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Allaire C, Long AJ, Bedaiwy MA, Yong PJ. Interdisciplinary Teams in Endometriosis Care. Semin Reprod Med 2020; 38:227-234. [PMID: 33080631 DOI: 10.1055/s-0040-1718943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Endometriosis-associated chronic pelvic pain can at times be a complex problem that is resistant to standard medical and surgical therapies. Multiple comorbidities and central sensitization may be at play and must be recognized with the help of a thorough history and physical examination. If a complex pain problem is identified, most endometriosis expert reviews and guidelines recommend multidisciplinary care. However, there are no specific recommendations about what should be the components of this approach and how that type of team care should be delivered. There is evidence showing the effectiveness of specific interventions such as pain education, physical therapy, psychological therapies, and pharmacotherapies for the treatment of chronic pain. Interdisciplinary team models have been well studied and validated in other chronic pain conditions such as low back pain. The published evidence in support of interdisciplinary teams for endometriosis-associated chronic pain is more limited but appears promising. Based on the available evidence, a model for an interdisciplinary team approach for endometriosis care is outlined.
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Affiliation(s)
- Catherine Allaire
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Alicia Jean Long
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.,BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
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Ahmed S, Zidarov D, Eilayyan O, Visca R. Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network. Qual Life Res 2020; 30:3035-3047. [PMID: 32876812 PMCID: PMC8528775 DOI: 10.1007/s11136-020-02600-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care. METHODS The Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network. RESULTS Both frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention. CONCLUSIONS The TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians' knowledge and skills and foster best practices.
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Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada. .,Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada. .,Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada. .,Institut Universitaire Sur La réadaptation en déficience Physique de Montréal, Centre intégré Universitaire de santé Et de Services Sociaux du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Québec, Canada. .,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Diana Zidarov
- Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada.,Institut Universitaire Sur La réadaptation en déficience Physique de Montréal, Centre intégré Universitaire de santé Et de Services Sociaux du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Québec, Canada.,Faculté de Médecine, Université de Montréal, École de réadaptation, Montréal, Canada
| | - Owis Eilayyan
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada.,Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada.,Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada
| | - Regina Visca
- RUISSS McGill Centre of Expertise in Chronic Pain, Montréal, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Eilayyan O, Visca R, Zidarov D, Ware P, Bussières A, Ahmed S. Developing theory-informed knowledge translation strategies to facilitate the use of patient-reported outcome measures in interdisciplinary low back pain clinical practices in Quebec: mixed methods study. BMC Health Serv Res 2020; 20:789. [PMID: 32843032 PMCID: PMC7445906 DOI: 10.1186/s12913-020-05616-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/02/2020] [Indexed: 01/23/2023] Open
Abstract
Background There is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings. Objectives to 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice. Methods We invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention. Results Eighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader. Conclusion The routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients’ outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs’ ability to integrate PROMs into clinical decision-making and to engage patients in their care.
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Affiliation(s)
- Owis Eilayyan
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,College of Applied Medical Sciences, Physical Therapy and Rehabilitation Department, Jouf University, Sakaka, Jouf, Saudi Arabia.,Center for outcome research and evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada
| | - Regina Visca
- RUISSS McGill Centre of Expertise in Chronic Pain, Montréal, QC, Canada.,Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Diana Zidarov
- Faculté de Médecine, École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
| | - Patrick Ware
- Centre for Global eHealth InnovationCentre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - André Bussières
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. .,Center for outcome research and evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada. .,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada. .,Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada.
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