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Starr M. Towards national paediatric clinical practice guidelines. Med J Aust 2024; 220:392-393. [PMID: 38532300 DOI: 10.5694/mja2.52272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/22/2023] [Indexed: 03/28/2024]
Affiliation(s)
- Mike Starr
- Royal Children's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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2
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Sargin F, Buldu E. Turkish Pediatrician Beliefs About Third-hand Smoking. J Pediatr Health Care 2024; 38:97-104. [PMID: 37831029 DOI: 10.1016/j.pedhc.2023.09.006] [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: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Although third-hand smoke (THS) is a relatively new concept, it emerges as an important health problem. This study evaluated the beliefs of Turkish Pediatricians about THS. METHOD The survey, designed to be self-filled by pediatricians, provided information on demographic data, lifestyle factors, and beliefs about THS. Participant beliefs about THS were evaluated using the Beliefs About Third-Hand Smoke scale. This study was conducted by applying a web-based survey to pediatricians in Turkey. RESULTS The Beliefs About Third-Hand Smoke scale scores were lower in participants who were male (odds ratio [OR] = 1.479; 95% confidence interval [CI], 0.246-0.526; p < .001), have children (OR = 0.656; 95% CI, 0.156-0.665; p = .002), widowed/separated (OR = 0.498; 95% CI, -1.072 to -0.360; p < .001), a smoker (OR = 0.586; 95% CI, -0.711 to -0.355; p < .001), worked in State Hospital (OR = 0.574; 95% CI, -0.768 to -0.423; p < .001), and specialists (OR = 0.621; 95% CI, -0.608 to -0.207; p < .001). DISCUSSION This study showed that pediatricians who were male, widowed/separated, a smoker, with children, working in a State Hospital, and specialists had less belief in the side effects of THS.
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Shears A, Hoskyns L, Flinders P, Conry R, McMaster P. Paediatric hospital antimicrobial guidelines: a national UK review. Arch Dis Child 2023; 108:946-947. [PMID: 37640430 DOI: 10.1136/archdischild-2023-325854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Annalie Shears
- Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Paediatrics, The University of Manchester, Manchester, UK
| | - Lucy Hoskyns
- Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Paul Flinders
- Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Rebeka Conry
- Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Paddy McMaster
- Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Paediatrics, North Manchester General Hospital, Manchester, UK
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4
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Akyüz S, Çelik Y. Physicians’ Attitudes Against Clinical Practice Guidelines on the Use of Guidelines: A Scale Development Study. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221088109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims at developing scale measuring attitudes of physicians against clinical practice guidelines (CPGs) and investigate whether the attitude of physicians against CPGs has an effect on the use of CPGs. ‘The Physicians’ Attitudes Against CPGs and The Use of CPGs’ was developed and used to collect data from the physicians working in a public education and research hospital. Physicians’ attitudes that were constructed as an upper latent variable were significant, positive and highly effective on the use of CPGs. Furthermore, the attitude upper latent variable explained 30% of the variance in the observed variable for the use of CPGs. The attitude upper latent variable was affected significantly, positively and at a remarkably high level by positive attitude latent variable while it was affected significantly, negatively and at a remarkably high level by negative attitude latent variable. Physicians’ attitudes against CPGs were found to be a highly important factor in the use of CPGs. And it was also observed that physicians’ positive attitudes against CPGs affected the use of CPGs in a positive way while negative attitudes had negative effect on use of CPGs.
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Affiliation(s)
- Selahattin Akyüz
- Dışkapı Yıldırım Beyazıt Education and Research Hospital, Neurology Clinic, Ankara, Turkey
| | - Yusuf Çelik
- Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey
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5
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Goff SL, Gahlon G, Geissler KH, Dick AW, Kranz AM. Variation in Current Guidelines for Fluoride Varnish Application for Young Children in Medical Settings in the United States. Front Public Health 2022; 10:785296. [PMID: 35309203 PMCID: PMC8930922 DOI: 10.3389/fpubh.2022.785296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background The United States Preventive Services Task Force recommends that medical providers apply fluoride varnish (FV) to the teeth of all children under 6 years of age, but fewer than 10% of eligible children receive FV as recommended. Prior studies suggest that variation in clinical guidelines is associated with low uptake of other evidence-based health-related interventions, but consistency of national guidelines for the delivery of FV in medical settings is unknown. Methods Eligible guidelines for application of FV in medical settings for children under 6 years of age were published in the past 10 years by national pediatric or dental professional organizations or by national public health entities. Guidelines were identified using the search terms fluoride varnish + [application; guidelines, or recommendations; children or pediatric; American Academy of Pediatrics (AAP); American Academy of Pediatric Dentistry] and a search of Guideline Central. Details of the guidelines were extracted and compared. Results Ten guidelines met inclusion criteria. Guidelines differed in terms of periodicity recommendations and whether FV was indicated for children with a dental home or level of risk of dental caries. Conclusion Numerous recommendations about FV delivery in medical settings are available to pediatric medical providers. Further study is warranted to determine whether the variation across current guidelines detected in this study may contribute to low FV application rates in medical settings.
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Affiliation(s)
- Sarah L. Goff
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
- *Correspondence: Sarah L. Goff
| | | | - Kimberley H. Geissler
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
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Hartog K, Ardura-Garcia C, Hammer J, Kuehni CE, Barben J. Acute bronchiolitis in Switzerland - Current management and comparison over the last two decades. Pediatr Pulmonol 2022; 57:734-743. [PMID: 34889073 DOI: 10.1002/ppul.25786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/02/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although international guidelines and Cochrane reviews emphasize that therapies do not alter the natural course of acute viral bronchiolitis (AVB), they are still prescribed frequently. This survey evaluated self-reported management of AVB by Swiss pediatricians in 2019 and compared it with previous surveys. METHODS We performed a cross-sectional online survey of all board-certified pediatricians in Switzerland in November 2019 and compared the reported use of therapies with that reported in the 2001 and 2006 surveys. We used multivariable ordered logistic regression to assess factors associated with reported prescription of bronchodilators, corticosteroids, antibiotics, and physiotherapy. RESULTS Among 1618 contacted board-certified pediatricians, 884 returned the questionnaires (55% response rate). After exclusions were applied, 679 were included in the final analysis. Pediatricians working in primary care reported using therapeutics more frequently than those working in a hospital setting, either always or sometimes: bronchodilators 53% versus 38%, corticosteroids 37% versus 23%, and antibiotics 39% versus 22%. The opposite occurred with physiotherapy: 53% reported prescribing it in hospital and 44% in primary care. There was an overall decrease in the prescription of therapeutics and interventions for AVB from 2001 to 2019. The proportion who reported "always" prescribing corticosteroids decreased from 71% to 2% in primary care, and of those "always" prescribing bronchodilators from 55% to 1% in hospitals. CONCLUSION Although we observed a significant decrease since 2001, more effort is required to reduce the use of unnecessary therapies in children with AVB.
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Affiliation(s)
- Katharina Hartog
- Division of Pediatric Pulmonology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | | | - Jürg Hammer
- Division of Respiratory and Critical Care, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürg Barben
- Division of Pediatric Pulmonology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
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Seed L, Klein A, Kagalwala F. Hospital intranet system is major barrier to paediatric clinical guideline use a cross-sectional single-centre survey of NHS doctors and nurses. Ann Med Surg (Lond) 2022; 75:103385. [PMID: 35194515 PMCID: PMC8850160 DOI: 10.1016/j.amsu.2022.103385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
Abstract
Across clinical specialties, the use of clinical guidelines is integral to maintaining patient safety, reducing variation in clinical practice and optimising patient care. Identifying specific barriers to the effective use of guidelines within individual healthcare settings allows for the implementation of effective strategies to overcome them, and ultimately improvements in patient care. Here, we report a single-centre survey of paediatric doctors and nurses, which formed part of a quality improvement project within the Acute Paediatrics Department of an NHS district general hospital. The primary aim of the study was to explore the perspective and resource barriers paediatrics healthcare staff experience when using local and national clinical guidelines. The secondary aim of the study was to examine the impact of the Covid-19 pandemic on local and national clinical guideline use. We found that local and national guidelines are frequently used by paediatric doctors and nurses, and that they have positive perceptions of guidelines, overall. However, the NHS Trust's Intranet system was identified as a direct barrier to the use of local paediatric clinical guidelines. Staff throughout the UK in the NHS rely on their Intranet system in order to access local guidelines. Our results provide an impetus for interventions within this NHS Trust, and in the many other NHS Trusts with similar Intranet systems, to increase clinical guideline use and, ultimately, improve patient care.
