1
|
Langaas HC, Salvesen Ø, Dyrkorn R, Blix HS, Spigset O. Academic Detailing Compared with Group Meetings to Change Drug Prescribing for Type 2 Diabetes-A Randomized Controlled Trial. J Gen Intern Med 2024:10.1007/s11606-024-09014-z. [PMID: 39231850 DOI: 10.1007/s11606-024-09014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/16/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Academic detailing (AD) is a one-on-one educational outreach with the goal to improve prescribing. There is insufficient evidence on the difference in impact between AD and group visits to facilitate behavior change among general practitioners (GPs). OBJECTIVE To compare the impact of individual AD visits and group visits conveying the same content on treatment of type 2 diabetes (T2D). DESIGN Randomized controlled trial. PARTICIPANTS GPs in Central Norway, visited September - November 2018. INTERVENTION A total of 210 GPs were randomized and invited to an individual AD visit lasting 20 min; 193 were visited, of whom 146 were included in the analyses. In addition, 293 GPs were randomized and invited to a group meeting lasting 30-45 min; 261 were visited, of whom 188 were included in the analyses. Finally, 167 GPs were randomized and included in a control group. Visits were conducted by trained pharmacists and physicians. MAIN MEASURES Changes in prescribing of metformin and other T2D drugs after the intervention. KEY RESULTS The use of metformin increased with 5.9% the year after AD and with 4.9% the year after group meetings, compared to no change (0.0%) in the control group (p = 0.006 and p = 0.016, respectively). There was no significant difference between the two intervention groups. The only drug group with a statistically significant difference between interventions was insulins, with an increase of 3.2% after AD compared to 19.1% after group visits (p < 0.001). For GLP-1 analogues (p = 0.031) and T2D drugs in total (p = 0.010), we found a significant difference between group intervention and control. Other differences between study groups did not reach statistical significance. CONCLUSIONS Short educational visits of 20-45 min impact the prescribing of drugs for T2D, either the education is given one-on-one as AD or in a group setting.
Collapse
Affiliation(s)
- Harald Christian Langaas
- The Hospital Pharmacy in Trondheim, Edvard Griegs Gt. 10, 7030, Trondheim, Norway.
- KUPP - The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Central Norway Pharmaceutical Trust, Trondheim, Norway.
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Roar Dyrkorn
- KUPP - The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| | - Hege Salvesen Blix
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
2
|
Skurla SE, Leishman NJ, Fagerlin A, Wiener RS, Lowery J, Caverly TJ. Clinician Perceptions on Using Decision Tools to Support Prediction-Based Shared Decision Making for Lung Cancer Screening. MDM Policy Pract 2024; 9:23814683241252786. [PMID: 38779527 PMCID: PMC11110512 DOI: 10.1177/23814683241252786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Background Considering a patient's full risk factor profile can promote personalized shared decision making (SDM). One way to accomplish this is through encounter tools that incorporate prediction models, but little is known about clinicians' perceptions of the feasibility of using these tools in practice. We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS). Design We conducted a qualitative study based on field notes from academic detailing visits during a multisite quality improvement program. The detailer engaged one-on-one with 96 primary care clinicians across multiple Veterans Affairs sites (7 medical centers and 6 outlying clinics) to get feedback on 1) the rationale for prediction-based LCS and 2) how to use the DecisionPrecision (DP) encounter tool with eligible patients to personalize LCS discussions. Results Thematic content analysis from detailing visit data identified 6 categories of clinician willingness to use the DP tool to personalize SDM for LCS (adoption potential), varying from "Enthusiastic Potential Adopter" (n = 18) to "Definite Non-Adopter" (n = 16). Many clinicians (n = 52) articulated how they found the concept of prediction-based SDM highly appealing. However, to varying degrees, nearly all clinicians identified challenges to incorporating such an approach in routine practice. Limitations The results are based on the clinician's initial reactions rather than longitudinal experience. Conclusions While many primary care clinicians saw real value in using prediction to personalize LCS decisions, more support is needed to overcome barriers to using encounter tools in practice. Based on these findings, we propose several strategies that may facilitate the adoption of prediction-based SDM in contexts such as LCS. Highlights Encounter tools that incorporate prediction models promote personalized shared decision making (SDM), but little is known about clinicians' perceptions of the feasibility of using these tools in practice.We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).While many clinicians found the concept of prediction-based SDM highly appealing, nearly all clinicians identified challenges to incorporating such an approach in routine practice.We propose several strategies to overcome adoption barriers and facilitate the use of prediction-based SDM in contexts such as LCS.
Collapse
Affiliation(s)
- Sarah E. Skurla
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | | | - Angela Fagerlin
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Julie Lowery
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Tanner J. Caverly
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Luetsch K, Wong G, Rowett D. A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter. BMJ Qual Saf 2023; 33:43-54. [PMID: 37142414 PMCID: PMC10804006 DOI: 10.1136/bmjqs-2022-015498] [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: 08/29/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many quality improvement initiatives in healthcare employ educational outreach visits, integrating academic detailing to bridge evidence-practice gaps and accelerate knowledge translation. Replicability of their outcomes in different contexts varies, and what makes some visiting programmes more successful than others is unclear. OBJECTIVE We conducted a realist synthesis to develop theories of what makes educational outreach visiting integrating academic detailing work, for whom, under which circumstances and why, focusing on the clinician-visitor interaction when influencing prescribing of medicines in ambulatory care settings. METHODS The realist review was performed in accordance with RAMESES standards. An initial programme theory was generated, academic databases and grey literature were screened for documents with detail on contexts, intervention and outcomes. Using realist logic of analysis, data from 43 documents were synthesised in the generation of a refined programme theory, supported by additional theoretical frameworks of learning and communication. RESULTS Twenty-seven interdependent context-mechanism-outcome configurations explain how clinicians engage with educational outreach visits integrating academic detailing through programme design, what matters in programme design and the educational visitor-clinician interaction and how influence extends beyond the visit. They suggest that in addition to relevance, credibility and trustworthiness of a visit's contents, communication and clinical skills of educational visitors, the relationship between the educational visitor and clinician, built on a dialogue of learning from and sense-making with each other, creates conditions of critical thinking which are conducive to facilitating prescribing practice change when necessary. CONCLUSION This realist synthesis elucidates that the quality of clinician-educational visitor interactions is pivotal to educational outreach visiting programmes. Building and sustaining relationships, and establishing an open dialogue are important; neglecting these undermines the impact of visits. Educational visitors can facilitate clinicians' reflection on practice and influence their prescribing. Clinicians value the discussion of individualised, tailored information and advice they can translate into their practice. PROSPERO REGISTRATION NUMBER CRD42021258199.
Collapse
Affiliation(s)
- Karen Luetsch
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debra Rowett
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
4
|
Langaas HC, Salvesen Ø, Dyrkorn R, Blix HS, Spigset O. Academic detailing as a method to improve general practitioners' drug prescribing in type 2 diabetes: evaluation of changes in prescribing. Scand J Prim Health Care 2023; 41:224-231. [PMID: 37326464 PMCID: PMC10478614 DOI: 10.1080/02813432.2023.2222781] [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: 09/14/2022] [Accepted: 06/04/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To investigate the effect of an academic detailing intervention on the utilisation of type 2 diabetes medication among general practitioners. DESIGN We developed an academic detailing campaign based on the revised national treatment guideline for diabetes and the best available evidence. General practitioners were offered a 20-minute one-to-one visit by a trained academic detailer. SETTING AND SUBJECTS A total of 371 general practitioners received a visit and represented the intervention group. The control group consisted of 1282 general practitioners not receiving a visit. MAIN OUTCOME MEASURES Changes in prescribing from 12 months before to 12 months after the intervention. The primary endpoint was a change in metformin. Secondary endpoints were changes in other groups of Type 2 diabetes medication and of these drugs in total. RESULTS Prescribing of metformin increased by 7.4% in the intervention group and 5.2% in the control group (p = .043). Sodium-glucose cotransporter-2 inhibitors increased by 27.6% in the intervention group and 33.8% in the control group (p = .019). For sulfonylureas there was a decrease of 3.6% in the intervention group vs. 8.9% in the control group (p = .026). The total amount of prescribed medications for type 2 diabetes increased by 9.1% in the intervention group and 7.3% in the control group (p = .08). CONCLUSION Academic detailing initiated a small but statistically significant increase in the prescription of metformin. For a complex subject like type 2 diabetes, we recommend reserving more time in the visit than the 20 min our campaign aimed for.
