1
|
Davis MT, Tschampl C, Hodgkin D, Regis C, Taveras E, Plant B, Reilly B, Horgan C. Mobile clinics for opioid use disorders: What they do and how they do it. A qualitative analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209428. [PMID: 38879017 DOI: 10.1016/j.josat.2024.209428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/10/2024] [Accepted: 06/04/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION People with substance use disorders (SUD) face many barriers to receiving evidence-based treatments including access to and cost of treatment. People who use drugs face stigma that limits access to traditional office-based clinics. With the goal of reducing morbidity and mortality, mobile clinics reduce many of these barriers by providing harm reduction and on-demand low-threshold medical care. METHODS In 2020 Massachusetts Department of Public Health (DPH) Mobile Addiction Services Program expanded a program called Community Care in Reach building on its success in reducing barriers to care and increasing patient encounters. In the current evaluation we conducted site visits to the four new mobile clinics and conducted one individual semi-structured provider interview at each of the four clinics. In addition, we supported a monthly learning collaborative of staff in four agencies involved with this initiative. The current evaluation used the RE-AIM framework to analyze the implementation of the mobile clinics. RESULTS Clinicians described many challenges and opportunities. The typical patient is unhoused, having a substance use disorder, and disconnected from traditional pathways to care. Clinicians are able to initiate people on buprenorphine largely due to the trust they establish with patients. Referral networks are facilitated by established community linkages. The philosophy of care is patient-centered. Mobile clinics provide a wide range of healthcare services including harm reduction, although finding a location to park and relations with police can be challenging. The workflow is uneven due to the model that is built on unscheduled visits. CONCLUSION This study provides insight into how mobile clinics address the gaps in care for persons with OUD and fatal opioid overdoses. Harm reduction services are a critical intervention and financial sustainability of mobile clinics has to be tested.
Collapse
Affiliation(s)
- Margot Trotter Davis
- Heller School for Social Policy and Management, Brandeis University, United States of America.
| | - Cynthia Tschampl
- Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Dominic Hodgkin
- Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Craig Regis
- Kraft Center for Community Health at Massachusetts General Brigham Hospital, United States of America
| | - Elsie Taveras
- Kraft Center for Community Health at Massachusetts General Brigham Hospital, United States of America
| | - Ben Plant
- Massachusetts Department of Public Health, United States of America
| | - Brittni Reilly
- Massachusetts Department of Public Health, United States of America
| | - Constance Horgan
- Heller School for Social Policy and Management, Brandeis University, United States of America
| |
Collapse
|
2
|
Bourgault AM, Davis JW, LaManna J, Conner NE, Turnage D. Trends in publication impact of evidence-based healthcare terminology (2013-2022). J Adv Nurs 2024; 80:3600-3615. [PMID: 38504441 DOI: 10.1111/jan.16128] [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: 09/07/2023] [Revised: 01/07/2024] [Accepted: 02/15/2024] [Indexed: 03/21/2024]
Abstract
AIMS This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms. BACKGROUND A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence. DESIGN This discursive article explored and discussed publication impact of evidence-based healthcare terms. METHODS Evidence-based healthcare terms were identified, and their 10-year (2013-2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage. RESULTS A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms. CONCLUSION We suggest a follow-up review in 3-5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology. IMPLICATIONS FOR NURSING Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.
