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Koenig E, Hoffmann U, Fegert JM, Keller F, Sicorello M, Spohrs J, Kraus L, Nickel S, Schmahl C, Abler B, In-Albon T, Koenig J, Ougrin D, Kaess M, Plener PL. Training approaches for the dissemination of clinical guidelines for NSSI: a quasi-experimental trial. Child Adolesc Psychiatry Ment Health 2024; 18:99. [PMID: 39127743 DOI: 10.1186/s13034-024-00789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is of high clinical relevance due to its high prevalence and negative long-term implications. In 2016, the German consensus-based clinical guidelines for diagnostic, assessment and treatment of NSSI in childhood and adolescence were published. However, research indicates that clinical guidelines are often poorly implemented in clinical practice. One crucial part of this process is the training of healthcare professionals to transfer knowledge and capacities to bring guideline recommendations into clinical practice. METHODS The effect of three different dissemination strategies (printed educational material, e-learning, and blended-learning) on the NSSI guidelines´ recommendations was examined among 671 physicians and psychotherapists via an online-survey. The quasi-experimental study included three measurement points (before the training, after the training, 3-month follow-up) and mixed effects models were used to test for changes in knowledge, competences and attitudes toward NSSI and treatment. Moreover, the transfer of gained competences to practical work and user satisfaction were reviewed. RESULTS With all three training formats, the intended changes of the outcome variables could be observed. Hereby, the printed educational material condition showed the lowest improvement in the scores for the 'negative attitudes toward NSSI and those who self-injure'. The training effect remained stable throughout the follow-up measurement. The highest application rate of acquired intervention techniques in clinical practice was reported for the blended-learning condition. For all three training strategies, user satisfaction was high and evaluation of training quality was positive, with printed educational material receiving the lowest and blended-learning the highest evaluations. CONCLUSIONS In summary, all three training formats were perceived to be of high quality and seem to be suited to cover the needs of a heterogeneous group of physicians and psychotherapists. The choice of training method could be driven by considering which training goals are desired to be achieved and by the benefit-cost ratio allowing for tailored training approaches.
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Affiliation(s)
- Elisa Koenig
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany.
- German Center of Mental Health (DZPG), Partner site Ulm, Germany.
| | - Ulrike Hoffmann
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- German Center of Mental Health (DZPG), Partner site Ulm, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Spohrs
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Laura Kraus
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Sandra Nickel
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center of Mental Health (DZPG), Partner site Mannheim, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis Ougrin
- Youth Resilience Unit, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Jääskeläinen J, Renko M, Kuitunen I. The impact of national guidelines on the diagnostics of sore throat in children. BMC Pediatr 2024; 24:503. [PMID: 39107694 PMCID: PMC11301984 DOI: 10.1186/s12887-024-04982-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The Finnish treatment guidelines for sore throat were updated in June 2020. The aim of this study was to determine how the publication of these guidelines affected the treatment of pediatric patients, particularly through the use of the Centor criteria, C-reactive protein tests, and microbiological testing in the diagnosis of Group A β-hemolytic streptococci tonsillitis. METHODS We conducted a retrospective single-center before-and-after cohort study in Finland from 2019 to 2022. We included all patients who visited the pediatric emergency department and were diagnosed with tonsillitis or pharyngitis. RESULTS We included 246 patients who were admitted before the guidelines were updated and 219 patients after. Only two patients in the after group had a Centor score reported in their patient records. Rapid antigen tests were administered to 231 patients (93.9%) before the update and 202 patients (92.2%) after (proportion difference of 1.7%, CI -3.0-6.6%). C-reactive protein was taken from 193 patients (78.5%) before the update and 189 patients (86.3%) after (proportion difference of 7.8%, CI 0.1-14.7%). CONCLUSIONS Centor scores were not used as recommended in the guidelines and did not impact the use of microbiological or C-reactive protein testing. More education and examining the preconceptions of health care personnel is required to implement the updated treatment guidelines in clinical practice.
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Affiliation(s)
- Johanna Jääskeläinen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
| | - Marjo Renko
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Ilari Kuitunen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
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Dubbeldeman EM, van der Kleij RMJJ, Brakema EA, Crone MR. Expert consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study. Health Res Policy Syst 2024; 22:89. [PMID: 39095848 PMCID: PMC11295487 DOI: 10.1186/s12961-024-01167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The implementation of youth care guidelines remains a complex process. Several evidence-based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence-based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses. METHODS A four-round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility. RESULTS Fourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective. CONCLUSION This study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.
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Affiliation(s)
- Eveline M Dubbeldeman
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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Salari H, Najm F, Yazdankhahfard M, Esfandiari A. Challenges, barriers and solutions for implementing clinical practice guidelines: a qualitative study in southern Iran. BMJ Open Qual 2024; 13:e002595. [PMID: 39043580 PMCID: PMC11268055 DOI: 10.1136/bmjoq-2023-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 07/01/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Identifying the challenges of implementing clinical practice guidelines (CPGs) can provide valuable information for decision-makers and health policymakers at the national and local levels. The implementation of CPGs requires the development of strategies to facilitate their use. This research aimed to determine the challenges, barriers and solutions for implementing CPGs from the expert point of view in Bushehr University of Medical Sciences. METHODS This qualitative research uses content analysis conducted in 2022 in southern Iran. In-depth interviews were conducted with the physicians and experts in the health system. Interviewing continued until reaching the saturation level. Altogether, 22 experts were interviewed. The interview guide was used to explore experts' opinions. All the interviews were recorded and then transcribed. Finally, coding and data analysis was done using MAXQDA 2022 software. RESULTS The analysis revealed 4 main themes and 20 subthemes. The four main themes included challenges related to physicians, medical education, the health system and patients. The most common themes were the lack of sufficient training (related to the medical education system), equipment and infrastructure, and the lack of adaptation of clinical guidelines (related to the health system). The solutions included 4 main themes and 19 subthemes. CONCLUSION The most mentioned topic by the experts was training CPGs in medical schools. In Iran's current medical education system, the training of CPGs is not included in the curriculum. It is proposed to reform the medical education system in Iran. In addition, health inequalities such as lack of access to equipment, supplies and insurance in under-resourced areas and disparities in research/training/medical education should be addressed to improve the validity of guidelines.
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Affiliation(s)
- Hedayat Salari
- Department of Health Policy & Management, Bushehr University of Medical Sciences, Bushehr, Iran (the Islamic Republic of)
| | - Fatemeh Najm
- Student Committee of Medical Education Development, Education Development Center, Bushehr University of Medical Sciences, Bushehr, Iran (the Islamic Republic of)
| | | | - Atefeh Esfandiari
- Department of Health Policy & Management, Bushehr University of Medical Sciences, Bushehr, Iran (the Islamic Republic of)
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Loveday S, Chen L, Constable LN, Kabir A, White N, Goldfeld S, Sanci L, Hiscock H. Opening Pandora's box - key facilitators of practice change in detecting and responding to childhood adversity - a practitioner perspective. BMC Pediatr 2024; 24:461. [PMID: 39026201 PMCID: PMC11256471 DOI: 10.1186/s12887-024-04918-5] [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: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Childhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change. METHODS Hub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change. RESULTS Fifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora's box. Following analysis, key drivers of practice change were 'social influence', 'belief in capability', 'knowledge' and 'behaviour regulation' while barriers to practice change were 'environmental context and resources' and 'emotion'. CONCLUSIONS Practitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora's box.
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Affiliation(s)
- Sarah Loveday
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Lingling Chen
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Leanne N Constable
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashraful Kabir
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Natalie White
- Policy and Equity, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Policy and Equity, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
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Kurotschka PK, Hemkeppler J, Gierszewski D, Ghirotto L, Gágyor I. General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study. BJGP Open 2024:BJGPO.2023.0224. [PMID: 38423622 DOI: 10.3399/bjgpo.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. AIM To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. DESIGN & SETTING A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany). METHOD Verbatim transcripts were analysed through inductive qualitative content analysis. RESULTS We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation and shared decision making were seen as helpful in this process. CONCLUSION We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.
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Affiliation(s)
- Peter K Kurotschka
- Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany
| | - Juliane Hemkeppler
- Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany
| | - David Gierszewski
- Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wurzburg, Wurzburg, Germany
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van Baal K, Ernst A, Schade F, Stiel S. Implementation of quality indicators for palliative care for patients with incurable cancer at palliative care units in Germany (Quincie): a study protocol for a mixed-methods study. BMJ Open 2024; 14:e077457. [PMID: 38925702 PMCID: PMC11202643 DOI: 10.1136/bmjopen-2023-077457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Guidelines are important tools for supporting quality management in the care of patients with cancer. However, in clinical practice barriers exist to their implementation. Consequently, Quincie aims at: (1) gaining a comprehensive picture of the implementation of quality indicators from the national guideline on palliative care for patients with incurable cancer in palliative care units and (2) describing the factors that facilitate and hinder their implementation to develop recommendations. METHODS AND ANALYSIS The Quincie study follows a mixed-methods approach across two study phases. In phase 1, routinely collected data of 845 patients with incurable cancer from eight palliative care units in the commuting area of the Comprehensive Cancer Centre Lower Saxony will be analysed, regarding the implementation of 10 quality indicators from the national guideline on palliative care. Structural characteristics of the palliative care units will also be collected. In phase 2, recommendations for the practical implementation of the quality indicators, focusing on the achievement of the quality objectives identified in phase 1, will be developed in an implementation workshop. These recommendations will be subsequently agreed on via a Delphi survey. ETHICS AND DISSEMINATION Ethical approval has been given by the ethics committee of the Hannover Medical School (first vote, No. 10567_BO_K_2022) and other relevant institutions. The results will provide urgently needed insights on the implementation of the national guideline on palliative care in clinical care and on the factors that facilitate and hinder this implementation. The results are expected to promote better care for patients with incurable cancer. The results will be directly reported to the participating palliative care units and will be published in relevant peer-reviewed journals. They will also be presented at national conferences. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00029965).