Collapse
Affiliation(s)
- Harald Christian Langaas
- KUPP – The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Roar Dyrkorn
- KUPP – The Norwegian Academic Detailing Program, Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
5
|
Arora P, Muehrcke M, Russell M, Jayasekare R. Impact of comparative effectiveness research on Medicare coverage of direct oral anticoagulants. J Comp Eff Res 2022; 11:1105-1120. [PMID: 36065839 DOI: 10.2217/cer-2021-0307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the association of comparative effectiveness research with Medicare coverage of direct oral anticoagulants. Materials & methods: A literature review for direct oral anticoagulants was conducted from 2011 to 2017. Monthly prescription drug plan and formulary files (n = 28) were used to conduct change-point analysis and assess each outcome variable. Results: Up to 2013, studies showed that dabigatran was more effective than rivaroxaban. In 2015, apixaban was shown to be the safest and most effective drug in comparison with all direct oral anticoagulants. In 2016-2017, dabigatran and apixaban were shown to have similar efficacy. Approximately 75% of plans covered dabigatran under tier 3 until 2015. From 2011 to 2017, less than 30% of plans required prior authorizations, 50% imposed quantity limits and mean copayment was lowest for rivaroxaban. Conclusion: Consistent with comparative effectiveness research, Medicare plans covered apixaban more favorably and edoxaban less favorably. However, discrepancies in comparative effectiveness research translation were found for rivaroxaban and dabigatran.
Collapse
Affiliation(s)
- Prachi Arora
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, USA
| | - Maria Muehrcke
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, USA
| | - Molly Russell
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, USA
| | - Rasitha Jayasekare
- Department of Mathematics, Statistics and Actuarial Science, College of Liberal Arts and Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, USA
| |
Collapse
|
6
|
Rindal DB, Kottke TE, Jurkovich MW, Asche SE, Enstad CJ, Truitt AR, Ziegenfuss JY, Romito LM, Thyvalikakath TP, O'Donnell J, Spallek H. FINDINGS AND FUTURE DIRECTIONS FROM A SMOKING CESSATION TRIAL UTILIZING A CLINICAL DECISION SUPPORT TOOL. J Evid Based Dent Pract 2022; 22:101747. [DOI: 10.1016/j.jebdp.2022.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
|
7
|
Xie Y, Zaccagna F, Rundo L, Testa C, Agati R, Lodi R, Manners DN, Tonon C. Convolutional Neural Network Techniques for Brain Tumor Classification (from 2015 to 2022): Review, Challenges, and Future Perspectives. Diagnostics (Basel) 2022; 12:diagnostics12081850. [PMID: 36010200 PMCID: PMC9406354 DOI: 10.3390/diagnostics12081850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 12/21/2022] Open
Abstract
Convolutional neural networks (CNNs) constitute a widely used deep learning approach that has frequently been applied to the problem of brain tumor diagnosis. Such techniques still face some critical challenges in moving towards clinic application. The main objective of this work is to present a comprehensive review of studies using CNN architectures to classify brain tumors using MR images with the aim of identifying useful strategies for and possible impediments in the development of this technology. Relevant articles were identified using a predefined, systematic procedure. For each article, data were extracted regarding training data, target problems, the network architecture, validation methods, and the reported quantitative performance criteria. The clinical relevance of the studies was then evaluated to identify limitations by considering the merits of convolutional neural networks and the remaining challenges that need to be solved to promote the clinical application and development of CNN algorithms. Finally, possible directions for future research are discussed for researchers in the biomedical and machine learning communities. A total of 83 studies were identified and reviewed. They differed in terms of the precise classification problem targeted and the strategies used to construct and train the chosen CNN. Consequently, the reported performance varied widely, with accuracies of 91.63–100% in differentiating meningiomas, gliomas, and pituitary tumors (26 articles) and of 60.0–99.46% in distinguishing low-grade from high-grade gliomas (13 articles). The review provides a survey of the state of the art in CNN-based deep learning methods for brain tumor classification. Many networks demonstrated good performance, and it is not evident that any specific methodological choice greatly outperforms the alternatives, especially given the inconsistencies in the reporting of validation methods, performance metrics, and training data encountered. Few studies have focused on clinical usability.
Collapse
Affiliation(s)
- Yuting Xie
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (F.Z.); (R.L.); (C.T.)
| | - Fulvio Zaccagna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (F.Z.); (R.L.); (C.T.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Leonardo Rundo
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, 84084 Fisciano, Italy;
| | - Claudia Testa
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
- Department of Physics and Astronomy, University of Bologna, 40127 Bologna, Italy
| | - Raffaele Agati
- Programma Neuroradiologia con Tecniche ad elevata complessità, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (F.Z.); (R.L.); (C.T.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - David Neil Manners
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (F.Z.); (R.L.); (C.T.)
- Correspondence:
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (F.Z.); (R.L.); (C.T.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| |
Collapse
|
8
|
Lowery J, Fagerlin A, Larkin AR, Wiener RS, Skurla SE, Caverly TJ. Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation. JMIR Hum Factors 2022; 9:e32399. [PMID: 35363144 PMCID: PMC9015752 DOI: 10.2196/32399] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 11/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Lung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient’s individualized lung cancer risk and estimated net benefit. Objective The objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD). Methods Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits. Results Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI −5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits. Conclusions The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients. Trial Registration ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412
Collapse
Affiliation(s)
- Julie Lowery
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics Decision-Enhancement and Analytics Sciences Center for Innovation, VA Salt Lake City Healthcare System, Salt Lake City, MI, United States
| | - Angela R Larkin
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States
| | - Renda S Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Sarah E Skurla
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States
| | - Tanner J Caverly
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States
- Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
9
|
Enguidanos S, Storms AD, Lomeli S, van Zyl C. Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study. J Palliat Med 2022; 25:1179-1185. [PMID: 35119300 DOI: 10.1089/jpm.2021.0559] [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: 11/12/2022] Open
Abstract
Background: Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. Methods: We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital. We used the Palliative Care Knowledge Scale (PaCKS) to assess palliative care knowledge. Two questions measured intention to enroll in palliative care. Paired sample t-tests were conducted to investigate change in PaCKS scores. McNemar's test was used to compare differences in intentions to enroll in palliative care from pretest to posttest. We conducted linear regression analysis to determine factors associated with improved knowledge at posttest. Results: PaCKS scores revealed significant improvement in palliative care knowledge following viewing of the video, with scores increasing from an average of 6.4-11.4 at posttest. Intentions to enroll a family member in palliative care increased from 64% at pretest to 64%-98% at posttest. Intentions to enroll oneself increased from 72% to 92%. Conclusions: Brief exposure to a relatable role model may be effective in improving knowledge and intentions to enroll in palliative care services. More research is needed to determine if these videos are effective in increasing enrollment in palliative care.
Collapse
Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Aaron D Storms
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Carin van Zyl
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| |
Collapse
|
10
|
Veziari Y, Kumar S, Leach M. Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review. BMC Complement Med Ther 2021; 21:201. [PMID: 34266441 PMCID: PMC8281683 DOI: 10.1186/s12906-021-03371-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. METHODS The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. RESULTS Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. CONCLUSIONS While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.