Collapse
Affiliation(s)
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Jacqueline LaManna
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Norma E Conner
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Dawn Turnage
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| |
Collapse
|
3
|
Coe JL, Morgan MH, Rehberg K, Kranzler EC, Ingersoll R, Namrow N, Huber-Krum S. Evaluating the implementation of family-centered substance use treatment for pregnant and postpartum people: A mixed-methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209409. [PMID: 38768816 PMCID: PMC11300141 DOI: 10.1016/j.josat.2024.209409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Family-centered substance use treatment (FCSUT) approaches for pregnant and postpartum people have the potential to prevent intergenerational transmission of adverse childhood experiences (ACEs). Guided by two theoretical frameworks drawn from implementation science (the Consolidated Framework for Implementation Research [CFIR] and the Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] framework), this study used a mixed methods approach to answer: (1) What is the extent to which FCSUT approaches are offered for pregnant and postpartum people seeking substance use disorder (SUD) treatment? and (2) How are FCSUT approaches for pregnant and postpartum people implemented? METHODS This study utilized a sequential mixed methods design that began with quantitative data collection followed by qualitative data collection. The quantitative component consisted of service provision surveys of facilities that provided FCSUT to pregnant and postpartum people (n = 118). The qualitative component consisted of semi-structured in-depth interviews with administrators and providers working at FCSUT facilities (n = 26) and pregnant and postpartum people who were currently receiving or had previously received services in the last two years from FCSUT facilities (n = 27). The qualitative findings were used to deepen understanding of the quantitative findings. RESULTS Findings from the quantitative survey of treatment facilities' FCSUT provision revealed that while most facilities offered services related to substance use treatment, behavioral health, and parenting skills development or parent training, a smaller proportion offered services related to prenatal and postpartum health, sexual and reproductive health, and family-related services. Qualitative in-depth interviews with program administrators and providers and pregnant and postpartum people who had participated in FCSUT programs revealed major themes around expanding reach of facilities by maintaining participants' familial connections, resources for implementation and maintenance of FCSUT, the importance of program adaptation, and gaps in service delivery. CONCLUSIONS Results indicated there is a wide range of FCSUT services offered at treatment facilities across the United States. Furthermore, while many pregnant and postpartum people expressed positive experiences with FCSUT, there are some areas that should be considered for future progress to be made.
Collapse
Affiliation(s)
- Jesse L Coe
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Harbert Morgan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | - Sarah Huber-Krum
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
4
|
Harden SM, Chang K, Chen S. Integrating a Dissemination and Implementation Science Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework as a Cornerstone of a Masters in Dietetics Training Program. J Acad Nutr Diet 2024; 124:1099-1108. [PMID: 38750789 DOI: 10.1016/j.jand.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia.
| | - Kristen Chang
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, California
| |
Collapse
|
5
|
Zimmermann K, Cui Ms L, Kaur R, Ford C, Carnahan LR, Jefferies P, Curtis Mpa P, Khare MM. Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:S152-S161. [PMID: 39041751 PMCID: PMC11268789 DOI: 10.1097/phh.0000000000001926] [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: 07/24/2024]
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of mortality for US women; lack of health insurance contributes to poor control of risk factors and increased mortality. Health coaching including motivational interviewing can support primary and secondary CVD prevention, but among uninsured women, improving health outcomes is dependent on successfully reaching priority populations. OBJECTIVE We evaluated the implementation and reach of health coaching with motivational interviewing among clients in the Illinois WISEWOMAN Program (IWP), a CVD screening and risk-reduction program for uninsured women aged 40 to 64. INTERVENTION Following CVD screening, motivational interviewing is offered to all IWP clients via four 30-min one-on-one health coaching sessions to offer personalized guidance on setting and achieving health behavior goals. SETTING Our analysis included clients from the eight community-based Illinois agencies that implemented IWP from 2019 to 2023. DESIGN AND MEASURES We assessed client demographic and baseline health characteristics among all IWP clients, those who participated in health coaching by attending at least one session, and those who completed health coaching by attending at least three of four sessions. We also assessed health coaching participation and completion by agency and examined agency-specific associations between client characteristics and health coaching participation and completion. RESULTS Among IWP enrollees (n = 3094), 89.7% participated in at least one health coaching session but only 31.4% completed health coaching by attending at least three sessions. Over 90% of IWP clients participated in at least one health coaching session at 4 IWP agencies. Further, over 85% of health coaching participants completed health coaching at four agencies. Across agencies, no client-level characteristics were consistently associated with health coaching participation or completion. CONCLUSIONS High motivational interviewing participation rates support its acceptability among uninsured women, but agency-level community-level barriers likely prevent client engagement in multiple sessions. Reducing CVD risk requires working with partner agencies to address barriers to reaching the priority population.