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Affiliation(s)
- Katharina van Baal
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Alexandra Ernst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Franziska Schade
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Burton JO, Chilcot J, Fielding K, Frankel AH, Lakhani N, Nye P, Parker K, Priestman W, Willingham F. Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach. BMJ Open 2024; 14:e085723. [PMID: 38890135 PMCID: PMC11191819 DOI: 10.1136/bmjopen-2024-085723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented. METHODS Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement. RESULTS 419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement. CONCLUSIONS The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care.
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Affiliation(s)
- James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Wall's Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joseph Chilcot
- Department of Psychology, King's College London, London, UK
| | - Katie Fielding
- Department of Medicine for the Elderly, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | | | - Pam Nye
- UK Kidney Association, Bristol, UK
| | - Kathrine Parker
- Manchester Institute of Nephrology and Transplantation, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | - Fiona Willingham
- Social Work and Sport, University of Central Lancashire, Preston, UK
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Sauro KM, Smith C, Ibadin S, Thomas A, Ganshorn H, Bakunda L, Bajgain B, Bisch SP, Nelson G. Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality: A Meta-Analysis of Randomized Clinical Trials. JAMA Netw Open 2024; 7:e2417310. [PMID: 38888922 PMCID: PMC11195621 DOI: 10.1001/jamanetworkopen.2024.17310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 06/20/2024] Open
Abstract
Importance A comprehensive review of the evidence exploring the outcomes of enhanced recovery after surgery (ERAS) guidelines has not been completed. Objective To evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors. Data Sources MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021. Study Selection Titles, abstracts, and full-text articles were screened by 2 independent reviewers. Eligible studies were randomized clinical trials that examined ERAS-guided surgery compared with a control group and reported on at least 1 of the outcomes. Data Extraction and Synthesis Data were abstracted in duplicate using a standardized data abstraction form. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool estimates for each outcome, and meta-regression identified sources of heterogeneity within each outcome. Main Outcome and Measures The primary outcomes were hospital length of stay, hospital readmission within 30 days of index discharge, 30-day postoperative complications, and 30-day postoperative mortality. Results Of the 12 047 references identified, 1493 full texts were screened for eligibility, 495 were included in the systematic review, and 74 RCTs with 9076 participants were included in the meta-analysis. Included studies presented data from 21 countries and 9 ERAS-guided surgical procedures with 15 (20.3%) having a low risk of bias. The mean (SD) Reporting on ERAS Compliance, Outcomes, and Elements Research checklist score was 13.5 (2.3). Hospital length of stay decreased by 1.88 days (95% CI, 0.95-2.81 days; I2 = 86.5%; P < .001) and the risk of complications decreased (risk ratio, 0.71; 95% CI, 0.59-0.87; I2 = 78.6%; P < .001) in the ERAS group. Risk of readmission and mortality were not significant. Conclusions and Relevance In this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications. Future studies should aim to improve implementation of ERAS and increase the reach of the guidelines.
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Affiliation(s)
- Khara M. Sauro
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology and Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christine Smith
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seremi Ibadin
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abigail Thomas
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Linda Bakunda
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bishnu Bajgain
- Department of Community Health Sciences and O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven P. Bisch
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Wagstaff D, Arfin S, Korver A, Chappel P, Rashan A, Haniffa R, Beane A. Interventions for improving critical care in low- and middle-income countries: a systematic review. Intensive Care Med 2024; 50:832-848. [PMID: 38748264 DOI: 10.1007/s00134-024-07377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/27/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To systematically review the typology, impact, quality of evidence, barriers, and facilitators to implementation of Quality Improvement (QI) interventions for adult critical care in low- and middle-income countries (LMICs). METHODS MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov were searched on 1st September 2022. The studies were included if they described the implementation of QI interventions for adult critical care in LMICs, available as full text, in English and published after 2000. The risks of bias were assessed using the ROB 2.0/ROBINS-I tools. Intervention strategies were categorised according to a Knowledge Translation framework. Interventions' effectiveness were synthesised by vote counting and assessed with a binomial test. Barriers and facilitators to implementation were narratively synthesised using the Consolidated Framework for Implementation Research. RESULTS 78 studies were included. Risk of bias was high. The most common intervention strategies were Education, Audit & Feedback (A&F) and Protocols/Guidelines/Bundles/Checklists (PGBC). Two multifaceted strategies improved both process and outcome measures: Education and A&F (p = 0.008); and PGBC with Education and A&F (p = 0.001, p < 0.001). Facilitators to implementation were stakeholder engagement, organisational readiness for implementation, and adaptability of interventions. Barriers were lack of resources and incompatibility with clinical workflows. CONCLUSIONS The evidence for QI in critical care in LMICs is sparse and at high risk of bias but suggests that multifaceted interventions are most effective. Co-designing interventions with and engaging stakeholders, communicating relative advantages, employing local champions and adapting to feedback can improve implementation. Hybrid study designs, process evaluations and adherence to reporting guidelines would improve the evidence base.
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Affiliation(s)
| | - Sumaiya Arfin
- The George Institute for Global Health, New Delhi, India.
| | - Alba Korver
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Rashan Haniffa
- Pandemic Sciences Hub and Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
- NICS-MORU, Colombo, Sri Lanka
| | - Abi Beane
- Pandemic Sciences Hub and Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
- NICS-MORU, Colombo, Sri Lanka
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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12
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Messer N, Benov A, Rov A, Bar-On T, Zlotnik O, Chen J, Paran H. Poor Compliance to Clinical Guidelines in the Diagnosis of Acute Appendicitis: Insights from a National Survey. J Clin Med 2024; 13:2862. [PMID: 38792404 PMCID: PMC11122132 DOI: 10.3390/jcm13102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms advocate against the routine use of radiological investigations when there is a high clinical suspicion of AA. However, there has been a significant rise in the use of imaging techniques for diagnosing AA in the past two decades. This is a national study aimed at assessing the adherence of residents assigned to the emergency department to the clinical guidelines for diagnosing AA. Methods: We introduced a case study of a male patient with highly suspicious clinical findings of AA to all surgical and emergency medicine residents assigned to the emergency department with the autonomy to make critical decisions to determine the preferred way of diagnosing AA. Results: A total of 62.4% of all relevant residents participated in this survey; 69.6% reported that the Alvarado score was eight or higher, and 82.1% estimated that the next step recommended by most clinical guidelines was appendectomy without further abdominal imaging tests. However, 83.4% chose to perform an imaging test to establish the diagnosis of AA. Conclusions: Our study revealed a notable non-adherence to clinical guidelines in diagnosing AA. Given the significance of these guidelines, we assert that adopting medical recommendations should not solely depend on individual education but should also be incorporated as a departmental policy.
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Affiliation(s)
- Nir Messer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel;
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Adi Rov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Tali Bar-On
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
| | - Oran Zlotnik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Jacob Chen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Hospital Administration, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Haim Paran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
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13
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Charette M, Pacheco-Brousseau L, Poitras S, Ashton R, McLean L. Management of urinary incontinence in females by primary care providers: a systematic review. BJU Int 2024; 133:498-512. [PMID: 38037509 DOI: 10.1111/bju.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines. METHODS Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only. RESULTS A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI. CONCLUSION This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.
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Affiliation(s)
- Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosalind Ashton
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Rideau Friel Medical Centre, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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14
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Gräff P, Bolduan L, Macke C, Clausen JD, Sehmisch S, Winkelmann M. Where Do We Stand on Cervical Spine Immobilisation? A Questionnaire among Prehospital Staff. J Clin Med 2024; 13:2325. [PMID: 38673598 PMCID: PMC11050990 DOI: 10.3390/jcm13082325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cervical collars (CC) are routinely used in prehospital trauma treatment. However, over the past years, their application was discussed more critically since they increase intravenous pressure due to reduced venous drainage and the possibility of secondary cervical spine injury. Guidelines have been adjusted accordingly. The question is how efficient has this been put into practice, and how good, as well as up to date, is the knowledge of prehospital emergency medicine personnel about indications on cervical spine immobilisation? Methods: A 15-item questionnaire regarding the self-evaluation and result checking of the right indications for the use of a cervical collar in the prehospital setting was sent to paramedics and emergency doctors in Germany. Two hundred and nineteen completed surveys were statistically analysed. Results: Mean age of the participants was 30.45 ± 8.8. 72% were male. Regarding subjective safety, the appropriate indication of CC participants reached 79.8 ± 19.5 on a metric scale from 0 (no safety) to 100 (full safety). Mean right answers were as follows: Ambulance man (RS) 0.78 ± 0.84, paramedic (RA) 0.9 ± 0.74, paramedic (NFS) 1.03 ± 0.83 and emergency doctor (ED) 1.75 ± 1.06 (p = 0.013, Kruskal-Wallis Test). Participants who estimated their knowledge < 85% had 0.83 ± 0.8 right answers, and > 85% had 1.14 ± 0.9 right answers. Conclusions: Rational spine immobilisation is still necessary in severely injured patients. This study highlights the importance of continuing education using ongoing training, lectures or online learning with a questionnaire as a monitor for success to ensure the transfer of evidence-based medicine into daily practice.
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Affiliation(s)
- Pascal Gräff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany (M.W.)