Collapse
Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, East Lismore, NSW 2480 Australia
| |
Collapse
|
11
|
Buchlak QD, Esmaili N, Leveque JC, Bennett C, Farrokhi F, Piccardi M. Machine learning applications to neuroimaging for glioma detection and classification: An artificial intelligence augmented systematic review. J Clin Neurosci 2021; 89:177-198. [PMID: 34119265 DOI: 10.1016/j.jocn.2021.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
Glioma is the most common primary intraparenchymal tumor of the brain and the 5-year survival rate of high-grade glioma is poor. Magnetic resonance imaging (MRI) is essential for detecting, characterizing and monitoring brain tumors but definitive diagnosis still relies on surgical pathology. Machine learning has been applied to the analysis of MRI data in glioma research and has the potential to change clinical practice and improve patient outcomes. This systematic review synthesizes and analyzes the current state of machine learning applications to glioma MRI data and explores the use of machine learning for systematic review automation. Various datapoints were extracted from the 153 studies that met inclusion criteria and analyzed. Natural language processing (NLP) analysis involved keyword extraction, topic modeling and document classification. Machine learning has been applied to tumor grading and diagnosis, tumor segmentation, non-invasive genomic biomarker identification, detection of progression and patient survival prediction. Model performance was generally strong (AUC = 0.87 ± 0.09; sensitivity = 0.87 ± 0.10; specificity = 0.0.86 ± 0.10; precision = 0.88 ± 0.11). Convolutional neural network, support vector machine and random forest algorithms were top performers. Deep learning document classifiers yielded acceptable performance (mean 5-fold cross-validation AUC = 0.71). Machine learning tools and data resources were synthesized and summarized to facilitate future research. Machine learning has been widely applied to the processing of MRI data in glioma research and has demonstrated substantial utility. NLP and transfer learning resources enabled the successful development of a replicable method for automating the systematic review article screening process, which has potential for shortening the time from discovery to clinical application in medicine.
Collapse
Affiliation(s)
- Quinlan D Buchlak
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Nazanin Esmaili
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia; Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Christine Bennett
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Farrokh Farrokhi
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Massimo Piccardi
- Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
12
|
Arora P, Look KA, Kreling DH. Does evidence matter? Comparative effectiveness research and prescribing of Type 2 diabetes mellitus drugs. J Comp Eff Res 2019; 8:1393-1403. [PMID: 31789054 DOI: 10.2217/cer-2019-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations were found in DPP4 inhibitors market. The translation of evidence into practice can be limited by the availability of superiority trials and timing of their availability.
Collapse
Affiliation(s)
- Prachi Arora
- College of Pharmacy & Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, USA
| | - Kevin A Look
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705-2222, USA
| | - David H Kreling
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705-2222, USA
| |
Collapse
|
13
|
Plow M, Finlayson M, Liu J, Motl RW, Bethoux F, Sattar A. Randomized Controlled Trial of a Telephone-Delivered Physical Activity and Fatigue Self-management Interventions in Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2019; 100:2006-2014. [DOI: 10.1016/j.apmr.2019.04.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
|
14
|
Decreasing Resource Utilization Using Standardized Clinical Assessment and Management Plans (SCAMPs). J Pediatr Orthop 2019; 39:169-174. [PMID: 30839474 DOI: 10.1097/bpo.0000000000000873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standardized clinical assessment and management plans (SCAMPs) are a novel quality improvement initiative shown to improve patient care, diminish practice variation, and reduce resource utilization. Unlike clinical practice guidelines, a SCAMP is a flexible algorithm that undergoes iterative updates based on periodic data collection and review. We recently implemented a SCAMP for the closed treatment of pediatric torus fractures. The purpose of this study is to analyze the effect of SCAMP implementation on resource utilization, practice variability, cost of care, and outcomes. METHODS This study was a retrospective review of prospectively collected data on 273 patients with pediatric torus fractures. The pre-SCAMP cohort included 116 subjects from 2008 to 2010. The SCAMP cohort included 157 subjects from 2011 to 2013. The pre-SCAMP cohort was treated according to the judgment of attending fellowship-trained pediatric orthopaedic surgeons. The SCAMP cohort was treated with a standardized algorithm including radiographs and splint application at initial presentation, with a single follow-up at 3 weeks. Patient demographics were analyzed to verify comparability between cohorts. Follow-up data including clinic visits, x-rays and practice variability was recorded. Costing analysis was conducted using time-derived activity-based costing methodology. Outcomes were compared using Poisson regression analysis. Incident rate ratios (IRR) with 95% confidence limits were estimated. RESULTS No differences in clinical results were observed between the pre-SCAMP and SCAMP cohorts, and all patients demonstrated return to baseline activity at final follow-up. Patient demographics were comparable across cohorts. The SCAMP cohort had a 48% reduction in clinic visits [IRR, 0.52; 95% confidence interval (CI), 0.44-0.60; P<0.001], 60% reduction in x-rays (IRR, 0.40; CI, 0.33-0.47; P<0.001), and a 23% reduction in x-rays per clinic visit (IRR, 0.77; 95% CI, 0.65-0.91; P<0.001). Furthermore, SCAMP implementation resulted in a 49% reduction in the overall cost of care. CONCLUSIONS SCAMPs provide a novel alternative to CPGs to implement cost effective changes in Orthopaedic practice. For pediatric torus fractures, SCAMP implementation resulted in decreased practice variability, resource utilization, and overall cost of care while maintaining clinical outcomes. LEVEL OF EVIDENCE Level 3.
Collapse
|
15
|
Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, Laeuchli S, Mosti G, Probst S, Weller C. Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice. J Wound Care 2018; 25 Suppl 6:S1-S67. [PMID: 27292202 DOI: 10.12968/jowc.2016.25.sup6.s1] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).
Collapse
Affiliation(s)
- Peter J Franks
- Centre for Research & Implementation of Clinical Practice, 128 Hill House, 210 Upper Richmond Road, London SW15 6NP, United Kingdom
| | | | - Mark Collier
- United Lincolnshire Hospitals NHS Trust (ULHT), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9QS, United Kingdom
| | | | - Emily Haesler
- Wound Management and Healing Node, Curtin University, Perth, Australia & Academic Unit of General Practice, Australian National University, Canberra, Australia (Visiting Fellow)
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | - Severin Laeuchli
- University Hospital Zürich, Department of Dermatology, Gloriastrasse 31, CH-8091 Zürich, Switzerland
| | | | - Sebastian Probst
- School of Health, University of Applied Sciences Western Switzerland, HES-SO Genève, Avenue de Champel 47, CH-1206 Geneva, Switzerland
| | - Carolina Weller
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| |
Collapse
|
16
|
Pinto D, Heleno B, Rodrigues DS, Papoila AL, Santos I, Caetano PA. Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial. Implement Sci 2018; 13:120. [PMID: 30185197 PMCID: PMC6126017 DOI: 10.1186/s13012-018-0810-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. METHODS Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20 min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18 months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. RESULTS Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18 months after the visit (46.28 vs 47.15%, p = 0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p = 0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18 months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p = 0.848). CONCLUSIONS Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18 months after the intervention, and there were no associated cost savings. TRIAL REGISTRATION ClinicalTrials.gov NCT01984034 . Registered 7 November 2013.
Collapse
Affiliation(s)
- Daniel Pinto
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Bruno Heleno
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - David S Rodrigues
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Luísa Papoila
- Department of Biostatistics and Informatics, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Isabel Santos
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro A Caetano
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
17
|
Gildea MR, Moler FW, Page K, Pemberton VL, Holubkov R, Nadkarni VM, Dean JM, Olson LM. Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians. J Pediatr Intensive Care 2018; 8:71-77. [PMID: 31093458 DOI: 10.1055/s-0038-1667380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/24/2018] [Indexed: 12/30/2022] Open
Abstract
The Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial showed therapeutic hypothermia, versus normothermia, did not significantly improve 1-year survival with good neurobehavioral outcome. Our survey of pediatric critical care physicians, designed to assess the use of targeted temperature management (TTM) after publication of the main THAPCA-OH Trial results, found most respondents were aware of trial results, and over 90% agreed THAPCA-OH was well-designed with important clinical outcomes. While most respondents reported TTM usage consistent with THAPCA-OH results in different patient scenarios, 15% did not select TTM for fever management. Since trials prior to THAPCA-OH established that fever is harmful following brain injury, the continued incomplete adoption of TTM warrants further research on challenges and facilitators to the adoption of clinical trial findings.
Collapse
Affiliation(s)
- Marianne R Gildea
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Frank W Moler
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Kent Page
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Victoria L Pemberton
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Lenora M Olson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| |
Collapse
|
18
|
Schumock GT, Pickard AS. Comparative effectiveness and patient-centered outcomes research: enhancing uptake and use by patients, clinicians and payers. J Comp Eff Res 2018; 7:177-180. [PMID: 29464965 DOI: 10.2217/cer-2017-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Evidence from comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) studies are increasingly available in the literature. However, there remain opportunities to better integrate that evidence into decision-making. An invitation-only conference held in January 2017, titled "Comparative Effectiveness and Patient-Centered Outcomes Research: Enhancing Uptake and Use by Patients, Clinicians and Payers", sought to identify and discuss both gaps in the uptake and use of CER/PCOR, and approaches to enhance the uptake and use of CER/PCOR evidence by patients, clinicians and payers. In this article, we summarize the conference proceedings, and highlight the themes and recommendations that resulted from the sessions. This paper also introduces other articles in this issue of CER from that conference.
