to implement evidence-informed mental health programs in trauma centers. STUDY DESIGN This report describes our application of the Exploration, Preparation, Implementation, Sustainment model to implement the Trauma Resilience and Recovery Program (TRRP) in 3 Level I and II trauma centers to address patients' mental health needs. TRRP is a scalable and sustainable stepped model of care-one of the few in the US-that provides early intervention and direct services after traumatic injury. RESULTS Trauma centers are well positioned to accelerate patients' mental health recovery via early identification, education, screening, and referrals to mental health agencies that provide best-practice care. We found that TRRP was acceptable to the 3 partnering trauma centers we studied. Early engagement of patient, provider, and hospital administration stakeholders enhanced buy-in during the early stages of the implementation process and promoted sustainability. Active processes to support monitoring, evaluation, and adaptation were critical. CONCLUSIONS Our work demonstrates the feasibility of implementing and adapting TRRP, a cost-efficient and sustainable stepped care intervention, in Level I and II trauma centers. Several factors should be carefully considered by trauma centers seeking to integrate behavioral health interventions into their trauma program.
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Affiliation(s)
- Tatiana M Davidson
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Hannah C Espeleta
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Leigh E Ridings
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Sara Witcraft
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Olivia Bravoco
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Kristen Higgins
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rachel Houchins
- Prisma Health Midlands, Level I Trauma Center, Columbia, SC (Houchins)
| | - Debra Kitchens
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Benjamin Manning
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Seon Jones
- Trident Medical Center, Level II Trauma Center, Charleston, SC (Jones)
| | - Bruce Crookes
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rochelle Hanson
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Kenneth J Ruggiero
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
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Macé F, De Vriese C, Nelissen-Vrancken M, Ruggli M, Brülhart M, Peyron C. General practitioners-community pharmacists pharmacotherapy discussion groups: Analysis of their implementation through a series of case studies. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100331. [PMID: 37772034 PMCID: PMC10523268 DOI: 10.1016/j.rcsop.2023.100331] [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: 06/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Background The evolution of primary care practice has led to the implementation of pharmacotherapy discussion groups between general practitioners and community pharmacists (PPPDGs) in some countries. The aim of these groups is to improve drug prescribing practices and strengthen interprofessional relationships. Objective To gain more insight into factors involved in successful implementation of PPPDGs. Methods PPPDG implementation in three countries (Belgium, the Netherlands, Switzerland), was analyzed in a series of case studies. A grid describing different evaluation criteria was completed by stakeholders in their respective country. The data collection was followed by a literature review. Results Various models were used to implement PPPDGs within each country and different dynamics were encountered. PPPDGs lead to positive effects on the quality and cost-effectiveness of drug prescribing and on the collaboration between general practitioners (GPs) and community pharmacists (CPs). Factors involved in implementation were also identified, such as expectations of GPs and CPs, configuration of the implemented model, and the role of CPs in the healthcare organization. Conclusions This study provides insight into the factors involved in successful implementation of PPPDGs in Belgium, the Netherlands and Switzerland. The findings can be used by healthcare professionals to improve the safety, cost-effectiveness of drug prescriptions and systems in primary care. This study offers a starting point for further research in the field.
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Affiliation(s)
- Florent Macé
- Economics Laboratory of Dijon, University of Burgundy, Dijon, France
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Martine Ruggli
- President of pharmaSuisse, Swiss Society of Pharmacists, Berne-Liebefeld, Switzerland
| | - Mélanie Brülhart
- Project manager Quality Circles, Swiss Society of Pharmacists, pharmaSuisse, Berne-Liebefeld, Switzerland
| | - Christine Peyron
- Economics Laboratory of Dijon, University of Burgundy, Dijon, France
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Frith M, Randall S, Savira F, Swann J, White N, Giddy A, McLean K, Peeters A, Robinson S. Evaluation of the priority primary care centre program to reduce emergency department burden in regional Victoria, Australia: a mixed-method study. BMJ Open 2023; 13:e075773. [PMID: 37945302 PMCID: PMC10649696 DOI: 10.1136/bmjopen-2023-075773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION In Australia, the Victorian State Government has established a number of priority primary care centres (PPCCs) across the state to address the increasing demand for emergency departments (EDs). PPCCs are general practitioner-led, free-of-charge services that aim to provide care for conditions that require urgent attention but do not require the high-acuity care of an ED. This study aims to evaluate the implementation processes, outcomes and the impact of the PPCC on reducing ED demand within Barwon, Warrnambool and Grampians Health Services in the Western region of Victoria, Australia. METHODS AND ANALYSIS This is a convergent mixed-method study. Qualitative data collection will be undertaken through semistructured interviews to understand the experiences of PPCC patients, PPCC clinical staff, PPCC managerial and administrative staff and ED clinical staff. A documentary analysis will be conducted on the materials relating to the implementation of the PPCC. The quantitative component will involve interrupted time series analysis of de-identified administrative data, comprising ED presentation records and PPCC clinical records. Implementation science frameworks will be integrated throughout the study. The RE-AIM framework is a guide used for the planning and evaluation of programmes through five outcomes: reach, effectiveness, adoption, implementation and maintenance. The Consolidated Framework for Implementation Research will be integrated. ETHICS AND DISSEMINATION This study has received ethical approval from Deakin University HREC (Ref No. 2023-046) and Barwon Health HREC (Ref No. 94374). Findings will be disseminated as reports, presentations and peer-reviewed journal articles.