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15
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Sanchez A, Pijoan JI, Sainz de Rozas R, Lekue I, San Vicente R, Quindimil JA, Rotaeche R, Etxeberria A, Mozo C, Martinez-Cengotitabengoa M, Monge M, Gómez-Ramírez C, Samper R, Ogueta Lana M, Celorrio S, Merino-Inda N, Llarena M, Gonzalez Saenz de Tejada M, García-Alvarez A, Grandes G. De-imFAR phase II project: a study protocol for a cluster randomised implementation trial to evaluate the effectiveness of de-implementation strategies to reduce low-value statin prescribing in the primary prevention of cardiovascular disease. BMJ Open 2024; 14:e078692. [PMID: 38631840 PMCID: PMC11029292 DOI: 10.1136/bmjopen-2023-078692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION This study aims to reduce potentially inappropriate prescribing (PIP) of statins and foster healthy lifestyle promotion in cardiovascular disease (CVD) primary prevention in low-risk patients. To this end, we will compare the effectiveness and feasibility of several de-implementation strategies developed following the structured design process of the Behaviour Change Wheel targeting key determinants of the clinical decision-making process in CVD prevention. METHODS AND ANALYSIS A cluster randomised implementation trial, with an additional control group, will be launched, involving family physicians (FPs) from 13 Integrated Healthcare Organisations (IHOs) of Osakidetza-Basque Health Service with non-zero incidence rates of PIP of statins in 2021. All FPs will be exposed to a non-reflective decision assistance strategy based on reminders and decision support tools. Additionally, FPs from two of the IHOs will be randomly assigned to one of two increasingly intensive de-implementation strategies: adding a decision information strategy based on knowledge dissemination and a reflective decision structure strategy through audit/feedback. The target population comprises women aged 45-74 years and men aged 40-74 years with moderately elevated cholesterol levels but no diagnosed CVD and low cardiovascular risk (REGICOR<7.5%), who attend at least one appointment with any of the participating FPs (May 2022-May 2023), and will be followed until May 2024. We use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes. The main outcome will be the change in the incidence rate of PIP of statins and healthy lifestyle counselling in the study population 12 and 24 months after FPs' exposure to the strategies. Moreover, FPs' perception of their feasibility and acceptability, and patient experience regarding the quality of care received will be evaluated. ETHICS AND DISSEMINATION The study was approved by the Basque Country Clinical Research Ethics Committee and was registered in ClinicalTrials.gov (NCT04022850). Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04022850.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Jose Ignacio Pijoan
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Clinical Epidemiology Unit, Osakidetza-Basque Health Service, Barakaldo, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Rita Sainz de Rozas
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Itxasne Lekue
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo San Vicente
- Zumarraga Health Center, Goierri-Alto Urola Integrated Health Organization, Osakidetza-Basque Health Service, Zumarraga, Spain
| | - Jose Antonio Quindimil
- Sestao Health Center, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Sestao, Spain
| | - Rafael Rotaeche
- Primary Care Research Unit of Gipuzkoa, Organization of Integrated Health Services of Gipuzkoa, Osakidetza-Basque Health Service, Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Spain
| | - Arritxu Etxeberria
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Carmela Mozo
- Primary Care Pharmacy, Donostialdea Integrated Health Organization, Osakidetza-Basque Health Service, Hernani, Spain
| | - Monica Martinez-Cengotitabengoa
- School of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
- Primary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Monica Monge
- Muskiz Health Center, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Muskiz, Spain
| | - Cristina Gómez-Ramírez
- Cardiology Department, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Ricardo Samper
- Corporate Pharmacy Service, Directorate of Healthcare Assistance, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Mikel Ogueta Lana
- Subdirectorate of Quality and Health Information Systems, Central Services, Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain
| | - Sara Celorrio
- Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
| | | | - Marta Llarena
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Marta Gonzalez Saenz de Tejada
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Arturo García-Alvarez
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barakaldo, Spain
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Haenen A, Huis A, Teerenstra S, Liefers J, Bos N, Voss A, de Greeff S, Hulscher M. Effect and Process Evaluation of an Intervention to Improve Hand Hygiene Compliance in Long-Term Care Facilities. J Am Med Dir Assoc 2024; 25:591-598. [PMID: 37549888 DOI: 10.1016/j.jamda.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES This study evaluated the effect of a tailored, multifaceted improvement strategy on hand hygiene compliance in long-term care facilities (LTCFs). We also performed a process evaluation to explore the mechanisms through which our strategy brought about change. DESIGN We conducted a stepped-wedge cluster-randomized controlled trial with a sequential rollout of the improvement strategy to all participating LTCFs. The strategy consisted of education, training, reminders, observation sessions (including feedback), and team meetings (including feedback). SETTING AND PARTICIPANTS The study included nursing professionals from 14 LTCFs (23 wards) in the Netherlands. METHODS Hand hygiene compliance was observed during 5 measurement periods using WHO's "Five Moments for Hand Hygiene." Multilevel analyses and corresponding tests were completed on an intention-to-treat basis. RESULTS The absolute intervention effect of overall hand hygiene compliance (primary outcome measure) was 13% (95% CI 9.3-16.7, P < .001), adjusted for time and clustering. The adjusted absolute effect was 23% (95% CI 7-39, P < .002) before a clean and aseptic procedure, 18% (95% CI 10-26, P < .001) after touching a resident, 14% (95% CI 7-22, P < .003) before touching a resident, 10% (95% CI 5-15, P < .001) after contact with body fluid, and 1% (95% CI -11 to 13, P = .8) after touching a resident's surroundings. With the exception of leadership, participants at LTCFs with more exposure to the intervention components showed statistically significantly more improvement than those at facilities with lower exposure scores. CONCLUSIONS AND IMPLICATIONS Our strategy was successful in improving hand hygiene compliance. LTCFs with more team members exposed to the different intervention components, demonstrated a greater effect from the intervention. To strengthen the impact of our intervention, we recommend that future improvement strategies provide more support to managers to ensure they are better equipped to take on their leadership roles and enable their teams to improve and maintain hand hygiene compliance.
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Affiliation(s)
- Anja Haenen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, Bilthoven, the Netherlands.
| | - Anita Huis
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health, Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janine Liefers
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nynke Bos
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sabine de Greeff
- Department of Antimicrobial Resistance and Healthcare Associated Infections, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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van Teunenbroek KC, Mulder RL, Ahout IML, Bindels-de Heus KGCB, Delsman-van Gelder CM, Galimont-Collen AFS, de Groot MAR, Heitink-Polle KMJ, Looijestijn J, Mensink MO, Mulder S, Schieving JH, Schouten-van Meeteren AYN, Verheijden JMA, Rippen H, Borggreve BCM, Kremer LCM, Verhagen AAE, Michiels EMC. A Dutch paediatric palliative care guideline: a systematic review and evidence-based recommendations for symptom treatment. BMC Palliat Care 2024; 23:72. [PMID: 38481215 PMCID: PMC10935792 DOI: 10.1186/s12904-024-01367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. METHODS A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. RESULTS We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. CONCLUSION Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Inge M L Ahout
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Marinka A R de Groot
- Emma Palliative Care Team, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | | | - Jeffry Looijestijn
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maarten O Mensink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Selma Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jolanda H Schieving
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Hester Rippen
- Stichting Kind en Ziekenhuis, Utrecht, the Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - A A Eduard Verhagen
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Erna M C Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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van der Laag PJ, Dorhout BG, Heeren AA, Veenhof C, Barten DJJA, Schoonhoven L. Identification and development of implementation strategies: the important role of codesign. FRONTIERS IN HEALTH SERVICES 2024; 4:1305955. [PMID: 38385048 PMCID: PMC10879593 DOI: 10.3389/frhs.2024.1305955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
Background To date, implementation strategies reported in the literature are commonly poorly described and take the implementation context insufficiently into account. To unravel the black box of implementation strategy development, insight is needed into effective theory-based and practical-informed strategies. The current study aims to describe the stepwise development of a practical-informed and theory-based implementation strategy bundle to implement ProMuscle, a nutrition and exercise intervention for community-dwelling older adults, in multiple settings in primary care. Methods The first four steps of Implementation Mapping were adopted to develop appropriate implementation strategies. First, previously identified barriers to implementation were categorized into the constructs of the Consolidated Framework for Implementation Research (CFIR). Second, the CFIR-ERIC matching tool linked barriers to existing implementation strategies. Behavioral change strategies were added from the literature where necessary. Third, evidence for implementation strategies was sought. Fourth, in codesign with involved healthcare professionals and implementation experts, implementation strategies were operationalized to practical implementation activities following the guidance provided by Proctor et al. These practical implementation activities were processed into an implementation toolbox, which can be tailored to a specific context and presents prioritized implementation activities in a chronological order. Results A previous study identified and categorized a total of 654 barriers for the implementation of a combined lifestyle intervention within the CFIR framework. Subsequently, the barriers were linked to 40 strategies. Due to the fact that many strategies impacted multiple barriers, seven overarching themes emerged based on the strategies: assessing the context, network internally, network externally, costs, knowledge, champions, and patient needs and resources. Codesign sessions with professionals and implementation experts resulted in the development of supported and tangible implementation activities for the final 20 strategies. The implementation activities were processed into a web-based implementation toolbox, which allows healthcare professionals to tailor the implementation activities to their specific context and guides healthcare professionals to prioritize implementation activities chronologically during their implementation. Conclusion A theory-based approach in combination with codesign sessions with stakeholders is a usable Implementation Strategy Mapping Method for developing a practical implementation strategy bundle to implement ProMuscle across multiple settings in primary care. The next step involves evaluating the developed implementation strategies, including the implementation toolbox, to assess their impact on the implementation and adoption of ProMuscle.
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Affiliation(s)
- Patricia J. van der Laag
- Julius Center for Health Sciences and Primary Care, Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Berber G. Dorhout
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Aaron A. Heeren
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
| | - Di-Janne J. A. Barten
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Avent ML, Hall L, van Driel M, Dobson A, Deckx L, Galal M, Plejdrup Hansen M, Gilks C. Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention. Aust J Prim Health 2024; 30:NULL. [PMID: 37844575 DOI: 10.1071/py23024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. METHODS A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. RESULTS A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. CONCLUSIONS A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future.
