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Holbert MD, Duff J, Wood F, Holland AJA, Teague W, Frear C, Crellin D, Phillips N, Storey K, Martin L, Singer Y, Dimanopoulos TA, Cuttle L, Vagenas D, McPhail S, Calleja P, De Young A, Kimble RM, Griffin BR. Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study. J Pediatr Nurs 2024; 77:e520-e530. [PMID: 38762422 DOI: 10.1016/j.pedn.2024.05.018] [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: 11/24/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. METHODS A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. RESULTS Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. CONCLUSION Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
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Affiliation(s)
- Maleea D Holbert
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia.
| | - Jed Duff
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Australia
| | - Fiona Wood
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Andrew J A Holland
- The Burns Unit, The Children's Hospital at Westmead, NSW 2145, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW 2050, Australia
| | - Warwick Teague
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Cody Frear
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dianne Crellin
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Nursing, The University of Melbourne, Victoria 3010, Australia
| | - Natalie Phillips
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Kristen Storey
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Lisa Martin
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Yvonne Singer
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Dimitrios Vagenas
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Steven McPhail
- Australian Centre for Health Services Innovation, and Centre for Healthcare Transformation, School of Public health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Pauline Calleja
- College of Healthcare Sciences, James Cook University, Cairns 4870, Australia
| | - Alexandra De Young
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Roy M Kimble
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
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Hyun E, Kim H, Kwak HY, Kim D. Clinical pathways for Korean medicine: An implementation approach to impact on the clinical process and association with attitudes. Heliyon 2024; 10:e32060. [PMID: 38882263 PMCID: PMC11176824 DOI: 10.1016/j.heliyon.2024.e32060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Background South Korea's Ministry of Health and Welfare has developed clinical pathways for Korean Medicine (KM-CPs). As part of this initiative, a panel comprising Korean Medicine doctors (KMD) was assembled. This implementation study aimed to preliminarily explore how KM-CP implementation affects the appropriateness and efficiency of the clinical process and its relation to attitude. Methods Through random sampling, 311 KMDs were recruited as panelists to participate in two surveys. The surveys included information regarding the KM clinical environment and KM-CP implementation. A panel management program and educational materials were provided to KMDs between the two survey periods. Only 262 KMDs who responded to both surveys were included in the analysis. Three analyses were conducted: 1) descriptive analysis of the study variables, 2) panel analysis using the ordered logit regression model to elucidate the impact of KM-CP on the appropriateness and efficiency of the clinical process, and 3) ordered logit regression analysis of the association between KM-CP implementation and attitude. Results More than two-thirds of the KMDs attempted to adopt KM-CP, with mostly positive perception expressed by these doctors. However, expectations and concerns coexist with the standardization of KM-CP. Cases in which KM-CPs were partially and mostly implemented respectively had negative and positive effects on the appropriateness and efficiency of the clinical process compared to those in which KM-CPs were not implemented. Compared to neutral attitude, positive and very positive attitudes tended to be associated with increased implementation of KM-CP. However, statistical significances were not observed. Conclusions The impact of KM-CP on the clinical process and its association with attitude were found to be statistically unclear or inconsistent. Considering the study limitations and implications, we suggest a policy and academic strategies aimed at fostering improvement to enhance its utility.
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Affiliation(s)
- Eunhye Hyun
- Institute of Health Policy and Management, Seoul National University Medical Research Center, 103, Daehakro, Jognogu, Seoul, Republic of Korea
| | - Hyunmin Kim
- Policy Development Center, National Institute for Korean Medicine Development, 14, Jeongdong-gil, Jung-gu, Seoul, Republic of Korea
| | - Hui-Yong Kwak
- Haneum Neuropsychiatry Clinic of Korean Medicine, 29, Dongmak-ro, Mapo-gu, Seoul, Republic of Korea
| | - Dongsu Kim
- School of Korean Medicine, Dongshin University, 67, Dongshindae-gil, Naju-si, Jeollanam-do, Republic of Korea
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Fraticelli L, Verot E, Späth HM, Genton MC, Kempf C, Clement C, Darlington-Bernard A, Roy S, Dussart C, Mick G, Carrouel F. Glossary of healthcare pathways: a methodological approach involving a transdisciplinary team in public health. Front Public Health 2024; 12:1347774. [PMID: 38645449 PMCID: PMC11026848 DOI: 10.3389/fpubh.2024.1347774] [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: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group. Methods The workgroup provided a list of words or expressions that, in their opinion, described, evaluated or compared the healthcare pathways for patients, caregivers or regulators. The review group checked this list and added or deleted words or expressions. Then, definitions were added by the workgroup based into account three dimensions: official, academic and from the field. The review group validated the definitions and provided complementary proposals if needed. Results After pooling the list of words proposed by each of the six members of the working group, 417 words/expressions were ranked. After the two rounds of evaluation, 294 words/expressions were rated "appropriate" and were analyzed by the review group. This group, after two rounds of evaluation, agreed on 263 words/expressions that were transmitted to the working group who defined them. These definitions were rated by the review group. The first round of evaluation established 195 definitions as being appropriated whereas 68 definitions were amended by the review group. Conclusion This glossary supports transdisciplinary communication, reduces the extent of variations in practice and optimizes decision-making. International debate on all aspects might be strengthened by an improved understanding of the concept of health pathway.
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Affiliation(s)
- Laurie Fraticelli
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Elise Verot
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Presage Institute, University Jean Monnet, Saint-Etienne, France
- CIC 1408 Inserm, CHU of Saint-Etienne, Saint-Etienne, France
| | - Hans-Martin Späth
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Marine C. Genton
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Cédric Kempf
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Celine Clement
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Laboratory Interpsy, UR4432, University of Lorraine, Nancy, France
| | - Adeline Darlington-Bernard
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Sylvain Roy
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Claude Dussart
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Gérard Mick
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- CHU Grenoble-Alpes-Voiron, Voiron, France
| | - Florence Carrouel
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
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Pinargote-Celorio H, Otero-Rodríguez S, González-de-la-Aleja P, Rodríguez-Díaz JC, Climent E, Chico-Sánchez P, Riera G, Llorens P, Aparicio M, Montiel I, Boix V, Moreno-Pérez Ó, Ramos-Rincón JM, Merino E. Mild SARS-CoV-2 infection in vulnerable patients: implementation of a clinical pathway for early treatment. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:195-201. [PMID: 37003904 PMCID: PMC10063154 DOI: 10.1016/j.eimce.2023.03.003] [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: 09/15/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The objective of this report is to describe the clinical pathway for early treatment of patients with acute SARS-CoV-2 infection and to evaluate the first results of its implementation. METHODS This is a descriptive and retrospective study of the implementation of a clinical pathway of treatment in outpatients (January 1 to June 30 2022). Clinical pathway: detection and referral systems from Primary Care, Emergency services, hospital specialities and an automated detection system; clinical evaluation and treatment administration in the COVID-19 day-hospital and subsequent clinical follow-up. Explanatory variables: demographics, comorbidity, vaccination status, referral pathways and treatment administration. OUTCOME VARIABLES hospitalization and death with 30 days, grade 2-3 toxicity related to treatment. RESULTS Treatment was administered to 262 patients (53,4% women, median age 60 years). The treatment indication criteria were immunosupression (68,3%), and the combination of age, vaccination status and comorbidity in the rest 47,3% of the patients s received remdesivir, 35,9% nirmatrelvir/ritonavir, 13,4% sotrovimab and 2,4% combined treatment with a median of 4 days after symptom onset. Hospital admission was required for 6,1% of the patients, 3,8% related to progression COVID-19. No patient died. Toxicity grade 2-3 toxicity was reported in 18,7%, 89,8% dysgeusia and metallic tasted related nirmatrelvir/ritonavir. Seven patients discontinued treatment due to toxicity. CONCLUSION The creation and implementation of a clinical pathway for non-hospitalized patients with SARS-CoV-2 infection is effective and it allows early accessibility and equity of currently available treatments.
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Affiliation(s)
- Héctor Pinargote-Celorio
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Otero-Rodríguez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pilar González-de-la-Aleja
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Juan-Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Producción Vegetal y Microbiología, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Eduardo Climent
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Pablo Chico-Sánchez
- Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Gerónima Riera
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marta Aparicio
- Farmacia de Atención Primaria, Hospital General Universitario Dr. Balmis, Alicante. Spain
| | - Inés Montiel
- Dirección de Atención Primaria, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Óscar Moreno-Pérez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Sección de Endocrinología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - José-Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
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Dineen-Griffin S, Benrimoj SI. The landscape of self-care in Australia: A pharmacy perspective. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100396. [PMID: 38174289 PMCID: PMC10762451 DOI: 10.1016/j.rcsop.2023.100396] [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: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
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Affiliation(s)
- Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Spain
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Parhar KKS, Knight GE, Soo A, Bagshaw SM, Zuege DJ, Niven DJ, Fiest KM, Stelfox HT. Designing a Behaviour Change Wheel guided implementation strategy for a hypoxaemic respiratory failure and ARDS care pathway that targets barriers. BMJ Open Qual 2023; 12:e002461. [PMID: 38160019 PMCID: PMC10759109 DOI: 10.1136/bmjoq-2023-002461] [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: 06/15/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND A significant gap exists between ideal evidence-based practice and real-world application of evidence-informed therapies for patients with hypoxaemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS). Pathways can improve the quality of care provided by helping integrate and organise the use of evidence informed practices, but barriers exist that can influence their adoption and successful implementation. We sought to identify barriers to the implementation of a best practice care pathway for HRF and ARDS and design an implementation science-based strategy targeting these barriers that is tailored to the critical care setting. METHODS The intervention assessed was a previously described multidisciplinary, evidence-based, stakeholder-informed, integrated care pathway for HRF and ARDS. A survey questionnaire (12 open text questions) was administered to intensive care unit (ICU) clinicians (physicians, nurses, respiratory therapists) in 17 adult ICUs across Alberta. The Behaviour Change Wheel, capability, opportunity, motivation - behaviour components, and Theoretical Domains Framework (TDF) were used to perform qualitative analysis on open text responses to identify barriers to the use of the pathway. Behaviour change technique (BCT) taxonomy, and Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side effects and safety and Equity (APEASE) criteria were used to design an implementation science-based strategy specific to the critical care context. RESULTS Survey responses (692) resulted in 16 belief statements and 9 themes with 9 relevant TDF domains. Differences in responses between clinician professional group and hospital setting were common. Based on intervention functions linked to each belief statement and its relevant TDF domain, 26 candidate BCTs were identified and evaluated using APEASE criteria. 23 BCTs were selected and grouped to form 8 key components of a final strategy: Audit and feedback, education, training, clinical decision support, site champions, reminders, implementation support and empowerment. The final strategy was described using the template for intervention description and replication framework. CONCLUSIONS Barriers to a best practice care pathway were identified and were amenable to the design of an implementation science-based mitigation strategy. Future work will evaluate the ability of this strategy to improve quality of care by assessing clinician behaviour change via better adherence to evidence-based care.