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Affiliation(s)
- Lydia Seed
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
- Corresponding author. Emmanuel College, St Andrews Street, Cambridge, Cambridgeshire, CB2 3AP, UK.
| | - Alannah Klein
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - Fatima Kagalwala
- Department of Paediatrics, Lister Hospital, Stevenage, SG1 4AB, UK
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Harris J, Chorath K, Balar E, Xu K, Naik A, Moreira A, Rajasekaran K. Clinical Practice Guidelines on Pediatric Gastroesophageal Reflux Disease: A Systematic Quality Appraisal of International Guidelines. Pediatr Gastroenterol Hepatol Nutr 2022; 25:109-120. [PMID: 35360381 PMCID: PMC8958056 DOI: 10.5223/pghn.2022.25.2.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/28/2021] [Accepted: 02/06/2022] [Indexed: 12/18/2022] Open
Abstract
PURPOSE While regurgitation is a common and often benign phenomenon in infants and younger children, it can also be a presenting symptom of gastroesophageal reflux disease (GERD). If untreated, GERD can lead to dangerous or lifelong complications. Clinical practice guidelines (CPGs) have been published to inform clinical diagnosis and management of pediatric GERD, but to date there has been no comprehensive review of guideline quality or methodological rigor. METHODS A systematic literature search was performed, and a total of eight CPGs pertaining to pediatric GERD were identified. These CPGs were evaluated using the Appraisal of Guidelines for Research and Evaluation instrument. RESULTS Three CPGs were found to be "high" quality, with 5 of 6 domains scoring >60%, one "average" quality, with 4 of 6 domains meeting that threshold, and the remaining four "low" quality. CONCLUSION Areas of strength among the CPGs included "Scope and Purpose" and "Clarity and Presentation," as they tended to be well-written and easily understood. Areas in need of improvement were "Stakeholder Involvement," "Rigor of Development," and "Applicability," suggesting these CPGs may not be appropriate for all patients or providers. This analysis found that while strong CPGs pertaining to the diagnosis and treatment of pediatric GERD exist, many published guidelines lack methodological rigor and broad applicability.
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Affiliation(s)
- Jacob Harris
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Eesha Balar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Xu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anusha Naik
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, TX, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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9
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Sundgaard JV, Värendh M, Nordström F, Kamide Y, Tanaka C, Harte J, Paulsen RR, Christensen AN, Bray P, Laugesen S. Inter-rater reliability of the diagnosis of otitis media based on otoscopic images and wideband tympanometry measurements. Int J Pediatr Otorhinolaryngol 2022; 153:111034. [PMID: 35033784 DOI: 10.1016/j.ijporl.2021.111034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aims to investigate the inter-rater reliability and agreement of the diagnosis of otitis media with effusion, acute otitis media, and no effusion cases based on an otoscopy image and in some cases an additional wideband tympanometry measurement of the patient. METHODS 1409 cases were examined and diagnosed by an otolaryngologist in the clinic, and otoscopy examination and wideband tympanometry (WBT) measurement were conducted. Afterwards, four otolaryngologists (Ear, Nose, and Throat doctors, ENTs), who did not perform the acute examination of the patients, evaluated the otoscopy images and WBT measurements results for diagnosis (acute otitis media, otitis media with effusion, or no effusion). They also specified their diagnostic certainty for each case, and reported whether they used the image, wideband tympanometry, or both, for diagnosis. RESULTS All four ENTs agreed on the diagnosis in 57% of the cases, with a pairwise agreement of 74%, and a Light's Kappa of 0.58. There are, however, large differences in agreement and certainty between the three diagnoses. Acute otitis media yields the highest agreement (77% between all four ENTs) and certainty (0.90), while no effusion shows much lower agreement and certainty (34% and 0.58, respectively). There is a positive correlation between certainty and agreement between the ENTs across all cases, and both certainty and agreement increase for cases where a WBT measurement is shown in addition to the otoscopy image. CONCLUSIONS The inter-rater reliability between four ENTs was high when diagnosing acute otitis media and lower when diagnosing otitis media with effusion. However, WBT can add valuable information to get closer to the ground-truth diagnosis without myringotomy. Furthermore, the diagnostic certainty increases when the WBT is examined together with the otoscopy image.
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Affiliation(s)
| | - Maria Värendh
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Otorhinolaryngology, Head and Neck Surgery, Lund, Sweden
| | - Franziska Nordström
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Otorhinolaryngology, Head and Neck Surgery, Lund, Sweden
| | | | | | - James Harte
- Interacoustics Research Unit, C/o Technical University of Denmark, Denmark
| | - Rasmus R Paulsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark
| | | | | | - Søren Laugesen
- Interacoustics Research Unit, C/o Technical University of Denmark, Denmark
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Experiences and Attitudes on Early Identification Practices of Autism: A Preliminary Survey of Pediatric Professionals in Ecuador. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020123. [PMID: 35204844 PMCID: PMC8869979 DOI: 10.3390/children9020123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
Abstract
Early identification of children with autism is necessary to support their social and communicative skills and cognitive, verbal, and adaptive development. Researchers have identified several barriers to early diagnosis. Data collected in low- and middle-income contexts—where the vast majority of children in the world live—is scarce. In Ecuador, as in many other countries, estimates are lower compared to the global prevalence. Health authorities estimate a prevalence of 0.28% (0.18%–0.41%) in children aged five years old or less. Based on the hypothesis that, as in many parts of the world, children in Ecuador are not routinely screened and that this situation may result from poor recognition of this condition, our objective was to identify potential obstacles to case identification in pediatric settings. Several barriers, consistent with those identified in other countries, were reported by 153 participants on a survey, including lack of time, lack of resources to refer, fear of unnecessarily alarming families, and lack of information to guide families with concerns. The vast majority of participants are aware of the need for a screening tool for autism detection but report a lack of knowledge of its formal application. Most of the barriers reported in this study could be overcome by educational programs tailored to professional needs in order to support the well-being of children with autism and their families.
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11
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Sundgaard JV, Harte J, Bray P, Laugesen S, Kamide Y, Tanaka C, Paulsen RR, Christensen AN. Deep metric learning for otitis media classification. Med Image Anal 2021; 71:102034. [PMID: 33848961 DOI: 10.1016/j.media.2021.102034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 01/20/2023]
Abstract
In this study, we propose an automatic diagnostic algorithm for detecting otitis media based on otoscopy images of the tympanic membrane. A total of 1336 images were assessed by a medical specialist into three diagnostic groups: acute otitis media, otitis media with effusion, and no effusion. To provide proper treatment and care and limit the use of unnecessary antibiotics, it is crucial to correctly detect tympanic membrane abnormalities, and to distinguish between acute otitis media and otitis media with effusion. The proposed approach for this classification task is based on deep metric learning, and this study compares the performance of different distance-based metric loss functions. Contrastive loss, triplet loss and multi-class N-pair loss are employed, and compared with the performance of standard cross-entropy and class-weighted cross-entropy classification networks. Triplet loss achieves high precision on a highly imbalanced data set, and the deep metric methods provide useful insight into the decision making of a neural network. The results are comparable to the best clinical experts and paves the way for more accurate and operator-independent diagnosis of otitis media.
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Affiliation(s)
| | - James Harte
- Interacoustics Research Unit, c/o Technical University of Denmark, Lyngby, Denmark
| | | | - Søren Laugesen
- Interacoustics Research Unit, c/o Technical University of Denmark, Lyngby, Denmark
| | | | | | - Rasmus R Paulsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Anders Nymark Christensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
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12
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Desalu OO, Adeoti AO, Makusidi MA, Fadare JO, Aremu GO, Amao EA, Opadijo OG. Family physicians/GP and Internist opinions, familiarity and practice behaviour regarding clinical practice guidelines (CPGs) of common medical conditions in Nigeria. J Family Med Prim Care 2021; 10:502-508. [PMID: 34017778 PMCID: PMC8132848 DOI: 10.4103/jfmpc.jfmpc_1505_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Few studies exist on physicians' opinions, attitudes, familiarity and practice behaviour regarding clinical practice guidelines in sub-Saharan Africa. Objectives: To determine the opinions, familiarity, and practice behaviour regarding clinical practice guidelines (CPGs) and factors associated with their use among internists and family physicians/GP in Nigeria. Methods: A semi-structured questionnaire regarding guidelines of five common medical conditions: hypertension, diabetes mellitus, tuberculosis, asthma and hepatitis B encountered in everyday medical practice were self-administered by 183 doctors across the country. Results: Over 90% of respondents believed that guidelines were evidence-based, improved management outcomes, and quality of care, nevertheless, 57.4% were against using them in litigations against doctors. The majority (>70%) of the respondents were familiar with the guidelines except that of hepatitis B. Overall, guidelines were used regularly by 45.9%, used in part by 23.5% and 30.6% never used it. Approximately 50% of physicians had immediate accessibility to them at the point of care. The proportions of respondents reporting a change in practice behaviour ranged from 37.7-57.9% depending on the guideline. The factors associated with guideline-related behaviour change were familiarity with its contents, postgraduate educational training, increased helpfulness score, and practiced >5 years. Conclusions: The present study shows that most physicians have favourable opinions and are familiar with these guidelines, however, the proportions reporting changes in their patient management because of the guidelines are not satisfactory. It is important to ensure guidelines accessibility and promotes factors that encourage their implementation in medical practice.