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Affiliation(s)
- Minyon L Avent
- UQ Centre for Clinical Research, The University of Queensland, Herston, Qld, Australia; and Queensland Statewide Antimicrobial Stewardship Program, Queensland Health, Herston, Qld, Australia
| | - Lisa Hall
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Mieke van Driel
- General Practice, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Annette Dobson
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Laura Deckx
- General Practice, Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Mahmoud Galal
- School of Public Health, The University of Queensland, Herston, Qld, Australia
| | | | - Charles Gilks
- School of Public Health, The University of Queensland, Herston, Qld, Australia
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20
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Unuvar M, Blansfield J, Wang S, Hoffman RL. Trends in adoption of total neoadjuvant therapy for locally advanced rectal cancer. Am J Surg 2024; 227:229-236. [PMID: 37923661 DOI: 10.1016/j.amjsurg.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Total neoadjuvant chemoradiation (TNT), an accepted strategy for the treatment of locally advanced rectal cancer (LARC), was first included in guidelines in 2018. We aimed to describe trends in, and factors associated with TNT receipt. METHODS A retrospective cohort study of adult patients with LARC was performed using the national cancer database (2012-2020). TNT status was determined, and temporal trends analyzed. Factors associated with TNT receipt were identified by stage. RESULTS A total of 51,407 patients were identified; 57.3 % received TNT. Increasing age and comorbidities were associated with higher rates of TNT receipt. Patients with stage III disease were more likely to receive TNT (stage II OR 0.92, 95%CI 0.88-0.96). Patients were 38 % more likely to get TNT after guideline inclusion (OR1.38, 95%CI 1.31-1.46). CONCLUSION Rates of TNT were consistently above 50 % and rose after inclusion in the NCCN guidelines. This study establishes baseline patterns in rates of TNT for future benchmarking.
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Affiliation(s)
- Maria Unuvar
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Joseph Blansfield
- Geisinger Medical Center, Department of General Surgery, Division of Surgical Oncology, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Shengxuan Wang
- Geisinger Department of Biostatistics, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Rebecca L Hoffman
- Geisinger Medical Center, Department of General Surgery, Division of Colon & Rectal Surgery, 100 N. Academy Ave, Danville, PA, 17822, USA
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21
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Cheng CHJ, Langford AV, Gnjidic D, Farrell BJ, Schneider CR. Survey content validation evaluating the dissemination and implementation of deprescribing guidelines. Basic Clin Pharmacol Toxicol 2024; 134:63-71. [PMID: 37357339 DOI: 10.1111/bcpt.13922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Policies, protocols and processes within organisations can facilitate or hinder guideline adoption. There is limited knowledge on the strategies used by organisations to disseminate and implement evidence-based deprescribing guidelines or their impact. METHODS We aimed to develop an online survey targeting key organisations involved in deprescribing guideline endorsement, dissemination, modification or translation internationally. Survey questions were drafted, mirroring the six components of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Content validation was undertaken and established by a panel of clinicians, researchers and implementation experts. RESULTS A 52-item survey underwent two rounds of content validation. The minimum threshold (I-CVI > 0.78) for relevance and importance was met for 39 items (75%) in the first round and 44 of 48 items (92%) in the second round. The expert panel concluded that the adoption, implementation and effectiveness survey sections were largely relevant and important to this topic, whereas the reach and maintenance sections were harder to understand and may be less pertinent to the research question. CONCLUSIONS A 44-item survey investigating dissemination and implementation strategies for deprescribing guidelines has been developed and its content validated. Widespread survey distribution may identify effective strategies and inform dissemination and implementation planning for newly developed guidelines.
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Affiliation(s)
- Chun Hei Justin Cheng
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aili V Langford
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), Parkville, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara J Farrell
- Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Carl R Schneider
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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22
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Batterham P, Allenhof C, Cerga Pashoja A, Etzelmueller A, Fanaj N, Finch T, Freund J, Hanssen D, Mathiasen K, Piera Jiminez J, Qirjako G, Rapley T, Sacco Y, Samalin L, Schuurmans J, van Genugten C, Vis C. Psychometric properties of two implementation measures: Normalization MeAsure Development questionnaire (NoMAD) and organizational readiness for implementing change (ORIC). IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241245448. [PMID: 38686322 PMCID: PMC11057218 DOI: 10.1177/26334895241245448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background Effective interventions need to be implemented successfully to achieve impact. Two theory-based measures exist for measuring the effectiveness of implementation strategies and monitor implementation progress. The Normalization MeAsure Development questionnaire (NoMAD) explores the four core concepts (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring) of the Normalization Process Theory. The Organizational Readiness for Implementing Change (ORIC) is based on the theory of Organizational Readiness for Change, measuring organization members' psychological and behavioral preparedness for implementing a change. We examined the measurement properties of the NoMAD and ORIC in a multi-national implementation effectiveness study. Method Twelve mental health organizations in nine countries implemented Internet-based cognitive behavioral therapy (iCBT) for common mental disorders. Staff involved in iCBT service delivery (n = 318) participated in the study. Both measures were translated into eight languages using a standardized forward-backward translation procedure. Correlations between measures and subscales were estimated to examine convergent validity. The theoretical factor structures of the scales were tested using confirmatory factor analysis (CFA). Test-retest reliability was based on the correlation between scores at two time points 3 months apart. Internal consistency was assessed using Cronbach's alpha. Floor and ceiling effects were quantified using the proportion of zero and maximum scores. Results NoMAD and ORIC measure related but distinct latent constructs. The CFA showed that the use of a total score for each measure is appropriate. The theoretical subscales of the NoMAD had adequate internal consistency. The total scale had high internal consistency. The total ORIC scale and subscales demonstrated high internal consistency. Test-retest reliability was suboptimal for both measures and floor and ceiling effects were absent. Conclusions This study confirmed the psychometric properties of the NoMAD and ORIC in multi-national mental health care settings. While measuring on different but related aspects of implementation processes, the NoMAD and ORIC prove to be valid and reliable across different language settings.
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Affiliation(s)
- P. Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Caroline Allenhof
- German Foundation for Research and Education on Depression, Leipzig, Germany
| | - Arlinda Cerga Pashoja
- London School of Hygiene & Tropical Medicine, London, UK
- St. Marys University Twickenham, UK
| | - A. Etzelmueller
- HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Hamburg, Germany
- Department Health and Sport Sciences, Technical University of Munich, School of Medicine and Health, Professorship Psychology & Digital Mental Health Care, München, Germany
| | - N. Fanaj
- Alma Mater Europaea Campus College Rezonanca, Pristina, Kosovo
| | - T. Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - J. Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - D. Hanssen
- Interdisciplinary Centre Psychopathology and Emotion Regulation, University Medical Centre Groningen, Groningen, Netherlands
| | - K. Mathiasen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Lillebaelt Hospital – University Hospital of Southern Denmark, Vejle, Denmark
| | - Jordi Piera Jiminez
- Government of Catalonia Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
| | - G. Qirjako
- Department of Public Health, University of Medicine of Tirana, Tirane, Albania
- Community Centre for Health and Wellbeing, Tirane, Albania
| | - T. Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Y. Sacco
- Fondazione Don Carlo Gnocchi, Presidio Ausiliatrice S. Maria ai Colli, Torino, Italy
| | - L. Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | | | - Claire van Genugten
- Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - C. Vis
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Public and Occupational Health, Amsterdam University Medical Center, Amsterdam, Netherlands
- Forhelse Research Centre for Digital Mental Health Services Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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23
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Langford AV, Bero L, Lin CWC, Blyth FM, Doctor JN, Holliday S, Jeon YH, Moullin JC, Murnion B, Nielsen S, Penm J, Reeve E, Reid S, Wale J, Osman R, Gnjidic D, Schneider CR. Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care. J Clin Epidemiol 2024; 165:111204. [PMID: 37931823 DOI: 10.1016/j.jclinepi.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. STUDY DESIGN AND SETTING Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. RESULTS The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations. CONCLUSION The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
| | - Lisa Bero
- School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Chung-Wei Christine Lin
- Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Janet Wale
- Independent Consumer Representative, Melbourne, Victoria, Australia
| | - Rawa Osman
- NPS MedicineWise, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Camirand-Lemyre F, Merson L, Tirupakuzhi Vijayaraghavan BK, Burrell AJC, Citarella BW, Domingue MP, Lévesque S, Usuf E, Wils EJ, Ohshimo S, Martin-Loeches I, Sǎndulescu O, Laake JH, Lamontagne F. Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19. JAMA Netw Open 2023; 6:e2346502. [PMID: 38147336 PMCID: PMC10751594 DOI: 10.1001/jamanetworkopen.2023.46502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/25/2023] [Indexed: 12/27/2023] Open
Abstract
Importance Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, Setting, and Participants This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main Outcomes and Measures Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and Relevance The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation.
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Affiliation(s)
| | - Laura Merson
- ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | | | - Aidan J. C. Burrell
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | | | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Evert-Jan Wils
- Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’s Hospital Dublin, Leinster, Ireland
| | - Oana Sǎndulescu
- Department of Infectious Diseases I, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- National Institute for Infectious Diseases Prof Dr Matei Balș, Bucharest, Romania
| | - Jon Henrik Laake
- Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care and Emergencies, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
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25
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van Teunenbroek KC, Kremer LCM, Verhagen AAE, Verheijden JMA, Rippen H, Borggreve BCM, Michiels EMC, Mulder RL. Palliative care for children: methodology for the development of a national clinical practice guideline. BMC Palliat Care 2023; 22:193. [PMID: 38041060 PMCID: PMC10691037 DOI: 10.1186/s12904-023-01293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Provision of paediatric palliative care for children with life-threatening or life-limiting conditions and their families is often complex. Guidelines can support professionals to deliver high quality care. Stakeholders expressed the need to update the first Dutch paediatric palliative care guideline with new scientific literature and new topics. This paper provides an overview of the methodology that is used for the revision of the Dutch paediatric palliative care guideline and a brief presentation of the identified evidence. METHODS The revised paediatric palliative care guideline was developed with a multidisciplinary guideline panel of 72 experts in paediatric palliative care and nine (bereaved) parents of children with life-threatening or life-limiting conditions. The guideline covered multiple topics related to (refractory) symptom treatment, advance care planning and shared-decision making, organisation of care, psychosocial care, and loss and bereavement. We established six main working groups that formulated 38 clinical questions for which we identified evidence by updating two existing systematic literature searches. The GRADE (CERQual) methodology was used for appraisal of evidence. Furthermore, we searched for additional literature such as existing guidelines and textbooks to deal with lack of evidence. RESULTS The two systematic literature searches yielded a total of 29 RCTs or systematic reviews of RCTs on paediatric palliative care interventions and 22 qualitative studies on barriers and facilitators of advance care planning and shared decision-making. We identified evidence for 14 out of 38 clinical questions. Furthermore, we were able to select additional literature (29 guidelines, two textbooks, and 10 systematic reviews) to deal with lack of evidence. CONCLUSIONS The revised Dutch paediatric palliative care guideline addresses many topics. However, there is limited evidence to base recommendations upon. Our methodology will combine the existing evidence in scientific literature, additional literature, expert knowledge, and perspectives of patients and their families to provide recommendations.