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Affiliation(s)
- Ken Kuljit S Parhar
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Gwen E Knight
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Blanco-Mavillard I, Personat-Labrador C, Castro-Sánchez E, Rodríguez-Calero MÁ, Fernández-Fernández I, Carr PJ, Armenteros-Yeguas V, Parra-García G, de Pedro-Gómez J. Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation. J Infect Public Health 2023; 16:1994-2000. [PMID: 37890222 DOI: 10.1016/j.jiph.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Around 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international consensus on relevance and feasibility of clinical practice guideline recommendations to reduce PIVC failure. METHODS e-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals. FINDINGS Over 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3). CONCLUSION We provide an international consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital de Manacor, Implementation, Research, and Innovation Unit, Manacor, Spain; Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Celia Personat-Labrador
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Health Public Office, Balearic Islands Health Service, Palma, Spain
| | - Enrique Castro-Sánchez
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom; Universitat de les Illes Balears, Global Health and Lifestyles (EVES) Group, Palma, Spain.
| | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Hospital Universitario Torrecárdenas, Almeria, Spain
| | | | - Peter J Carr
- School of Nursing and Midwifery at the National University of Ireland Galway (NUIG), Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) group, Australia
| | - Victoria Armenteros-Yeguas
- Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain; Bioaraba, Vascular Care Research Group, Vitoria-Gasteiz, Spain
| | | | - Joan de Pedro-Gómez
- Universitat de les Illes Balears, Department of Nursing and Physiotherapy, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Shin HD, Zaheer J, Torous J, Strudwick G. Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project. JMIR Res Protoc 2023; 12:e50643. [PMID: 37943582 PMCID: PMC10667981 DOI: 10.2196/50643] [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: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. OBJECTIVE The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). METHODS We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. RESULTS This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. CONCLUSIONS Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50643.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Ontario, Canada, Toronto, ON, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gillian Strudwick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Southerland LT, Gulker P, Van Fossen J, Rine-Haghiri L, Caterino JM, Mion LC, Carpenter CR, Cardone MS, Hill M, Hunold KM. Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research. Acad Emerg Med 2023; 30:1117-1128. [PMID: 37449967 PMCID: PMC11195318 DOI: 10.1111/acem.14776] [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: 03/14/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Implementation of evidence-based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real-world use of theory-based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening program in the ED using the Consolidated Framework for Implementation Research (CFIR). METHODS The EBP involved nurses screening older patients for delirium (Delirium Triage Screen), fall risk (4-Stage Balance Test), and vulnerability (Identification of Seniors at Risk score) with subsequent appropriate referrals to physicians, therapy specialists, or social workers. The proportions of screened adults ≥65 years old were tracked monthly. Outcomes are reported January 2021-December 2022. Barriers encountered were classified according to CFIR. Implementation strategies were classified according to the CFIR-Expert Recommendations for Implementing Change (ERIC). RESULTS Implementation strategies increased geriatric screening from 5% to 68%. This did not meet our prespecified goal of 80%. Change was sustained through several COVID-19 waves. Inner setting barriers included culture and implementation climate. Initially, the ED was treated as a single inner setting, but we found different cultures and uptake between ED units, including night versus day shifts. Characteristics of individuals barriers included high levels of staff turnover in both clinical and administrative roles and very low self-efficacy from stress and staff turnover. Initial attempts with individualized audit and feedback were not successful in improving self-efficacy and may have caused moral injury. Adjusting feedback to a team/unit level approach with unitwide stretch goals worked better. Identifying early adopters and conducting on-shift education increased uptake. Lessons learned regarding ED culture, implementation in interconnected health systems, and rapid cycle process improvement are reported. CONCLUSIONS The pandemic exacerbated barriers to implementation in the ED. Cognizance of a large ED as a sum of smaller units and using the CFIR model resulted in improvements.
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Affiliation(s)
| | - Peg Gulker
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jenifer Van Fossen
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lorri Rine-Haghiri
- The Ohio State University James Cancer Hospital & Solove Research Center, Columbus, Ohio, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lorraine C. Mion
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | | | - Michael S. Cardone
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Katherine M. Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
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Grubenhoff JA, Bakel LA, Dominguez F, Leonard J, Widmer K, Sanders JS, Spencer SP, Stein JM, Searns JB. Clinical Pathway Adherence and Missed Diagnostic Opportunities Among Children with Musculoskeletal Infections. Jt Comm J Qual Patient Saf 2023; 49:547-556. [PMID: 37495472 DOI: 10.1016/j.jcjq.2023.06.011] [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: 02/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Clinical care pathways (CPs) integrate best evidence into the local care delivery context to promote efficiency and patient safety. However, the impact of CPs on diagnostic performance remains poorly understood. The objectives of this study were to evaluate adherence to a musculoskeletal infection (MSKI) diagnostic CP and identify recurrent failure points leading to missed diagnostic opportunities (MDOs). METHODS Retrospective chart review was performed from January 2018 to February 2022 for children 6 months to 18 years of age who had an unplanned admission for MSKI after being evaluated and discharged from the pediatric emergency department (PED) for related complaints within the previous 10 days. MDOs were identified using the Revised Safer Dx. Demographic and clinical characteristics of children with and without MDOs were compared using bivariate descriptive statistics. An improvement team reviewed the diagnostic trajectories of MDOs for deviations from the MSKI CP and developed a fishbone diagram to describe contributing factors to CP deviations. RESULTS The study identified 21 children with and 13 children without MSKI-associated MDOs. Children with MDOs were more likely to have an initial C-reactive protein value > 2 mg/dL (90.0% vs. 0%, p = 0.01) and returned to care earlier than children without MDOs (median 2.8 days vs. 6.7 days, p = 0.004). Factors contributing to MDOs included failure to obtain screening laboratory tests, misinterpretation of laboratory values, failure to obtain orthopedic consultation, and failure to obtain definitive imaging. CONCLUSION Several recurrent deviations from an MSKI diagnostic CP were found to be associated with MDOs. Future quality improvement efforts to improve adherence to this MSKI CP may prevent MDOs.
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11
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Fernandes DC, Cheong JA, Suryadevera U, Fernandes JS, Shorr R, Uphold CR. A Clinician's Roadmap to the Research and Data Acquisition Process Within the Veterans Health System. Sr Care Pharm 2023; 38:423-426. [PMID: 37771055 DOI: 10.4140/tcp.n.2023.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Objective Identify and address potential obstacles to initiation of older population-related research within the NF/SG VHS through the provision of a concise flowchart. Setting North Florida/South Georgia Veterans Health System (NF/SG VHS). Practice Description The Department of Veterans Affairs (VA) Research Service with connection to the University of Florida facilitates research that contributes to improving the delivery of inpatient/outpatient care to veterans and their families. Practice Innovation A compendium of a senior care pharmacist's experiences will be compiled and reviewed by other specialists within the field while attempting to submit research protocols for publication within the VHS through the use of data platforms such as VINCI (VA Informatics and Computing Infrastructure) and the Corporate Data Warehouse. Main Outcome Measurements Impact of navigating research websites affiliated with and directly pertaining to the NF/SG VHS upon clinicians attempting to begin research processes within the institution. Results It was determined that for the most expeditious publication experience to result the following six steps had to be pursued sequentially: VA Institutional Review Board (IRB) Net documentation/ submission, local myIRB submission, Data Access Request Tracker/VINCI access request, setup of VINCI workspace, drafting of VINCI cohort specification, data analysis and tracking, statistical methods, abstract, and manuscript production. Conclusion This study outlines a consistent/clear method from first-hand experiences on how to navigate, more efficiently, complex research processes to produce successful future impacts on patient care.