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Affiliation(s)
- Madison Frith
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Sean Randall
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Feby Savira
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Jamie Swann
- Health Analytics and Research, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Naomi White
- Regional Parnterships and Public Health, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Andrew Giddy
- Strategy and Engagement, Western Victorian Primary Health Network, Ballarat, Victoria, Australia
| | - Kirsty McLean
- Emergency Nursing, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Anna Peeters
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Suzanne Robinson
- Deakin Health Economics, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
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Mianda S, Todowede O, Schneider H. Service delivery interventions to improve maternal and newborn health in low- and middle-income countries: scoping review of quality improvement, implementation research and health system strengthening approaches. BMC Health Serv Res 2023; 23:1223. [PMID: 37940974 PMCID: PMC10634015 DOI: 10.1186/s12913-023-10202-6] [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: 03/15/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION This review explores the characteristics of service delivery-related interventions to improve maternal and newborn health (MNH) in low-and middle-income countries (LMICs) over the last two decades, comparing three common framings of these interventions, namely, quality improvement (QI), implementation science/research (IS/IR), and health system strengthening (HSS). METHODS The review followed the staged scoping review methodology proposed by Levac et al. (2010). We developed and piloted a systematic search strategy, limited to English language peer-reviewed articles published on LMICs between 2000 and March 2022. Analysis was conducted in two-quantitative and qualitative-phases. In the quantitative phase, we counted the year of publication, country(-ies) of origin, and the presence of the terms 'quality improvement', 'health system strengthening' or 'implementation science'/ 'implementation research' in titles, abstracts and key words. From this analysis, a subset of papers referred to as 'archetypes' (terms appearing in two or more of titles, abstract and key words) was analysed qualitatively, to draw out key concepts/theories and underlying mechanisms of change associated with each approach. RESULTS The searches from different databases resulted in a total of 3,323 hits. After removal of duplicates and screening, a total of 231 relevant articles remained for data extraction. These were distributed across the globe; more than half (n = 134) were published since 2017. Fifty-five (55) articles representing archetypes of the approach (30 QI, 16 IS/IR, 9 HSS) were analysed qualitatively. As anticipated, we identified distinct patterns in each approach. QI archetypes tended towards defined process interventions (most typically, plan-do-study-act cycles); IS/IR archetypes reported a wide variety of interventions, but had in common evaluation methodologies and explanatory theories; and HSS archetypes adopted systemic perspectives. Despite their distinctiveness, there was also overlap and fluidity between approaches, with papers often referencing more than one approach. Recognising the complexity of improving MNH services, there was an increased orientation towards participatory, context-specific designs in all three approaches. CONCLUSIONS Programmes to improve MNH outcomes will benefit from a better appreciation of the distinctiveness and relatedness of different approaches to service delivery strengthening, how these have evolved and how they can be combined.
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Affiliation(s)
- Solange Mianda
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa.
| | - Olamide Todowede
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Helen Schneider
- School of Public Health & SAMRC Health Services to Systems Research Unit, University of the Western Cape, Private Bag X17, Bellville, 7535, Cape Town, South Africa
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Waldén M, Mountjoy M, McCall A, Serner A, Massey A, Tol JL, Bahr R, D'Hooghe M, Bittencourt N, Della Villa F, Dohi M, Dupont G, Fulcher M, Janse van Rensburg DCC, Lu D, Andersen TE. Football-specific extension of the IOC consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020. Br J Sports Med 2023; 57:1341-1350. [PMID: 36609352 PMCID: PMC10646851 DOI: 10.1136/bjsports-2022-106405] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/09/2023]
Abstract
Several sports have published consensus statements on methods and reporting of epidemiological studies concerning injuries and illnesses with football (soccer) producing one of the first guidelines. This football-specific consensus statement was published in 2006 and required an update to align with scientific developments in the field. The International Olympic Committee (IOC) recently released a sports-generic consensus statement outlining methods for recording and reporting epidemiological data on injury and illness in sport and encouraged the development of sport-specific extensions.The Fédération Internationale de Football Association Medical Scientific Advisory Board established a panel of 16 football medicine and/or science experts, two players and one coach. With a foundation in the IOC consensus statement, the panel performed literature reviews on each included subtopic and performed two rounds of voting prior to and during a 2-day consensus meeting. The panel agreed on 40 of 75 pre-meeting and 21 of 44 meeting voting statements, respectively. The methodology and definitions presented in this comprehensive football-specific extension should ensure more consistent study designs, data collection procedures and use of nomenclature in future epidemiological studies of football injuries and illnesses regardless of setting. It should facilitate comparisons across studies and pooling of data.