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Affiliation(s)
| | - Leontien C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
- University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - A A Eduard Verhagen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Hester Rippen
- Stichting Kind en Ziekenhuis, Utrecht, the Netherlands
| | | | - Erna M C Michiels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Renée L Mulder
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
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Yan M, Chen L, Yang M, Zhang L, Niu M, Wu F, Chen Y, Song Z, Zhang Y, Li J, Tian J. Evidence mapping of clinical practice guidelines recommendations and quality for depression in children and adolescents. Eur Child Adolesc Psychiatry 2023; 32:2091-2108. [PMID: 35262810 DOI: 10.1007/s00787-022-01958-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023]
Abstract
This study systematically reviewed the clinical practice guidelines (CPGs) for depression in children and adolescents and assessed the quality and recommendation consistency of those CPGs. Evidence mapping was presented to illustrate the research trends and identify gaps to guide future research. Literature on CPGs for depression was systematically collected from PubMed, Embase, Web of Science, guideline databases, and psychiatric association/ society websites. The basic information, recommendations, methodological quality, and reporting quality of CPGs were extracted, and the supporting evidence strength for the included CPGs was analyzed in Excel. Four appraisers independently assessed the eligible CPGs using AGREE II instrument and the RIGHT checklist. All recommendations from the CPGs were summarized and analyzed, and the evidence mapping bubble charts were plotted in Excel. After excluding 15,184 records, 12 depression CPGs were eventually proved eligible, six of which were of high quality and six medium quality. A total of 39 major recommendations were summarized, 35 of which were supported by high-quality CPGs. Although direct comparisons are challenging due to differences in grading schemes and research quality, most CPGs share many pivotal recommendations that can help guide clinical practice. However, the evidence for some clinical problems is still lacking. Thus, more research is necessary on the screening and treatment of children and adolescents to put forward more evidence-based and high-quality recommendations.
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Affiliation(s)
- Meili Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Fangfang Wu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
- Shangluo Vocational and Technical College, Shangluo, Shanxi, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou, Gansu, China.
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China.
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Chen M, Zhang X, Liu C, Chen H, Wang D, Liu C. Effects of public reporting of prescription indicators on patient choices: evidence from propensity scores matching. Front Pharmacol 2023; 14:1110653. [PMID: 37876730 PMCID: PMC10591321 DOI: 10.3389/fphar.2023.1110653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background: Public reporting on health providers' performance (PRHPP) is increasingly used for empowering patients. This study aimed to test the effect of PRHPP using the theory of the consumer choice model. Methods: The study was conducted in 10 primary care institutions in Hubei province, China. Information related to the percentage of prescriptions requiring antibiotics, the percentage of prescriptions requiring injections, and average costs per prescription for each prescriber was calculated, ranked and displayed in a public place on a monthly basis. A questionnaire survey was undertaken on 302 patients 10 months after the initiation of the PRHPP, tapping into patient awareness, understanding, perceived value and use of the information in line with the theory of the consumer choice model. The fitness of data with the model was tested using structural equation modelling. The patients who were aware of the PRHPP were compared with those who were unaware of the PRHPP. The propensity score method (considering differences between the two groups of patients in age, gender, education, health and income) was used for estimating the effects of the PRHPP. Results: About 22% of respondents were aware of the PRHPP. Overall, the patients showed limited understanding, perceived value and use of the disclosed information. The data fit well into the consumer choice model. Awareness of the PRHPP was found to be associated with increased understanding of the antibiotic (p = 0.028) and injection prescribing indictors (p = 0.030). However, no significant differences in perceived value and use of the information (p > 0.097) were found between those who were aware and those who were unaware of the PRHPP. Conclusion: Although PRHPP may improve patient understanding of the prescribing performance indicators, its impacts on patient choices are limited due to low levels of perceived value and use of information from patients. Additional support is needed to enable patients to make informed choices using the PRHPP.
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Affiliation(s)
- Manli Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Haihong Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- Research Center for the Development of Traditional Chinese Medicine, Key Research Institute of Humanities and Social Sciences of Hubei Province, Wuhan, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Patel SV, Cance JD, Bonar EE, Carter PM, Dickerson DL, Fiellin LE, Fernandes CSF, Palimaru AI, Boomer TMP, Saldana L, Singh RR, Tinius E, Walton MA, Youn S, Young S, Philbrick S, Lambdin BH. Accelerating Solutions for the Overdose Crisis: an Effectiveness-Implementation Hybrid Protocol for the HEAL Prevention Cooperative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:40-49. [PMID: 36399222 PMCID: PMC9673891 DOI: 10.1007/s11121-022-01465-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
Given increasing opioid overdose mortality rates in the USA over the past 20 years, accelerating the implementation of prevention interventions found to be effective is critical. The Helping End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is a consortium of research projects funded to implement and test interventions designed to prevent the onset or escalation of opioid misuse among youth and young adults. The HPC offers a unique opportunity to synthesize and share lessons learned from participating research projects' varied implementation experiences, which can facilitate quicker integration of effective prevention interventions into practice. This protocol paper describes our hybrid approach to collecting and analyzing information about the implementation experiences of nine of the HPC research projects while they maintain their focus on assessing the effectiveness and cost-effectiveness of prevention interventions. To better understand implementation within this context, we will address five research questions: (1) What were the context and approach for implementing the prevention interventions, and how was the overall implementation experience? (2) How representative of the target population are the participants who were enrolled and retained in the research projects' effectiveness trials? (3) For what purposes and how were stakeholders engaged by the research projects? (4) What are the adaptable components of the prevention interventions? And finally, (5) how might implementation of the prevention interventions vary for non-trial implementation? This work will result in intervention-specific and general practical dissemination resources that can help potential adopters and deliverers of opioid misuse prevention make adoption decisions and prepare for successful implementation.
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Affiliation(s)
- S V Patel
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - P M Carter
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - D L Dickerson
- Integrated Substance Abuse Programs (ISAP), University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - L Saldana
- Oregon Social Learning Center, Eugene, OR, USA
| | - R R Singh
- Oregon Social Learning Center, Eugene, OR, USA
| | - E Tinius
- Texas Christian University, Fort Worth, TX, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Young
- Texas Christian University, Fort Worth, TX, USA
| | - S Philbrick
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B H Lambdin
- RTI International, Research Triangle Park, Durham, NC, USA
- University of Washington, Seattle, WA, USA
- University of California San Francisco, San Francisco, CA, USA
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Elliott J, Stolee P, Mairs K, Kothari A, Conklin J. A Community of Practice on Environmental Design for Long-Term Care Residents with Dementia. Can J Aging 2023; 42:404-415. [PMID: 36799024 DOI: 10.1017/s0714980823000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The use of communities of practice (CoP) to support the application of knowledge in improved geriatric care practice is not widely understood. This case study's aim was to gain a deeper understanding of the knowledge-to-action (KTA) processes of a CoP focused on environmental design, to improve how persons with dementia find their way around in long-term care (LTC) homes. Qualitative data were collected (key informant interviews, observations, and document review), and analysed using emergent coding. CoP members contributed extensive knowledge to the KTA process characterized by the following themes: team dynamics, employing a structured process, technology use, varied forms of knowledge, and a clear initiative. The study's CoP effectively synthesized and translated knowledge into practical tools to inform changes in practice, programs, and policy on dementia care. More research is needed on how to involve patients and caregivers in the KTA processes, and to ensure that practical application of knowledge has financial and policy support.
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Affiliation(s)
- Jacobi Elliott
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Lawson Health Research Institute, London, Canada
- School of Health Studies, Western University, London, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Katie Mairs
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, Canada
| | - James Conklin
- Department of Applied Human Sciences, Concordia University, Montreal, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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30
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Aloisio LD, Graham N, Grinspun D, Naik S, Coughlin M, Medeiros C, McConnell H, Sales A, McNeill S, Santos WJ, Squires JE. Indicators to measure implementation and sustainability of nursing best practice guidelines: A mixed methods analysis. Heliyon 2023; 9:e19983. [PMID: 37809679 PMCID: PMC10559663 DOI: 10.1016/j.heliyon.2023.e19983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs). Methods Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders. Results Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey. Conclusions Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.
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Affiliation(s)
- Laura D. Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nicole Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
| | - Doris Grinspun
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Shanoja Naik
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christina Medeiros
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Anne Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan McNeill
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Wilmer J. Santos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Janet E. Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada
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Tummers F, Coppus S, Lagerveld B, Demirkiran A, van Schrojenstein Lantman E, Brouwer T, Draaisma W, Jansen F. Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery. Facts Views Vis Obgyn 2023; 15:215-224. [PMID: 37742198 PMCID: PMC10643014 DOI: 10.52054/fvvo.15.3.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Updating evidence-based clinical practice guidelines is an onerous process and there is a call for more efficient determination of key questions that need updating. Especially for surgical techniques it is unclear if new evidence will result in substantial changes after wide implementation and if continuous updating is always necessary. Objectives This study analyses the impact of updating a surgical guideline and proposes suggestions for optimising this process. Materials and methods The Dutch Minimally Invasive Surgery guideline was developed in 2011 and updated in 2021. For both versions a multidisciplinary guideline working group (GDG) was created, that determined key questions. Changes in conclusions and recommendations were analysed by the GDG and statements for expected change of recommendations in the future were made. Results 15 key questions were formed, of which 12 were updates of the previous guideline. For only 27% of the updated key questions, the conclusions changed. In ten years, the body grew only marginally for most key questions and quality of the evidence did not improve substantially for almost all key questions. However, in this first update of the MIC guideline, many recommendations did change due to a more robust interpretation of the conclusions by the GDG. Based on analysis of this updating process, the GDG expects that only four out of 15 recommendations may change in the future. Conclusion We propose an additional step at the end of guideline development and updating, where the necessity for updating in the future is determined for each key question by the GDG, using their valuable knowledge gained from developing or updating the guideline. For surgical guidelines, the authors suggest updating key issues if it includes a relatively newly introduced surgical- or adapted technique or a new patient group. Low quality or small body of evidence should not be a reason in itself for updating, as this mostly does not lead to new evidence-based conclusions. This new step is expected to result in a more efficient prioritising of key questions that need updating. What’s new? By adding one additional step at the end of the updating process, the future updating process could become more efficient.