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Affiliation(s)
- Deanna C Fernandes
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
| | - Josepha A Cheong
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
| | - Uma Suryadevera
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
| | - Joel S Fernandes
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
| | - Ronald Shorr
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
| | - Constance R Uphold
- 1North Florida/South Georgia Veterans Health System; Geriatric Research Education and Clinical Center, Gainesville, Florida
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Wendel SK, Bookman K, Holmes M, Wiler JL. Successful Implementation of Workflow-Embedded Clinical Pathways During the COVID 19 Pandemic. Qual Manag Health Care 2023; 32:205-210. [PMID: 36913774 PMCID: PMC10289068 DOI: 10.1097/qmh.0000000000000408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical pathways have been found effective for improving adherence to evidence-based guidelines, thus providing better patient outcomes. As coronavirus disease-2019 (COVID-19) clinical guidance changed rapidly and evolved, a large hospital system in Colorado established clinical pathways within the electronic health record to guide clinical practice and provide the most up-to-date information to frontline providers. METHODS On March 12, 2020, a system-wide multidisciplinary committee of specialists in emergency medicine, hospital medicine, surgery, intensive care, infectious disease, pharmacy, care management, virtual health, informatics, and primary care was recruited to develop clinical guidelines for COVID-19 patient care based on the limited available evidence and consensus. These guidelines were organized into novel noninterruptive digitally embedded pathways in the electronic health record (Epic Systems, Verona, Wisconsin) and made available to nurses and providers at all sites of care. Pathway utilization data were analyzed from March 14 to December 31, 2020. Retrospective pathway utilization was stratified by each care setting and compared with Colorado hospitalization rates. This project was designated as a quality improvement initiative. RESULTS Nine unique pathways were developed, including emergency medicine, ambulatory, inpatient, and surgical care guidelines. Pathway data were analyzed from March 14 to December 31, 2020, and showed that COVID-19 clinical pathways were used 21 099 times. Eighty-one percent of pathway utilization occurred in the emergency department setting, and 92.4% applied embedded testing recommendations. A total of 3474 distinct providers employed these pathways for patient care. CONCLUSIONS Noninterruptive digitally embedded clinical care pathways were broadly utilized during the early part of the COVID-19 pandemic in Colorado and influenced care across many care settings. This clinical guidance was most highly utilized in the emergency department setting. This shows an opportunity to leverage noninterruptive technology at the point of care to guide clinical decision-making and practice.
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Affiliation(s)
- Sarah K. Wendel
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Kelly Bookman
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Molly Holmes
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
| | - Jennifer L. Wiler
- Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler)
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Martí-Lluch R, Bolíbar B, Llobera J, Maderuelo-Fernández JA, Magallón-Botaya R, Sánchez-Pérez Á, Fernández-Domínguez MJ, Motrico E, Vicens-Pons E, Notario-Pacheco B, Alves-Cabratosa L, Ramos R. Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis. Front Public Health 2023; 11:1067249. [PMID: 37427254 PMCID: PMC10325828 DOI: 10.3389/fpubh.2023.1067249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals' approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up. Methods This protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC. Discussion The analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.
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Affiliation(s)
- Ruth Martí-Lluch
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
- Parc Hospitalari Martí Julià, Institut d'Investigació Biomèdica de Girona (IDIBGI), Salt, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Bonaventura Bolíbar
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan Llobera
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Balearic Islands Health Service (Ib-Salut), Primary Care Research Unit of Mallorca, Palma, Spain
- Hospital Universitari Son Espases, GrAPP-caIB—Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - José A Maderuelo-Fernández
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Salamanca, Spain
- Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Gerencia Regional de salud de Castilla y León (SACyL), Gerencia de Atención Primaria de Salamanca, Salamanca, Spain
| | - Rosa Magallón-Botaya
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Álvaro Sánchez-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Unidad de Investigación Atención Primaria de Bizkaia. Subdirección para la Coordinación de la Atención Primaria, Dirección General Osakiadetza, Vitoria, Spain
- Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios Instituto Investigación Biocruces, Baracaldo, Bizkaia, Spain
| | - Ma José Fernández-Domínguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Ourense Health Area, SERGAS, Ourense, Spain
- Centro de Saúde de Leiro, SERGAS, Leiro, Spain
- I-Saúde Group, Hospital Álvaro Cunqueiro Bloque Técnico, South Galicia Health Research Institute, Vigo, Spain
| | - Emma Motrico
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain
| | - Enric Vicens-Pons
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
| | - Blanca Notario-Pacheco
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Faculty of Nursing, Universidad de Castilla-La Mancha, Cuenca, Spain
- Social and Health Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Rafel Ramos
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
- Parc Hospitalari Martí Julià, Institut d'Investigació Biomèdica de Girona (IDIBGI), Salt, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Department of Medical Sciences, School of Medicine, Campus Salut, Universitat de Girona, Girona, Spain
- Atenció Primària, Institut Català de la Salut, Girona, Catalonia, Spain
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [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: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Use of clinical pathways integrated into the electronic health record to address the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:260-267. [PMID: 35314010 PMCID: PMC9043631 DOI: 10.1017/ice.2022.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)-integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care. OBJECTIVE To describe our institution's creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools. SETTING Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices. METHODS Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19-specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19-specific pathways for a 6-month period (March 1-September 1, 2020), and we have described their impact using case studies. RESULTS In total, 45 COVID-19-specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting. CONCLUSIONS E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.
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Chernick LS, Bugaighis M, Britton L, Cruz AT, Goyal MK, Mistry RD, Reed JL, Bakken S, Santelli JS, Dayan PS. Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis. Acad Emerg Med 2023; 30:99-109. [PMID: 36478023 DOI: 10.1111/acem.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Health care providers (HCPs) in the emergency department (ED) frequently must decide whether to conduct or forego confidential conversations with adolescent patients about sensitive topics, such as those related to mental health, substance use, and sexual and reproductive health. The objective of this multicenter qualitative analysis was to identify factors that influence the conduct of confidential conversations with adolescent patients in the ED. METHODS In this qualitative study, we conducted semistructured interviews of ED HCPs from five academic, pediatric EDs in distinct geographic regions. We purposively sampled HCPs across gender, professional title, and professional experience. We used the Theoretical Domains Framework (TDF) to develop an interview guide to assess individual and system-level factors affecting HCP behavior regarding the conduct of confidential conversations with adolescents. Enrollment continued until we reached saturation. Interviews were recorded, transcribed, and coded by three investigators based on thematic analysis. We used the coded transcripts to collaboratively generate belief statements, which are first-person statements that reflect shared perspectives. RESULTS We conducted 38 interviews (18 physicians, 11 registered nurses, five nurse practitioners, and four physician assistants). We generated 17 belief statements across nine TDF domains. Predominant influences on having confidential conversations included self-efficacy in speaking with adolescents alone, wanting to address sexual health complaints, maintaining patient flow, experiencing parental resistance and limited space, and having inadequate resources to address patient concerns and personal preconceptions about patients. Perspectives divided between wanting to provide focused medical care related only to their chief complaint versus self-identifying as a holistic medical HCP. CONCLUSIONS The factors influencing the conduct of confidential conversations included multiple TDF domains, elucidating how numerous intersecting factors influence whether ED HCPs address sensitive adolescent health needs. These data suggest methods to enhance and facilitate confidential conversations when deemed appropriate in the care of adolescents in the ED.
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Affiliation(s)
- Lauren S Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Population and Family Health, Columbia University, New York, New York, USA
| | - Mona Bugaighis
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Laura Britton
- Department of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrea T Cruz
- Divisions of Emergency Medicine and Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Rakesh D Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Ohio, Cincinnati, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, Cincinnati, USA
| | - Suzanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Irving Medical Center, New York, New York, USA
| | - John S Santelli
- Department of Population and Family Health, Columbia University, New York, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
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17
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Wilkinson SA, Fjeldsoe B, Willcox JC. Evaluation of the Pragmatic Implementation of a Digital Health Intervention Promoting Healthy Nutrition, Physical Activity, and Gestational Weight Gain for Women Entering Pregnancy at a High Body Mass Index. Nutrients 2023; 15:nu15030588. [PMID: 36771295 PMCID: PMC9921852 DOI: 10.3390/nu15030588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m2, between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans.
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Affiliation(s)
- Shelley A. Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Correspondence: ; Tel.: +61-7-3365-6849
| | | | - Jane C. Willcox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Centre for Quality and Patient Safety, Institute of Health Transformation, Deakin University, Burwood, VIC 3125, Australia
- Impact Obesity, South Melbourne, VIC 3205, Australia
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18
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Pinargote-Celorio H, Otero-Rodríguez S, González-de-la-Aleja P, Rodríguez-Díaz JC, Climent E, Chico-Sánchez P, Riera G, Llorens P, Aparicio M, Montiel I, Boix V, Moreno-Pérez Ó, Ramos-Rincón JM, Merino E. [Mild SARS-CoV-2 infection in vulnerable patients: implementation of a clinical pathway for early treatment]. Enferm Infecc Microbiol Clin 2022:S0213-005X(22)00282-8. [PMID: 36506459 PMCID: PMC9722674 DOI: 10.1016/j.eimc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The objective of this report is to describe the clinical pathway for early treatment of patients with acute SARS-CoV-2 infection and to evaluate the first results of its implementation. METHODS This is a descriptive and retrospective study of the implementation of a clinical pathway of treatment in outpatients (January 1 to June 30 2022). Clinical pathway: detection and referral systems from Primary Care, Emergency services, hospital specialities and an automated detection system; clinical evaluation and treatment administration in the COVID-19 day-hospital and subsequent clinical follow-up. Explanatory variables: demographics, comorbidity, vaccination status, referral pathways and treatment administration. OUTCOME VARIABLES hospitalization and death with 30 days, grade 2-3 toxicity related to treatment. RESULTS Treatment was administered to 262 patients (53,4% women, median age 60 years). The treatment indication criteria were immunosupression (68,3%), and the combination of age, vaccination status and comorbidity in the rest47,3% of the patients s received remdesivir, 35,9% nirmatrelvir/ritonavir, 13,4% sotrovimab and 2,4% combined treatment with a median of 4 days after symptom onset. Hospital admission was required for 6,1% of the patients, 3,8% related to progression COVID-19. No patient died. Toxicity grade 2-3 toxicity was reported in 18,7%, 89,8% dysgeusia and metallic tasted related nirmatrelvir/ritonavir. Seven patients discontinued treatment due to toxicity. CONCLUSION The creation and implementation of a clinical pathway for non-hospitalized patients with SARS-CoV-2 infection is effective and it allows early accessibility and equity of currently available treatments.