Collapse
Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood Street (MC 871), Chicago, IL 60612, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood Street (MC 871), Chicago, IL 60612, USA
| |
Collapse
|
19
|
Anthierens S, Verhoeven V, Schmitz O, Coenen S. Academic detailers' and general practitioners' views and experiences of their academic detailing visits to improve the quality of analgesic use: process evaluation alongside a pragmatic cluster randomized controlled trial. BMC Health Serv Res 2017; 17:841. [PMID: 29268730 PMCID: PMC5740934 DOI: 10.1186/s12913-017-2797-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background Continuous medical education strategies, including academic detailing (AD), have mixed effects on the quality of prescribing in general practice. Alongside a cluster-randomized controlled trial (cRCT) to assess the effectiveness of AD visits (on appropriate prescribing of analgesics for chronic pain in osteoarthritis) by Farmaka, an independent drug information center, we performed a process evaluation to identify possible barriers and success factors to improve these AD visits, both from the perspective of the academic detailers delivering the visits and the general practitioners (GPs) receiving them. Methods We performed semi-structured interviews with 20 GPs who participated in the cRCT and 13 academic detailers. The interviews were transcribed verbatim and analysed using thematic analysis. Results GPs viewed AD visits as a practical and useful CME strategy, that is less time consuming than other CME activities, and the visitors as providers of objective and independent information relevant to their daily practice with whom they can have meaningful discussion. Academic detailers saw themselves as content experts, mainly informing GPs about the topic and not emphasizing on behavior change. Both GPs and academic detailers believed that the AD visits could have better interaction and discussion if performed in small groups. According to the GPs, the visits on analgesic use provided some new and relevant information as well as clarifying some misconceptions. They increased awareness of the disadvantages of particular non-steroidal anti-inflammatory drugs and of the lower doses of paracetamol that should be prescribed for chronic use, which may have changed their beliefs and/or attitudes towards more appropriate prescribing for osteoarthritis. However, the transfer of knowledge into practice was seen as not so straightforward. Conclusions GPs view AD visits as a credible and interesting way of CME that enhances their knowledge and increases reflection on their prescribing behavior.
Collapse
Affiliation(s)
- Sibyl Anthierens
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Olivier Schmitz
- Research Institute Health and Society (IRSS), Catholic University of Leuven, Brussels, Belgium
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610, Antwerp, Belgium.,Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium
| |
Collapse
|
20
|
Shuman CJ, Xie XJ, Herr KA, Titler MG. Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults. West J Nurs Res 2017; 40:1749-1764. [PMID: 29103368 DOI: 10.1177/0193945917738781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.
Collapse
Affiliation(s)
| | - Xian-Jin Xie
- 2 University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keela A Herr
- 3 University of Iowa College of Nursing, IA, USA
| | - Marita G Titler
- 1 University of Michigan School of Nursing, Ann Arbor, MI, USA
| |
Collapse
|
21
|
Herbst JL, Richards VE, Schramm ME, Mattie A. First Amendment Protection of Evidence-Based Promotion of Prescription Drugs: A Study of Published Clinical Evidence Supporting Off-Label Promotion in the USA. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
22
|
Academy of Nutrition and Dietetics Methodology for Developing Evidence-Based Nutrition Practice Guidelines. J Acad Nutr Diet 2017; 117:794-804. [DOI: 10.1016/j.jand.2016.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/18/2022]
|
23
|
Burstein PD, Zalenski DM, Edwards JL, Rafi IZ, Darden JF, Firneno C, Santos P. Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes. Health Serv Res 2016; 51 Suppl 3:2472-2486. [PMID: 27766653 DOI: 10.1111/1475-6773.12589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. DATA SOURCES/STUDY SETTING Primary data collection was conducted over 3 years. Implementation of the protocol spanned 13 months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. STUDY DESIGN Case study evaluation methodology was used to examine clinician engagement and protocol adoption. DATA COLLECTION METHODS The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator. PRINCIPAL FINDINGS In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow-up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol. CONCLUSIONS System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.
Collapse
Affiliation(s)
- Paul D Burstein
- Department of Obstetrics and Gynecology, Columbia St. Mary's, Milwaukee, WI
| | - David M Zalenski
- Department of Obstetrics and Gynecology, St. John Hospital & Medical Center, Detroit, MI
| | - John L Edwards
- Department of Obstetrics and Gynecology, St. Vincent's Birmingham, Birmingham, AL
| | - Ishrat Z Rafi
- Department of Obstetrics and Gynecology, Saint Agnes Hospital, Baltimore, MD
| | | | - Cassandra Firneno
- Meyers Primary Care Institute, University of MassachusettsMedical School, Worcester, MA
| | - Palmira Santos
- Institute on Healthcare Systems, Brandeis University, Waltham, MA
| |
Collapse
|
24
|
Abstract
Most diabetes care is provided in primary care settings, but typical primary care clinicians struggle to keep up with the latest evidence on diabetes screening, pharmacotherapy, and monitoring. Accordingly, many patients with diabetes are not receiving optimal guideline-based therapy. Relying on front-line clinicians on their own to assess the huge volume of new literature and incorporate it into their practice is unrealistic, and conventional continuing medical education has not proven adequate to address gaps in care. Academic detailing, direct educational outreach to clinicians that uses social marketing techniques to provide specific evidence-based recommendations, has been proven in clinical trials to improve the quality of care for a range of conditions. By directly engaging with clinicians to assess their needs, identify areas for change in practice, and provide them with specific tools to implement these changes, academic detailing can serve as a tool to improve care processes and outcomes for patients with diabetes.
Collapse
Affiliation(s)
- Michael A Fischer
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont St, suite 3030, Boston, MA, 02120, USA.
| |
Collapse
|
25
|
Zhang X, Faries DE, Boytsov N, Stamey JD, Seaman JW. “A Bayesian sensitivity analysis to evaluate the impact of unmeasured confounding with external data: a real world comparative effectiveness study in osteoporosis”. Pharmacoepidemiol Drug Saf 2016; 25:982-92. [DOI: 10.1002/pds.4053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Xiang Zhang
- Eli Lilly and Company; Lilly Corporate Center; Indianapolis IN United States
| | - Douglas E. Faries
- Eli Lilly and Company; Lilly Corporate Center; Indianapolis IN United States
| | - Natalie Boytsov
- Eli Lilly and Company; Lilly Corporate Center; Indianapolis IN United States
| | - James D. Stamey
- Department of Statistical Science; Baylor University; Waco TX United States
| | - John W. Seaman
- Department of Statistical Science; Baylor University; Waco TX United States
| |
Collapse
|
26
|
Jayakumar KL, Lavenberg JA, Mitchell MD, Doshi JA, Leas B, Goldmann DR, Williams K, Brennan PJ, Umscheid CA. Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making. J Hosp Med 2016; 11:185-92. [PMID: 26505618 DOI: 10.1002/jhm.2498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/18/2015] [Accepted: 09/26/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospital evidence-based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. OBJECTIVE To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. DESIGN, SETTING, AND PARTICIPANTS Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006-June 2014), and survey of report requestors from the EPC's last 4 fiscal years. MEASUREMENTS Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5-point Likert scales reflected greater agreement). RESULTS The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). CONCLUSIONS This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making.