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Affiliation(s)
- F.H.M.P. Tummers
- Department of Gynecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - S.F.P.J. Coppus
- Department of Gynecology, Maxima Medical Center, 5631 BM Veldhoven/Eindhoven, The Netherlands
| | - B.W. Lagerveld
- Department of Urology, OLVG, 1091 AC Amsterdam, The Netherlands
| | - A Demirkiran
- Department of Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | | | - T.A. Brouwer
- Department of Anesthesiology, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - W.A. Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 5223 GZ Den Bosch, The Netherlands
| | - F.W. Jansen
- Department of Gynecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
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Lorenz C, Güler D, Halms T, Khorikian-Ghazari N, Röh A, Flick M, Burschinski A, Pielenz C, Salveridou-Hof E, Schneider-Axmann T, Schneider M, Wagner E, Falkai P, Gaebel W, Leucht S, Hasan A, Gaigl G. Conventional and living guideline for schizophrenia: barriers and facilitating factors in guideline implementation. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01663-1. [PMID: 37581691 DOI: 10.1007/s00406-023-01663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Abstract
This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An online survey was performed under participation of mental healthcare professionals (medical doctors, psychologists/psychotherapists, psychosocial therapists, caregivers) in 17 hospitals for psychiatry in Southern Germany and a professional association for German neurologists and psychiatrists. 524 participants opened the survey, 439 completed the demographic questions and commenced the content-related survey and 309 provided complete data sets. Results indicate a higher occurrence of knowledge-related barriers for the living guideline. The print version is associated with more attitude-related and external barriers. Older professionals reported more attitude-related barriers to a living guideline compared to younger professionals. Differences between professions regarding barriers were found for both formats. Various barriers exist for both guideline formats and a need for facilitators was expressed across professions. Many of the mentioned obstacles and facilitators can be more easily addressed with living guidelines. However, also living guidelines face barriers. Thus, the introduction of these new formats alone cannot lead to sustainable behavior change regarding guideline adherence. Yet, living guidelines seem to be a cornerstone to improved and tailored guideline implementation as they facilitate to keep recommendations up to date and to address the need of individual professional groups.
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Affiliation(s)
- Carolin Lorenz
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany.
| | - Duygu Güler
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Theresa Halms
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Naiiri Khorikian-Ghazari
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Astrid Röh
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Marisa Flick
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany
| | - Charline Pielenz
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Eva Salveridou-Hof
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Schneider
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, DEU-131, Düsseldorf, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, School of Medicine, Medical Faculty, Technical University of Munich, 81675, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
| | - Gabriele Gaigl
- Department of Psychiatry, Psychotherapy and Psychosomatic, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
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Al-Baghli NA, Al Saif AZ, Al Dorazi SA, Zainaldeen MH, Alameer AH, Albaghli S, Al-Dawood AM, Buhelaiga SM, Alsalim BS, Rabaan AA. Antibiotic-Prescribing Patterns Among Patients With Respiratory Symptoms in the Eastern Province, Kingdom of Saudi Arabia. Cureus 2023; 15:e44298. [PMID: 37649929 PMCID: PMC10462910 DOI: 10.7759/cureus.44298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/01/2023] Open
Abstract
Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests (RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.
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Affiliation(s)
| | - Ahmed Z Al Saif
- Keep Well, Model of Care, Eastern Health Cluster, Dammam, SAU
| | | | - Mariam H Zainaldeen
- Directorate of Infection Prevention and Control, General Directorate of Health Affairs in Eastern Province, Dammam, SAU
| | | | - Slava Albaghli
- Pathology and Laboratory Medicine, King Saud Medical City, Riyadh, SAU
| | | | | | | | - Ali A Rabaan
- Molecular Microbiology, Johns Hopkins Aramco Healthcare, Dhahran, SAU
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Kareskoski M. Accreditation in continuing veterinary education: development of an accreditation system and selection of accreditation criteria. Front Vet Sci 2023; 10:1181961. [PMID: 37576832 PMCID: PMC10416105 DOI: 10.3389/fvets.2023.1181961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
With the increased supply and demand of veterinary continuing education (CE) and the growing number of CE providers, a clear need has arisen for a multinational accreditation system for veterinary CE. The objective of this document is to describe the current state of veterinary CE accreditation and the development of an accreditation system for veterinary CE, and discuss accreditation criteria and their pedagogical and practical significance. The hypothesis is that a profile of essential, pedagogically grounded, accreditation criteria can be established and utilized effectively in quality assessment. Accreditation criteria for veterinary CE can be created based on four selection principles: educational minimum requirements, coherence, efficacy, and assessability. The selected educational quality criteria are related to needs assessment, correlation of target audience and level of instruction, definition of scope, workload, and number of credits, organizer and instructor qualifications, constructive alignment, assessment of learning, learner engagement, and scientific quality of CE content. The created accreditation criteria and protocols should be regularly re-evaluated and modified in close collaboration with the relevant stakeholders. The desired outcome of CE, including behavior change and improvement of practice and ultimately human and animal health, remains challenging to predict based on course descriptions by the providers, and further research is needed.
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Affiliation(s)
- Maria Kareskoski
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Veterinary Continuing Education in Europe (VetCEE), Brussels, Belgium
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Haghpanah S, Naderi M, Kamalian S, Tavoosi H, Parand S, Javanmardi N, Karimi M. The impact of inhibitors on the quality of life in patients with hemophilia. SAGE Open Med 2023; 11:20503121231182284. [PMID: 37456083 PMCID: PMC10338721 DOI: 10.1177/20503121231182284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To investigate the association of health-related quality of life in hemophilia patients with inhibitor and clinical and demographic characteristics. Methods In this multi-center cross-sectional study, 41 male patients with hemophilia A were investigated from May to October 2021. All patients were registered at the Hemophilia Clinic affiliated with Shiraz and Zahedan Universities of Medical Sciences in Iran. Health-related quality of life of the patients was evaluated by the Short Form-36 questionnaire. Results The patients' mean ± SD of age was 36.9 ± 13.2 (range: 18-76) years. Eleven patients (26.8%) were inhibitor positive. In univariate analysis, physical function, mental health dimension, and total Short Form-36 scores were significantly lower in the inhibitor-positive patients (p < 0.001, p = 0.045, and p = 0.035, respectively). Moreover, patients with severe disease showed significantly lower scores in physical function (p < 0.001), physical health dimension (p = 0.018), and total Short Form-36 (p = 0.031) than those with mild and moderate hemophilia. Also, blood-borne infections showed a significant association with lower score in physical health dimension (p = 0.038). In addition, annual bleeding rate showed significant negative correlations with physical health dimension (rs = -0.609, p < 0.001), mental health dimension (r = -0.317, p = 0.044), and total Short Form-36 (r = -0.455, p = 0.003) scores. In multiple linear regression analysis, disease severity revealed a significant negative relationship with scores in physical function (p = 0.001), role physical (RP) (p = 0.015), general health (GH) (p = 0.006), physical health dimension (p = 0.006), and marginally in total Short Form-36 score (p = 0.054). Also, age of the patients showed a significant negative association with physical function and GH scores (p < 0.001 and p = 0.015, respectively). Conclusion Disease severity and age were shown as independent factors affecting health-related quality of life, but inhibitor alone was not an independent influencing factor. Reduced health-related quality of life was also observed in hemophilia patients with higher annual bleeding rate and blood-borne infections. Therefore, it is necessary to pay more attention to these subgroups. Further studies with larger sample size are needed for more accurate results.
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Affiliation(s)
- Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Naderi
- Department of Pediatrics, School of medicine, Genetics of Non-Communicable Disease Research Center, Ali Ibne Abitaleb Hospital Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sepideh Kamalian
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hakimeh Tavoosi
- Shiraz Hemophilia Comprehensive Center, Dastgheib Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Parand
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Javanmardi
- Student Research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Olude O, Vlassoff C, Niyikora J, Krentel A. A systematic review of participatory approaches to empower health workers in low- and middle-income countries, highlighting Health Workers for Change. Int Health 2023; 15:462-473. [PMID: 36349618 PMCID: PMC10318970 DOI: 10.1093/inthealth/ihac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/26/2022] [Accepted: 10/21/2022] [Indexed: 07/20/2023] Open
Abstract
This systematic review assesses participatory approaches to motivating positive change among health workers in low- and middle-income countries (LMICs). The mistreatment of clients at health centres has been extensively documented, causing stress among clients, health complications and even avoidance of health centres altogether. Health workers, too, face challenges, including medicine shortages, task shifting, inadequate training and a lack of managerial support. Solutions are urgently needed to realise global commitments to quality primary healthcare, country ownership and universal health coverage. This review searched 1243 titles and abstracts, of which 32 were extracted for full text review using a published critical assessment tool. Eight papers were retained for final review, all using a single methodology, 'Health Workers for Change' (HWFC). The intervention was adapted to diverse geographical and health settings. Nine indicators from the included studies were assessed, eliciting many common findings and documenting an overall positive impact of the HWFC approach. Health workers acknowledged their negative behaviour towards clients, often as a way of coping with their own unmet needs. In most settings they developed action plans to address these issues. Recommendations are made on mainstreaming HWFC into health systems in LMICs and its potential application to alleviating stress and burnout from COVID-19.