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Affiliation(s)
- Héctor Pinargote-Celorio
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Silvia Otero-Rodríguez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Pilar González-de-la-Aleja
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Juan-Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España, Departamento de Producción Vegetal y Microbiología, Universidad Miguel Hernández, Elche, España
| | - Eduardo Climent
- Servicio de Farmacia. Hospital General Universitario Dr. Balmis, Alicante - Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España, Área de Farmacia y Tecnología Farmacéutica. Universidad Miguel Hernández, Elche, España
| | - Pablo Chico-Sánchez
- Servicio Medicina Preventiva. Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL. Hospital General Universitario Dr. Balmis, Alicante, España
| | - Gerónima Riera
- Servicio de Farmacia. Hospital General Universitario Dr. Balmis - Instituto Investigación, Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Alicante. Instituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, España, Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Marta Aparicio
- Farmacia de Atención Primaria. Hospital General Universitario Dr. Balmis, Alicante, España
| | - Inés Montiel
- Dirección Atención Primaria Hospital General Universitario Dr. Balmis, Alicante. Instituto. Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, España
| | - Vicente Boix
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis - Instituto, Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España, Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Óscar Moreno-Pérez
- Sección Endocrinología, Hospital General Universitario Dr. Balmis-Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España, Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - José-Manuel Ramos-Rincón
- Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España, Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, España
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis - Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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19
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Salma I, Waelli M. Mapping research findings on change implementation in nursing practice: A scoping literature review. Nurs Open 2022; 10:450-468. [PMID: 36112719 PMCID: PMC9834520 DOI: 10.1002/nop2.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies. DESIGN Scoping literature review following PRISMA-ScR extension. METHODS Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected. RESULTS A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation. CONCLUSION We advocate the development of framework including systematic factors and which capture the local context flexibility.
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Affiliation(s)
- Israa Salma
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance
| | - Mathias Waelli
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance,Global Health InstituteGeneva UniversityGeneveSwitzerland
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20
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Sheron VA, Shanmugathas S, Gooden TE, Guruparan M, Kumarendran B, Lip GYH, Manaseki-Holland S, Nirantharakumar K, Shribavan K, Subaschandren K, Haniffa R, Surenthirakumaran R, Thomas GN, Uruthirakumar P, Greenfield S, Lane DA, Beane A. Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care. BMC Health Serv Res 2022; 22:1078. [PMID: 35999563 PMCID: PMC9400248 DOI: 10.1186/s12913-022-08440-1] [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: 04/08/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08440-1.
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Affiliation(s)
- Vethanayagam Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Shivany Shanmugathas
- Department of Marketing, Faculty of Management Studies and Commerce, University of Jaffna, Jaffna, Sri Lanka
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | - Gregory Y H Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kaneshamoorthy Shribavan
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Kumaran Subaschandren
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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21
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Aziz Alimul Hidayat A, Chen WL, Nor RM, Uliyah M, Badriyah FL, Ubudiyah M. The determinants of patient care manager role and the implementation of COVID-19 clinical pathway: a cross-sectional study. PeerJ 2022; 10:e13764. [PMID: 35910779 PMCID: PMC9332306 DOI: 10.7717/peerj.13764] [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: 04/18/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023] Open
Abstract
Objective This study aims to determine the factors associated with patient care manager role and the implementation of the clinical pathway among nurses in private hospitals. Methods This study was conducted from January-July 2021 using the cross-sectional approach. The sample consisted of 168 nurses working in a private hospital in Surabaya City, East Java, Indonesia. Meanwhile, the data were collected using the Patient Care Manager Role Scale (PCMRS) and analyzed by multiple logistic regression to find the correlation between the variables. Results A higher percentage of nurses namely 64.3% had compliance in COVID-19 clinical pathways with an average PCMRS score of 27.81 ± 2.43. Nurses with a high-level patient care manager role level had a significant compliance risk with odds ratio [OR] 440.137, 95% confidence interval [CI] [51.850-3736.184], and p-value = 0.000 compared to those with a low role. Conclusion The role of patient care manager and compliance with COVID-19 clinical pathways correlated significantly. Based on the results, several actions are needed for the early identification of patient service managers' roles to ensure compliance with COVID-19 clinical pathways and reduce the number of cases in Indonesia.
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Affiliation(s)
| | - Wen-Ling Chen
- Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Kaohsiung, Taiwan
| | - Rahimah Mohd Nor
- Faculty of Health & Life Sciences, Management & Science University, Selangor, Selangor, Malaysia
| | - Musrifatul Uliyah
- Nursing, University Muhammadiyah of Surabaya, Surabaya, East Jawa, Indonesia
| | | | - Masunatul Ubudiyah
- Nursing, Universitas Muhammadiyah Lamongan, Lamongan, East Java, Indonesia
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22
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Noehammer E, Ponweiser M, Romeyke T, Eibinger F. Benefits, Barriers and Determinants of Clinical Pathway Use in Germany, Austria and Switzerland. A pilot study. Health Serv Manage Res 2022; 36:119-126. [PMID: 35771177 PMCID: PMC10080374 DOI: 10.1177/09514848221107485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Performance-oriented financing of healthcare aims at demand-based and efficient resource allocation. Often, clinical pathways (CPs) are introduced in this context. PURPOSE For CP success (a) the degree of utilization of and divergence, (b) cost effects and (c) health professionals' acceptance rate of and satisfaction are relevant. There are gaps in research regarding these issues in general, and more specifically in the German speaking part of Europe. METHODOLOGY/APPROACH Employing a two-stage mixed-methods pilot study, we studied (a) and (b) quantitatively in Germany, Austria, and Switzerland, and (c) qualitatively in Germany and Austria. RESULTS Many hospitals already implemented CPs, but the utilization varies. They are expected to yield middle-range savings, but intangible benefits are more important. In general, employees are in favor of CPs, but several conditions need to be met, e.g. adaptability to local requirements. CONCLUSION Linking the results to the Consolidated Framework for Implementation Research showed many criteria are covered, which might lead to the positive evaluations, but also highlights the complexity of the intervention. PRACTICE IMPLICATION As enhanced acceptance rates are expected to lead to higher benefits and vice versa, management team should safeguard employee participation and perceived benefits in all phases of the CP cycle.
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Affiliation(s)
- Elisabeth Noehammer
- Department for Public Health, Health Services Research and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Austria
| | - Matthias Ponweiser
- Department for Public Health, Health Services Research and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Austria
| | - Tobias Romeyke
- Department for Public Health, Health Services Research and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Austria
| | - Florian Eibinger
- Department for Public Health, Health Services Research and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Austria
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23
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Wind A, van der Linden C, Hartman E, Siesling S, van Harten W. Patient involvement in clinical pathway development, implementation and evaluation - A scoping review of international literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1441-1448. [PMID: 34666931 DOI: 10.1016/j.pec.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although various pathway design methods recognize patients as stakeholders, an overview of current practice is lacking. This article describes the results of a literature review assessing patient involvement in clinical cancer pathway development, implementation and evaluation. METHODS A scoping review was conducted following PRISMA-ScR. Two databases were searched to identify studies published in English between 2014 and 2021. RESULTS Of 12841articles identified 22 articles met the inclusion criteria and reported on one or more of the three phases: development phase (N = 2), implementation (N = 4), evaluation (N = 11), development/evaluation (N = 3), and implementation/evaluation (N = 2) of clinical pathways. The numbers of involved patients ranged from 10 to 793, and the reported methods varied considerably. CONCLUSION This review presents a synthesis of methods for involving patients in the clinical pathway lifecycle. No relationship was found between methods and the number of involved patients or between pathway complexity and methods. Although patients are seen as valuable stakeholders in the pathway design, to involve them in practice using the best practice can be improved. PRACTICE IMPLICATIONS The lack of a clear justification for the choice of methods and number of involved patients calls for further research and framework development to inform pathway developers.
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Affiliation(s)
- Anke Wind
- Rijnstate Hospital, Arnhem, the Netherland; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Elmar Hartman
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; dept Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Wim van Harten
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; The Netherlands Cancer Institute, Amsterdam. The Netherlands.
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24
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Mora C, Sampedro I, Rodríguez-Caballero A, Martín-Láez R, Ortega-Roldán M, Venkatraghavan L, Fernández-Miera M, Varea M, Pajaron-Guerrero M, Esteban J, Moreno B, Manzano A, Ruiz I, Martino J, Zadeh G, Bernstein M, Velásquez C. Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program. Neurosurg Focus 2022; 52:E8. [DOI: 10.3171/2022.3.focus2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process.
METHODS
An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol’s implementation were identified from the feedback of all participants.
RESULTS
An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient’s admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care.
CONCLUSIONS
Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.
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Affiliation(s)
- Carla Mora
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
| | - Isabel Sampedro
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | | | - Rubén Martín-Láez
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
| | - Marta Ortega-Roldán
- Ciencias Jurídicas y Empresariales, Universidad de Cantabria, Santander, Cantabria, Spain
- Medtronic Ibérica, Madrid, Spain
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto
| | | | - Mar Varea
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | | | - Jesus Esteban
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
| | - Blanca Moreno
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | - Asunción Manzano
- Hospital-at-Home Department, Hospital Universitario Marqués de Valdecilla
| | - Isabel Ruiz
- Department of Anesthesiology, Hospital Universitario Marqués de Valdecilla
| | - Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Carlos Velásquez
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria
- Department of Anatomy and Cell Biology, Universidad de Cantabria, Santander, Cantabria; and
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Lim J, Kim K, Song M, Yoo S, Baek H, Kim S, Park S, Jeong WJ. Assessment of the feasibility of developing a clinical pathway using a clinical order log. J Biomed Inform 2022; 128:104038. [DOI: 10.1016/j.jbi.2022.104038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
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Quereshy HA, Quinton BA, Ruthberg JS, Maronian NC, Otteson TD. Practice Consolidation in Otolaryngology: The Decline of the Single-Provider Practice. OTO Open 2022; 6:2473974X221075232. [PMID: 35237738 PMCID: PMC8883306 DOI: 10.1177/2473974x221075232] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021. Study Design Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services. Setting United States. Methods Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021. Results Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%. Conclusion The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.