Collapse
Affiliation(s)
- Kishore L Jayakumar
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Julia A Lavenberg
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Matthew D Mitchell
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jalpa A Doshi
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Leas
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David R Goldmann
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kendal Williams
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Craig A Umscheid
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
27
|
Gardner P, Slater H, Jordan JE, Fary RE, Chua J, Briggs AM. Physiotherapy students' perspectives of online e-learning for interdisciplinary management of chronic health conditions: a qualitative study. BMC MEDICAL EDUCATION 2016; 16:62. [PMID: 26879982 PMCID: PMC4754862 DOI: 10.1186/s12909-016-0593-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/10/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND To qualitatively explore physiotherapy students' perceptions of online e-learning for chronic disease management using a previously developed, innovative and interactive, evidence-based, e-learning package: Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL). METHODS Physiotherapy students participated in three focus groups in Perth, Western Australia. Purposive sampling was employed to ensure maximum heterogeneity across age, gender and educational background. To explore students' perspectives on the advantages and disadvantages of online e-learning, ways to enhance e-learning, and information/learning gaps in relation to interdisciplinary management of chronic health conditions, a semi-structured interview schedule was developed. Verbatim transcripts were analysed using inductive methods within a grounded theory approach to derive key themes. RESULTS Twenty-three students (78 % female; 39 % with previous tertiary qualification) of mean (SD) age 23 (3.6) years participated. Students expressed a preference for a combination of both online e-learning and lecture-style learning formats for chronic disease management, citing flexibility to work at one's own pace and time, and access to comprehensive information as advantages of e-learning learning. Personal interaction and ability to clarify information immediately were considered advantages of lecture-style formats. Perceived knowledge gaps included practical application of interdisciplinary approaches to chronic disease management and developing and implementing physiotherapy management plans for people with chronic health conditions. CONCLUSIONS Physiotherapy students preferred multi-modal and blended formats for learning about chronic disease management. This study highlights the need for further development of practically-oriented knowledge and skills related to interdisciplinary care for people with chronic conditions among physiotherapy students. While RAP-eL focuses on rheumatoid arthritis, the principles of learning apply to the broader context of chronic disease management.
Collapse
Affiliation(s)
- Peter Gardner
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Joanne E Jordan
- HealthSense (Aust) Pty. Ltd., Melbourne, VIC, 3204, Australia.
| | - Robyn E Fary
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Jason Chua
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
- Department of Health, Government of Western Australia, PO Box 8172, Perth Business Centre, Perth, WA, 6849, Australia.
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
- Arthritis and Osteoporosis Victoria, PO Box 130, Caulfield South, VIC, 3162, Australia.
| |
Collapse
|
28
|
Fordis M, King JE, Bonaduce de Nigris F, Morrow R, Baron RB, Kues JR, Norton JC, Kessler H, Mazmanian PE, Colburn L. Dissemination of Evidence From Systematic Reviews Through Academic CME Providers: A Feasibility Study. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:104-112. [PMID: 27262153 DOI: 10.1097/ceh.0000000000000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. METHODS A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. RESULTS Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. DISCUSSION This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.
Collapse
Affiliation(s)
- Michael Fordis
- Dr. Fordis: Director, Center for Collaborative and Interactive Technologies, Senior Associative Dean of Continuing Medical Education, Baylor College of Medicine, Houston, TX. Dr. King: Associate Director, Center for Collaborative and Interactive Technologies, Baylor College of Medicine, Houston, TX. Dr. Bonaduce de Nigris: Research Associate, Center for Collaborative and Interactive Technologies, Baylor College of Medicine, Houston, TX. Dr. Morrow: Associate Clinical Professor, Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY. Dr. Baron: Professor of Medicine, Department of Medicine, University of California, San Francisco, CA. Dr. Kues: Professor Emeritus of Family and Community Medicine, Center for Continuous Professional Development, University of Cincinnati College of Medicine, Cincinnati, OH. Dr. Norton: Director, Center for Interprofessional Health Education, and Professor of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY. Dr. Kessler: Professor, Departments of Medicine and Immunology/Microbiology, Rush University Medical Center, Chicago, IL. Dr. Mazmanian: Associate Dean, Office of Assessment and Evaluation Studies, Department of Family Medicine and Population Health, VCU School of Medicine, Richmond, VA. Dr. Colburn: Executive Director, Center for Continuing Education, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Yank V, Tribett E, Green L, Pettis J. Learning from marketing: Rapid development of medication messages that engage patients. PATIENT EDUCATION AND COUNSELING 2015; 98:1025-1034. [PMID: 25913245 PMCID: PMC4684954 DOI: 10.1016/j.pec.2015.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/11/2015] [Accepted: 02/21/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To adapt marketing approaches in a health services environment. METHODS Researchers and advertising professionals partnered in developing advertising-style messages designed to activate patients pre-identified as having chronic kidney disease to ask providers about recommended medications. We assessed feasibility of the development process by evaluating partnership structure, costs, and timeframe. We tested messages with patients and providers using preliminary surveys to refine initial messages and subsequent focus groups to identify the most persuasive ones. RESULTS The partnership achieved an efficient structure, $14,550 total costs, and 4-month timeframe. The advertising team developed 11 initial messages. The research team conducted surveys and focus groups with a total of 13 patients and 8 providers to identify three messages as most activating. Focus group themes suggested the general approach of using advertising-style messages was acceptable if it supported patient-provider relationships and had a credible evidence base. Individual messages were more motivating if they elicited personal identification with imagery, particular emotions, active patient role, and message clarity. CONCLUSION We demonstrated feasibility of a research-advertising partnership and acceptability and likely impact of advertising-style messages on patient medication-seeking behavior. PRACTICE IMPLICATIONS Healthcare systems may want to replicate our adaptation of marketing approaches to patients with chronic conditions.
Collapse
Affiliation(s)
- Veronica Yank
- General Medical Disciplines, Stanford University School of Medicine, Stanford, USA.
| | - Erika Tribett
- General Medical Disciplines, Stanford University School of Medicine, Stanford, USA
| | | | - Jasmine Pettis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
| |
Collapse
|
30
|
Milne CP, Cohen JP, Felix A, Chakravarthy R. Impact of Postapproval Evidence Generation on the Biopharmaceutical Industry. Clin Ther 2015; 37:1852-8. [PMID: 26143223 DOI: 10.1016/j.clinthera.2015.05.514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Meeting marketplace demands for proving the value of new products requires more data than the industry has routinely produced. These data include evidence from comparative effectiveness research (CER), including randomized, controlled trials; pragmatic clinical trials; observational studies; and meta-analyses. METHODS We designed and conducted a survey to examine the industry's perceptions on new data requirements regarding CER evidence, the acceptability of postapproval study types, payer-specific issues related to CER, communication of data being generated postapproval, and methods used for facilitating postapproval evidence generation. FINDINGS CER is being used by payers for most types of postapproval decisions. Randomized, controlled trials were indicated as the most acceptable form of evidence. At the same time, there was support for the utility of other types of studies, such as pragmatic clinical trials and observational studies. Respondents indicated the use of multiple formats for communicating postapproval data with many different stakeholders including regulators, payers, providers, and patients. Risk-sharing agreements with payers were unanimously supported by respondents with regard to certain products with unclear clinical and economic outcomes at launch. In these instances, conditional reimbursement through coverage with evidence development was considered a constructive option. The Food and Drug Administration's initiative called Regulatory Science was considered by the respondents as having the most impact on streamlining the generation of postapproval research-related evidence. IMPLICATIONS The biopharmaceutical industry is faced with a broad and complex set of challenges related to evidence generation for postapproval decisions by a variety of health care system stakeholders. Uncertainty remains as to how the industry and payers use postapproval studies to guide decision making with regard to pricing and reimbursement status. Correspondingly, there is uncertainty regarding whether the industry's investment in CER will have a positive return on investment in terms of reimbursement and market access.