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Affiliation(s)
- Markus Waldén
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Football Research Group, Linköping, Sweden
| | - Margo Mountjoy
- Department of Family Medicine-Sport, McMaster University, Hamilton, Ontario, Canada
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- School of Sport and Exercise Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Andrew Massey
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- Department of Orthopedic Surgery and Sports Medicine, Academic Center for Evidence Based Sports Medicine, Amsterdam University Medical Centres, Amsterdam IOC Center ACHSS, Amsterdam, The Netherlands
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Division of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Michel D'Hooghe
- FIFA Medical Committee, Federation Internationale de Football Association, Zurich, Switzerland
| | - Natália Bittencourt
- Sports Physiotherapy Specialization Program - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Complex System Approach in Sports and Health Research Group - CNPq Brazil, Belo Horizonte, Brazil
| | - Francesco Della Villa
- Education and Research Department, Isokinetic FIFA Medical Centre of Excellence, Bologna, Italy
| | | | - Gregory Dupont
- Liverpool John Moores University, School of Sport and Exercise Sciences, Liverpool, UK
| | | | | | - Donna Lu
- Medical Services, Football Australia, Sydney, New South Wales, Australia
- Operations, Australian Professional Leagues, Sydney, New South Wales, Australia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian FA Medical Center, Oslo, Norway
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Chibi M, Wasswa W, Ngongoni CN, Lule F. Scaling up delivery of HIV services in Africa through harnessing trends across global emerging innovations. FRONTIERS IN HEALTH SERVICES 2023; 3:1198008. [PMID: 38028944 PMCID: PMC10644308 DOI: 10.3389/frhs.2023.1198008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023]
Abstract
Globally, innovations for HIV response present exciting opportunities to enhance the impact and cost-effectiveness of any HIV program. However, countries especially in the African region are not on equal footing to effectively harness some of the existing innovations to accelerate impact on HIV services delivery. This paper aims to add to the discourse on innovative solutions to support countries to make informed decisions related to technologies that can be adapted in different contexts to strengthen HIV programs. A scoping review which involved a search of innovations that can be used in response to the HIV epidemic was carried out between June 2021 and December 2022. The results showed that a high level of technological advancement occurred in the area of digital technologies and devices. Out of the 202 innovations, 90% were digital technologies, of which 34% were data collection and analytics, 45% were mobile based applications, and 12% were social media interventions. Only 10% fell into the category of devices, of which 67% were rapid diagnostic tools (RDTs) and 19% were drone-based technologies among other innovative tools. The study noted that most of the innovations that scaled relied on a strong ICT infrastructure backbone. The scoping review presents an opportunity to assess trends, offer evidence, and outline gaps to drive the adoption and adaptation of such technologies in Africa.
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Affiliation(s)
- Moredreck Chibi
- Science and Innovation, Assistant Regional Director, World Health Organization Africa Region, Brazzaville, Congo
| | - William Wasswa
- HIV, Tuberculosis and Hepatitis, Universal Health Coverage/Communicable and Non Communicable Disease Cluster, World Health Organization Africa Region, Brazzaville, Congo
| | - Chipo Nancy Ngongoni
- Science and Innovation, Assistant Regional Director, World Health Organization Africa Region, Brazzaville, Congo
| | - Frank Lule
- HIV, Tuberculosis and Hepatitis, Universal Health Coverage/Communicable and Non Communicable Disease Cluster, World Health Organization Africa Region, Brazzaville, Congo
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Komesidou R, Hogan TP. A Generic Implementation Framework for School-Based Research and Practice. Lang Speech Hear Serv Sch 2023; 54:1165-1172. [PMID: 37433304 PMCID: PMC10734895 DOI: 10.1044/2023_lshss-22-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE One of our biggest challenges is integrating evidence-based research into practice to serve students with communication disorders. To encourage the systematic application of research findings into practice, implementation science offers frameworks and tools, many of which have a narrow scope. It is important to have comprehensive frameworks that encompass all essential implementation concepts to support implementation in schools. METHOD Guided by the generic implementation framework (GIF; Moullin et al., 2015), we reviewed implementation science literature to identify and tailor frameworks and tools covering all core concepts of implementation: (a) the process of implementation, (b) the domains and determinants of practice, (c) implementation strategies, and (d) evaluations. RESULTS We created a version of the GIF for school settings, called the GIF-School, to bring together frameworks and tools that sufficiently cover core concepts of implementation. The GIF-School is accompanied by an open access toolkit, which lists selected frameworks, tools, and useful resources. CONCLUSION Researchers and practitioners, in speech-language pathology and education more broadly, who seek to apply implementation science frameworks and tools to improve school services for students with communication disorders may turn to the GIF-School as a resource. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23605269.
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Affiliation(s)
- Rouzana Komesidou
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Tiffany P. Hogan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Christopulos TT, Redmond SM. Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools. Lang Speech Hear Serv Sch 2023; 54:1080-1102. [PMID: 37459613 DOI: 10.1044/2023_lshss-22-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. METHOD Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. RESULTS Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. CONCLUSION Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23661876.
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Affiliation(s)
- Tyler T Christopulos
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Abstract
OBJECTIVE In an increasingly competitive healthcare climate, ensuring an innovative nursing workforce is essential for organizational success and survival. BACKGROUND The authors aimed to evaluate the literature examining the association between leadership styles and innovative behaviors in the nursing workforce. METHODS A systematic review of articles from 5 databases was conducted from August 2022 to October 2022. RESULTS A total of 21 articles published in the English language were included in the review. This study provides evidence for the vital role of "relationship-oriented" leadership styles in fostering innovative behaviors among nurses. However, more research is needed to examine how "task-oriented" leadership styles contribute to innovativeness in nurses. Twelve mediators linking leadership styles to healthcare workers' innovative behaviors were identified and clustered into motivation-based, relation-based, and affective mediators. CONCLUSION Organizational strategies to foster relationship-based leadership styles among healthcare leaders are vital to support nurses' innovative behaviors.