Collapse
Affiliation(s)
- Kristine Zimmermann
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Liyong Cui Ms
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Ravneet Kaur
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Chloe Ford
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Leslie R Carnahan
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Pam Jefferies
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Phallisha Curtis Mpa
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| | - Manorama M Khare
- Health Research and Evaluation Division of the Department of Family and Community Medicine, College of Medicine, University of Illinois Rockford, Rockford, (Drs Zimmerman and Kaur, Ms Ford, and Dr Khare); Epidemiology and Biostatistics Division in the School of Public Health, (Mr Cui); Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, (Drs Zimmermann and Carnahan); University of Illinois Cancer Center, Chicago, (Dr Carnahan); and Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
- Community Health Sciences Division in the School of Public Health, University of Illinois Chicago, Chicago, Illinois (Dr Carnahan)
- University of Illinois Cancer Center, Chicago, Illinois (Dr Carnahan)
- Illinois Department of Public Health Office of Women's Health and Family Service, Springfield, Illinois (Mss Jefferies and Curtis)
| |
Collapse
|
6
|
Nadkarni A, Gandhi Y, Fernandes L, Mirchandani K, Kamat S, Weiss HA, Singla DR, Velleman R, Lu C, Bhatia U, Biswal B, Sequeira M, D'souza E, Raikar K, Patel V. Effectiveness and cost-effectiveness of a community intervention in enhancing access to care and improving clinical outcomes for depression: a protocol for a cluster randomised controlled trial in India. Trials 2024; 25:569. [PMID: 39198915 DOI: 10.1186/s13063-024-08236-0] [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: 01/18/2024] [Accepted: 06/10/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Although depression is the leading cause of disability worldwide, treatment coverage for the condition is inadequate. Supply-side barriers (e.g. shortage of specialist mental health professionals) and demand-side barriers (e.g. lack of awareness about depression) lead to limited availability of evidence-based interventions, poor demand for care, and low levels of adherence to care. The aim of our study is to examine if the addition of a community intervention delivered by community volunteers enhances the population-level impact of an evidence based psychosocial intervention (Healthy Activity Program [HAP]) in routine primary care by increasing demand for HAP and improving HAP adherence and effectiveness. METHODS A hybrid type 2 effectiveness implementation cluster randomised controlled trial will be implemented in the state of Goa, India. Twenty-eight clusters of villages and their associated public sector health centres will be randomly allocated through restricted randomisation. Clusters will be randomly allocated to the 'Community Model' or 'Facility Model' arms. All clusters will offer the HAP and clusters in the 'Community Model' arm will additionally receive activities delivered by community volunteers ("Sangathis") to increase awareness about depression and support demand for and adherence to HAP. The primary outcomes are Contact Coverage (Patient Health Questionnaire [PHQ-9] score > 4 as a proportion of those screened) and Effectiveness Coverage (mean PHQ-9 score amongst those who score ≥ 15 at baseline, i.e. those who have moderately severe to severe depression) at 3 months post-recruitment. Additional outcomes at 3 and 6 months will assess sustained effectiveness, remission, response to treatment, depression awareness, social support, treatment completion, and activation levels. Economic and disability outcomes will be assessed to estimate incremental cost-effectiveness ratios. Implementation will be evaluated through process data and qualitative data informed by the RE-AIM framework. A minimum of 79488 primary care attenders will be screened for the Contact Coverage outcome, and 588 individuals with PHQ-9 ≥ 15 will be recruited for the Effectiveness Coverage outcome. DISCUSSION If effective, our community intervention will have relevance to India's Ayushman Bharat universal healthcare programme which is scaling up care for depression in primary care, and also to other low- and middle- income countries. TRIAL REGISTRATION Registered on ClincalTrials.gov ( NCT05890222 .) on 12/05/2023.