Collapse
Affiliation(s)
- Christopher-Paul Milne
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
| | - Joshua P Cohen
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts.
| | - Abigail Felix
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
| | - Ranjana Chakravarthy
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
| |
Collapse
|
31
|
Fary RE, Slater H, Chua J, Ranelli S, Chan M, Briggs AM. Policy-Into-Practice for Rheumatoid Arthritis: Randomized Controlled Trial and Cohort Study of E-Learning Targeting Improved Physiotherapy Management. Arthritis Care Res (Hoboken) 2015; 67:913-22. [DOI: 10.1002/acr.22535] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/07/2014] [Accepted: 12/16/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Robyn E. Fary
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Jason Chua
- School of Physiotherapy and Exercise Science; Curtin University and Department of Health, Government of Western Australia; Perth Australia
| | - Sonia Ranelli
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | | | - Andrew M. Briggs
- Curtin University and Department of Health, Government of Western Australia, Perth, and Arthritis and Osteoporosis Victoria; Elsternwick Victoria Australia
| |
Collapse
|
32
|
Su LL, Adamski J, Gilman EA, Cusick R, Hernandez JS. Decreasing preoperative autologous blood donation: collaboration between a hospital and a blood center to prompt change in physician ordering behavior. Lab Med 2015; 46:74-8. [PMID: 25617398 DOI: 10.1309/lmn2n6oehfjg9uzt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To describe the collaborative efforts of a large healthcare institution and its local blood center in reducing preoperative autologous blood donation (PABD). METHODS Through an educational letter-based campaign, we contacted physicians who historically had ordered PABD units. Follow-up educational efforts occurred at departmental and individual meetings. RESULTS Our educational campaign to reduce PABD achieved complete elimination of PABD orders and the resultant waste of PABD units within 3 years of the start of the program. These changes were sustained for at least 2 subsequent years without the need for additional educational efforts. CONCLUSION Targeted educational efforts directed at practitioners of PABD were successful in significantly decreasing the use and waste of PABD at the health care institution we studied and may yield the same results in comparable institutions.
Collapse
Affiliation(s)
- Leon L Su
- Division of Laboratory Medicine, Mayo Clinic, Phoenix, Arizona, Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona,
| | - Jill Adamski
- Division of Laboratory Medicine, Mayo Clinic, Phoenix, Arizona
| | | | | | | |
Collapse
|
33
|
E. Schramm M, L. Herbst J, Mattie A. The False Claims Act: a review and policy recommendations. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2014. [DOI: 10.1108/ijphm-04-2014-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– The purpose of the study is to review The False Claims Act (FCA) settlements and challenges facing the industry to suggest the motivation behind firms’ alleged fraudulent activity. FCA has been applied against pharmaceutical companies by the US Government to combat marketing fraud including kickbacks, improper pricing and off-label promotion. The interests of the US Government and medical professionals are also considered. Changes to the law governing pharmaceutical marketing practices are recommended.Design/methodology/approach– Cases settled under the FCA between 2005 and 2012 were identified by accessing the US Department of Health and Human Services (DHHS) Corporate Integrity Agreements Web site and annual reports and thequitamhelp.comWeb site. Case details were collected from US Department of Justice press releases, DHHS annual reports, and case documents in the Public Access to Court Electronic Records database.Findings– Of the settled cases in the final sample, improper pricing practices were evident in 33 per cent of the cases; off-label promotion in 52 per cent; and both in 15 per cent of the cases. Forty-eight per cent of the alleged fraudulent marketing activity occurred within the brands’ first year and 68 per cent within the first two years on the market. Reported settlements ranged from US$4 million to US$4.3 billion.Originality/value– This research simultaneously considers business issues facing the pharmaceutical industry and alleged fraudulent marketing activity to recommend changes to the law governing drug promotion. Changes have the potential to improve the balance between the respective interests of industry, medicine and government and to improve compliance and patient care in the future.
Collapse
|
34
|
Hughes EK, Le Grange D, Court A, Yeo M, Campbell S, Whitelaw M, Atkins L, Sawyer SM. Implementation of family-based treatment for adolescents with anorexia nervosa. J Pediatr Health Care 2014; 28:322-30. [PMID: 24055072 DOI: 10.1016/j.pedhc.2013.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/04/2013] [Accepted: 07/17/2013] [Indexed: 11/24/2022]
Abstract
Although the implementation of new treatment models can be a challenging process for health care services, the outcomes can be greatly beneficial to patients and service providers. This article describes the process of change experienced within our multidisciplinary specialist eating disorder service when we implemented a new evidence-based model of care focusing on outpatient family-based treatment (FBT). Clinical outcomes were positive, including a 56% decrease in admissions, a 75% decrease in readmissions, and a 51% decrease in total bed days. Of families referred to FBT, 83% completed treatment and 97% of completers achieved >90% of their expected body weight. Despite these gains, many challenges were experienced, including misgivings about the suitability of FBT and difficulties in adhering to changes in professional roles. We describe these challenges, describe how they were overcome, and review factors perceived to be critical to the program's success, including integration of medical and mental health services, communication, and training.
Collapse
|
35
|
Hartung DM, Guise JM, Fagnan LJ, Davis MM, Stange KC. Role of practice-based research networks in comparative effectiveness research. J Comp Eff Res 2014; 1:45-55. [PMID: 23105964 DOI: 10.2217/cer.11.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Comparative effectiveness research fundamentally reorients how clinical evidence is generated and used with the goal of providing actionable information to decision-makers. To achieve this, it is vital that decision-makers and the research enterprise are engaged from research inception, to evidence generation and translation. Practice-based research networks are affiliated clinicians in diverse communities with the goal of conducting research to improve care. Practice-based research networks have the potential to advance all phases of the comparative effectiveness research cycle. The aim of this paper is to explore current and potential roles of practice-based research networks in conducting comparative effectiveness research.
Collapse
|
36
|
Halley MC, Rendle KAS, Frosch DL. A conceptual model of the multiple stages of communication necessary to support patient-centered care. J Comp Eff Res 2014; 2:421-33. [PMID: 24236683 DOI: 10.2217/cer.13.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Patient-centered care requires that both healthcare providers and patients have access to comparative effectiveness research (CER), which provides direct comparisons of the risks and benefits of available clinical options. However, insufficient attention has been paid to developing the comprehensive communication systems necessary to ensure that CER reaches patients and healthcare providers. In this review, we propose a model of the multiple stages of CER communication necessary for patient-centered care and review the existing research and gaps in knowledge relevant to each stage. These stages include: promotion of the underlying concepts and value of CER; translation of CER results; dissemination of CER results; and utilization of the results of CER in shared decision-making between patients and providers. A comprehensive approach to CER communication is necessary to ensure that the growing interest in and availability of CER is able to support a more patient-centered model of healthcare.
Collapse
Affiliation(s)
- Meghan C Halley
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301, USA
| | | | | |
Collapse
|
37
|
Affiliation(s)
- Navkiran K Shokar
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, 9849 Kenworthy Street, El Paso, TX, 79924, USA,
| |
Collapse
|
38
|
Song M, O'Donnell JA, Bekhuis T, Spallek H. Are dentists interested in the oral-systemic disease connection? A qualitative study of an online community of 450 practitioners. BMC Oral Health 2013; 13:65. [PMID: 24261423 PMCID: PMC3924341 DOI: 10.1186/1472-6831-13-65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Dentists in the US see an increasing number of patients with systemic conditions. These patients are challenging to care for when the relationship between oral and systemic disease is not well understood. The prevalence of professional isolation exacerbates the problem due to the difficulty in finding expert advice or peer support. This study aims to identify whether dentists discuss the oral-systemic connection and what aspects they discuss; to understand their perceptions of and attitudes toward the connection; and to determine what information they need to treat patients with systemic conditions. Methods We retrieved 14,576 messages posted to the Internet Dental Forum from April 2008 to May 2009. Using natural language processing and human classification, we identified substantive phrases and keywords and used them to retrieve 141messages on the oral-systemic connection. We then conducted coding and thematic analysis to identify recurring themes on the topic. Results Dentists discuss a variety of topics on oral diseases and systemic health, with the association between periodontal and systemic diseases, the effect of dental materials or procedures on general health, and the impact of oral-systemic connection on practice behaviors as the leading topics. They also disseminate and share research findings on oral and systemic health with colleagues online. However, dentists are very cautious about the nature of the oral-systemic linkage that may not be causal. Nonetheless, they embrace the positive association as a motivating point for patients in practice. When treating patients with systemic conditions, dentists enquire about the cause of less common dental diseases potentially in relation to medical conditions in one-third of the cases and in half of the cases seek clinical guidelines and evidence-based interventions on treating dental diseases with established association with systemic conditions. Conclusions Dentists’ unmet information needs call for more research into the association between less studied dental conditions and systemic diseases, and more actionable clinical guidelines for well-researched disease connections. To improve dissemination and foster behavioral change, it is imperative to understand what information clinicians need and in which situations. Leveraging peer influence via social media could be a useful strategy to achieve the goal.