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Affiliation(s)
| | - Carol Vlassoff
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
| | | | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa K1G 5Z3, Canada
- Bruyère Research Institute, Ottawa K1N 5C8, Canada
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Lamloum D, Arghittu A, Ferrara P, Castiglia P, Dettori M, Gaeta M, Odone A, Campus G. A Systematic Review of Clinical Practice Guidelines for Caries Prevention following the AGREE II Checklist. Healthcare (Basel) 2023; 11:1895. [PMID: 37444729 DOI: 10.3390/healthcare11131895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Untreated oral diseases are detrimental to overall well-being and quality of life and are in close relationship with social and economic consequences. The presence of strong evidence for caries primary and secondary prevention is a compulsory tool for the development of clinical practice guidelines (CPGs). This paper was aimed to assess systematically the importance of clinical practice guidelines in caries prevention management considering both the adult and pediatric populations and evaluate them using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Checklist. Records were extracted from EMBASE, SCOPUS, PubMed/Medline and seven other relevant guideline databases between 6 January and 14 February 2023. Two reviewers independently conducted the appraisal using the web-based platform My AGREE PLUS. Twenty-one guidelines/papers met the inclusion criteria and were reviewed. Eight CPGs included both primary and secondary prevention interventions, whereas thirteen presented a single preventive model. Overall, 12 guidelines were published in the USA. The mean AGREE II scores ranged from 35.4% to 84.3%. Of the total twenty-one included guidelines, twelve were classified as "Recommended", ranging from 56.3% to 84.3%, the others were described as "Recommended with modification", ranging from 35.4% to 68.9%. From the AGREE II analysis carried out, the CPGs included in this survey adopted a punctual methodological rigor but lacked applicative power. The present survey showed that the public, as the primary beneficiary, played a limited role in the development of the twenty-one CPGs. Hence, methodological improvement can better support high-quality CPG development in the future.
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Affiliation(s)
- Demetrio Lamloum
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Antonella Arghittu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan-Bicocca, 20126 Monza, Italy
- IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Paolo Castiglia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Marco Dettori
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Guglielmo Campus
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Department of Cariology, Saveetha Dental College and Hospitals, Chennai 600077, India
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Abt E, Weyant RJ, Frantsve-Hawley J, Carrasco-Labra A. The potential harm of not following clinical practice guideline recommendations. J Am Dent Assoc 2023:S0002-8177(23)00276-3. [PMID: 37367711 DOI: 10.1016/j.adaj.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide recommendations for clinicians on the basis of best evidence. CPGs are often not followed because of numerous barriers, including lack of awareness, inability to understand recommendations, and problems with implementation. CASE DESCRIPTION A case report is presented in which treatment of a patient's incipient caries lesions may not have followed a CPG available to practitioners, recommending conservative nonrestorative medical interventions. The resulting treatment led to pain and the need for endodontic therapy and full-coverage restoration. PRACTICAL IMPLICATIONS This case represents possible mismanagement leading to undue pain and additional costs that could have been avoided by being aware of, and following, the recommendations from CPGs.
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Leicester L, Reid A, Gilbert S, Marshall R, O'Neill DG. Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary-care emergency practice. Vet Rec 2023; 192:e2485. [PMID: 36628550 DOI: 10.1002/vetr.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The paucity of published veterinary clinical audits suggests that clinical audit is an under-used tool for quality improvement (QI) in the veterinary profession. Therefore, a continuous QI process was designed and implemented at a UK multisite small animal emergency practice, focusing on audit of clinical management of canine dystocia. METHODS Data collection phases were undertaken in 2014, 2019 and 2021, with intervening knowledge dissemination activities. Nine variables relating to clinical management of canine dystocia were selected as audit criteria in the initial dataset, and 21 variables were measured in each subsequent phase. RESULTS Between 2014 and 2021, statistically significant increases (p < 0.05) were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section. A clinical audit planning template was created for future audits. LIMITATIONS Typical case presentation and management of canine dystocia cases may vary between dedicated emergency and non-emergency primary-care settings. CONCLUSION This study demonstrates the feasibility of large-scale veterinary clinical audit and suggests that the application of the clinical audit process promotes learning within the veterinary team and improved clinical outcomes.
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Affiliation(s)
| | | | | | | | - Dan G O'Neill
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
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Nomali M, Amini MR, Aalaa M, Sanjari M, Mohajeri-Tehrani MR, Adibi H, Yarahmadi M, Alijani N, Saeidi H, Molavi B, Kazemi M, Mansoori P, Nasli-Esfahani E, Larijani B, Mehrdad N. Adoption of IWGDF guidance on prevention and management of foot problems in diabetes for local use in Iran by ADAPTE methodology: a step toward best practice. J Diabetes Metab Disord 2023; 22:245-254. [PMID: 37255820 PMCID: PMC10225394 DOI: 10.1007/s40200-022-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/01/2022] [Indexed: 06/01/2023]
Abstract
Purpose Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01121-0.
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Affiliation(s)
- Mahin Nomali
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of medical Sciences, Tehran, Iran
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Adibi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Yarahmadi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Alijani
- Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Saeidi
- Rehabilitation Research Center, Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Molavi
- Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahlisha Kazemi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mansoori
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al-e- Ahmad Highway, 1411713139 Tehran, Iran
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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Pearson EJ, Denehy L, Edbrooke L. Identifying strategies for implementing a clinical guideline for cancer-related fatigue: a qualitative study. BMC Health Serv Res 2023; 23:395. [PMID: 37095506 PMCID: PMC10127293 DOI: 10.1186/s12913-023-09377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Clinical practice guidelines assist health professionals' (HPs) decisions. Costly to develop, many guidelines are not implemented in clinical settings. This paper describes an evaluation of contextual factors to inform clinical guideline implementation strategies for the common and distressing problem of cancer-related fatigue (CRF) at an Australian cancer hospital. METHODS A qualitative inquiry involving interviews and focus groups with consumers and multidisciplinary HPs explored key Canadian CRF guideline recommendations. Four HP focus groups examined the feasibility of a specific recommendation, while a consumer focus group examined experiences and preferences for managing CRF. Audio recordings were analysed using a rapid method of content analysis designed to accelerate implementation research. Strategies for implementation were guided by the Consolidated Framework for Implementation Research. RESULTS Five consumers and 31 multidisciplinary HPs participated in eight interviews and five focus groups. Key HP barriers to fatigue management were insufficient knowledge and time; and lack of accessible screening and management tools or referral pathways. Consumer barriers included priority for cancer control during short health consultations, limited stamina for extended or extra visits addressing fatigue, and HP attitudes towards fatigue. Enablers of optimal fatigue management were alignment with existing healthcare practices, increased HP knowledge of CRF guidelines and tools, and improved referral pathways. Consumers valued their HPs addressing fatigue as part of treatment, with a personal fatigue prevention or management plan including self-monitoring. Consumers preferred fatigue management outside clinic appointments and use of telehealth consultations. CONCLUSIONS Strategies that reduce barriers and leverage enablers to guideline use should be trialled. Approaches should include (1) accessible knowledge and practice resources for busy HPs, (2) time efficient processes for patients and their HPs and (3) alignment of processes with existing practice. Funding for cancer care must enable best practice supportive care.
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Affiliation(s)
- Elizabeth J Pearson
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
| | - Linda Denehy
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Lara Edbrooke
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Antonacci G, Whitney J, Harris M, Reed JE. How do healthcare providers use national audit data for improvement? BMC Health Serv Res 2023; 23:393. [PMID: 37095495 PMCID: PMC10123973 DOI: 10.1186/s12913-023-09334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Substantial resources are invested by Health Departments worldwide in introducing National Clinical Audits (NCAs). Yet, there is variable evidence on the NCAs' effectiveness and little is known on factors underlying the successful use of NCAs to improve local practice. This study will focus on a single NCA (the National Audit of Inpatient Falls -NAIF 2017) to explore: (i) participants' perspectives on the NCA reports, local feedback characteristics and actions undertaken following the feedback underpinning the effective use of the NCA feedback to improve local practice; (ii) reported changes in local practice following the NCA feedback in England and Wales. METHODS Front-line staff perspectives were gathered through interviews. An inductive qualitative approach was used. Eighteen participants were purposefully sampled from 7 of the 85 participating hospitals in England and Wales. Analysis was guided by constant comparative techniques. RESULTS Regarding the NAIF annual report, interviewees valued performance benchmarking with other hospitals, the use of visual representations and the inclusion of case studies and recommendations. Participants stated that feedback should target front-line healthcare professionals, be straightforward and focused, and be delivered through an encouraging and honest discussion. Interviewees highlighted the value of using other relevant data sources alongside NAIF feedback and the importance of continuous data monitoring. Participants reported that engagement of front-line staff in the NAIF and following improvement activities was critical. Leadership, ownership, management support and communication at different organisational levels were perceived as enablers, while staffing level and turnover, and poor quality improvement (QI) skills, were perceived as barriers to improvement. Reported changes in practice included increased awareness and attention to patient safety issues and greater involvement of patients and staff in falls prevention activities. CONCLUSIONS There is scope to improve the use of NCAs by front-line staff. NCAs should not be seen as isolated interventions but should be fully embedded and integrated into the QI strategic and operational plans of NHS trusts. The use of NCAs could be optimised, but knowledge of them is poor and distributed unevenly across different disciplines. More research is needed to provide guidance on key elements to consider throughout the whole improvement process at different organisational levels.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Julie Whitney
- Department of Physiotherapy, King's College London, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, South Kensington, UK
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Julie Reed Consultancy Ltd, London, UK
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Moldovan F, Moldovan L, Bataga T. Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040796. [PMID: 37109755 PMCID: PMC10143905 DOI: 10.3390/medicina59040796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Quality Engineering Research Center, Faculty of Engineering and Information Technology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Faulds ER, Dungan KM, McNett M. Implementation of Continuous Glucose Monitoring in Critical Care: A Scoping Review. Curr Diab Rep 2023; 23:69-87. [PMID: 37052790 PMCID: PMC10098233 DOI: 10.1007/s11892-023-01503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to identify the implementation approaches, strategies, and outcomes for continuous glucose monitoring (CGM) in the intensive care unit (ICU). Medline and Web of Science databases were searched to report relevant literature published between September 12, 2016 and September 12, 2021. Implementation outcomes and strategies, defined by the Expert Recommendations for Implementing Change (ERIC) project, were extracted. RECENT FINDINGS Of the 324 titles reviewed, 16 articles were included in the review. While no studies were identified as implementation research, 14 of 16 identified implementation strategies that aligned with ERIC definitions. Included studies described a multi-disciplinary approach. Clinical outcomes included Mean Absolute Relative Difference (MARD), ranging from 7.5 to 15.3%, and 33-71% reduction in frequency of point-of-care (POC) blood glucose monitoring (BGM) using hybrid protocols. This scoping review provides valuable insight into the process of CGM implementation in the ICU. Continued research should include implementation outcomes to inform widespread utilization.