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Affiliation(s)
- Leodoro J Labrague
- Author Affiliations: Clinical Assistant Professor (Dr Labrague) and Instructor (Toquero), Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois
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Wong AKC, Wong FKY, Liang J, Tong DWK, Chan ML, Chu TK, Wong BC, Chan RSY, Ho WH, Tang CYS, Chiang SC. Outcomes of a risk assessment and management program using telecare consultation among patients with diabetes mellitus in general out-patient clinic: a hybrid effectiveness-implementation study protocol. Ann Med 2023; 55:2262088. [PMID: 37748120 PMCID: PMC10521334 DOI: 10.1080/07853890.2023.2262088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
Diabetes Mellitus (DM) is a chronic disease characterized by abnormally uncontrolled high blood glucose level. The Risk Assessment and Management Program (RAMP) in Hong Kong has been providing long-term face-to-face follow-up to DM patients in the government out-patient clinics since 2009. However, under the current outbreak of COVID-19, these face-to-face consultations were ceased over and over again to lower the risk of disease transmission. With the advancement in technology, the recent emergence of telecare has provided an alternative to replace the conventional consultations in the clinics. Its clinical effectiveness on DM patients has also been supported by numerous studies. Yet, there is only a paucity of literatures discussing the practicality of such implementation design in the real-world settings. This study aims at studying both the effectiveness and implementation outcomes of telecare in Hong Kong DM patients. It adopts a type 2 hybrid effectiveness-implementation design. It will be conducted in seven government out-patient clinics in Hong Kong. The subjects will be randomly assigned to an intervention group or a control group when they 1) are aged 18 or above, 2) have a confirmed diagnosis of diabetes, and 3) are having regular follow-up appointment in the clinic. Subjects in the intervention group will receive a 84-week Risk Assessment and Management Program (RAMP) in an alternate telecare and face-to-face consultations mode, while the control group will receive the same program but in usual face-to-face consultation mode. RE-AIM is employed as the implementation and effectiveness outcome evaluation framework. The primary outcome measure will be HbA1c. Data will be collected pre-intervention (T1), 42-week (T2), and 84-week (T3). The study will provide effectiveness-implementation assessment of telecare mode for DM patients in Hong Kong, as an alternative or in addition to conventional face-to-face consultations. It also aimed to provide insights for the future adoption in a broader health care setting.
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Affiliation(s)
| | | | - Jun Liang
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
| | | | - Man Li Chan
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
| | - Tsun kit Chu
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
| | - Bo Chu Wong
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
| | - Rinis Sin Yi Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wai Hing Ho
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
| | | | - Sau Ching Chiang
- New Territories West Cluster, Hospital Authority, Homantin, Hong Kong
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Johnson L, Mardo J, Demain S. Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory. PLoS One 2023; 18:e0282612. [PMID: 37682841 PMCID: PMC10490858 DOI: 10.1371/journal.pone.0282612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation. METHODS Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory. RESULTS How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more "flexible" interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, "rule based" interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists' concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it. CONCLUSIONS Changing practice, whether in a research study or in the "real world", is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are 'flexible' cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention. TRIAL REGISTRATION Clinical Trials - NCT03792126.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, United Kingdom
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Julia Mardo
- Dorset Healthcare NHS Foundation Trust, Yeatman Hospital, Hospital Lane, Sherborne, Dorset, United Kingdom
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Brooks C, Mirzoev T, Chowdhury D, Deuri SP, Madill A. Using evidence in mental health policy agenda-setting in low- and middle-income countries: a conceptual meta-framework from a scoping umbrella review. Health Policy Plan 2023; 38:876-893. [PMID: 37329301 PMCID: PMC10394497 DOI: 10.1093/heapol/czad038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 06/19/2023] Open
Abstract
The purpose of this article is to close the gap in frameworks for the use of evidence in the mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting is important because mental health remains a culturally sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low-resource contexts. A scoping 'review of reviews' of evidence-to-policy frameworks was conducted, which followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews, which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context and approach, which are linked via the cross-cutting dimensions of beliefs, values and interests; capacity; power and politics; and trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilized in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information.