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Affiliation(s)
- Humzah A. Quereshy
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brooke A. Quinton
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeremy S. Ruthberg
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicole C. Maronian
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Todd D. Otteson
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Veziari Y, Kumar S, Leach MJ. An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study. PLoS One 2022; 17:e0264221. [PMID: 35180276 PMCID: PMC8856519 DOI: 10.1371/journal.pone.0264221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/06/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Most studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research. METHODS This research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis. RESULTS CAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes-lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes-intrinsic perceptions in CAM, and lack of communication within and outside CAM. CONCLUSIONS Promoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges.
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Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Saravana Kumar
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Matthew J. Leach
- Southern Cross University, National Centre for Naturopathic Medicine, East Lismore, New South Wales, Australia
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Shin HD, Zaheer J, Rodak T, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review protocol. BMJ Open 2022; 12:e056232. [PMID: 35105648 PMCID: PMC8804626 DOI: 10.1136/bmjopen-2021-056232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There is a surplus of information and communication technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognise the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multiphase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterise ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterise the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximise implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings. METHODS AND ANALYSIS This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. The following databases will be searched: Medline, PsycInfo, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and Library, Information Science & Technology Abstracts (LISTA). Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterise extracted data using frameworks, typology and taxonomies to address the proposed review questions. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication and conference presentations. Furthermore, the findings will be shared with relevant health organisations through lay language summaries and informal presentations.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Terri Rodak
- Library, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Caldwell L, Papermaster AE, Halder GE, White AB, Young A, Rogers RG. Evidence-based pelvic floor disorder care pathways optimize shared decision making between patients and surgeons. Int Urogynecol J 2022; 33:2841-2847. [PMID: 35001160 PMCID: PMC8743070 DOI: 10.1007/s00192-021-05021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Evidence-based care pathways improve care standardization and patient outcomes. We created pelvic organ prolapse (POP) and stress urinary incontinence (SUI) care pathways as decision aids for our multidisciplinary team to use when counseling patients. Methods Using a modified Delphi process, an expert team reviewed existing guidelines and literature to reach consensus on pathway definitions and components. Results Entry to the care pathways occurs via an advanced practice provider visit. Symptom and quality-of-life questionnaires as well as open-ended patient goals are used to guide patient–provider shared decision making. All treatment choices, including surgical and nonsurgical management, are presented to patients by advanced practice providers. Patients electing nonsurgical management follow-up by telehealth (preferred) or in-person visits as determined by the care pathway. Surgeon consultations are scheduled for patients desiring surgery. Surgical patients undergo urodynamics, simple cystometrics or deferred bladder testing according to the urodynamics clinical pathway. Postoperative follow-up includes telehealth visits and minimizes in-person visits for women with uncomplicated postoperative courses. Patients with resolution of symptoms are graduated from clinic and return to their referring physician. The pathways are revised following publication of new compelling evidence. Conclusions We developed POP and SUI care pathways to standardize care across a diverse provider group. Advanced practice providers use care pathways with patients as shared decision-making tools for initial evaluation of patients with prolapse and incontinence. These pathways serve as components of value-based care and encourage team members to function independently while utilizing the full scope of their training.
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Affiliation(s)
- Lauren Caldwell
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA.
| | - Amy E Papermaster
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | | | - Amanda B White
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
| | - Amy Young
- University of Texas Dell Medical School, 1301 W. 38th Street, Suite 705, Austin, TX, 78705, USA
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Alahmar A, AlMousa M, Benlamri R. Automated clinical pathway standardization using SNOMED CT- based semantic relatedness. Digit Health 2022; 8:20552076221089796. [PMID: 35392252 PMCID: PMC8980435 DOI: 10.1177/20552076221089796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
The increasing number of patients and heavy workload drive health care institutions to search for efficient and cost-effective methods to deliver optimal care. Clinical pathways are promising care plans that proved to be efficient in reducing costs and optimizing resource usage. However, most clinical pathways are circulated in paper-based formats. Clinical pathway computerization is an emerging research field that aims to integrate clinical pathways with health information systems. A key process in clinical pathway computerization is the standardization of clinical pathway terminology to comply with digital terminology systems. Since clinical pathways include sensitive medical terms, clinical pathway standardization is performed manually and is difficult to automate using machines. The objective of this research is to introduce automation to clinical pathway standardization. The proposed approach utilizes a semantic score-based algorithm that automates the search for SNOMED CT terms. The algorithm was implemented in a software system with a graphical user interface component that physicians can use to standardize clinical pathways by searching for and comparing relevant SNOMED CT retrieved automatically by the algorithm. The system has been tested and validated on SNOMED CT ontology. The experimental results show that the system reached a maximum search space reduction of 98.9% within any single iteration of the algorithm and an overall average of 71.3%. The system enables physicians to locate the proper terms precisely, quickly, and more efficiently. This is demonstrated using case studies, and the results show that human-guided automation is a promising methodology in the field of clinical pathway standardization and computerization.
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Affiliation(s)
- Ayman Alahmar
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
| | - Mohannad AlMousa
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
| | - Rachid Benlamri
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
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Shin HD, Cassidy C, Weeks LE, Campbell LA, Drake EK, Wong H, Donnelly L, Dorey R, Kang H, Curran JA. Interventions to change clinicians' behavior related to suicide-prevention care in the emergency department: a scoping review. JBI Evid Synth 2021; 20:788-846. [PMID: 34907133 DOI: 10.11124/jbies-21-00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. INTRODUCTION An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care. INCLUSION CRITERIA This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. METHODS This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively. RESULTS Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. CONCLUSIONS Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
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Affiliation(s)
- Hwayeon Danielle Shin
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada Faculty of Health, Dalhousie University, Halifax, NS, Canada Nova Scotia Health Authority, Halifax, NS, Canada
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Wang X, Chen J, Peng F, Lu J. Construction of Clinical Pathway Information Management System under the Guidance of Evidence-Based Medicine. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4425449. [PMID: 34900187 PMCID: PMC8660212 DOI: 10.1155/2021/4425449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
This study focuses on clinical pathways guided by evidence-based medicine (EBM). With the clinical pathway as the center, the subjective and objective medical knowledge of medical staff are collected, and a clinical pathway management system guided by EBM is established through a unified process; user demand analysis; main considerations; implementation, evaluation, and monitoring of the clinical path; and dictionary maintenance, to help hospitals fully regulate medical behaviors. Next, the study displays the path access prompt box, area 1 management page, table management page, exit prompt box, mutation record page, doctor order interface, revocation of execution, and monitoring interface, and the system designed is compared with the Beijing Shankang Technology (ASK) clinical data management system in terms of user experience. The results showed that the reporting rate of medical adverse events in the system in this study was 0.21%, and the work efficiency was increased by 14%. In terms of users' satisfaction, the hospital managers' satisfaction was 84 ± 5.36%, and it was 95 ± 4.72% for medical staff and 88 ± 4.91% for system administrators, superior to the ASK system; the differences were statistically significant (P < 0.05). In conclusion, the clinical pathway information management system is in line with the working environment of medical staff, and the synchronous monitoring and management of medical quality are achieved through digital means, which can reduce the occurrence of medical adverse events and improve the work efficiency of medical staff.
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Affiliation(s)
- Xinyu Wang
- Department of Outpatient, PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Jie Chen
- Department of Outpatient, PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
| | - Fang Peng
- Department of Medicine, Yangtze University, Jingzhou 434023, China
| | - Jingtai Lu
- Department of Information Technology, PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
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Curtis K, Moules P, McKenzie J, Weidl L, Selak T, Binks S, Hernandez D, Rijsdijk J, Risi D, Wright J, O'Rourke L, Knapman M, Ristevski M, Stephens T, Harris I, Close JCT. Development of an Early Activation Hip Fracture Care Bundle and Implementation Strategy to Improve Adherence to the National Hip Fracture Clinical Care Standard. J Multidiscip Healthc 2021; 14:2891-2903. [PMID: 34703242 PMCID: PMC8524060 DOI: 10.2147/jmdh.s323678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To develop and implement a multidisciplinary early activation mechanism and bundle of care (eHIP) to improve adherence to ACSQHC standards in a regional trauma centre. Methods Barriers to implementation were categorised using the Theoretical Domains Framework, then linked to specific strategies guided by the Behaviour Change Wheel and Behaviour Change Technique Taxonomy (BCTT). The resulting implementation strategies were assessed using Affordable, Practical, Effective, Acceptable, had Side-effects (APEASE) criteria. Results Eighty-three barriers to implementation of the hip fracture care bundle were identified. The behaviour change wheel process resulted in the identification of 41 techniques to address these barriers. The predominant mechanisms to achieve this were development and implementation of 1) formal policy that outlines eHIP roles; 2) video promotion; 3) pager group; 4) fascia iliaca block enabling; 5) eMR modifications; 6) face-to-face reinforcement and modelling; 7) communication and prompts; 8) environmental restructuring. Conclusion We applied behaviour change theory through a pragmatic evidence-based process. This resulted in a codesigned strategy to overcome staff and organisational barriers to the implementation of a multidisciplinary early activation mechanism and bundle of care (eHIP). Future work will include evaluation of the uptake and clinical impact of the care bundle.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,George Institute for Global Health, Newtown, NSW, Australia
| | - Peter Moules
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - John McKenzie
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Lauren Weidl
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Tanya Selak
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Simon Binks
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Daniel Hernandez
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Joshua Rijsdijk
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Dante Risi
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - James Wright
- Agency for Clinical Innovation, St Leonards, NSW, Australia
| | - Lauren O'Rourke
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Myles Knapman
- Western NSW LHD, Department of Surgery, Dubbo, NSW, Australia
| | - Meagan Ristevski
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Teala Stephens
- Illawarra Shoalhaven LHD, Emergency Department, Wollongong, NSW, Australia
| | - Ian Harris
- Ingham Institute of Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Prince Wales Clinical School, UNSW, Sydney, NSW, Australia.,Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
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Handayani S, Maidin A, Birawida AB, Suriah S, Ansariadi A, Indriasari R, Stang S. Determinants Model in Reducing HIV-Related Stigma in Health care Workers: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The stigma accepted by people living with HIV (PLWHA) is a major obstacle in HIV prevention, especially from health workers.