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Affiliation(s)
- Olufemi O Desalu
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Muhammad A Makusidi
- Department of Medicine, Usmanu Dan Fodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Joseph O Fadare
- Department of Pharmacology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Gbolahan O Aremu
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel A Amao
- Medical Director, Department of Family Medicine, Shallom Medical Centre, Ogbomoso, Nigeria
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Nasir K, Javed Z, Khan SU, Jones SL, Andrieni J. Big Data and Digital Solutions: Laying the Foundation for Cardiovascular Population Management CME. Methodist Debakey Cardiovasc J 2021; 16:272-282. [PMID: 33500755 DOI: 10.14797/mdcj-16-4-272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There are huge gaps in evidence-based cardiovascular care at the national, organizational, practice, and provider level that can be attributed to variation in provider attitudes, lack of incentives for positive change and care standardization, and observed uncertainty in clinical decision making. Big data analytics and digital application platforms-such as patient care dashboards, clinical decision support systems, mobile patient engagement applications, and key performance indicators-offer unique opportunities for value-based healthcare delivery and efficient cardiovascular population management. Successful implementation of big data solutions must include a multidisciplinary approach, including investment in big data platforms, harnessing technology to create novel digital applications, developing digital solutions that can inform the actions of clinical and policy decision makers and relevant stakeholders, and optimizing engagement strategies with the public and information-empowered patients.
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Affiliation(s)
- Khurram Nasir
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON, TEXAS.,HOUSTON METHODIST RESEARCH INSTITUTE, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Zulqarnain Javed
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON, TEXAS.,HOUSTON METHODIST RESEARCH INSTITUTE, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Safi U Khan
- WEST VIRGINIA UNIVERSITY, MORGANTOWN, WEST VIRGINIA
| | - Stephen L Jones
- HOUSTON METHODIST RESEARCH INSTITUTE, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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14
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Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties. Infect Control Hosp Epidemiol 2020; 41:666-671. [PMID: 32252848 DOI: 10.1017/ice.2020.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics. OBJECTIVE To understand the factors that contribute to pediatric surgeons' decisions regarding the use of perioperative antibiotic prophylaxis. METHODS Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery. RESULTS A total of 23 surgeons with a median of 9 years of experience (range, 0.5-29 years) participated in the focus groups that lasted 30-90 minutes each. Five themes emerged influencing beliefs about antibiotic prescribing practices: (1) reliance on previous experience and early education, (2) balancing antibiotic use with risk of infection, (3) uncertainty about the state of the scientific evidence, (4) understanding importance of communication and team collaboration, and (5) a prevalence of hospital-level concerns. CONCLUSIONS Surgeons describe a complex set of factors that impact their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices. Antimicrobial stewardship programs should work with surgeons to develop acceptable implementation strategies to optimize antibiotic prescribing.
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15
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Change in the strategy for prophylactic diazepam use for febrile seizures and the impact on seizure recurrence within 24 h. Seizure 2020; 75:70-74. [DOI: 10.1016/j.seizure.2019.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/22/2022] Open
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16
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Tanaka M, Natsume J, Hamano SI, Iyoda K, Kanemura H, Kubota M, Mimaki M, Niijima SI, Tanabe T, Yoshinaga H, Kojimahara N, Komaki H, Sugai K, Fukuda T, Maegaki Y, Sugie H. The effect of the guidelines for management of febrile seizures 2015 on clinical practices: Nationwide survey in Japan. Brain Dev 2020; 42:28-34. [PMID: 31604594 DOI: 10.1016/j.braindev.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of guidelines for management of febrile seizures on the clinical practice, we conducted a nationwide survey in Japan. METHODS The Japanese guidelines for management of febrile seizures 2015 (GL2015) was released in 2015. In 2016, a questionnaire was sent to all 512 certified hospitals (3 pediatricians each) of the Japan Pediatric Society and all 47 prefecture Pediatric Associations (10 private pediatricians each) in Japan asking about management policies for febrile seizures (FSs) during 2013-2014 and 2016. The questionnaires were about the following procedures: (1) lumbar punctures, blood examinations, and diazepam suppositories for children after a first simple FS at emergency departments; and (2) prophylactic diazepam during febrile illnesses in children with two or three past simple FSs, with no known predictors of recurrence. RESULTS A total of 1327 pediatricians (66.2%) answered the questionnaire. Numbers of pediatricians performing lumbar punctures and blood examinations, and giving diazepam suppositories after a first simple FS were less in 2016 than in 2013-2014 (1.2% and 2.0%, 53.1% and 61.3%, and 36.7% and 51.9%, respectively). Pediatricians recommending prophylactic diazepam for children with two and three FSs decreased from 45.7% and 82.4% in 2013-2014 to 31.0% and 65.0% in 2016, respectively. CONCLUSION GL2015 had an effect on the clinical practices of pediatricians. On the other hand, 65% recommended prophylactic diazepam to children with three simple FSs even though GL2015 did not recommend use of diazepam based on number of previous FS. Anxiety about frequent seizures may affect pediatricians' clinical practice.
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Affiliation(s)
- Masaharu Tanaka
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Natsume
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shin-Ichiro Hamano
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Kuniaki Iyoda
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Fukuyama Support Center of Development and Care for Children, Fukuyama, Japan
| | - Hideaki Kanemura
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masaya Kubota
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Masakazu Mimaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Niijima
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takuya Tanabe
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Tanabe Children's Clinic, Osaka, Japan
| | - Harumi Yoshinaga
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, Okayama University Graduate Schools of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Kojimahara
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirofumi Komaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tokiko Fukuda
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Division of Child Neurology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hideo Sugie
- Working Group for Guidelines for Management of Febrile Seizures, Japanese Society of Child Neurology, Nagoya, Japan; Faculty of Health and Medical Sciences, Tokoha University Hamamatsu Campus, Hamamatsu, Japan
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Kalavani K, Mohebbifar R, Rafiei S. Evidence based practice among healthcare providers: a cross-sectional study. Int J Health Care Qual Assur 2019; 32:867-878. [PMID: 31195935 DOI: 10.1108/ijhcqa-08-2017-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Nowadays health systems in most of the countries are trying to build their healthcare provision system based on scientific knowledge based evidence. Evidence-based practice (EBP) is a crucial factor for quality improvement focusing on compliance with clinical standards. The purpose of this paper is to assess evidence-based knowledge and skills among healthcare providers in Qazvin hospitals in 2016. DESIGN/METHODOLOGY/APPROACH This was a descriptive study conducted among 300 health professionals working in hospitals affiliated by Qazvin University of Medical Sciences in 2016. A self-administered questionnaire was used to gather data on health providers' attitude, knowledge and skill regarding EBP. Descriptive statistics and multiple linear regressions were used to analyze data using SPSS 16 software. FINDINGS A total of 254 participants (84.6 percent) completed the questionnaire in which their attitude, knowledge and skill toward EBP were assessed at a low level. Study results indicated that among different occupational groups, physicians and those with greater awareness toward EBP terminology had a more positive attitude compared with others. Furthermore, a higher level of knowledge and skill toward EBP was associated with being a physician and having a positive attitude toward the issue. PRACTICAL IMPLICATIONS Given the importance of EBP and due to insufficient knowledge of healthcare providers about the issue, it is necessary to hold appropriate educational courses to empower health workforce in implementing EBP principles. ORIGINALITY/VALUE The authors applied a self-administered questionnaire to assess health workforce knowledge and skills toward EBP. The results obtaining from the analysis not only highlights weaknesses related to service providers' knowledge and capabilities to implement EBP but also reveals facilities required for realization of the subject in hospital settings.
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Affiliation(s)
- Khalil Kalavani
- Student Research Committee, School of Health, Qazvin University of Medical Sciences , Qazvin, The Islamic Republic of Iran
| | - Rafat Mohebbifar
- School of Health, Qazvin University of Medical Sciences , Qazvin, The Islamic Republic of Iran
| | - Sima Rafiei
- School of Health, Qazvin University of Medical Sciences , Qazvin, The Islamic Republic of Iran
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Toy JM, Drechsler A, Waters RC. Clinical pathways for primary care: current use, interest and perceived usability. J Am Med Inform Assoc 2019. [PMID: 29529203 DOI: 10.1093/jamia/ocy010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. Methods An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Results Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. Conclusion There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.
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Affiliation(s)
- Jennifer M Toy
- Department of Clinical Pharmacy, University of California at San Francisco, San Francisco, CA 94143, USA
| | | | - Richard C Waters
- Site medical director, Homeless Services Programs, Neighborcare Health, Seattle, WA 98144, USA
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19
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Amer YS, Al Nemri A, Osman ME, Saeed E, Assiri AM, Mohamed S. Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital. J Eval Clin Pract 2019; 25:543-549. [PMID: 29611621 DOI: 10.1111/jep.12923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To explore perception, attitude, and satisfaction of paediatric clinicians, trainees, and nurses at King Khalid University Hospital towards clinical practice guidelines (CPGs) including the locally adapted diabetic ketoacidosis CPG (DKA-CPG). METHODS A cross-sectional survey was distributed to 260 doctors and nurses working in the paediatrics department. RESULTS The response rate was 95.4%. The respondents had a positive perception and attitude towards general CPGs and specifically for the DKA-CPG; 98.7% thought CPGs were useful sources of advice, improved safety, and decreased risk, and reduced variation in practice. A total of 99.2% thought CPGs were good clinical tools, 98.3% satisfied with, had confidence in well-developed CPGs, and would recommend them to their colleagues to use, and 94.6% agreed they were cost-effective. The preferred format for CPGs was paper (46.6%) and electronic (42.9%). The DKA-CPG helped in managing patients and respondents were all satisfied and had confidence with it (100%). The rationale and objectives of the DKA-CPG were clear for 99.25%; 98.5% thought the layout was clear and well organized and user-friendly (96.2%). Compared with nurses, physicians had a higher perception towards CPGs in general (P < .05) and the DKA-CPG (P < .05). CONCLUSIONS The paediatric doctors, and nurses have a great perception and satisfaction and positive attitude towards CPGs in general, towards the paediatric diabetic ketoacidosis CPG in particular, which in turn had a positive impact on the acceptability and implementation of the CPGs. These findings could help in sustaining a safe and high-quality health care environment through implementation of evidence-based CPGs.