Collapse
Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- Addictions and Related Research Group, Sangath, Goa, India.
| | - Yashi Gandhi
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Addictions and Related Research Group, Sangath, Goa, India
| | | | | | - Shreyas Kamat
- Addictions and Related Research Group, Sangath, Goa, India
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daisy R Singla
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Goa, India
- Department of Psychology, University of Bath, Bath, UK
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Urvita Bhatia
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Addictions and Related Research Group, Sangath, Goa, India
| | | | | | - Ethel D'souza
- Addictions and Related Research Group, Sangath, Goa, India
| | - Kedar Raikar
- Non-Communicable Disease Cell, Directorate of Health Services, Panaji, Goa, India
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| |
Collapse
|
7
|
Abelson JM, Burgess H, Limtiaco F, Long E, Brown BR, Hannawalt-Morales D, Allen E, Watkins DC. State Department of Health's Equitable Funding Allocation Methodology to Address COVID-19 Health Disparities Among High-Risk and Underserved Populations. Am J Public Health 2024:e1-e6. [PMID: 39197133 DOI: 10.2105/ajph.2024.307833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
The Washington State Department of Health developed an equitable funding allocation methodology incorporating quantitative and qualitative decision-making components. We describe the methodology and an implementation evaluation performed by an external evaluation team using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework. The evaluation team concluded that the methodology was developed in a way that used a racial equity lens and prioritized intersectionalities in the communities that the funding was intended to serve. (Am J Public Health. Published online ahead of print August 28, 2024:e1-e6. https://doi.org/10.2105/AJPH.2024.307833).
Collapse
Affiliation(s)
- Jamie M Abelson
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Hannah Burgess
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Frances Limtiaco
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Elisabeth Long
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Brittany Ribeiro Brown
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Daniel Hannawalt-Morales
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Eric Allen
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| | - Daphne C Watkins
- Jamie M. Abelson, Hannah Burgess, Brittany Ribeiro Brown, and Daphne C. Watkins are with the Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan School of Social Work, Ann Arbor. Frances Limtiaco, Elisabeth Long, and Eric Allen are with the Washington State Department of Health, Tumwater. Daniel Hannawalt-Morales is with Community Health Organization Improving Care and Equity, Olympia, WA
| |
Collapse
|
8
|
Münchenberg PS, Schulz RS, Wainwright K, Mayer I, Holtkamp M, Meisel C, Kurth T. Effect evaluation of outpatient long-term video EEGs for people with seizure disorders - study protocol of the ALVEEG project: a randomized controlled trial in Germany. BMC Health Serv Res 2024; 24:994. [PMID: 39192270 DOI: 10.1186/s12913-024-11076-y] [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: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Epilepsy and other seizure disorders account for a high disease burden in Germany. As a timely diagnosis and accurate treatment are crucial, improving the management of these disorders is important. Outside of Germany, outpatient long-term video EEGs (ALVEEGs) have demonstrated the potential to support the diagnosis and management of epilepsy and other seizure disorders. This study aims to evaluate the implementation of ALVEEGs as a new diagnostic pathway in eastern parts of Germany to diagnose epilepsy and other seizure disorders and to assess if ALVEEGs are equally effective as the current inpatient-monitoring gold standard, which is currently only available at a limited number of specialized centers in Germany. METHODS ALVEEG is a prospective, multicenter, randomized controlled equivalence trial, involving five epilepsy centers in the eastern states of Germany. Patients will be randomized into either intervention (IG) or control group (CG), using a permuted block randomization. The sample size targeted is 688 patients, continuously recruited over the trial. The IG will complete an ALVEEG in a home setting, including getting access to a smartphone app to document seizure activity. The CG will receive care as usual, i.e., inpatient long-term video-EEG monitoring. The primary outcome is the proportion of clinical questions being solved in the IG compared to the CG. Secondary outcomes include hospital stays, time until video EEG, time until diagnosis and result discussion, patients' health status, quality of life and health competence, and number and form of epilepsy-related events and epileptiform activity. Alongside the trial, a process implementation and health economic evaluation will be conducted. DISCUSSION The extensive evaluation of this study, including an implementation and health economic evaluation, will provide valuable information for health policy decision-makers to optimize future delivery of neurological care to patients affected by epilepsy and other seizure disorders and on the uptake of ALVEEG into standard care in Germany. TRIAL REGISTRATION German Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.
