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Pintado-Outumuro E, Morin-Fraile V, Salvador-González B, Benito L, Julve-Ibáñez M, Sancho-Campos MP, Alves-Tafur C, Lumillo-Gutiérrez I. Exploring the factors influencing evidence-based approaches to advanced chronic kidney disease: a qualitative study involving nurses and physicians. BMC PRIMARY CARE 2024; 25:177. [PMID: 38773496 PMCID: PMC11107048 DOI: 10.1186/s12875-024-02418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Advanced chronic kidney disease (ACKD) is associated with a high risk of adverse cardiovascular and renal events and has a significant impact on quality of life and life expectancy. Several studies have identified areas for improvement in their management in primary care. Some professional and environmental factors can act as key barriers to appropriate care. OBJECTIVE To analyse attitudes, subjective norms, and perceived behavioural control among primary care professionals related to the implementation of an evidence-based approach for individuals with ACKD in primary care. METHODOLOGY This was a qualitative study using an interpretative phenomenological approach based on the theory of planned behaviour. Two aspects of the evidence-based approach were explored: the implementation of clinical practice guidelines and the utilisation of electronic kidney disease records within the scope of this study. Primary care nurses and physicians participated in a previous pilot interview and five focus groups. Subsequently, a thematic analysis of the gathered data was conducted. FINDINGS Thirty-three primary care professionals participated. The emerging themes included: experiences in the management of ACKD (highlighting a distinct profile of older, frail patients with comorbidities masking CKD and a CKD follow-up primarily focused on analytical monitoring and drug adjustment); factors in the professional environment influencing the use of scientific evidence (such as time constraints, excessive electronic health records, and unfamiliar reference guidelines); attitudes towards the application of recommendations on ACKD (recognising limitations of computer systems despite considering them as guidance); and capacities to implement evidence-based recommendations (acknowledging formative needs and challenges in coordinating care with nephrology services). CONCLUSIONS Several psychological elements identified through the TBP hinder the adequate implementation of an evidence-based approach for individuals with CKD. Attitudes have been identified as factors modulating the use of standardised electronic records. Instead, subjective norms (influences from the professional environment) and perceived behavioral control (perception of capabilities) acted as barriers to the proper application of clinical practice guidelines and standardised records. IMPLICATIONS FOR PRACTICE Strategies aimed at optimising the management of people with ACKD should focus not only on training but also on improving attitudes, organisational structures, IT systems and coordination between primary care and nephrology.
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Grants
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
- SLT021/21/000031 Departamento de Salud, Generalitat de Cataluña , España
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Affiliation(s)
- Elena Pintado-Outumuro
- Primary Care Center El Pla. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, 08980, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Victoria Morin-Fraile
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain
| | - Betlem Salvador-González
- Unitat de Suport a la Recerca Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain
| | - Llúcia Benito
- Fundamental and Clinic Nursing Department, Faculty of Nursing, University of Barcelona, Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Avinguda de la Gran Via, 199, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - Maricel Julve-Ibáñez
- Primary Care Center El Castell, Servei d'Atenció Primària Delta del Llobregat, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Castelldefels, 08860, Barcelona, Spain
| | - M-Pilar Sancho-Campos
- Primary Care Center Sant Ildefons. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, 08940, Spain
| | - Carolina Alves-Tafur
- Primary Care Center Montclar and Primary Care Center Camps Blancs. Servei d'Atenció Primària Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Iris Lumillo-Gutiérrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing. Faculty of Nursing, University of Barcelona. Pavelló de Govern, 3Rd Floor, L'Hospitalet de Llobregat, Barcelona, 08907, Spain.
- Research Group On Disease, Cardiovascular Risk and Lifestyles in Primary Care, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, 08007, Spain.
- Research Group On Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain.
- Chronicity and Complexity Care Unit (UTACC) Baix Llobregat Centre, Atenció Primària Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, 08940, Spain.
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Barreira LF, Paiva A, Araújo B, Campos MJ. Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1698. [PMID: 36767064 PMCID: PMC9914432 DOI: 10.3390/ijerph20031698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.
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Affiliation(s)
- Luís Filipe Barreira
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Abel Paiva
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
| | - Beatriz Araújo
- Center for Interdisciplinary Research in Health, Instituto Ciências da Saúde, Universidade Católica Portuguesa, Rua de Diogo Botelho 1327, 4169-005 Porto, Portugal
- Instituto de Ciências da Saúde do Porto, Universidade Católica Portuguesa, R. de Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Maria Joana Campos
- Porto School of Nursing, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
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Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:187-194.e6. [PMID: 36108926 DOI: 10.1016/j.jaip.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/17/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.
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Oostendorp RAB, Elvers JWH, Trijffel EV. We are missing more. An international measurable model of clinical reasoning using quality indicators and routinely collected data. J Man Manip Ther 2020; 27:253-257. [PMID: 31671045 DOI: 10.1080/10669817.2019.1648714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rob A B Oostendorp
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Brussels, Belgium.,Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, The Netherlands
| | - J W Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Amersfoort, The Netherlands
| | - Emiel Van Trijffel
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Falck L, Zoller M, Rosemann T, Martínez-González NA, Chmiel C. Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Development of a Tool by Adapted Delphi Procedure. JMIR Med Inform 2020; 8:e14483. [PMID: 32209535 PMCID: PMC7142740 DOI: 10.2196/14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/18/2019] [Accepted: 01/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Long-term care for patients with chronic diseases poses a huge challenge in primary care. There are deficits in care, especially regarding monitoring and creating structured follow-ups. Appropriate electronic medical records (EMR) could support this, but so far, no generic evidence-based template exists. Objective The aim of this study is to develop an evidence-based standardized, generic template that improves the monitoring of patients with chronic conditions in primary care by means of an EMR. Methods We used an adapted Delphi procedure to evaluate a structured set of evidence-based monitoring indicators for 5 highly prevalent chronic diseases (ie, diabetes mellitus type 2, asthma, arterial hypertension, chronic heart failure, and osteoarthritis). We assessed the indicators’ utility in practice and summarized them into a user-friendly layout. Results This multistep procedure resulted in a monitoring tool consisting of condensed sets of indicators, which were divided into sublayers to maximize ergonomics. A cockpit serves as an overview of fixed goals and a set of procedures to facilitate disease management. An additional tab contains information on nondisease-specific indicators such as allergies and vital signs. Conclusions Our generic template systematically integrates the existing scientific evidence for the standardized long-term monitoring of chronic conditions. It contains a user-friendly and clinically sensible layout. This template can improve the care for patients with chronic diseases when using EMRs in primary care.
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Affiliation(s)
- Leandra Falck
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Marco Zoller
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | | | - Corinne Chmiel
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
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