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Affiliation(s)
- Yasser Sami Amer
- Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Centre for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Abdulrahman Al Nemri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Elfaki Osman
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Asaad Mohamed Assiri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Sarar Mohamed
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Department of Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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20
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Rivera-Sepulveda AV, Rebmann T, Gerard J, Charney RL. Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments. Clin Pediatr (Phila) 2019; 58:1008-1018. [PMID: 31122050 DOI: 10.1177/0009922819850462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.
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Affiliation(s)
| | - Terri Rebmann
- 2 Saint Louis University Institute of Biosecurity, Saint Louis, MO, USA
| | - James Gerard
- 1 Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Rachel L Charney
- 1 Saint Louis University School of Medicine, Saint Louis, MO, USA
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21
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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.
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Judge P, Tabeshi R, Yao RJ, Meckler G, Doan Q. Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study. Paediatr Child Health 2018; 24:227-233. [PMID: 31239811 DOI: 10.1093/pch/pxy125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/28/2018] [Indexed: 11/14/2022] Open
Abstract
Background We recently introduced a clinical practice pathway for the management of asthma that uses the Pediatric Respiratory Assessment Measure (PRAM) to guide emergency department (ED) treatment and disposition. The pathway recommends discharge for patients who achieve improvement to PRAM <4 at 1 hour after the last bronchodilator. We evaluated practice variation and patient outcomes associated with PRAM-directed disposition recommendations. Methods We conducted a retrospective cohort study of children aged 2 to 17 years treated for moderate asthma (PRAM score 4-7) using our asthma clinical pathway. We measured 1) the proportion of children discharged per pathway criteria who returned to our ED within 24 hours and 2) the proportion of children observed beyond the pathway discharge criteria who deteriorated (PRAM ≥4). Results We analyzed 385 patient records from September 2013 to February 2015. Among 145 (37.7%) patients discharged per pathway criteria, 4 (4/145; 2.8%) returned within 24 hours. The remaining 240 (62.2%) were observed beyond the pathway discharge criteria; 76/240 (31.7%) had a subsequent deterioration (PRAM score ≥ 4) and 25/240 (10.4%) were hospitalized. Of those who deteriorated, 46/76 (60.5%) worsened within the first additional hour of observation. Conclusion We observed significant deviation from our PRAM-directed pathway discharge criteria and that a significant proportion of observed patients experienced clinical deterioration beyond the first hour of observation. We recommend observing children with moderate asthma for 2 or 3 hours from last bronchodilator therapy if PRAM < 4 is maintained, to capture the majority (97.7% or 99.7%) of patients who require further intervention and hospitalization.
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Affiliation(s)
- Pavan Judge
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Raymond Tabeshi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Ren Jie Yao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Garth Meckler
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Quynh Doan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia
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23
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Issel LM. Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle. Med Care Res Rev 2018; 76:359-385. [DOI: 10.1177/1077558718774905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven’s (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners’ work processes to health care organizations; this has potential benefits for organizations, clinicians/employees, and patients.
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Aljazeeri J, Punthakee Z. THE IMPACT OF RESIDENT SENIORITY ON GUIDELINES ADHERENCE: A COMMENTARY ON DIABETES MANAGEMENT IN THE HOSPITAL. Endocr Pract 2017; 23:1479-1481. [PMID: 29144804 DOI: 10.4158/ep-2017-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Barends E, Villanueva J, Rousseau DM, Briner RB, Jepsen DM, Houghton E, ten Have S. Managerial attitudes and perceived barriers regarding evidence-based practice: An international survey. PLoS One 2017; 12:e0184594. [PMID: 28972977 PMCID: PMC5626028 DOI: 10.1371/journal.pone.0184594] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/25/2017] [Indexed: 11/18/2022] Open
Abstract
Evidence-based practice (EBP) in management is still in its infancy. Several studies suggest that managers in businesses and other organizations do not consult the scientific evidence when making decisions. To facilitate its uptake, we need to better understand practitioner attitudes and perceived barriers related to EBP. In medicine and nursing, an abundance of research exists on this subject, although such studies are rare in management. To address this gap, we surveyed 2,789 management practitioners in Belgium, the Netherlands, the United States, the United Kingdom and Australia. Our findings indicate that most managers we studied have positive attitudes towards EBP. However, lack of time and a limited understanding of scientific research are perceived as major barriers to the uptake and implementation of EBP in management. Studies in other professions where EBP is far more established also report similar barriers. We discuss the implications of our findings for practice, education and research, providing suggestions to enhance use of EBP in management practice.
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Affiliation(s)
- Eric Barends
- Center for Evidence Based Management (CEBMa), Amsterdam, The Netherlands
| | - Josh Villanueva
- Claremont Graduate University, Claremont, California, United States of America
| | - Denise M. Rousseau
- Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Rob B. Briner
- School of Business and Management, Queen Mary University of London, London, United Kingdom
| | - Denise M. Jepsen
- Faculty of Business and Economics, Macquarie University, North Ryde, Australia
| | - Edward Houghton
- Human Capital and Metrics, Chartered Institute of Personnel & Development (CIPD), London, United Kingdom
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Liu M, Zhang C, Zha Q, Yang W, Yuwen Y, Zhong L, Bian Z, Han X, Lu A. A national survey of Chinese medicine doctors and clinical practice guidelines in China. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:451. [PMID: 28877689 PMCID: PMC5588680 DOI: 10.1186/s12906-017-1946-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 08/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) for Chinese medicine (CM) are being developed to assist doctors with appropriate decisions concerning CM care. To date, there has been little investigation on the perspectives of those to whom the guidelines are directed. METHODS A self-administered questionnaire was sent to 4503 doctors in 28 provinces of China in the latter half of 2012. Questions were organized around the topics of knowledge, application, practice changes, beliefs and outcomes of implementation. Basic classificatory data on specialties and years of qualification were also collected. RESULTS Replies were received from 4495 CM doctors (99.82%). Of these, 85.56% of CM doctors reported being familiar with CPG recommendations, but the overall adherence rate was only 50.39%. The length of time practicing CM may influence the rate of adherence, since 709 doctors (51.90%) with less than 5 years of experience reported never having followed CPGs. Doctors in nine specialties showed a modest degree of homogeneity in their attitudes towards CM diagnosis and treatment, which were generally positive. Most doctors regarded CPG-recommended therapies as safe (92%), economic (84%), and effective (76%). Approximately four-fifths of those questioned selected 'acceptable' (60.84%) and 'acceptable after revision' (19.23%) regarding their comprehensive assessment of the CPGs. CONCLUSIONS An encouraging result from this survey is that the majority of CM doctors support the concept of CPGs for the practice of CM. However, the results of this survey also suggest that improving the adherence of CM doctors to the guidelines remains a major challenge to improving the practice standards for CM.
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Affiliation(s)
- Mengyu Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
| | - Chi Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077 Hong Kong
| | - Qinglin Zha
- School of Computer, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004 China
| | - Wei Yang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
| | - Ya Yuwen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
| | - Linda Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077 Hong Kong
| | - Zhaoxiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077 Hong Kong
| | - Xuejie Han
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
| | - Aiping Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700 China
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077 Hong Kong
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Spruiell MD, Searns JB, Heare TC, Roberts JL, Wylie E, Pyle L, Donaldson N, Stewart JR, Heizer H, Reese J, Scott HF, Pearce K, Anderson CJ, Erickson M, Parker SK. Clinical Care Guideline for Improving Pediatric Acute Musculoskeletal Infection Outcomes. J Pediatric Infect Dis Soc 2017; 6:e86-e93. [PMID: 28419275 DOI: 10.1093/jpids/pix014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children's Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical and resource outcomes PRE and POST this CCG. METHODS Retrospective chart review evaluated patients admitted to a large pediatric quaternary referral center (CHCO) diagnosed with acute osteomyelitis, septic arthritis, pyomyositis, and/or musculoskeletal abscess prior to and after guideline implementation. Primary outcomes included length of stay and overall antibiotic use, with additional secondary clinical, process, and therapeutic outcomes examined. RESULTS 82 patients were identified in both the pre-CCG and post-CCG cohorts. There was a reduction in the median of all primary outcomes, including length of stay (0.6 median days decrease, P = .04), length of IV antibiotic therapy (4.9 median days decrease, P < .0001), and days of IV antibiotic therapy (6.4 median days decrease, P = .0004). Our median length of stay post-CCG was 4.9 days, the shortest reported length of stay for pediatric acute musculoskeletal infections to date. Additionally, there was a 24.5 hour reduction in median length of fever (P = .02), faster CRP normalization (P < .0001), 50% decrease in the number of related readmissions (P = .02), 34% decrease in central venous catheters placed (P < .0001), decreased time to first culture (P = .02), and 79% pathogen identification post-CCG (P = .056). CONCLUSIONS Implementation of a CCG for acute musculoskeletal infections improves patient, process and resource outcomes.