Aims: This study aims to determine the factors associated with HIV stigma among health workers.
Methods: This systematic review was conducted using the 2015 PRISMA guidelines. All publications by reading the title and abstract. In the final screening stage, the authors read the full text of the remainder of the article and held back studies that were consistent with inclusion criteria, focusing on HIV-related stigma determinants published in 2010-2020.
Results: The stigma that comes from health workers to PLWHA can come from personal beliefs or a lack of personal confidence, which can be derived from self-confidence, self-confidence, knowledge, working time, and institutional support or policies from the workplace that create discriminatory behavior when dealing with PLWHA. The created stigma can reduce social interactions and the quality of life of PLWHA.
Conclusion: It is important to find determinants to formulate appropriate intervention plans in reducing HIV-related stigma, especially among health workers.
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Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, McShea K, Tsou AY. Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Netw Open 2021; 4:e2125846. [PMID: 34542615 PMCID: PMC8453321 DOI: 10.1001/jamanetworkopen.2021.25846] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. OBJECTIVE To identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS. EVIDENCE REVIEW Multiple databases, including MEDLINE and Embase, were searched for English-language systematic reviews from January 1, 2010, through September 30, 2020, with updated searches through January 19, 2021. The scope of the protocol was determined with input from AHRQ Key Informants. Systematic reviews were included if they reported on hospital-led interventions intended to decrease LOS for high-risk populations, defined as those with high-risk medical conditions or socioeconomically vulnerable populations (eg, patients with high levels of socioeconomic risk, who are medically uninsured or underinsured, with limited English proficiency, or who are hospitalized at a safety-net, tertiary, or quaternary care institution). Exclusion criteria included interventions that were conducted outside of the hospital setting, including community health programs. Data extraction was conducted independently, with extraction of strength of evidence (SOE) ratings provided by systematic reviews; if unavailable, SOE was assessed using the AHRQ Evidence-Based Practice Center methods guide. FINDINGS Our searches yielded 4432 potential studies. We included 19 systematic reviews reported in 20 articles. The reviews described 8 strategies for reducing LOS in high-risk populations: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure. There were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk. For patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations. For patients with heart failure, clinical pathways and case management were associated with reduced length of stay (clinical pathways: mean difference reduction, 1.89 [95% CI, 1.33 to 2.44] days; case management: mean difference reduction, 1.28 [95% CI, 0.52 to 2.04] days). CONCLUSIONS AND RELEVANCE This systematic review found inconsistent results across all high-risk populations on the effectiveness associated with interventions, such as discharge planning, that are often widely used by health systems. This systematic review highlights important evidence gaps, such as the lack of existing systematic reviews focused on patients with socioeconomic risk factors, and the need for further research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - Kelley Tipton
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Brian Leas
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - S. Ryan Greysen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Nikhil K. Mull
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia
| | - Kristina McShea
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Amy Y. Tsou
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Alona I, Harahap J, Aribi A, Ikhsan R, Siregar MIR. Assessment of Healthcare Professional’s Knowledge, Skills, Motivation, and Commitment to Clinical Pathways Implementation. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Healthcare providers are facing challenges to deliver qualified and efficient health services in response to the current health system. Clinical pathways (CPs) are a tool to achieve the best clinical outcomes at the lowest cost. The implementation should be supported by healthcare professional’s capacity involved in the process.
AIM: The aim of the study was to assess healthcare professionals’ knowledge, skills, motivation, and commitment to clinical pathways (CPs) implementation in Universitas Sumatera Utara (USU) Hospital.
METHODS: This cross-sectional study was conducted at USU Hospital with 65 healthcare professionals as participants who consist of 10 specialist doctors, 50 nurses, and 5 pharmacists. These participants were selected using quota sampling and interviewed using a developed and structured questionnaire. This questionnaire was tested for its validity and reliability with r > 0.5 and Cronbach’s Alpha > 0.6. Pearson correlation test with p < 0.05 was used for analyzing the relationship among variables on CPs implementation.
RESULTS: The healthcare professionals in USU Hospital had high knowledge, motivation, and commitment, but moderate skills in CPs implementation. There were positive correlations between knowledge and skill (p = 0.039), motivation and skill (p = 0.001), commitment and skill (p = 0.001), and motivation and commitment (p = 0.001) on CPs implementation.
CONCLUSION: USU Hospital healthcare professional’s knowledge, motivation, and commitment to CPs implementation were adequate, but their skills were moderate. The motivation is substantially related to the healthcare professional’s commitment to CPs implementation. This study recommended the hospital explore and grow skills in communication, coordination, and affective commitment among individuals, teamwork, and leaders for the sake of willingness to achieve the values or goals of the CP implementation in their organization.
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Dmitriew C, Ohle R. Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome. Implement Sci Commun 2021; 2:60. [PMID: 34088362 PMCID: PMC8178923 DOI: 10.1186/s43058-021-00160-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The 2020 Canadian clinical practice guidelines for the diagnosis of AAS incorporate all available evidence into four key recommendations. In order to facilitate the implementation of these recommendations, a clinical decision aid was created. The objective of this study was to identify barriers and facilitators among physicians prior to implementation of the guideline recommendations in a multicentre step wedge cluster randomized control trial. METHODS We conducted semi-structured interviews with nine emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to guideline recommendation uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. RESULTS Two themes and six subthemes encompassing 13 theoretical domains were identified. These included clinical decision-making support, awareness of the evidence, social factors, expected consequences, ability of physicians to acquire the necessary data and ease of use. A majority of interviewees anticipated that the guideline recommendations would support clinical decision making and more effectively risk-stratify patients. Other facilitators included endorsement of the guidelines by professional organizations and peers. Barriers to implementation include the fact that laboratory testing and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the clinical decision aid and concerns about test specificity were also identified as potential barriers to use. CONCLUSION Physicians were amenable to using the AAS guideline recommendations to support clinical decision-making and to reduce resource use. A structured intervention should be developed to address the identified barriers and leverage the facilitators in order to ensure successful implementation. Our findings may have implications for the implementation of other guidelines used in emergency departments.
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Affiliation(s)
- Caitlin Dmitriew
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Robert Ohle
- The Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5 J1, Canada.
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Whitehorn A, Fu L, Porritt K, Lizarondo L, Stephenson M, Marin T, Aye Gyi A, Dell K, Mignone A, Lockwood C. Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs). Worldviews Evid Based Nurs 2021; 18:190-200. [PMID: 33973346 PMCID: PMC8251858 DOI: 10.1111/wvn.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
Background Low‐to‐middle income countries (LMICs) experience a high burden of disease from both non‐communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. Aim To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. Methods A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6‐month, multi‐phase, intensive evidence‐based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. Results A total of 60 implementation projects reporting 58 evidence‐based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process‐related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence‐based practice; most strategies were categorized as educational meetings for healthcare workers. Linking Evidence to Action Context‐specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low‐cost resources. Education for healthcare workers in LMICs is an effective awareness‐raising, workplace culture, and practice‐transforming strategy for evidence implementation.
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Affiliation(s)
| | - Liang Fu
- JBI, The University of Adelaide, Adelaide, SA, Australia.,Department of Nursing, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.,School of Nursing, Fudan University, Shanghai, China
| | - Kylie Porritt
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - Tania Marin
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Aye Aye Gyi
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Kim Dell
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Alex Mignone
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, The University of Adelaide, Adelaide, SA, Australia
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Wind M, Hendriks M, van Brussel BTJ, Eikenboom J, Allaart CF, Lamb HJ, Siebelink HMJ, Ninaber MK, van Geloven N, van Lith JMM, Huizinga TWJ, Rabelink TJ, Sueters M, Teng YKO. Effectiveness of a multidisciplinary clinical pathway for women with systemic lupus erythematosus and/or antiphospholipid syndrome. Lupus Sci Med 2021; 8:8/1/e000472. [PMID: 33952625 PMCID: PMC8103373 DOI: 10.1136/lupus-2020-000472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/05/2021] [Accepted: 04/18/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES SLE and/or antiphospholipid syndrome (SLE/APS) are complex and rare systemic autoimmune diseases that predominantly affect women of childbearing age. Women with SLE/APS are at high risk of developing complications during pregnancy. Therefore, clinical practice guidelines recommend that patients with SLE/APS should receive multidisciplinary counselling before getting pregnant. We investigated the clinical effectiveness of implementing a multidisciplinary clinical pathway including prepregnancy counselling of patients with SLE/APS. METHODS A clinical pathway with specific evaluation and prepregnancy counselling for patients with SLE/APS was developed and implemented in a tertiary, academic hospital setting. Patients were prospectively managed within the clinical pathway from 2014 onwards and compared with a retrospective cohort of patients that was not managed in a clinical pathway. Primary outcome was a combined outcome of disease flares for SLE and thromboembolic events for APS. Secondary outcomes were maternal and fetal pregnancy complications. RESULTS Seventy-eight patients with 112 pregnancies were included in this study. The primary combined outcome was significantly lower in the pathway cohort (adjusted OR (aOR) 0.20 (95% CI 0.06 to 0.75)) which was predominantly determined by a fivefold risk reduction of SLE flares (aOR 0.22 (95% CI 0.04 to 1.09)). Maternal and fetal pregnancy complications were not different between the cohorts (respectively, aOR 0.91 (95% CI 0.38 to 2.17) and aOR 1.26 (95% CI 0.55 to 2.88)). CONCLUSIONS The outcomes of this study suggest that patients with SLE/APS with a pregnancy wish benefit from a multidisciplinary clinical pathway including prepregnancy counselling.