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Affiliation(s)
- Chloe Brooks
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Diptarup Chowdhury
- Department of Clinical Psychology, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Sonia Pereira Deuri
- Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam 784001, India
| | - Anna Madill
- School of Psychology, University of Leeds, Lifton Terrace, Leeds LS2 9JT, UK
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Martines JC, Portela A, Bahl R. Developing context-specific models to achieve high coverage and quality of KMC in India and Ethiopia: Learnings from implementation research. Acta Paediatr 2023; 112 Suppl 473:3-5. [PMID: 37519119 DOI: 10.1111/apa.16862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Jose Carlos Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Ferguson MA, Eikelboom RH, Sucher CM, Maidment DW, Bennett RJ. Remote Technologies to Enhance Service Delivery for Adults: Clinical Research Perspectives. Semin Hear 2023; 44:328-350. [PMID: 37484990 PMCID: PMC10361795 DOI: 10.1055/s-0043-1769742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
There are many examples of remote technologies that are clinically effective and provide numerous benefits to adults with hearing loss. Despite this, the uptake of remote technologies for hearing healthcare has been both low and slow until the onset of the COVID-19 pandemic, which has been a key driver for change globally. The time is now right to take advantage of the many benefits that remote technologies offer, through clinical, consumer, or hybrid services and channels. These include greater access and choice, better interactivity and engagement, and tailoring of technologies to individual needs, leading to clients who are better informed, enabled, and empowered to self-manage their hearing loss. This article provides an overview of the clinical research evidence-base across a range of remote technologies along the hearing health journey. This includes qualitative, as well as quantitative, methods to ensure the end-users' voice is at the core of the research, thereby promoting person-centered principles. Most of these remote technologies are available and some are already in use, albeit not widespread. Finally, whenever new technologies or processes are implemented into services, be they clinical, hybrid, or consumer, careful consideration needs to be given to the required behavior change of the key people (e.g., clients and service providers) to facilitate and optimize implementation.
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Affiliation(s)
- Melanie A. Ferguson
- Ear Science Institute Australia, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Robert H. Eikelboom
- Ear Science Institute Australia, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Perth, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Cathy M. Sucher
- Ear Science Institute Australia, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Perth, Australia
| | - David W. Maidment
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom
| | - Rebecca J. Bennett
- Ear Science Institute Australia, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Perth, Australia
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Adje M, Steinhäuser J, Laekeman M, Rogan S, Karstens S. Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students. BMC MEDICAL EDUCATION 2023; 23:545. [PMID: 37525131 PMCID: PMC10391990 DOI: 10.1186/s12909-023-04517-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care. METHODOLOGY A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN' 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists' (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons. RESULTS Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice). CONCLUSION The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants' attitude towards care with the potential of being translated into long-term practice.
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Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany.
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany
| | - Marjan Laekeman
- Department of Physiological Psychology, University of Bamberg, Bochum, Germany
| | - Slavko Rogan
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sven Karstens
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
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Reyneke RA, Richens IF, Buchanan H, Bethan Davies E, Sorrell C, Ashmore A, Brennan ML. The use of theories, models, and frameworks to inform the uptake of evidence-based practices in veterinary medicine - a scoping review. Prev Vet Med 2023; 216:105928. [PMID: 37224662 DOI: 10.1016/j.prevetmed.2023.105928] [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: 09/09/2022] [Revised: 03/19/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
Evidence-based practices (EBPs) provide strategies to improve the health, welfare and productivity of animal species. However, ensuring implementation and uptake into routine practice of these EBPs is often challenging. In human health research, one approach used to improve uptake of EBPs is the use of theories, models and/or frameworks (TMFs), however the extent of the use of this approach in veterinary medicine is unknown. The aim of this scoping review was to identify existing veterinary uses of TMFs to inform the uptake of EBPs, and to understand the focus of these applications. Searches were conducted in CAB Abstracts, MEDLINE, Embase and Scopus, alongside grey literature, and ProQuest Dissertations & Theses. The search strategy consisted of a list of known existing TMFs that have been used to improve uptake of EBPs in human health, alongside more generic terminology for implementation and terminology relevant to veterinary medicine. Peer reviewed journal articles and grey literature detailing the use of a TMF to inform uptake of EBP(s) in a veterinary context were included. The search identified 68 studies that met the eligibility criteria. Included studies represented a diverse spread of countries, areas of veterinary concern and EBP. A range of 28 different TMFs were used, although the Theory of Planned Behaviour (TPB) predominated, featuring in 46% of included studies (n = 31). The majority of studies (n = 65, 96%) utilised a TMF with the aim to understand and/or explain what influences implementation outcomes. Only 8 studies (12%) reported the use of a TMF alongside/in conjunction with the actual implementation of an intervention. It is clear there has been some use to date of TMFs to inform uptake of EBPs in veterinary medicine, however it has been sporadic. There has been a heavy reliance on usage of the TPB and other similar classic theories. This has typically been to inform the understanding of factors, such as barriers and facilitators, that may influence the outcome of an implementation effort without then applying this knowledge to the actual implementation of an intervention. Furthermore, there has been a lack of acknowledgement of wider contextual factors and consideration of sustainability of interventions. There is clear potential to increase and expand the usage of TMFs to improve uptake of EBPs in veterinary medicine, including utilising a wider range of TMFs and developing interdisciplinary collaborations with human implementation experts.
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Affiliation(s)
- Rosemary A Reyneke
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, United Kingdom
| | - Imogen F Richens
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, United Kingdom
| | - Heather Buchanan
- School of Medicine, The University of Nottingham, United Kingdom
| | - E Bethan Davies
- School of Medicine, The University of Nottingham, United Kingdom
| | - Caitlin Sorrell
- School of Medicine, The University of Nottingham, United Kingdom
| | - Alison Ashmore
- University of Nottingham Libraries, The University of Nottingham, United Kingdom
| | - Marnie L Brennan
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, United Kingdom.