Collapse
Affiliation(s)
| | | | - Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Mayer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Meisel
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
9
|
Miah MAA, Chandna J, Gurung R, Masoud NS, Paul P, Ameen S, Basnet O, Miraji M, Tann C, Mili IA, Hossain AKMT, Chowdhury AI, Alam A, Milner KM, Arifeen SE, Kc A, Manji K, Lynch P, Lawn JE, Hamadani JD. Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)- a parent group intervention for school readiness in Bangladesh, Nepal, and Tanzania: study protocol for a cluster randomized controlled trial. Trials 2024; 25:556. [PMID: 39180108 PMCID: PMC11342614 DOI: 10.1186/s13063-024-08381-6] [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: 04/29/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn-Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility. METHODS EN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent-child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is "school readiness", assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders' perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. DISCUSSION: This protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities. TRIAL REGISTRATION The trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627).
Collapse
Affiliation(s)
- Mohammad Abdul Awal Miah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Rejina Gurung
- Golden Community, Research Division, Lalitpur, Nepal
| | - Nahya Salim Masoud
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Proma Paul
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Omkar Basnet
- Golden Community, Research Division, Lalitpur, Nepal
| | - Mustafa Miraji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Temeke Regional Referral Hospital, Dar es Salaam, Tanzania
| | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Ismat Ara Mili
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - A K M Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Atique Iqbal Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Asraful Alam
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kate Mackinnon Milner
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashish Kc
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Lynch
- School of Education, University of Glasgow, Glasgow, Scotland
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Jena Derakhshani Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| |
Collapse
|
10
|
Parasuraman G, Jeemon P, Thankappan KR, Ali MK, Mahal A, McPake B, Chambers J, Absetz P, Thirunavukkarasu S, Nabil AM, Shiby Kripa SV, Akshay PK, Ayyasamy L, Nambirajan MK, Ramalingam A, Nagarajan R, Shrestha A, Gopal B, Selvam JM, Haregu T, Oldenburg B. Community Control of Hypertension and Diabetes (CoCo-HD) program in the Indian states of Kerala and Tamil Nadu: a study protocol for a type 3 hybrid trial. BMC Public Health 2024; 24:2275. [PMID: 39169312 PMCID: PMC11340170 DOI: 10.1186/s12889-024-19746-6] [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: 03/14/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION India grapples with a formidable health challenge, with an estimated 315 million adults afflicted with hypertension and 100 million living with diabetes mellitus. Alarming statistics reveal rates for poor treatment and control of hypertension and diabetes. In response to these pressing needs, the Community Control of Hypertension and Diabetes (CoCo-HD) program aims to implement structured lifestyle interventions at scale in the southern Indian states of Kerala and Tamil Nadu. AIMS This research is designed to evaluate the implementation outcomes of peer support programs and community mobilisation strategies in overcoming barriers and maximising enablers for effective diabetes and hypertension prevention and control. Furthermore, it will identify contextual factors that influence intervention scalability and it will also evaluate the program's value and return on investment through economic evaluation. METHODS The CoCo-HD program is underpinned by a longstanding collaborative effort, engaging stakeholders to co-design comprehensive solutions that will be scalable in the two states. This entails equipping community health workers with tailored training and fostering community engagement, with a primary focus on leveraging peer supportat scale in these communities. The evaluation will undertake a hybrid type III trial in, Kerala and Tamil Nadu states, guided by the Institute for Health Improvement framework. The evaluation framework is underpinned by the application of three frameworks, RE-AIM, Normalisation Process Theory, and the Consolidated Framework for Implementation Research. Evaluation metrics include clinical outcomes: diabetes and hypertension control rates, as well as behavioural, physical, and biochemical measurements and treatment adherence. DISCUSSION The anticipated outcomes of this study hold immense promise, offering important learnings into effective scaling up of lifestyle interventions for hypertension and diabetes control in low- and middle-income countries (LMICs). By identifying effective implementation strategies and contextual determinants, this research has the potential to lead to important changes in healthcare delivery systems. CONCLUSIONS The project will provide valuable evidence for the scaling-up of structured lifestyle interventions within the healthcare systems of Kerala and Tamil Nadu, thus facilitating their future adaptation to diverse settings in India and other LMICs.