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Affiliation(s)
- Murray D Spruiell
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
| | | | - Travis C Heare
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
| | - Jesse L Roberts
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
| | - Erin Wylie
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Children's Hospital Colorado, Aurora
| | - Laura Pyle
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
| | - Nathan Donaldson
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
| | | | | | - Jennifer Reese
- Division of Pediatric Hospital Medicine, Department of Pediatrics
| | | | - Kelly Pearce
- Department of Epidemiology, Children's Hospital Colorado, Aurora
| | - Colin J Anderson
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
| | - Mark Erickson
- Department of Orthopedic Surgery, University of Colorado Denver School of Medicine, Aurora
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Law Y. Does standardization improve care or stifle innovation? Pediatr Transplant 2017; 21. [PMID: 28707756 DOI: 10.1111/petr.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuk Law
- Division of Cardiology, Seattle Children's Hospital, Seattle, WA, USA
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Peterson J, Louden DT, Gribben V, Blankenburg R. Teaching Residents Clinical Practice Guidelines Using a Flipped Classroom Model. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10548. [PMID: 30800750 PMCID: PMC6342164 DOI: 10.15766/mep_2374-8265.10548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/20/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Prior studies have demonstrated poor guideline compliance by pediatricians, and there is no published curriculum on how to teach clinical guidelines. Furthermore, in a national survey of pediatric residency training programs conducted in 2015, only two had a formal curriculum for teaching clinical guidelines. This module provides a framework for teaching residents clinical guidelines through a modified flipped classroom approach. Associated materials include a guide for faculty facilitators, sample slides and worksheet, and pictures of the classroom setup. METHODS In this module, the guidelines for acute otitis media (AOM), obstructive sleep apnea syndrome (OSAS), and attention deficit-hyperactivity disorder (ADHD) are taught in three sessions and evaluated with a pre-/posttest assessing knowledge, attitudes, self-efficacy, and satisfaction. Each guideline is delivered in a 30-minute session, with five learners per group. Faculty training requires approximately 30 minutes of preparation. The intervention groups (n = 9 for OSAS, 10 each for AOM and ADHD) received three weekly, half-hour flipped classroom lessons. The control group (n = 19) had no formal guideline education. RESULTS Pre-/posttests showed a statistically significant improvement in knowledge and attitudes in the group of interns who received this educational intervention over the control group. The learners rated the sessions as highly effective. DISCUSSION This module provides an efficient and effective way of utilizing a modified flipped classroom approach to teach learners the correct use of clinical guidelines, a skill residents must master to provide evidence-based care. This curriculum has been successfully incorporated into our pediatric residency program.
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Affiliation(s)
- Jaime Peterson
- Postdoctoral Fellow, Stanford University School of Medicine
- Clinical Instructor in General Pediatrics, Stanford University School of Medicine
| | - Drew Taylor Louden
- Postdoctoral Fellow in Pediatric Emergency Medicine, Seattle Children's Hospital
| | - Valerie Gribben
- Clinical Instructor in Pediatrics, Division of Hospitalist Medicine, Washington University in St. Louis School of Medicine
| | - Rebecca Blankenburg
- Clinical Associate Professor, Stanford University School of Medicine
- Pediatric Residency Program Director, Stanford University School of Medicine
- Associate Chair of Education, Stanford University School of Medicine
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Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, Vassar M. Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity. Clin Obes 2017; 7:34-45. [PMID: 28112500 DOI: 10.1111/cob.12174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/13/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.
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Affiliation(s)
- T Nissen
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Wayant
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - A Wahlstrom
- Department of Pediatrics, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - P Sinnett
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Fugate
- Department of Pediatrics, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - J Herrington
- Department of Emergency Medicine, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - M Vassar
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Tinkle MB, Tigges BB, Boursaw B, McFarlane DR. Adherence to the Women's Preventive Services Guidelines in the Affordable Care Act. J Obstet Gynecol Neonatal Nurs 2016; 45:813-824. [PMID: 27615503 PMCID: PMC5198580 DOI: 10.1016/j.jogn.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the adherence of women's health providers in New Mexico to the Women's Preventive Services Guidelines and to examine how providers' knowledge, attitudes, and external barriers are associated with adherence. DESIGN Cross-sectional, descriptive survey. SETTING New Mexico. PARTICIPANTS Women's health providers in New Mexico, including nurse practitioners, certified nurse-midwives, and family practice and obstetrician-gynecologist physicians. METHODS Participants completed a self-administered survey to measure knowledge, attitudes, external barriers, and adherence to each of the eight guidelines. Adherence was defined as following a guideline more than 90% of the time. RESULTS The response rate was 22% (399/1,798). Among the eight guidelines, participant adherence ranged from 17.2% to 88.4%. Only 39.7% of participants indicated adherence to most of the guidelines (four or more). Overall, provider adherence was directly associated with familiarity with the guidelines (odds ratio = 3.69; 95% confidence interval [1.96, 6.96]), self-efficacy to implement them (odds ratio = 4.25; 95% confidence interval [2.21, 8.20]), and younger age (odds ratio = 0.97; 95% confidence interval [0.94, 1.00]). CONCLUSION Adherence to the Women's Preventive Services Guidelines by providers in New Mexico is variable and, for many recommended practices, less than optimal. New targeted implementation strategies are needed to address barriers to adherence.
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Knutson S, Kelleman MS, Kochilas L. Implementation of Developmental Screening Guidelines for Children with Congenital Heart Disease. J Pediatr 2016; 176:135-141.e2. [PMID: 27301570 DOI: 10.1016/j.jpeds.2016.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/27/2016] [Accepted: 05/10/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess awareness and implementation among pediatric primary care providers of the 2012 American Heart Association (AHA) guidelines for the evaluation and management of developmental abnormalities in children with congenital heart disease (CHD). We hypothesized that children with CHD are not being provided neurodevelopmental screening and support according to the AHA guidelines. STUDY DESIGN An online survey was administered to licensed pediatric primary care providers in Minnesota (pediatricians = 530, family physicians = 1469) to evaluate awareness of the AHA guidelines, current screening practices, and barriers to implementation of these guidelines. RESULTS A total of 326 providers (17% of 1911 successful e-mails) responded to the survey, which included 148 pediatricians (29% of 518 successful e-mails) and 178 family physicians (13% of 1393 successful e-mails). Overall, 202 providers (62%) reported caring for children with CHD. Among those caring for children with CHD, the most commonly reported reasons for neurodevelopmental referral were nonspecific to CHD. Presence of risks specific to children with CHD, such as history of cyanotic heart disease or open heart surgery as an infant, accounted for only 25% and 22% of the referrals, respectively. Only 21% of providers were aware of the guidelines, and only 7% received guidance from a pediatric cardiologist regarding neurodevelopmental screening in children with CHD. CONCLUSION There is need for further education of primary care providers on the developmental risks associated with CHD as well as increased involvement by the pediatric cardiology community to enhance the developmental outcomes of children with CHD.
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Affiliation(s)
- Stacie Knutson
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
| | - Michael S Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study. PLoS One 2016; 11:e0152649. [PMID: 27031700 PMCID: PMC4816333 DOI: 10.1371/journal.pone.0152649] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. Aim This study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting. Methods Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Results Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. Conclusion The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.
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Hsiao JL, Chen RF. Critical factors influencing physicians' intention to use computerized clinical practice guidelines: an integrative model of activity theory and the technology acceptance model. BMC Med Inform Decis Mak 2016; 16:3. [PMID: 26772169 PMCID: PMC4715302 DOI: 10.1186/s12911-016-0241-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/08/2016] [Indexed: 01/22/2023] Open
Abstract
Background With the widespread use of information communication technologies, computerized clinical practice guidelines are developed and considered as effective decision supporting tools in assisting the processes of clinical activities. However, the development of computerized clinical practice guidelines in Taiwan is still at the early stage and acceptance level among major users (physicians) of computerized clinical practice guidelines is not satisfactory. This study aims to investigate critical factors influencing physicians’ intention to computerized clinical practice guideline use through an integrative model of activity theory and the technology acceptance model. Methods The survey methodology was employed to collect data from physicians of the investigated hospitals that have implemented computerized clinical practice guidelines. A total of 505 questionnaires were sent out, with 238 completed copies returned, indicating a valid response rate of 47.1 %. The collected data was then analyzed by structural equation modeling technique. Results The results showed that attitudes toward using computerized clinical practice guidelines (γ = 0.451, p < 0.001), organizational support (γ = 0.285, p < 0.001), perceived usefulness of computerized clinical practice guidelines (γ = 0.219, p < 0.05), and social influence (γ = 0.213, p < 0.05) were critical factors influencing physicians’ intention to use computerized clinical practice guidelines, and these factors can explain 68.6 % of the variance in intention to use computerized clinical practice guidelines. Conclusions This study confirmed that some subject (human) factors, environment (organization) factors, tool (technology) factors mentioned in the activity theory should be carefully considered when introducing computerized clinical practice guidelines. Managers should pay much attention on those identified factors and provide adequate resources and incentives to help the promotion and use of computerized clinical practice guidelines. Through the appropriate use of computerized clinical practice guidelines, the clinical benefits, particularly in improving quality of care and facilitating the clinical processes, will be realized.