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Ångerman S, Kirves H, Nurmi J. Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services. Scand J Trauma Resusc Emerg Med 2023; 31:21. [PMID: 37122004 PMCID: PMC10148755 DOI: 10.1186/s13049-023-01086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process. METHODS The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records. RESULTS During the study period (2012-2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25-42] vs. 29 [IQR 21-39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7-77.8%) to 97.6% (95% CI 96.7-98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0-73.9%) to 93.4% (95% CI 92.3-94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6-88.9%) to 98.5% (95% CI 97.7-99.0%), respectively. Deterioration in compliance indicators was not observed. CONCLUSIONS We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.
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Affiliation(s)
- Susanne Ångerman
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
| | - Hetti Kirves
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
| | - Jouni Nurmi
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
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Graells M, Schaad L, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Bodenmann P, Grazioli VS. Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11091228. [PMID: 37174770 PMCID: PMC10178271 DOI: 10.3390/healthcare11091228] [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: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
AIMS Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland. METHODS Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis. RESULTS Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences. CONCLUSION The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.
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Affiliation(s)
- Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of Population Health, Curtin University, Perth 6845, Australia
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Julia Ambrosetti
- Emergency Department, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Julien Ombelli
- Emergency Department, North Vaud Hospital Group, 1400 Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Emergency Department, La Broye Hospital, 1530 Payerne, Switzerland
| | - Vincent Ribordy
- Emergency Department, Fribourg Hospital, 1700 Fribourg, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
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Bawab N, Moullin J, Jotterand S, Rossier C, Schneider MP, Perraudin C. Building Interprofessional Collaborative Practices Through a Support Program for Patients With Type 2 Diabetes in Primary Care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:77-86. [PMID: 36877813 PMCID: PMC10219666 DOI: 10.1097/ceh.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/20/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The building of interprofessional collaborative practices throughout the implementation process of a patient support program (Siscare) in primary care for patients with type 2 diabetes was assessed. Siscare included regular patient-pharmacist motivational-based interviews; medication adherence, patient-reported, and clinical outcomes monitoring; and physician-pharmacist interactions. METHOD This investigation was a prospective, multicenter, observational, mixed-methods cohort study. Interprofessionality was operationalized through four progressive levels of interrelationship practices between the health care professionals. The target number of patients per pharmacy was 10 among 20 pharmacies. RESULTS The project started with the recognition of Siscare by stakeholders, the creation of an interprofessional steering committee, and the adoption of Siscare by 41 pharmacies among 47 pharmacies in April 2016. Nineteen pharmacies presented Siscare at 43 meetings attended by 115 physicians. Twenty-seven pharmacies included 212 patients; however, no physician prescribed Siscare. Collaboration primarily occurred through the unidirectional transmission of information from the pharmacist to the physician (level 1: 70% of pharmacists transmitted interview reports to physicians), bidirectional exchange of information sometimes occurred (level 2: 42% received physician responses), and concerted measures of treatment objectives took place occasionally (level 3). Twenty-nine of 33 physicians surveyed were in favor of this collaboration. DISCUSSION Despite multiple implementation strategies, physician resistance and lack of motivation to participate exists, but Siscare was well received by pharmacists, patients, and physicians. Barriers to collaborative practice (financial and IT) need to be further explored. Interprofessional collaboration is a clear need to improve type 2 diabetes adherence and outcomes.
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Affiliation(s)
- Noura Bawab
- Bawab: Research fellow, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. Moullin: Senior Research Fellow, Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Australia. Jotterand : General practitioner, Médcins de famille et de l'enfance Suisse, Zürich, Switzerland; and Sispha SA, Ofac, Lausanne, Switzerland. Rossier: Pharmacist, Sispha SA, Ofac, Lausanne, Switzerland. Schneider: Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland, and Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. Perraudin: Health economist, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
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Al Bulushi S, McIntosh T, Grant A, Stewart D, Cunningham S. Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review. Int J Clin Pharm 2023; 45:342-354. [PMID: 36719590 PMCID: PMC10147734 DOI: 10.1007/s11096-023-01534-8] [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: 06/16/2022] [Accepted: 12/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several guidelines support polypharmacy management in individual patients. More organisational-level focus is needed on the use of implementation frameworks. AIM To characterise the peer reviewed literature on implementation frameworks, focussing on barriers and facilitators to implementation at organisational level in the context of polypharmacy management. METHOD A scoping review protocol was devised, supporting retrieval of studies published in English, reporting from any sector of practice. Medline, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature and Business Source Complete were searched to January 2022 using Medical Subject Headings including: 'polypharmacy', 'deprescriptions', 'strategic planning' and 'organizational innovation'. A narrative approach to data synthesis was applied. Searching, data extraction and synthesis were undertaken independently by two reviewers. RESULTS After screening 797 records eight papers remained. Two were descriptive outlining details of specific initiatives, six used qualitative methods to explore determinants for implementation including barriers and enablers. Organisation level barriers included: poor organisational culture with a lack of sense of urgency and national plans, resource availability and communication issues including patient information and at transitions of care. Organisational facilitators included availability of government funding and regulatory environment promoting patient safety, a national emphasis on quality of care for older adults, co-ordinated national efforts and local evidence. CONCLUSION Limited literature focusses on the use of implementation frameworks at organisational levels. This review highlights the need for further work on implementation frameworks in this context to help achieve effective organisational change.