Collapse
Affiliation(s)
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Abdul Majeed Nabil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | - Abha Shrestha
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Bipin Gopal
- State Health Department of Kerala, Trivandrum, India
| | | | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
- Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - Brian Oldenburg
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
11
|
Lebin LG, Nouri PK, Kwitowski MA, Dempsey AG, Lebin JA, Nagle-Yang S. Implementation and evaluation of a proactive consultation-liaison model on an inpatient obstetric unit. Gen Hosp Psychiatry 2024; 90:124-131. [PMID: 39178701 DOI: 10.1016/j.genhosppsych.2024.08.003] [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: 07/01/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. METHODS We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. CONCLUSIONS A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.
Collapse
Affiliation(s)
- Lindsay G Lebin
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA.
| | - Parvaneh K Nouri
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Melissa A Kwitowski
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Allison G Dempsey
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Jacob A Lebin
- University of Colorado School of Medicine, Department of Emergency Medicine, 12401 East 17(th) Avenue, 7(th) floor, Aurora, CO, USA
| | - Sarah Nagle-Yang
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| |
Collapse
|
12
|
Kracht CL, Neshteruk CD, Moding KJ, Rolke LJ, Wagner BE, Kielb E, Ferrante MJ, Robinson C, Keinsley J, Colella J, Speirs KE, Luecking CT. Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review. Obes Rev 2024:e13815. [PMID: 39159998 DOI: 10.1111/obr.13815] [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: 11/21/2023] [Revised: 04/19/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024]
Abstract
Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.
Collapse
Affiliation(s)
- Chelsea L Kracht
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Kameron J Moding
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
| | - Laura J Rolke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Brooke E Wagner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth Kielb
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
| | - Mackenzie J Ferrante
- Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Cayla Robinson
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Jason Keinsley
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Jordan Colella
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Katherine E Speirs
- Human Development and Family Science, John and Doris Norton School of Human Ecology, University of Arizona, Tucson, AZ, USA
| | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
13
|
Tierney-Hendricks C, Schliep ME, Sun M, Gochyyev P, Carter C. Using the RE-AIM and TDF frameworks to evaluate the implementation of a standardized cognitive assessment protocol in outpatient rehabilitation. PM R 2024. [PMID: 39158202 DOI: 10.1002/pmrj.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Impairments in cognition significantly affect patient functioning and rehabilitation outcomes. Assessment is essential to identifying at-risk individuals and guiding care plans. OBJECTIVE A cognitive assessment protocol was implemented in occupational therapy (OT) and speech-language pathology (SLP) outpatient practice. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Domains Framework (TDF), this study (1) measured the reach and adoption of the cognitive assessment protocol and (2) explored determinants and strategies that may affect adoption. DESIGN Sequential mixed methods. SETTING Two outpatient rehabilitation clinics (A and B) within a health care network. PARTICIPANTS Medical records from 220 adult patients with neurologic diagnosis and 15 OT and SLP clinicians. INTERVENTIONS Cognitive assessment protocol. MAIN OUTCOME MEASURE(S) Reach of the assessment protocol across patient characteristics and adoption across clinical sites were measured quantitatively via retrospective electronic medical records review. Qualitative data on effectiveness and the implementation process were collected via clinician focus groups. RESULTS Protocol adoption rates were 71% and 54% at clinics A and B, respectively. Site B OT was more likely to be noncompliant with protocol adoption compared to Site A, when controlling for patient characteristics, (81% vs. 16%, respectively; odds ratio = 11.4, 95% confidence interval [3.36-38.64], p ≤ .001). Patient age was a significant factor for protocol reach; older age was associated with noncompliance of the SLP protocol adoption, p < .05. Both sites employed implementation strategies targeting the provider level (eg, education/training); Site A additionally included organization-level strategies (eg, leadership engagement). In the absence of organization-level strategies, OT and SLP clinicians at Site B identified barriers related to leadership support, resources, and workflow. CONCLUSIONS Standardized practice protocols are feasible to implement within the rehabilitation setting, though multilevel implementation strategies may be needed to promote adoption. Aligning practices with the needs, values and priorities of the organization, providers, and patients and families is imperative.