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Affiliation(s)
- Merlijn Wind
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maike Hendriks
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen Eikenboom
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Y K Onno Teng
- Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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Jacobs D, Breen CT, Pucar D, Holt EH, Judson BL, Mehra S. Changes in Population-Level and Institutional-Level Prescribing Habits of Radioiodine Therapy for Papillary Thyroid Cancer. Thyroid 2021; 31:272-279. [PMID: 32811347 DOI: 10.1089/thy.2020.0237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In the past two decades, new evidence and guidelines have emerged to refine recommendations for the use of radioactive iodine (RAI) therapy after thyroidectomy for cancer. We aim to describe national trends in RAI utilization, assess the impact of individual hospitals on RAI utilization, and examine whether variation in prescribing habits has declined over time. Methods: The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with papillary thyroid cancer (PTC) who received total thyroidectomy. Trends were analyzed using Joinpoint analysis. Hospital-specific effects and variation in prescribing habits were assessed through a hierarchical, mixed regression model. Results: RAI utilization declined from 61.0% in 2004 to 43.9% in 2016. RAI use declined most profoundly in patients with T1a, N0/X, M0 PTC without extrathyroidal extension (34.8% in 2004 to 9.5% in 2015), but continues to be used commonly in patients with advanced disease for whom it is routinely recommended (73.4% in 2004 to 72.0% in 2015). Furthermore, ∼80% of hospitals in 2016 utilized at or below the median utilization rate in 2006. Variation in RAI utilization across hospitals decreased by ∼50% from 2004 to 2016 (Levene's test p < 0.001), with a significant decline (p = 0.002) in the variation after 2012 (confidence interval: 2010 to 2014). Conclusions: Recommendations for whom to prescribe RAI appear to have impacted both the number of patients receiving RAI and the variation in prescribing habits across hospitals. Hospital selection has contributed less to the probability of receiving RAI over time.
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Affiliation(s)
- Daniel Jacobs
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher T Breen
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Darko Pucar
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth H Holt
- Division of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Apte Y, Jacobs K, Shewdin S, Murray A, Tung L, Ramanan M, Massey D. Prone positioning in patients with acute respiratory distress syndrome, translating research and implementing practice change from bench to bedside in the era of coronavirus disease 2019. Aust Crit Care 2021; 34:176-181. [PMID: 33487546 PMCID: PMC7825921 DOI: 10.1016/j.aucc.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 01/21/2023] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is a relatively common condition of varied aetiology associated with high morbidity and mortality. A range of therapies have been proven to be useful for patients with ARDS, including ventilatory and nonventilatory strategies. Prone positioning is one of the nonventilatory strategies and has been proven to be safe and is associated with significant mortality benefit in patients with moderate to severe ARDS. It is now included in several international guidelines as the standard of care for these cases. Objectives The aim of the study was to develop, implement, and evaluate a prone positioning program in two nonmetropolitan, nontertiary intensive care units in South East Queensland. Methods A Plan–Do–Study–Act quality improvement model was used to implement changes in clinical practice in relation to prone positioning of patients. Results A description of the methods used to promote a complex change strategy is provided in this article. Conclusions In this article, we demonstrate the feasibility of introducing a nonventilatory intervention of prone positioning in the management of patients with moderate to severe ARDS in regional intensive care in South East Queensland. This implementation strategy could be replicated and adopted in other similar intensive care units that do not have the ability to provide tertiary services such as extracorporeal life support.
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Affiliation(s)
- Yogesh Apte
- Intensive Care Unit, Redcliffe Hospital, Australia; Intensive Care Unit, Caboolture Hospital, Australia; University of Queensland, Australia.
| | - Kylie Jacobs
- Intensive Care Unit, Redcliffe Hospital, Australia; University of Queensland, Australia
| | - Shaun Shewdin
- Intensive Care Unit, Redcliffe Hospital, Australia; Intensive Care Unit, Caboolture Hospital, Australia; University of Queensland, Australia
| | - Andrew Murray
- Intensive Care Unit, Redcliffe Hospital, Australia; Intensive Care Unit, Caboolture Hospital, Australia; University of Queensland, Australia
| | - Luke Tung
- Intensive Care Unit, Redcliffe Hospital, Australia; Intensive Care Unit, Caboolture Hospital, Australia
| | - Mahesh Ramanan
- Intensive Care Unit, Redcliffe Hospital, Australia; Intensive Care Unit, Caboolture Hospital, Australia; University of Queensland, Australia; Intensive Care Unit, Prince Charles Hospital, Australia; The George Institute for Global Health, Australia; University of New South Wales, Australia
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Serv Res 2021; 21:11. [PMID: 33397382 PMCID: PMC7784254 DOI: 10.1186/s12913-020-06011-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.
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Affiliation(s)
- R van Zelm
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - E Coeckelberghs
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Sermeus
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Quality, Academic Policy Advisor, University Hospital Leuven, Leuven, Belgium
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Daghash H, Lim Abdullah K, Ismail MD. The effect of acute coronary syndrome care pathways on in-hospital patients: A systematic review. J Eval Clin Pract 2020; 26:1280-1291. [PMID: 31489762 DOI: 10.1111/jep.13280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/31/2019] [Accepted: 08/21/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Health care institutions need to construct management strategies for patients diagnosed with acute coronary syndrome (ACS) that focus on evidence-based treatments, adherence to treatment guidelines, and organized care. These help to reduce variations as well as the mortality and morbidity rates, which indicates the critical need for standardized care and adherence to evidence-based practices for patients hospitalized with ACS. The care pathways translate research and guidelines into clinical practice to close the gap between the guidelines and the clinical practices. OBJECTIVES This review focuses on identifying the indicators used to evaluate ACS care pathways and their effect on the care process and clinical outcomes. METHODS This review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The systematic research was conducted using five research databases. Two groups were created by dividing the studies according to their year of publication. The first group included those studies published from 1997 to 2007 ("Group 1"), while the second included those published from 2008 to 2018 ("Group 2"). Selected studies were screened using the Effective Public Health Practice Project (EPHPP) quality assessment tool. RESULTS Seventeen studies were included in this review. One study was a randomized controlled trial, 14 were predesigns and postdesigns, and two were longitudinal observational designs. The Group 1 studies demonstrated that ACS care pathways had a positive effect on reducing the length of the hospital stay and the door-to-balloon times. Similar effects were observed for the Group 2 studies. CONCLUSION Implementing ACS care pathway helps to organize care processes and decrease treatment delays as well as improve the patient outcomes without adverse consequences for patients or additional resources and costs. While the current level of evidence is inadequate to warrant a formal recommendation, there is a need for more studies with an emphasis on well-designed randomization to measure patient outcomes.
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Affiliation(s)
- Hanan Daghash
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Oliwa JN, Odero SA, Nzinga J, van Hensbroek MB, Jones C, English M, van’t Hoog A. Perspectives and practices of health workers around diagnosis of paediatric tuberculosis in hospitals in a resource-poor setting - modern diagnostics meet age-old challenges. BMC Health Serv Res 2020; 20:708. [PMID: 32738917 PMCID: PMC7395417 DOI: 10.1186/s12913-020-05588-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Detection of tuberculosis (TB) in children in Kenya is sub-optimal. Xpert MTB/RIF® assay (Xpert®) has the potential to improve speed of TB diagnosis due to its sensitivity and fast turnaround for results. Significant effort and resources have been put into making the machines widely available in Kenya, but use remains low, especially in children. We set out to explore the reasons for the under-detection of TB and underuse of Xpert® in children, identifying challenges that may be relevant to other newer diagnostics in similar settings. METHODS This was an exploratory qualitative study with an embedded case study approach. Data collection involved semi-structured interviews; small-group discussions; key informant interviews; observations of TB trainings, sensitisation meetings, policy meetings, hospital practices; desk review of guidelines, job aides and policy documents. The Capability, Opportunity and Motivation (COM-B) framework was used to interpret emerging themes. RESULTS At individual level, knowledge, skill, competence and experience, as well as beliefs and fears impacted on capability (physical & psychological) as well as motivation (reflective) to diagnose TB in children and use diagnostic tests. Hospital level influencers included hospital norms, processes, patient flows and resources which affected how individual health workers attempted to diagnose TB in children by impacting on their capability (physical & psychological), motivation (reflective & automatic) and opportunity (physical & social). At the wider system level, community practices and beliefs, and implementation of TB programme directives impacted some of the decisions that health workers made through capability (psychological), motivation (reflective & automatic) and opportunity (physical). CONCLUSION We used comprehensive approaches to identify influencers of TB case detection and use of TB diagnostic tests in children in Kenya. These results are being used to design a contextually-appropriate intervention to improve TB diagnosis, which may be relevant to similar low-resource, high TB burden countries and can be feasibly implemented by the National TB programme.