Collapse
Affiliation(s)
- Mei Song
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, USA.
| | | | | | | |
Collapse
|
39
|
Abstract
Occupational health promotion programs with documented efficacy have not penetrated worksites. Establishing an implementation model would allow focusing on mediating aspects to enhance installation and use of evidence-based occupational wellness interventions. The purpose of the study was to implement an established wellness program in fire departments and define predictors of program exposure/dose to outcomes to define a cross-sectional model of translational effectiveness. The study is a prospective observational study among 12 NW fire departments. Data were collected before and following installation, and findings were used to conduct mediation analysis and develop a translational effectiveness model. Worker age was examined for its impact. Leadership, scheduling/competing demands, and tailoring were confirmed as model components, while organizational climate was not a factor. The established model fit data well (χ (2)(9) = 25.57, CFI = 0.99, RMSEA = 0.05, SRMR = 0.03). Older firefighters, nearing retirement, appeared to have influences that both enhanced and hindered participation. Findings can inform implementation of worksite wellness in fire departments, and the prioritized influences and translational model can be validated and manipulated in these and other settings to more efficiently move health promotion science to service.
Collapse
|
40
|
Wettermark B. The intriguing future of pharmacoepidemiology. Eur J Clin Pharmacol 2013; 69 Suppl 1:43-51. [DOI: 10.1007/s00228-013-1496-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 02/25/2013] [Indexed: 02/03/2023]
|
41
|
Comparative-Effectiveness Research: Does It Matter? Clin Ther 2013; 35:371-9. [DOI: 10.1016/j.clinthera.2012.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/21/2012] [Accepted: 01/04/2012] [Indexed: 11/20/2022]
|
42
|
Cars T, Wettermark B, Malmström RE, Ekeving G, Vikström B, Bergman U, Neovius M, Ringertz B, Gustafsson LL. Extraction of Electronic Health Record Data in a Hospital Setting: Comparison of Automatic and Semi‐Automatic Methods Using Anti‐
TNF
Therapy as Model. Basic Clin Pharmacol Toxicol 2013; 112:392-400. [DOI: 10.1111/bcpt.12055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/21/2013] [Indexed: 12/25/2022]
Affiliation(s)
- Thomas Cars
- Public Healthcare Services Committee Administration Stockholm County Council Stockholm Sweden
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Björn Wettermark
- Public Healthcare Services Committee Administration Stockholm County Council Stockholm Sweden
- Centre for Pharmacoepidemiology Department of Medicine Karolinska Institutet Stockholm Sweden
- Division of Clinical Pharmacology Department of Laboratory Medicine Karolinska Institutet at Karolinska University Hospital Stockholm Sweden
| | - Rickard E. Malmström
- Division of Clinical Pharmacology Department of Medicine Karolinska Institutet at Karolinska University Hospital Solna Stockholm Sweden
| | - Gunnar Ekeving
- Department of IT Management Karolinska University Hospital Stockholm Sweden
| | - Bo Vikström
- TakeCare Cooperation Centre Karolinska University Hospital Stockholm Sweden
| | - Ulf Bergman
- Centre for Pharmacoepidemiology Department of Medicine Karolinska Institutet Stockholm Sweden
- Division of Clinical Pharmacology Department of Laboratory Medicine Karolinska Institutet at Karolinska University Hospital Stockholm Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Stockholm Sweden
| | - Bo Ringertz
- Division of Rheumatology Department of Medicine Karolinska Institutet at Karolinska University Hospital Solna Stockholm Sweden
| | - Lars L. Gustafsson
- Division of Clinical Pharmacology Department of Laboratory Medicine Karolinska Institutet at Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
43
|
Van Hoof TJ, Miller NE, Meehan TP. Do published studies of educational outreach provide documentation of potentially important characteristics? Am J Med Qual 2013; 28:480-4. [PMID: 23401622 DOI: 10.1177/1062860613476335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Educational outreach is a common intervention used to translate research findings into practice; however, the intervention has a mixed effect on changing clinician behavior and improving patient outcomes. Based on a published set of characteristics aimed at standardizing the approach to educational outreach, the authors undertook a careful review of the literature to determine the consistency and completeness of documentation. Using a 25-item abstraction tool, the authors reviewed 68 published studies of a recent Cochrane meta-analysis to determine the extent to which educational outreach studies provide recommended documentation of important characteristics. The results indicate that studies are generally inconsistent (documentation range of 0% to 100% across characteristics) and incomplete (documentation average of 43.1% across studies) in their descriptions. Documentation shortcomings of educational outreach studies make understanding the intervention and interpreting its findings particularly challenging. The authors recommend the creation of a guideline to help improve documentation of educational outreach efforts.
Collapse
|
44
|
Kling MA, Trojanowski JQ, Wolk DA, Lee VMY, Arnold SE. Vascular disease and dementias: paradigm shifts to drive research in new directions. Alzheimers Dement 2013; 9:76-92. [PMID: 23183137 PMCID: PMC3640817 DOI: 10.1016/j.jalz.2012.02.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/23/2012] [Accepted: 02/29/2012] [Indexed: 12/31/2022]
Abstract
Vascular disease was once considered the principal cause of aging-related dementia. More recently, however, research emphasis has shifted to studies of progressive neurodegenerative disease processes, such as those giving rise to neuritic plaques, neurofibrillary tangles, and Lewy bodies. Although these studies have led to critical insights and potential therapeutic strategies, interest in the role of systemic and cerebrovascular disease mechanisms waned and has received relatively less attention and research support. Recent studies suggest that vascular disease mechanisms play an important role in the risk for aging-related cognitive decline and disorders. Vascular disease frequently coexists with cognitive decline in aging individuals, shares many risk factors with dementias considered to be of the "Alzheimer type," and is observed more frequently than expected in postmortem material from individuals manifesting "specific" disease stigmata, such as abundant plaques and tangles. Considerable difficulties have emerged in attempting to classify dementias as being related to vascular versus neurodegenerative causes, and several systems of criteria have been used. Despite multiple attempts, a lack of consensus remains regarding the optimal means of incorporating vascular disease into clinical diagnostic, neurocognitive, or neuropathologic classification schemes for dementias. We propose here an integrative, rather than a strictly taxonomic, approach to the study and elucidation of how vascular disease mechanisms contribute to the development of dementias. We argue that, instead of discriminating between, for example, "Alzheimer's disease," "vascular dementia," and other diseases, there is a greater need to focus clinical and research efforts on elucidating specific pathophysiologic mechanisms that contribute to dementia phenotypes and neuropathologic outcomes. We outline a multitiered strategy, beginning with clinical and public health interventions that can be implemented immediately, enhancements to ongoing longitudinal studies to increase their informative value, and new initiatives to capitalize on recent advances in systems biology and network medicine. This strategy will require funding from multiple public and private sources to support collaborative and interdisciplinary research efforts to take full advantage of these opportunities and realize their societal benefits.
Collapse
Affiliation(s)
- Mitchel A Kling
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | | |
Collapse
|
45
|
Hartung DM, Hamer A, Middleton L, Haxby D, Fagnan LJ. A pilot study evaluating alternative approaches of academic detailing in rural family practice clinics. BMC FAMILY PRACTICE 2012; 13:129. [PMID: 23276303 PMCID: PMC3558441 DOI: 10.1186/1471-2296-13-129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Academic detailing is an interactive, convenient, and user-friendly approach to delivering non-commercial education to healthcare clinicians. While evidence suggests academic detailing is associated with improvements in prescribing behavior, uncertainty exists about generalizability and scalability in diverse settings. Our study evaluates different models of delivering academic detailing in a rural family medicine setting. METHODS We conducted a pilot project to assess the feasibility, effectiveness, and satisfaction with academic detailing delivered face-to-face as compared to a modified approach using distance-learning technology. The recipients were four family medicine clinics within the Oregon Rural Practice-based Research Network (ORPRN). Two clinics were allocated to receive face-to-face detailing and two received outreach through video conferencing or asynchronous web-based outreach. Surveys at midpoint and completion were used to assess effectiveness and satisfaction. RESULTS Each clinic received four outreach visits over an eight month period. Topics included treatment-resistant depression, management of atypical antipsychotics, drugs for insomnia, and benzodiazepine tapering. Overall, 90% of participating clinicians were satisfied with the program. Respondents who received in person detailing reported a higher likelihood of changing their behavior compared to respondents in the distance detailing group for five of seven content areas. While 90%-100% of respondents indicated they would continue to participate if the program were continued, the likelihood of participation declined if only distance approaches were offered. CONCLUSIONS We found strong support and satisfaction for the program among participating clinicians. Participants favored in-person approaches to distance interactions. Future efforts will be directed at quantitative methods for evaluating the economic and clinical effectiveness of detailing in rural family practice settings.