Collapse
Affiliation(s)
| | - Megan E Schliep
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Minsi Sun
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Perman Gochyyev
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | | |
Collapse
|
14
|
Huebschmann AG, Wagner NM, Gleason M, Brinton JT, Brtnikova M, Brewer SE, Begum A, Armstrong R, DeCamp LR, McFarlane A, DeKeyser H, Coleman H, Federico MJ, Szefler SJ, Cicutto LC. Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK). Implement Sci 2024; 19:60. [PMID: 39148094 PMCID: PMC11325631 DOI: 10.1186/s13012-024-01387-3] [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: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS gov/ct2/show/NCT06003569 .
Collapse
Affiliation(s)
- Amy G Huebschmann
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA.
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA.
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA.
| | - Nicole M Wagner
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - John T Brinton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Michaela Brtnikova
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Sarah E Brewer
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anowara Begum
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Rachel Armstrong
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Lisa Ross DeCamp
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Arthur McFarlane
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Heather DeKeyser
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Holly Coleman
- Trailhead Institute, 1999 Broadway Suite 200, Denver, CO, 80202, USA
| | - Monica J Federico
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Lisa C Cicutto
- National Jewish Health and University of Colorado College of Nursing and Clinical Sciences, Aurora, CO, USA
| |
Collapse
|
15
|
Lafferty L, Altice FL, Leone F, Stoové M, Lloyd AR, Hajarizadeh B, Kronfli N. Using nominal group technique with people who are incarcerated in Canadian federal prisons to identify barriers and solutions to improving Prison Needle Exchange Program uptake. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 131:104549. [PMID: 39141957 DOI: 10.1016/j.drugpo.2024.104549] [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: 05/31/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate. METHODS Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving >10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully. RESULTS Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access. CONCLUSION Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised.
Collapse
Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederic Leone
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
16
|
Martens N, Haverkate TMI, Hindori-Mohangoo AD, Hindori MP, Aantjes CJ, Beeckman K, Damme AV, Reis R, Rijnders M, Kleij RRVD, Crone MR. Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers. BMC Pregnancy Childbirth 2024; 24:527. [PMID: 39134970 PMCID: PMC11318268 DOI: 10.1186/s12884-024-06720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/25/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. METHODS Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. RESULTS Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. INNOVATION HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. PROCESS Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. CONCLUSIONS While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.
Collapse
Affiliation(s)
- Nele Martens
- Leiden University Medical Centre, Leiden, The Netherlands.
| | - Tessa M I Haverkate
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Manodj P Hindori
- Foundation for Perinatal Interventions and Research in Suriname (Perisur), Paramaribo, Suriname
| | - Carolien J Aantjes
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Katrien Beeckman
- Vrije Universiteit Brussel (VUB), Universitair ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
- Universiteit Antwerpen, Antwerpen, Belgium
| | - Astrid Van Damme
- Department of Public Health, Vrije Universiteit Brussel (VUB), Brussel, Belgium
- Department of Nursing and Midwifery Research Group (NUMID), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Ria Reis
- Leiden University Medical Centre, Leiden, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Children's Institute, University of Cape Town, Amsterdam, The Netherlands
| | - Marlies Rijnders
- TNO (Nederlandse organisatie voor toegepast-natuurwetenschappelijk onderzoek), Leiden, The Netherlands
| | | | - Mathilde R Crone
- Leiden University Medical Centre, Leiden, The Netherlands
- University Maastricht, Maastricht, The Netherlands
| |
Collapse
|
17
|