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Affiliation(s)
- Jacquie Narotso Oliwa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Michaël Boele van Hensbroek
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Caroline Jones
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Anja van’t Hoog
- Department of Global Health, The Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Bertilsson E, Serhal S, Emmerton L, Bosnic-Anticevich S, Krass I, Bereznicki B, Bereznicki L, Armour C, Saini B. Pharmacists experience of and perspectives about recruiting patients into a community pharmacy asthma service trial. Res Social Adm Pharm 2020; 17:595-605. [PMID: 32448767 DOI: 10.1016/j.sapharm.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Research trials testing the impact of community pharmacy services require adequate and appropriate recruitment of patients by participating pharmacists, however, this step presents an ongoing challenge. OBJECTIVE To identify factors affecting recruitment of patients in community pharmacies participating in a multi-center trial of a pharmacy asthma service in Australia (Pharmacy Trial Program - Asthma and Rhinitis Control (PTP-ARC). METHODS The PTP-ARC protocol required identification and recruitment of seven eligible asthma patients per pharmacy. Pharmacists responsible for sites that failed to recruit or retain any patients into the PTP-ARC trial participated in a semi-structured telephone interview about their experiences with these elements of the trial. The interviews were recorded, transcribed and coded using QSR International's NVivo 11 software. The analysis was conducted with reference to the COM-B framework (Capability, Opportunity, Motivation). RESULTS Pharmacists from 47 of 50 eligible pharmacies were interviewed. Seventeen factors were isolated and mapped to the COM-B framework. Psychological capability (recruitment hesitancy, research literacy and health literacy), physical capability (technological barriers, staffing issues and pharmacy busyness), physical opportunity (patient busyness, trial timing, study protocol, support and location), social opportunity (health literacy and supportive milieu), reflective motivation (incentive for participation, simplification) and automatic motivation (patient attitudes and pharmacist-felt experience) were factors affecting pharmacists' participation. Challenges identified included: issues with the software, unfamiliarity with research procedures generally (and specifically with the PTP-ARC protocols), the patients' lack of interest and pharmacists' lack of time. CONCLUSIONS To the best of our knowledge, this is the first study to focus on issues affecting patient recruitment into a pharmacy health services (asthma) trial in real time. To propel evidence-based trials towards practice implementation, user-friendly software, pharmacists' training on research and patient-engagement and adequate remuneration to address pharmacist time issues need to be key foci for health services design and implementation research.
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Affiliation(s)
| | - Sarah Serhal
- Woolcock Institute of Medical Research - 431 Glebe Point Road, Glebe, NSW, 2031, Australia.
| | - Lynne Emmerton
- Curtin University - School of Pharmacy and Biomedical Sciences, Building 306, Brand Drive, Curtin University Bentley Campus, Perth, WA, 6845, Australia.
| | | | - Ines Krass
- The University of Sydney -The University of Sydney, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Bonnie Bereznicki
- University of Tasmania - Tasmanian School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania, 7001, Australia.
| | - Luke Bereznicki
- University of Tasmania - School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Carol Armour
- Woolcock Institute of Medical Research - 431 Glebe Point Road, Glebe, NSW, 2031, Australia
| | - Bandana Saini
- The University of Sydney -The University of Sydney, A15, Science Rd, Camperdown, NSW, 2006, Australia.
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Dwyer M, Peterson GM, Gall S, Francis K, Ford KM. Health care providers' perceptions of factors that influence the provision of acute stroke care in urban and rural settings: A qualitative study. SAGE Open Med 2020; 8:2050312120921088. [PMID: 32435489 PMCID: PMC7223863 DOI: 10.1177/2050312120921088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/26/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives Individuals living in rural areas have comparatively less access to acute stroke care than their urban counterparts. Understanding the local barriers and facilitators to the use of current best practice for acute stroke may inform efforts to reduce this disparity. Methods A qualitative study featuring semi-structured interviews and focus groups was conducted in the Australian state of Tasmania. Clinical staff from a range of disciplines involved in acute stroke care were recruited from three of the state's four major public hospitals (one urban and two rural). A semi-structured interview guide based on the findings of an earlier quantitative study was used to elicit discussion about the barriers and facilitators associated with providing acute stroke care. An inductive process of thematic analysis was then used to identify themes and subthemes across the data set. Results Two focus groups and five individual interviews were conducted. Four major themes were identified from analysis of the data: systemic issues, clinician factors, additional support and patient-related factors. Acute stroke care within the study's urban hospital was structured and comprehensive, aided by the hospital's acute stroke unit and specialist nursing support. In contrast, care provided in the study's rural hospitals was somewhat less comprehensive, and often constrained by an absence of infrastructure or poor access to existing resources. Conclusion The identified factors help to characterise acute stroke care within urban and rural hospitals and will assist quality improvement efforts in Tasmania's hospitals.
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Affiliation(s)
- Mitchell Dwyer
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
| | | | - Seana Gall
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
| | - Karen Francis
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
| | - Karen M Ford
- Tasmanian Health Service, Hobart, TAS, Australia
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Arakelian E, Hellman T, Svartengren M. Experiences of the Initial Phase Implementation of the STAMINA-Model in Perioperative Context Addressing Environmental Issues Systematically-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3037. [PMID: 32349408 PMCID: PMC7246937 DOI: 10.3390/ijerph17093037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022]
Abstract
(1) Background: Challenges in perioperative settings put demands on staff working with systematic work environment management. A support model, STAMINA (Structured and Time-effective Approach through Methods for an Inclusive and Active working life), was implemented in a hospital in Sweden, to help staff address environmental issues systematically. The aim was to describe the experiences of the initial phase of implementation of the adapted STAMINA model in perioperative context. (2) Methods: Qualitative individual interviews were held with 14 managers and employees (three men and 11 women). Data were analysed by systematic text condensation. (3) Results: Five themes were identified: Limited knowledge of the model and the implementation process; scepticism, lack of confidence in the model and a passive attitude; the model offered increased participation; the culture in the organization-to understand one's role as employees and managers; and endurance and feedback are key factors for success in the implementation process. (4) Conclusions: Scepticism turned to positive attitude by recognising that the STAMINA model offered increased participation. In order to have successful implementation, the organisational culture must be taken into consideration by giving the employees increased responsibilities and timely feedbacks. Role description, goal definition, feedback, and sticking to one model are key factors for success.
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Affiliation(s)
- Erebouni Arakelian
- Department of Surgical Sciences, Uppsala University, and AnOpIVA, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, 752 36 Uppsala, Sweden; (T.H.); (M.S.)
| | - Magnus Svartengren
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, 752 36 Uppsala, Sweden; (T.H.); (M.S.)
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Kwok C, Levesque L, DeWit Y, Olajos-Clow J, Madeley C, Jabbour M, To T, Lougheed MD. Implementation of Ontario's emergency department asthma care pathway for adults: determinants of uptake. J Asthma 2019; 58:378-385. [PMID: 31738603 DOI: 10.1080/02770903.2019.1694940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Ontario Government funded the development and implementation of a standardized adult emergency department (ED) asthma care pathway (EDACP). We aimed to describe baseline patterns of ED use by adults for asthma in Ontario, Canada, and determine site characteristics associated with the EDACP implementation workshop attendance and subsequent pathway implementation. METHODS All Ontario EDs were offered EDACP implementation workshops by the Lung Assocation-Ontario between 2008 and 2011, and were surveyed regarding site implementation status as of October, 2013. Survey data were linked by site to Ontario's administrative health databases. Logistic regression models investigated the association between site and patient characteristics and: a) workshop attendance; b) pathway implementation. RESULTS In the 2 years prior to EDACP implementation, there were 41 143 asthma visits to 167 sites by adults (62.3% female). Asthma-related return visits within 72 h varied by hospital type (teaching 2.1%, community 2.8%, small 4.0%; p < 0.05). Implementation workshops were attended by staff from 122 sites (72.6%). Implementation status was known for 108 sites and varied by hospital type (p < 0.001), but not workshop attendance (p = 0.11). By 2013, 47% of all hospitals were using or planning to use the EDACP. Uptake was more likely in community hospitals. CONCLUSIONS Ontario adult asthma ED visitors are more often women. Asthma-related return visits are uncommon, but significantly higher in small community hospitals. This provincial QI initiative reached almost 75% of Ontario EDs, and achieved almost 50% implementation rate within 2 years. Factors other than workshop attendance, such as hospital size, were associated with EDACP implementation.
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Affiliation(s)
- Chanel Kwok
- Asthma Research Unit, Kingston Health Sciences Centre, Department of Medicine, Queen's University, Kingston, Canada
| | - Linda Levesque
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Yvonne DeWit
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jennifer Olajos-Clow
- Asthma Research Unit, Kingston Health Sciences Centre, Department of Medicine, Queen's University, Kingston, Canada
| | | | - Mona Jabbour
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Teresa To
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Dalla Lana Graduate School of Public Health, University of Toronto, Toronto, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Department of Medicine, Queen's University, Kingston, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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Dineen-Griffin S, Garcia-Cardenas V, Rogers K, Williams K, Benrimoj SI. Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13973. [PMID: 31400107 PMCID: PMC6709938 DOI: 10.2196/13973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 01/17/2023] Open
Abstract
Background Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. Objective This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. Methods The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost-utility and cost-effectiveness analysis compared with usual care. Results The study began in July 2018. Thirty community pharmacies were recruited. Pharmacists from the 15 intervention pharmacies were trained. A total of 27 general practices consented. Pharmacy patient recruitment began in August 2018 and was completed on March 31, 2019. Conclusions This study may demonstrate the efficacy of a protocolized intervention to manage minor ailments in the community and will assess the clinical, economic, and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and appropriate self-medication may contribute to greater efficiency of health care resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a national MAS service in Australia, using a robust framework for management and referral for common ailments. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/13973
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Affiliation(s)
| | | | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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Kourouche S, Buckley T, Van C, Munroe B, Curtis K. Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study. BMC Health Serv Res 2019; 19:461. [PMID: 31286954 PMCID: PMC6615309 DOI: 10.1186/s12913-019-4177-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term ‘care bundle’ (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway. Electronic supplementary material The online version of this article (10.1186/s12913-019-4177-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Kourouche
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia.
| | - Tom Buckley
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia
| | - Connie Van
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia
| | - Belinda Munroe
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia.,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia
| | - Kate Curtis
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia.,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia
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