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Affiliation(s)
- Ju-Ling Hsiao
- Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science, Tainan City, Taiwan R.O.C..
| | - Rai-Fu Chen
- Department of Information Management, Chia-Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Rd., Rende Dist., Tainan City, 71710, Taiwan R.O.C..
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Jeong HJ, Jo HS, Oh MK, Oh HW. Applying the RE-AIM Framework to Evaluate the Dissemination and Implementation of Clinical Practice Guidelines for Sexually Transmitted Infections. J Korean Med Sci 2015; 30:847-52. [PMID: 26130944 PMCID: PMC4479935 DOI: 10.3346/jkms.2015.30.7.847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/17/2015] [Indexed: 11/24/2022] Open
Abstract
Clinical practice guidelines (CPG) are one of the most effective ways to translate evidence of medical improvement into everyday practice. This study evaluated the dissemination and implementation of the Sexually Transmitted Infections-Korean Guidelines (STIKG) by applying the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. A survey questionnaire was administered to clinicians via the internet. Among the 332 respondents, 190 (57.2%) stated that they were aware of STIKG and 107 (33.2%) implemented STIKG in their practice. The odds that a physician was exposed to STIKG (dissemination) were 2.61 times greater among physicians with previous training or education for any CPG than those who did not. Clinicians who indicated that STIKG were easy to understand were 4.88 times more likely to implement STIKG in their practice than those who found them not so easy. When a clinician's workplace had a supporting system for CPG use, the odds of implementation was 3.76 times higher. Perceived level of effectiveness of STIKG did not significantly influence their implementation. The findings of this study suggest that, ultimately, knowing how to engage clinicians in CPG implementation is as important as how to disseminate such guidelines; moreover, easy-to-use guidelines and institutional support are key factors.
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Affiliation(s)
- Heon-Jae Jeong
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA
| | - Heui-Sug Jo
- Department of Health Management and Policy, Kangwon National University School of Medicine, Chuncheon, Korea
- The Executive Committee for Clinical Practice Guideline, The Korean Academy of Medical Sciences, Seoul, Korea
| | - Moo-Kyung Oh
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hyung-Won Oh
- Department of Health Management and Policy, Kangwon National University School of Medicine, Chuncheon, Korea
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Mota da Silva T, da Cunha Menezes Costa L, Garcia AN, Costa LOP. What do physical therapists think about evidence-based practice? A systematic review. ACTA ACUST UNITED AC 2015; 20:388-401. [DOI: 10.1016/j.math.2014.10.009] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 11/30/2022]
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Cohn SL, Gautam B, Preddy JS, Connors JR, Kennedy SE. Barriers to the use of paediatric clinical practice guidelines in rural and regional New South Wales Australia. Aust J Rural Health 2015; 24:23-8. [DOI: 10.1111/ajr.12190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Sarah L. Cohn
- Rural Medical School; University of New South Wales; Wagga Wagga Australia
| | - Bijender Gautam
- Rural Medical School; University of New South Wales; Wagga Wagga Australia
| | - John S. Preddy
- Rural Medical School; University of New South Wales; Wagga Wagga Australia
| | - John R. Connors
- Rural Medical School; University of New South Wales; Wagga Wagga Australia
| | - Sean E. Kennedy
- School of Women's & Children's Health; University of New South Wales; Sydney Australia
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Iovu MB, Goian C, Runcan PL. Evidence-Based Practice among Romanian Social Workers: Attitudes, Utilization, and Barriers. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 12:524-33. [PMID: 25844488 DOI: 10.1080/15433714.2014.899173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this article the authors report on a small survey of Romanian social workers regarding their attitudes toward evidence-based practice (EBP) and thoughts on the factors affecting its implementation in their clinical work. Eighty social workers were asked to complete a pen-and-paper questionnaire on their attitudes toward EBP, the use of research, and perceived barriers on implementation. Social workers have generally positive attitudes toward EBP. Insufficient time surfaced as the greatest barrier to successful implementation. Previous training during academic programs on the EBP foundations was associated with more positive attitudes and beliefs and also with stronger commitment toward implementation. Given the constant pressure that the limited resources pose on the social services, practitioners from the social work field must assure that their clients will have access to the best available programs and interventions. However, as the transfer of research into practice appears more complex than EBP suggests, the authors sought to understand how professionals construct their attitudes, level of commitment, and barriers.
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Affiliation(s)
- Mihai-Bogdan Iovu
- a Social Work Department , Babe¸-Bolyai University , Cluj-Napoca , Romania
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Isensee C, Hagmayer Y, Rothenberger A, Rothenberger LG, Becker A. [The AWMF-Guidelines for Hyperkinetic Disorders in therapeutic practice- knowledge, familiarity, utilization, and attitude of psychotherapists and physicians]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2015; 43:91-100. [PMID: 25769762 DOI: 10.1024/1422-4917/a000338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The AWMF-Guidelines for Hyperkinetic Disorders (ADHD) provide psychotherapists and physicians with guidance concerning diagnostics and treatment for one of the most common disorders in children and adolescents. To date, however, it is unclear how these guidelines are being applied by practicing therapists (both physicians and psychotherapists) and what they consider to be its pros and cons. This study proposes (1) to analyze the differences between the estimation of ADHD-guidelines by users and nonusers, their corresponding attitudes, experiences, and evaluations of context factors; and (2) to analyze whether users and nonusers differ in their therapeutic practice. METHODS 71 therapists participated in a nonrepresentative online survey. RESULTS The hypothesis was confirmed that, on average, users had a more positive attitude toward and experience with guideline-driven treatment than did nonusers. The results also show a small positive effect of guideline use on treatment quality. However, the methods employed by users and nonusers only moderately corresponded with the recommendations of the guidelines. CONCLUSIONS It was shown that the ADHD guideline is only rarely being used, even under advantageous conditions, and that a practice-oriented form of the guideline does not exist until now.
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Affiliation(s)
- Corinna Isensee
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin Göttingen
| | - York Hagmayer
- Institut für Psychologie, Georg-August-Universität Göttingen
| | - Aribert Rothenberger
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin Göttingen
| | | | - Andreas Becker
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsmedizin Göttingen
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Does active dissemination of evidence result in faster knowledge transfer than passive diffusion?: An analysis of trends of the management of pediatric asthma and croup in US emergency departments from 1995 to 2009. Pediatr Emerg Care 2015; 31:190-6. [PMID: 24694945 DOI: 10.1097/pec.0000000000000099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to compare knowledge transfer (KT) in the emergency department (ED) management of pediatric asthma and croup by measuring trends in corticosteroid use for both conditions in EDs. METHODS A retrospective, cross-sectional study of the National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 of corticosteroid use at ED visits for asthma or croup was conducted. Odds ratios (OR) were calculated using logistic regression. Trends over time were compared using an interaction term between disease and year and were adjusted for all other covariates in the model. We included children aged 2 to 18 years with asthma who received albuterol and were triaged emergent/urgent. Children aged between 3 months to 6 years with croup were included. The main outcome measure was the administration of corticosteroids in the ED or as a prescription at the ED visit. RESULTS The corticosteroid use in asthma visits increased from 44% to 67% and from 32% to 56% for croup. After adjusting for patient and hospital factors, this trend was significant both for asthma (OR, 1.07; 95% confidence interval [CI], 1.04-1.10) and croup (OR, 1.07; 95% CI, 1.03-1.12). There was no statistical difference between the 2 trends (P = 0.69). Hospital location in a metropolitan statistical area was associated with increased corticosteroid use in asthma (OR, 1.76; 95% CI, 1.10-2.82). Factors including sex, ethnicity, insurance, or region of the country were not significantly associated with corticosteroid use. CONCLUSIONS During a 15-year period, knowledge transfer by passive diffusion or active guideline dissemination resulted in similar trends of corticosteroid use for the management of pediatric asthma and croup.
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Barriers to autism screening in family medicine practice: a qualitative study. Prim Health Care Res Dev 2014; 16:356-66. [DOI: 10.1017/s1463423614000449] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimWe explored potential barriers to adoption of recommended screening for autism by family physicians at 18- and 24-month well-child visits.BackgroundThe American Academy of Pediatrics recommends early detection and intervention of autism through the use of a standardized autism-specific screening tool on all children at the 18- and 24-month well-child visits. However, not all family physicians screen for autism.MethodsThree focus groups and six semi-structured interviews were conducted with 15 family physicians in the Kansas City metropolitan area. Verbatim transcripts were inductively coded; data were analyzed using standard text analysis.FindingsParticipants had differing views on the increased incidence of autism. Most participants attributed the increase to changes in diagnostic criteria. There was no consensus on the benefit of implementing universal screening for autism during the 18- or 24-month visit. Many preferred to identify potential problems through general developmental assessments and observations. No participants used specific screening tools for autism, and only one participant was aware of such a tool (M-CHAT). Lack of adequate training on child development and screening methods as well as limited availability of community-based resources to manage children with autism was seen as major barriers to routine screening. Suggested solutions included working toward a stronger evidence base, improving physician training and continuing education, and making systemic changes in healthcare. In conclusion, universal screening for autism at the 18- and 24-month visits is not widely accepted, nor is it implemented by family physicians.