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Affiliation(s)
- Eileen R Faulds
- The Ohio State University College of Nursing, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Kathleen M Dungan
- Department of Internal Medicine, Division of Endocrinology, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Diabetes & Metabolism, Columbus, OH, USA
| | - Molly McNett
- Implementation Science, Helene Fuld Health Trust National Institute for EBP, The Ohio State University College of Nursing, Columbus, OH, USA
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Bora AM, Piechotta V, Kreuzberger N, Monsef I, Wender A, Follmann M, Nothacker M, Skoetz N. The effectiveness of clinical guideline implementation strategies in oncology-a systematic review. BMC Health Serv Res 2023; 23:347. [PMID: 37024867 PMCID: PMC10080872 DOI: 10.1186/s12913-023-09189-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023] Open
Abstract
IMPORTANCE Guideline recommendations do not necessarily translate into changes in clinical practice behaviour or better patient outcomes. OBJECTIVE This systematic review aims to identify recent clinical guideline implementation strategies in oncology and to determine their effect primarily on patient-relevant outcomes and secondarily on healthcare professionals' adherence. METHODS A systematic search of five electronic databases (PubMed, Web of Science, GIN, CENTRAL, CINAHL) was conducted on 16 december 2022. Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence outcomes (screening, referral, prescribing, attitudes, knowledge) in the oncological setting were targeted. The Cochrane risk-of-bias tool and the ROBINS-I tool were used for assessing the risk of bias. Certainty in the evidence was evaluated according to GRADE recommendations. This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42021268593. FINDINGS Of 1326 records identified, nine studies, five cluster RCTs and four controlled before-and after studies, were included in the narrative synthesis. All nine studies assess the effect of multi-component interventions in 3577 cancer patients and more than 450 oncologists, nurses and medical staff. PATIENT-LEVEL Educational meetings combined with materials, opinion leaders, audit and feedback, a tailored intervention or academic detailing may have little to no effect on overall survival, quality of life and adverse events of cancer patients compared to no intervention, however, the evidence is either uncertain or very uncertain. PROVIDER-LEVEL Multi-component interventions may increase or slightly increase guideline adherence regarding screening, referral and prescribing behaviour of healthcare professionals according to guidelines, but the certainty in evidence is low. The interventions may have little to no effect on attitudes and knowledge of healthcare professionals, still, the evidence is very uncertain. CONCLUSIONS AND RELEVANCE Knowledge and skill accumulation through team-oriented or online educational training and dissemination of materials embedded in multi-component interventions seem to be the most frequently researched guideline implementation strategies in oncology recently. This systematic review provides an overview of recent guideline implementation strategies in oncology, encourages future implementation research in this area and informs policymakers and professional organisations on the development and adoption of implementation strategies.
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Affiliation(s)
- Ana-Mihaela Bora
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Vanessa Piechotta
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Wender
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, C/O Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Pereira VC, Silva SN, Vidal ÁT, Lins GVE, Barreto JOM. How to improve the dissemination of clinical practice guidelines in the Brazilian Unified Health System? Report of a pilot project. Health Res Policy Syst 2023; 21:22. [PMID: 36959620 PMCID: PMC10035473 DOI: 10.1186/s12961-023-00966-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/14/2023] [Indexed: 03/25/2023] Open
Abstract
In Brazil, there have been some initiatives to improve the development of Ministry of Health clinical protocols and therapeutic guidelines (PCDTs in Portuguese, and clinical practice guidelines-CPGs, in English) and their implementation so that best practices can be disseminated and adopted at multiple levels of health systems. One of the initiatives was to conduct a pilot project to improve the format of these CPGs. The objective of this article is to present the processes and results of the pilot project, including the development of a new standardized format for CPGs to promote national dissemination and uptake. The pilot project was designed in three phases: identification and selection of strategies to effectively implement clinical practice guidelines, definition of the ideal characteristics for the format of CPGs, and development and implementation of the new format. Initially, an overview of systematic reviews was conducted to map the global evidence on the effectiveness of dissemination and implementation strategies of CPGs. Among the most effective interventions, a low-cost strategy was selected to improve the format of CPGs, namely a full format and a short format. The two formats were evaluated for usefulness and acceptability by professionals who use or develop CPGs, and after several reiterations, the formats were finalized, considering the progression of care (from diagnosis of the disease to treatment, including specific technologies indicated in each stage of the disease). Related to the technical aspects, the visual presentation of the CPGs was improved, ensuring that key information was easily identified for decision-making by end users. The initial phase of implementation involved 33 clinical conditions, equating to approximately 20% of published CPGs. It is anticipated that disseminating the CPGs in the new formats will promote the accessibility of information and implementation of standardized CPGs by health professionals in the public health sector (servicing more than 210 million Brazilians). Further research should be considered to determine the impact of the use of the new CPGs formats, contributing to the knowledge base related to the implementation of guidelines in Brazil and internationally.
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Kengne Talla P, Makansi N, Michaud PL, Durand R, Allison PJ, Emami E. Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054671. [PMID: 36901681 PMCID: PMC10002179 DOI: 10.3390/ijerph20054671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 05/13/2023]
Abstract
During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.
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Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
- Correspondence:
| | - Nora Makansi
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
| | - Pierre-Luc Michaud
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS B3H 1W2, Canada
| | - Robert Durand
- Faculty of Dental Medicine, Université de Montreal, Montreal, QC H3T 1J4, Canada
| | - Paul J. Allison
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Science, McGill University, Montreal, QC H3A 1G1, Canada
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Jasaui Y, Mortazhejri S, Dowling S, Duquette D, L’Heureux G, Linklater S, Mrklas KJ, Wilkinson G, Beesoon S, Patey AM, Ruzycki SM, Grimshaw JM. Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing. Perioper Med (Lond) 2023; 12:3. [PMID: 36864470 PMCID: PMC9979452 DOI: 10.1186/s13741-023-00292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/12/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery ('low-value preoperative testing') among anesthesiologists, internal medicine specialists, nurses, and surgeons. METHODS Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. RESULTS Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). CONCLUSIONS We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels.
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Affiliation(s)
- Yamile Jasaui
- grid.22072.350000 0004 1936 7697Continuing Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sameh Mortazhejri
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Shawn Dowling
- grid.22072.350000 0004 1936 7697Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - D’Arcy Duquette
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Geralyn L’Heureux
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Stefanie Linklater
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Kelly J. Mrklas
- grid.413574.00000 0001 0693 8815Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Edmonton, AB Canada
| | - Gloria Wilkinson
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Sanjay Beesoon
- grid.413574.00000 0001 0693 8815Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB Canada
| | - Andrea M. Patey
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Shannon M. Ruzycki
- grid.17089.370000 0001 2190 316XFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada ,grid.22072.350000 0004 1936 7697Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeremy M. Grimshaw
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada
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Donovan T, Abell B, Fernando M, McPhail SM, Carter HE. Implementation costs of hospital-based computerised decision support systems: a systematic review. Implement Sci 2023; 18:7. [PMID: 36829247 PMCID: PMC9960445 DOI: 10.1186/s13012-023-01261-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The importance of accurately costing implementation strategies is increasingly recognised within the field of implementation science. However, there is a lack of methodological guidance for costing implementation, particularly within digital health settings. This study reports on a systematic review of costing analyses conducted alongside implementation of hospital-based computerised decision support systems. METHODS PubMed, Embase, Scopus and CINAHL databases were searched between January 2010 and August 2021. Two reviewers independently screened and selected original research studies that were conducted in a hospital setting, examined the implementation of a computerised decision support systems and reported implementation costs. The Expert Recommendations for Implementing Change Framework was used to identify and categorise implementation strategies into clusters. A previously published costing framework was applied to describe the methods used to measure and value implementation costs. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Titles and abstracts of 1836 articles were screened, with nine articles eligible for inclusion in the review. Implementation costs were most frequently reported under the 'evaluative and iterative strategies' cluster, followed by 'provide interactive assistance'. Labour was the largest implementation-related cost in the included papers, irrespective of implementation strategy. Other reported costs included consumables, durable assets and physical space, which was mostly associated with stakeholder training. The methods used to cost implementation were often unclear. There was variation across studies in the overall quality of reporting. CONCLUSIONS A relatively small number of papers have described computerised decision support systems implementation costs, and the methods used to measure and value these costs were not well reported. Priorities for future research should include establishing consistent terminology and appropriate methods for estimating and reporting on implementation costs. TRIAL REGISTRATION The review protocol is registered with PROSPERO (ID: CRD42021272948).
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Affiliation(s)
- Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Bridget Abell
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Manasha Fernando
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Steven M. McPhail
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia ,grid.474142.0Digital Health and Informatics, Metro South Health, Brisbane, QLD Australia
| | - Hannah E. Carter
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
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