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Affiliation(s)
- S Al Bulushi
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
- Ministry of Health, Muscat, Oman
| | - T McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - A Grant
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - D Stewart
- College of Pharmacy, Qatar University, Doha, Qatar
| | - S Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK.
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43
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Gelman R, Whelan J, Spiteri S, Duric D, Oakhill W, Cassar S, Love P. Adoption, implementation, and sustainability of early childhood feeding, nutrition and active play interventions in real-world settings: a systematic review. Int J Behav Nutr Phys Act 2023; 20:32. [PMID: 36941649 PMCID: PMC10029282 DOI: 10.1186/s12966-023-01433-1] [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: 08/01/2022] [Accepted: 03/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Instilling healthy dietary habits and active play in early childhood is an important public health focus. Interventions supporting the establishment of nutrition and active play behaviours in the first years of life have shown positive outcomes and long-term cost-effectiveness, however, most are research trials, with limited evidence regarding real-world application. Implementation science theories, models and frameworks (TMFs) can guide the process of research translation from trial to real-world intervention. The application of TMFs within nutrition and active play intervention studies in early childhood (< 5 years) is currently unknown. This systematic review identified the use of TMFs and barriers/ enablers associated with intervention adoption, implementation, and sustainability in early childhood nutrition and active play interventions implemented under real-world conditions. METHODS Six databases were searched for peer-reviewed publications between 2000-2021. Studies were included if primary outcomes reported improvement in diet, physical activity or sedentary behaviours amongst children aged < 5 years and interventions were delivered under real-world conditions within a community and/or healthcare setting. Two reviewers extracted and evaluated studies, cross checked by a third and verified by all authors. Quality assessment of included studies was completed by two authors using the Mixed Methods Appraisal Tool (MMAT). RESULTS Eleven studies comprising eleven unique interventions were included. Studies represented low, middle and high-income countries, and were conducted across a range of settings. Five TMFs were identified representing four of Nilsen's implementation model categories, predominantly 'evaluation models'. Ninety-nine barriers/facilitators were extracted across the three intervention phases-Implementation (n = 33 barriers; 33 facilitators), Sustainability (n = 19 barriers; n = 9 facilitators), Adoption (n = 2 barriers; n = 3 facilitators). Identified barriers/facilitators were mapped to the five domains of the Durlak and DuPre framework, with 'funding', 'compatibility' and 'integration of new programming' common across the three intervention phases. CONCLUSIONS Findings demonstrate that there is no systematic application of TMFs in the planning, implementation and/or evaluation of early childhood nutrition and active play interventions in real-world settings, and selective and sporadic application of TMFs occurs across the intervention lifespan. This apparent limited uptake of TMFs is a missed opportunity to enhance real-world implementation success. TRIAL REGISTRATION PROSPERO (CRD42021243841).
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Affiliation(s)
- Rivka Gelman
- School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jillian Whelan
- School of Medicine, Institute of Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
| | - Sheree Spiteri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, 3220, Australia
| | - Danijela Duric
- School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, 3220, Australia
| | - Winnie Oakhill
- School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, 3220, Australia
| | - Samuel Cassar
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, 3220, Australia
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Maroongroge S, De B, Woodhouse KD, Bassett Jr RL, Lee P, Bloom ES, Smith GL, Frank SJ, Li J, Perkins G, Das P, Koong AC, Smith BD, Wang C. Physician Perspectives on Telemedicine in Radiation Oncology. Adv Radiat Oncol 2023; 8:101005. [PMID: 36311822 PMCID: PMC9598490 DOI: 10.1016/j.adro.2022.101005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be used after the COVID-19 public health emergency ends is unclear. Herein, we report on our institution's provider experience after the mature adoption of telemedicine. Methods and Materials We distributed a survey to all radiation oncology attending physicians at our institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and identify influencing factors whether telemedicine is employed. We calculated the average proportion of visits that providers expected to be appropriately performed with telemedicine for each disease site and visit type. Results A total of 60 of the 82 eligible radiation oncologists (73%) responded to the survey, of whom 78% were satisfied with telemedicine in the radiation oncology department and 83% wished to continue offering video visits after the COVID-19 public health emergency ends. Common patient factors influencing whether physicians offer telemedicine include the patient's travel burden, patient preferences, and whether a physical examination is required. Approximately 20% of new consultations and 50% of weekly management visits were estimated to be appropriate for telemedicine. The central nervous system/pediatrics and thoracic faculty considered telemedicine appropriate for the greatest proportion of new consultations, and 93% of respondents felt comfortable determining whether telemedicine was appropriate. Conclusions Surveyed radiation oncologists were satisfied with telemedicine in their practice, and wished to continue offering video visits in the future. Our data suggest that payers should continue to support this patient-centered technology.