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Filice CE, Green JC, Rosenthal MS, Ross JS. Pediatric screening urinalysis: a difference-in-differences analysis of how a 2007 change in guidelines impacted use. BMC Pediatr 2014; 14:260. [PMID: 25303836 PMCID: PMC4287447 DOI: 10.1186/1471-2431-14-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/19/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Practice guidelines can promote higher-quality care, yet they are inconsistently adopted. The purpose of this study is to evaluate the impact of a 2007 American Academy of Pediatrics recommendation to discontinue routine screening urinalysis in children. METHODS Using data from the National Ambulatory Medical Care Survey, we used a difference-in-differences approach to estimate visit-level screening urinalysis proportions before (2005-2006, n = 1,247) and after (2008-2009, n = 1,772) the 2007 AAP recommendation. We compared visits by children 4-18 years old to visits by young adults aged 19-32. Analyses were adjusted for continuous patient age, patient race/ethnicity, physician specialty, and stratified by patient gender and visit setting. RESULTS The 2007 recommendation was associated with no significant change in adjusted visit-level screening urinalysis proportions in child visits (20.4% to 22.5%) compared to an increase in young adult visits (20.1% to 27.0%) - a differential impact of -4.8 percentage points (95% Confidence Interval [CI] -9.0, -0.5). In private practices, visit proportions differentially decreased by 7.6 percentage points (95% CI -13.7, -1.5) in female children and by 0.5 percentage points (95% CI -10.6, 9.6) in male children. In community health centers, visit proportions differentially decreased by 17.4 percentage points (95% CI -27.9, -6.8) in female children and by 33.5 percentage points (95% CI -47.4, -19.7) in male children. CONCLUSIONS A 2007 recommendation to discontinue routine screening urinalysis in children was associated with no change in use in child visits relative to an increase in use in adult visits. Overall, nearly one-quarter of child visits still included screening urinalysis.
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Affiliation(s)
- Clara E Filice
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
| | - Jeremy C Green
- />Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO USA
| | - Marjorie S Rosenthal
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
- />Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
| | - Joseph S Ross
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
- />Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
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Parisi P, Vanacore N, Belcastro V, Carotenuto M, Giudice ED, Mariani R, Papetti L, Pavone P, Savasta S, Striano P, Toldo I, Tozzi E, Verrotti A, Raucci U. Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument. J Headache Pain 2014; 15:57. [PMID: 25178699 PMCID: PMC4167157 DOI: 10.1186/1129-2377-15-57] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/03/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs. METHODS A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument. RESULTS Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was "strongly recommended" while the French and Danish CGs were mainly "not recommended". The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs. 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the "editorial independence" domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services dedicated pediatric headache assigned a higher overall quality score to the NICE CGs as compared to professionals from non-outpatient services (6.86 ± 0.38 vs. 6.0 ± 0.82; p = 0.038). CONCLUSIONS CGs resulted definitely of low-moderate quality and non "homogeneous". Further major efforts are needed to update the existing CGs according to the principles of evidence based medicine.
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Affiliation(s)
- Pasquale Parisi
- NESMOS Department, Chair of Paediatrics, Pediatric Headache Centre, Paediatric Sleep, Centre & Child Neurology, Faculty of Medicine & Psychology, “Sapienza University” c/o Sant’Andrea Hospital, Via di Grottarossa, 1035-1039 Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | | | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Center for Childhood Headache, Second University of Naples, Naples, Italy
| | - Ennio Del Giudice
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Rosanna Mariani
- Department of Neuroscience, Headache Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Laura Papetti
- Department of Pediatrics, Child Neurology, Sapienza University of Rome, Rome, Italy
| | - Piero Pavone
- Unit of Pediatrics and Pediatrics Emergency, University Hospital “Vittorio Emanuele”, Catania, Italy
| | - Salvatore Savasta
- Department of Pediatrics, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Pasquale Striano
- Department of Neurosciences, Pediatric Neurology and Muscular Diseases Unit, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, “G. Gaslini” Institute, Genova, Italy
| | - Irene Toldo
- Department of Woman and Child Health, Juvenile Headache Centre, University of Padua, Padua, Italy
| | - Elisabetta Tozzi
- Child and Maternal Department, Headache centre University and S. Salvatore Hospital L'Aquila, L'Aquila, Italy
| | | | - Umberto Raucci
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Mittal V, Hall M, Morse R, Wilson KM, Mussman G, Hain P, Montalbano A, Parikh K, Mahant S, Shah SS. Impact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment. J Pediatr 2014; 165:570-6.e3. [PMID: 24961787 DOI: 10.1016/j.jpeds.2014.05.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/27/2014] [Accepted: 05/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the association between institutional inpatient clinical practice guidelines (CPGs) for bronchiolitis and the use of diagnostic tests and treatments. STUDY DESIGN A multicenter retrospective cohort study of infants aged 29 days to 24 months with a discharge diagnosis of bronchiolitis was conducted between July 2011 and June 2012. An electronic survey was sent to quality improvement leaders to determine the presence, duration, and method of CPG implementation at participating hospitals. The Wilcoxon rank-sum test was used to perform bivariate comparisons between hospitals with CPGs and those without CPGs. Multivariable analysis was used to determine associations between CPG characteristics and the use of tests and treatments; analyses were clustered by hospital. RESULTS The response rate to our electronic survey was 77% (33 of 43 hospitals). The majority (85%) had an institutional bronchiolitis CPG in place. Hospitals with a CPG had universal agreement regarding recommendations against routine tests and treatments. The presence of a CPG was not associated with significant reductions in the use of tests and treatments (eg, complete blood count, chest radiography, bronchodilator use, steroid and antibiotic use). A longer interval duration since CPG implementation and presence of an easily accessible online CPG document were associated with significant reductions in the performance of complete blood count and chest radiography and the use of corticosteroids. Other implementation factors demonstrated mixed results. CONCLUSION Most children's hospitals have an institutional bronchiolitis CPG in place. The content of these CPGs is largely uniform in practice recommendations against tests and treatments. The presence of institutional CPGs did not significantly reduce the ordering of tests and treatments. Online accessibility of a written CPG and prolonged duration of implementation reduce tests and treatments.
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Affiliation(s)
- Vineeta Mittal
- Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX.
| | - Matt Hall
- Children's Hospital Association, Overland Park, KS
| | - Rustin Morse
- Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX
| | - Karen M Wilson
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Grant Mussman
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paul Hain
- Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX
| | - Amanda Montalbano
- Department of Pediatrics, University of Nebraska and Children's Hospital and Medical Center, Omaha, NE
| | - Kavita Parikh
- Department of Pediatrics, Section of Hospital Medicine, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
| | - Sanjay Mahant
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Hendaus MA, Alhammadi AH, Razig EA, Alnaimi L. Pediatricians' perceptions of clinical practice guidelines. J Multidiscip Healthc 2014; 7:349-54. [PMID: 25125984 PMCID: PMC4130713 DOI: 10.2147/jmdh.s66147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Clinical practice guidelines (CPGs) are propositions for health care providers about the care of patients and are usually described as “systematically developed statements to assist practitioners’ and patients’ decisions about appropriate health care for specific circumstances”. Objectives The purpose of this study was to investigate pediatricians’ perceptions of clinical practice guidelines at Hamad Medical Corporation (HMC) in Qatar. Methods A cross-sectional study was conducted at HMC between May 1 and August 31, 2013 using a self-administered questionnaire that was distributed to 240 pediatricians. Results A total of 169/240 questionnaires were completed for a response rate of 70.4%. Our main finding was that pediatricians at all levels are familiar with CPGs and use them. In addition, our doctors believe that CPGs lead to good quality of care, are practical, provide standardized patient care, will keep them up-to-date, decrease the rate of litigation, are evidence-based, do not restrict continuity of self-education, do not alter physician esteem, lead to improvement of outcome, and are practical. However, barriers that might impede pediatricians’ use of CPGs are that CPGs affect their clinical judgment, do not match with their practice style, and do not reduce health care costs. Conclusions Pediatricians at HMC have positive perceptions of CPGs. The results of our study suggest that CPGs are likely to be implemented if more counseling and education are provided to pediatricians regarding the usefulness of evidence-based guidelines. In addition, a program should be initialized to remove barriers while simultaneously addressing physicians’ concerns.