Collapse
Affiliation(s)
- Daniel M Hartung
- Oregon State University College of Pharmacy, Oregon Health & Science University, Portland, OR, 97239, USA.
| | | | | | | | | |
Collapse
|
46
|
Abuabara K, Wan J, Troxel AB, Shin DB, Van Voorhees AS, Bebo BF, Krueger GG, Callis Duffin K, Gelfand JM. Variation in dermatologist beliefs about the safety and effectiveness of treatments for moderate to severe psoriasis. J Am Acad Dermatol 2012; 68:262-9. [PMID: 22910105 DOI: 10.1016/j.jaad.2012.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple systemic treatments are available for moderate to severe psoriasis, but dermatologists' perceptions of these treatments are unknown. Physician perceptions can influence prescribing patterns and patient outcomes, and may help to explain variations in clinical practice. OBJECTIVE We sought to describe the variation in dermatologist's beliefs about the safety and effectiveness of psoriasis treatments and evaluate how these relate to dermatologist characteristics and treatment preferences. METHODS We conducted a cross-sectional mail survey of a random sample of 500 National Psoriasis Foundation (NPF) members and 500 American Academy of Dermatology (AAD) members who treat psoriasis. RESULTS Of 989 clinicians who could be contacted, 246 NPF members and 141 AAD members returned the survey (39% response rate). Respondents perceived infliximab, ustekinumab, cyclosporine, and adalimumab to have the highest likelihood of skin clearance in 3 months (67%-75%). Etanercept, adalimumab, ultraviolet B, and ustekinumab had the lowest perceived likelihood of side effects requiring treatment discontinuation (9%-11%). Up to 49% of respondents "didn't know" the effectiveness or likelihood of side effects; calculated coefficients of variation were higher for perceived likelihood of side effects than perceived effectiveness. There were few significant associations between safety and effectiveness perceptions and respondent characteristics, and treatment preferences were not consistently predictive of perceptions. LIMITATIONS Only dermatologists with interest in treating psoriasis were surveyed and general perceptions were elicited via survey format. Perceptions may differ between survey respondents and nonrespondents. CONCLUSIONS Psoriasis providers demonstrate wide variation in their perception of the effectiveness and especially safety of systemic treatments.
Collapse
Affiliation(s)
- Katrina Abuabara
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Glasgow RE, Kaplan RM, Ockene JK, Fisher EB, Emmons KM. Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records. Health Aff (Millwood) 2012; 31:497-504. [PMID: 22392660 DOI: 10.1377/hlthaff.2010.1295] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent legislation and delivery system reform efforts are greatly expanding the use of electronic health records. For these efforts to reach their full potential, they must actively involve patients and include patient-reported information about such topics as health behavior, preferences, and psychosocial functioning. We offer a plan for including standardized, practical patient-reported measures as part of electronic health records, quality and performance indexes, the primary care medical home, and research collaborations. These measures must meet certain criteria, including being valid, reliable, sensitive to change, and available in multiple languages. Clinicians, patients, and policy makers also must be able to understand the measures and take action based on them. Including more patient-reported items in electronic health records would enhance health, patient-centered care, and the capacity to undertake population-based research.
Collapse
Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
| | | | | | | | | |
Collapse
|
48
|
Meisel ZF, Carr BG, Conway PH. From comparative effectiveness research to patient-centered outcomes research: integrating emergency care goals, methods, and priorities. Ann Emerg Med 2012; 60:309-16. [PMID: 22520987 DOI: 10.1016/j.annemergmed.2012.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 03/06/2012] [Accepted: 03/19/2012] [Indexed: 12/29/2022]
Abstract
Federal legislation placed comparative effectiveness research and patient-centered outcomes research at the center of current and future national investments in health care research. The role of this research in emergency care has not been well described. This article proposes an agenda for researchers and health care providers to consider comparative effectiveness research and patient-centered outcomes research methods and results to improve the care for patients who seek, use, and require emergency care. This objective will be accomplished by (1) exploring the definitions, frameworks, and nomenclature for comparative effectiveness research and patient-centered outcomes research; (2) describing a conceptual model for comparative effectiveness research in emergency care; (3) identifying specific opportunities and examples of emergency care-related comparative effectiveness research; and (4) categorizing current and planned funding for comparative effectiveness research and patient-centered outcomes research that can include emergency care delivery.
Collapse
Affiliation(s)
- Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | | |
Collapse
|
49
|
Schauer GL, Thompson JR, Zbikowski SM. Results From an Outreach Program for Health Systems Change in Tobacco Cessation. Health Promot Pract 2012; 13:657-65. [DOI: 10.1177/1524839911432931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Washington state has experienced a dramatic reduction in adult smoking prevalence (22.4% in 1999 to 14.8% in 2010) because of a comprehensive tobacco control effort that includes a proactive health professional education and an outreach program. The outreach program uses academic detailing and online tools to increase routine identification and treatment of tobacco users. This article summarizes outcomes from the first 2 years of the program. Method. Outcome measures include the frequency of contact with providers, changes in the percentage of callers reporting that they had heard about the Quit Line from a health professional, and changes in provider Quit Line fax referrals. Data are compared between Initial, Expanded, and Never Outreach Counties. Results. From 2008 to 2010, a total of 629 unique health care organizations and 3,989 unique health professionals received services. Between 2007 and 2010, the ratio of health professional “How Heard Abouts” to total Quit Line registrations increased by 142.6% and 95.4% in Initial and Expanded Outreach Counties, whereas Never Outreach Counties showed an 11.2% increase. Fax referrals to the Quit Line increased by 132% and 232% in Initial and Expanded Outreach Counties whereas they declined by 39% in Never Outreach Counties. Discussion. Results suggests that health professionals can be an important and reliable source of referrals to a treatment resource such as a tobacco quitline. A field-based outreach program using academic detailing principles can be used to increase treatment referrals and holds application for other chronic disease areas and quality improvement programs.
Collapse
Affiliation(s)
| | - Juliet R. Thompson
- Washington State Department of Health, Tobacco Prevention and Control Program, Tumwater, WA, USA
| | | |
Collapse
|
50
|
Gonzales R, Handley MA, Ackerman S, Oʼsullivan PS. A framework for training health professionals in implementation and dissemination science. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:271-8. [PMID: 22373617 PMCID: PMC3307591 DOI: 10.1097/acm.0b013e3182449d33] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The authors describe a conceptual framework for implementation and dissemination science (IDS) and propose competencies for IDS training. Their framework is designed to facilitate the application of theories and methods from the distinct domains of clinical disciplines (e.g., medicine, public health), population sciences (e.g., biostatistics, epidemiology), and translational disciplines (e.g., social and behavioral sciences, business administration education). They explore three principles that guided the development of their conceptual framework: Behavior change among organizations and/or individuals (providers, patients) is inherent in the translation process; engagement of stakeholder organizations, health care delivery systems, and individuals is imperative to achieve effective translation and sustained improvements; and IDS research is iterative, benefiting from cycles and collaborative, bidirectional relationships. The authors propose seven domains for IDS training-team science, context identification, literature identification and assessment, community engagement, intervention design and research implementation, evaluation of effect of translational activity, behavioral change communication strategies-and define 12 IDS training competencies within these domains. As a model, they describe specific courses introduced at the University of California, San Francisco, which they designed to develop these competencies. The authors encourage other training programs and institutions to use or adapt the design principles, conceptual framework, and proposed competencies to evaluate their current IDS training needs and to support new program development.
Collapse
Affiliation(s)
- Ralph Gonzales
- Department of Medicine, University of California, San Francisco, School of Medicine, USA.
| | | | | | | |
Collapse
|