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Affiliation(s)
- Sean Maroongroge
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian De
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D. Woodhouse
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland L. Bassett Jr
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth S. Bloom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L. Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J. Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Perkins
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C. Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chenyang Wang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Nasser JS, Chung KC. Implementation Science in Surgery: Translating Outcomes to Action. Plast Reconstr Surg 2023; 151:237-243. [PMID: 36696301 DOI: 10.1097/prs.0000000000009822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jacob S Nasser
- From The George Washington School of Medicine and Health Sciences
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School
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46
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Yang L, Friedenreich CM. From evidence to implementation of lifestyle behaviour in cancer prevention and control: A Preventive Medicine Golden Jubilee Commentary. Prev Med 2023; 166:107342. [PMID: 36368342 DOI: 10.1016/j.ypmed.2022.107342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Preventive interventions targeting tobacco, alcohol, healthy diets and physical activity are key strategies to tackle the most pressing health challenges in modern society. A major gap remains in how to translate research evidence into population-level behaviour change to reduce the disease burden. We use the case for the role of physical activity-related behaviour and cancer to illustrate the iterative, multidirectional, and transdisciplinary nature of translational research. The issues we address in this context are generalizable and applicable to other behavioral risk factors and non-communicable diseases. There is now solid evidence that physical activity reduces cancer risk and improves outcomes after cancer diagnosis. Here we provide a framework for how to implement this knowledge into real-world settings. We provide the rationale for combining systems, causal and design thinking to develop interventions that can be implemented for this type of behaviour change. The proposed model is iterative, multidirectional and transdisciplinary. We identify major knowledge gaps in epidemiology and science of behaviour change on physical activity and cancer control and propose approaches to suggest priorities for future research.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
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Schaad L, Graells M, Kasztura M, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Grazioli VS, Bodenmann P. Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231159745. [PMID: 36927138 PMCID: PMC10026145 DOI: 10.1177/00469580231159745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation. OBJECTIVES Explore the FUED's perspectives about CM in Switzerland. DESIGN, SETTING & PARTICIPANTS Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. OUTCOMES MEASURES & ANALYSIS Inductive content analysis. MAIN RESULTS Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (ie, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.
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Affiliation(s)
- Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Olivier Hugli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Jean-Bernard Daeppen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Julien Ombelli
- North Vaud Hospital Group, Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Broye Intercantonal Hospital, Payerne, Switzerland
| | | | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
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Mielke J, Brunkert T, Zúñiga F, Simon M, Zullig LL, De Geest S. Methodological approaches to study context in intervention implementation studies: an evidence gap map. BMC Med Res Methodol 2022; 22:320. [PMID: 36517765 PMCID: PMC9749183 DOI: 10.1186/s12874-022-01772-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Within implementation science studies, contextual analysis is increasingly recognized as foundational to interventions' successful and sustainable implementation. However, inconsistencies between methodological approaches currently limit progress in studying context and guidance to standardize the use of those approaches is scant. Therefore, this study's objective was to systematically review and map current methodological approaches to contextual analysis in intervention implementation studies. The results would help us both to systematize the process of contextual analysis and identify gaps in the current evidence. METHODS We conducted an evidence gap map (EGM) based on literature data via a stepwise approach. First, using an empirically developed search string, we randomly sampled 20% of all intervention implementation studies available from PubMed per year (2015-2020). Second, we assessed included studies that conducted a contextual analysis. Data extraction and evaluation followed the Basel Approach for CoNtextual ANAlysis (BANANA), using a color-coded rating scheme. Also based on BANANA and on the Context and Implementation of Complex Interventions (CICI) framework-an implementation framework that pays ample attention to context- we created visual maps of various approaches to contextual analysis. RESULTS Of 15, 286 identified intervention implementation studies and study protocols, 3017 were screened for inclusion. Of those, 110 warranted close examination, revealing 22% that reported on contextual analysis. Only one study explicitly applied a framework for contextual analysis. Data were most commonly collected via surveys (n = 15) and individual interviews (n = 13). Ten studies reported mixed-methods analyses. Twenty-two assessed meso-level contextual and setting factors, with socio-cultural aspects most commonly studied. Eighteen described the use of contextual information for subsequent project phases (e.g., intervention development/adaption, selecting implementation strategies). Nine reported contextual factors' influences on implementation and/or effectiveness outcomes. CONCLUSIONS This study describes current approaches to contextual analysis in implementation science and provides a novel framework for evaluating and mapping it. By synthesizing our findings graphically in figures, we provide an initial evidence base framework that can incorporate new findings as necessary. We strongly recommend further development of methodological approaches both to conduct contextual analysis and to systematize the reporting of it. These actions will increase the quality and consistency of implementation science research.
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Affiliation(s)
- Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Thekla Brunkert
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Leah L. Zullig
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System and Department of Population Health Sciences, Duke University Medical Center, Durham, NC USA
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Department of Public Health and Primary Care, KU Leuven, Academic Center for Nursing and Midwifery, Louvain, Belgium
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Kelly L, Twohig C, Woods CB, Luszczynska A, Murrin C, Lien N, Meshkovska B, Kamphuis CBM, Poelman MP, Terragani L, Forberger S, Hebestreit A, Ahrens W, Harrington JM. Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. Eur J Public Health 2022; 32:iv10-iv20. [PMID: 36444104 PMCID: PMC9706120 DOI: 10.1093/eurpub/ckac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.
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Affiliation(s)
- Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona Twohig
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, CARE-BEH Center for Applied Research on Health Behaviour and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Laura Terragani
- Department of Nutrition, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17:75. [DOI: 10.1186/s13012-022-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework.
Methods
User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2.
Results
The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation.
Conclusion
The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances.
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