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Affiliation(s)
- Mohamed A Hendaus
- General Pediatrics Division, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed H Alhammadi
- General Pediatrics Division, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Eshraga A Razig
- General Pediatrics Division, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Lulwa Alnaimi
- General Pediatrics Division, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
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Mascia D, Dandi R, Di Vincenzo F. Professional networks and EBM use: a study of inter-physician interaction across levels of care. Health Policy 2014; 118:24-36. [PMID: 25022323 DOI: 10.1016/j.healthpol.2014.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/19/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022]
Abstract
Physicians around the globe are increasingly encouraged to adopt guidelines, protocols and other scientific material when making clinical decisions. Extant research suggests that the clinicians' propensity to use evidence-based medicine (EBM) is strongly associated with the professional collaborative networks they establish and maintain with peers. In this paper we explore whether and how the connectedness of primary care physicians with colleagues working in hospital settings is related to their frequency of EBM use in clinical practice. We used survey data from 104 pediatricians working in five local health authorities in the Italian NHS. Social network and attributional data concerning single physicians, as well as their self-reported frequency of EBM use, were collected for three major pathologies in pediatric care: asthmatic, gastro-enteric and urinary pathologies. Ordered regression analysis was employed. Our findings documented a positive association between the number of physicians' relationships with hospital colleagues and the frequency of use EBM. Results also indicated that physicians' organizational affiliations influence the frequency of EBM use. Finally, contrary to our expectations, it was found that clinicians' affiliation to formal collaborative arrangements is at odds with the likelihood of reporting higher frequency of EBM use.
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Affiliation(s)
- Daniele Mascia
- Catholic University of the Sacred Heart, Department of Public Health, Largo F. Vito 1, 00168 Rome, Italy.
| | - Roberto Dandi
- LUISS Guido Carli University, Department of Business and Management, Viale Pola 12, 00198 Rome, Italy.
| | - Fausto Di Vincenzo
- G. d'Annunzio University, Department of Economic Studies, Viale Pindaro 42, 65100 Pescara, Italy.
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Kotzeva A, Guillamón I, Gracia J, Díaz del Campo P, Gich I, Calderón E, Gaminde I, Louro-González A, Martínez F, Orrego C, Rotaeche R, Salcedo F, Alonso-Coello P. Use of clinical practice guidelines and factors related to their uptake: a survey of health professionals in Spain. J Eval Clin Pract 2014; 20:216-24. [PMID: 24921083 DOI: 10.1111/jep.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE This study aims to assess the use of clinical practice guidelines (CPGs) among health professionals and factors related to their uptake in clinical practice. METHODS Cross-sectional study based on an online survey conducted among primary care (PC) and hospital-based care (HC) doctors in Spain in 2011. Questionnaire development included adaptation of similar surveys and contextualization through a qualitative study. After a pilot study and review, the final survey contained five domains: demographics, involvement in CPGs, consultation of CPGs, perceptions and attitudes regarding CPGs and Spanish NHS CPGs Programme. Professionals from selected health care centres in seven regions were contacted by email with an invitation and link to the Web-based questionnaire. We analysed between-group differences and explored potential predictors of CPGs use by means of a logistic regression. RESULTS Six hundred seventy-six doctors responded to the survey (27.7% response rate). 47.1% were PC and 49.5% were HC doctors. 32.5% stated previous involvement in CPGs and 56.5% stated training in research methodology. 67.5% of the surveyed professionals reported using CPGs more than one time per week. The use of a system for classifying the quality of evidence (62.3%) and for grading the strength of the recommendations (58.6%), as well as the use of a rigorous methodology (49.6%), were the most frequently reported aspects related to CPG credibility. The lack of time (56.4%), especially in PC (65.3% versus 49.5% in HC; P < 0.001), and the absence of brief and easily accessible format (42.2%) were the main reported barriers to using CPGs. None of the studied factors showed statistically significant association in the logistic regression model. CONCLUSIONS Study results suggest that, in general, Spanish doctors trust and use CPGs frequently. To improve uptake by health professionals and to overcome existing barriers, CPGs should be rigorously developed and made accessible at the point-of-care in user-friendly electronic formats. Due to the low response rate, findings should be extrapolated with caution.
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Affiliation(s)
- Anna Kotzeva
- Agency for Health Quality and Assessment of Catalonia (AQuAS); Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP); Madrid Spain
| | - Imma Guillamón
- Agency for Health Quality and Assessment of Catalonia (AQuAS); Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP); Madrid Spain
| | - Javier Gracia
- Chair of the Scientific Committee of GuiaSalud - National CPG Programme of the NHS; Madrid Spain
| | - Petra Díaz del Campo
- Health Technology Assessment Unit, UETS; Health Technology and Innovation General Subdirectorate, Regional Health Council; Madrid Spain
| | - Ignasi Gich
- Department of Pharmacology and Therapeutics; Universitat Autonoma de Barcelona; Barcelona Spain
| | - Enrique Calderón
- CIBER de Epidemiología y Salud Pública (CIBERESP); Madrid Spain
- Instituto de Biomedicina de Sevilla; Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla; Seville Spain
| | - Idoia Gaminde
- Research, Innovation and Continuous Education Unit; Department of Health, Government of Navarre; Pamplona Navarre Spain
| | - Arturo Louro-González
- Centro de Saúde de Cambre; Xerencia de Atención Primaria A Coruña, SERGAS; A Coruña Spain
| | - Flora Martínez
- General Secretariat of Public Health, Social Inclusion and Quality of Life; Andalusian Regional Ministry of Health and Social Well-being; Seville Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD); Universitat Autonoma de Barcelona; Barcelona Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Madrid Spain
| | - Rafa Rotaeche
- Grupo Kronikgune Sobre Gestión del Conocimiento; Centro de Salud de Alza; Donostia-San Sebastián Spain
| | - Flavia Salcedo
- Instituto Aragonés de Ciencias de la Salud; Zaragoza Spain
| | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP); Madrid Spain
- Iberoamerican Cochrane Centre; Clinical Epidemiology and Public Health Department; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
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Grace RF. Standardized clinical assessment and management plans (SCAMPs): perspectives on a new method to understand treatment decisions and outcomes in immune thrombocytopenia. Semin Hematol 2014; 50 Suppl 1:S31-8. [PMID: 23664514 DOI: 10.1053/j.seminhematol.2013.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Modern evidence based guidelines in immune thrombocytopenia (ITP) are mostly based on expert opinion. Standardized clinical assessment and management plans (SCAMPs) are flexible, feedback-based practice guidelines that could be valuable for both managing patients with ITP and understanding treatment decisions and outcomes. At Boston Children's Hospital, we have implemented a SCAMP for patients with newly diagnosed and persistent ITP. To develop the algorithm, a group of local ITP experts devised an initial guideline, which was then modified by the attending hematologists who care for ITP patients until consensus was reached. Since deviations from the algorithm are encouraged, all clinicians did not need to agree with all aspects of the algorithm. At each clinic visit, clinicians fill out data collection forms explaining practice deviations. The goals of this process are to decrease practice variation and resource utilization and learn from the outcomes and deviations that occur to continually improve our practice. SCAMPs are an innovative approach to improve quality of care in ITP.
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Affiliation(s)
- Rachael F Grace
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02115, USA.
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Park JW, Ahn JA, Park MM. Factors influencing evidence-based nursing utilization intention in Korean practice nurses. Int J Nurs Pract 2014; 21:868-75. [DOI: 10.1111/ijn.12296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jee-Won Park
- College of Nursing; Ajou University; Suwon Korea
| | - Jeong-Ah Ahn
- College of Nursing; Ajou University; Suwon Korea
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Mittal V, Darnell C, Walsh B, Mehta A, Badawy M, Morse R, Pop R, Tidwell J, Sheehan M, McDermott S, Cannon C, Kahn J. Inpatient bronchiolitis guideline implementation and resource utilization. Pediatrics 2014; 133:e730-7. [PMID: 24534398 DOI: 10.1542/peds.2013-2881] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Provider-dependent practice variation in children hospitalized with bronchiolitis is not uncommon. Clinical practice guidelines (CPGs) can streamline practice and reduce utilization however, CPG implementation is complex. METHODS A multidisciplinary team developed and implemented CPGs for management of bronchiolitis for children <2 years old. Children with comorbidities, ICU admissions, and outside hospital transfers were excluded. Implementation involved teamwork and collaboration, provider education, online access to CPGs, order sets, data sharing, and monthly team meetings. Resource utilization was defined as use of chest x-rays (CXRs), antibiotics, steroids, and more than 2 doses of inhaled bronchodilator use. Outcome metrics included length of stay (LOS) and readmission rate. Bronchiolitis season was defined as September to April. Data were collected for 2 seasons post implementation. RESULTS The number CPG-eligible patients in the pre- and 2 postimplementation periods were similar (1244, preimplementation; 1159, postimplementation season 1; 1283 postimplementation season 2). CXRs decreased from 59.7% to 45.1% (P < .0001) in season 1 to 39% (P < .0001) in season 2. Bronchodilator use decreased from 27% to 20% (P < .01) in season 1 to 14% (P < .002) in season 2. Steroid use significantly reduced from 19% to 11% (P < .01). Antibiotic use did not change significantly (P = .16). LOS decreased from 2.3 to 1.8 days (P < .0001) in season 1 and 1.9 days (P < .05) in season 2. All-cause 7-day readmission rate did not change (P = .45). CONCLUSIONS Bronchiolitis CPG implementation resulted in reduced use of CXRs, bronchodilators, steroids, and LOS without affecting 7-day all-cause readmissions.
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Affiliation(s)
- Vineeta Mittal
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; and
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