Garner BR, Tueller SJ, Bradshaw M, Speck KJ, Satre D, Rash C, Donohoe T, Mungo J, Philbrick S, Ruwala R, Roosa MR, Zehner M, Ii JHF. Testing the incremental effectiveness of pay-for-performance to improve implementation of a motivational interviewing brief intervention for substance use disorders in HIV settings: Results of a parallel cluster-randomized type 3 hybrid trial. RESEARCH SQUARE 2024:rs.3.rs-4614222. [PMID: 39149465 PMCID: PMC11326404 DOI: 10.21203/rs.3.rs-4614222/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background: Substance use disorders (SUDs) have a serious adverse impact on the physical and mental well-being of people with HIV. Previously, using a 39-site dual-randomized type 2 hybrid trial design, findings from the Substance Abuse Treatment to HIV Care Project supported the Implementation and Sustainment Facilitation (ISF) strategy to improve implementation and effectiveness of a motivational interviewing brief intervention (MIBI) for SUD within HIV service settings across the United States (US). Building on this trial, this parallel cluster-randomized type 3 hybrid trial aimed to test the incremental effectiveness of a pay-for-performance (P4P), a form of the "alter incentive/allowance structures" strategy. Methods: Twenty-six HIV service organizations, their staff participants (N=87), and their client participants (N=341) were cluster-randomized to one of two implementation conditions. The control condition included staff-focused training, feedback, and consultation (TFC) and team-focused implementation and sustainment (ISF). The experimental condition included TFC+ISF as well as P4P (TFC+ISF+P4P). P4P used financial incentives to reward MIBI implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined. Results: The addition of P4P had a large and significant effect on the number of MIBIs implemented ( d =1.30, p<.05) and reduction in anxiety ( d= -1.54), but there was no impact on days of substance use. P4P had large effects on MIBI quality ( d =1.24) and MIBI implementation effectiveness ( d =1.28), but these were not significant ( p <.10). Conclusions: P4P is a form of the "alter incentive/allowance structures" strategy. Its function is to reward the implementation of a clinical innovation. Rewarding implementation is consistent with the theory of implementation effectiveness, which suggests implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key antecedent of implementation effectiveness (i.e., the consistency and quality of implementation). We found that P4P had a significant, positive impact on MIBI implementation in HIV service settings, but client-level outcomes were mixed. Future research should examine the effectiveness of the P4P strategy to improve implementation and sustainment of other evidence-based innovations. Trial registration: ClinicalTrials.gov: NCT04687917. Registered 12/18/2020.
Collapse
|
18
|
Sajatovic M, Beem Jelley P, Schrag K, Varanese P, Needham K, Black J, Adeniyi C, Barigye R, Yala J, Ghearing GR, Glasgow RE, Briggs F. A case study in science-to-service application of epilepsy self-management. Epilepsy Behav 2024; 159:109945. [PMID: 39121751 DOI: 10.1016/j.yebeh.2024.109945] [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: 05/10/2024] [Revised: 06/12/2024] [Accepted: 07/07/2024] [Indexed: 08/12/2024]
Abstract
AIMS Epilepsy self-management (ESM), the overall approach of reducing seizures and optimizing whole-health, is a targeted approach to improve population health for people with epilepsy (PWE). "Self-management for people with epilepsy and a history of negative health events" (SMART) is an 8-session group-format, remotely delivered ESM. This report describes the evolution of SMART development, testing and scale-up, taking advantage of ESM team expertise, community relationships and infrastructure established by social service agencies that deliver support to PWE. METHODS This is a case-study dissemination and implementation (D&I) science-to-service model using the RE-AIM framework approach (Reach, Effectiveness, Adoption, Implementation, and Maintenance) focused on 5 dimensions of individual- and setting-level outcomes important to program adoption, impact and sustainability. Performance evaluations include participation representativeness, ESM attendance and acceptability as well as change in relevant health outcomes. RESULTS SMART D & I is implemented via a collaboration of 3 unique regional, epilepsy-focused nonprofit social service organizations and a university team that developed SMART. The ongoing collaboration is expanding SMART delivery to PWE across 13 U.S. states. Thus far, we have trained 17 Nurse and Peer Educators (NEs and PEs). PEs (N = 10) have a mean age 51.1 (SD 10.4) years and a mean age of epilepsy diagnosis of 29.4 (SD 19.3). Of 128 participants offered SMART, and who provided age data (N = 86) mean age was 37.7 years (SD 14.4). Of participants who provided data on gender and race (N = 89), 65 were women (73.9 %), 18 African-American (20.2 %). Mean age of epilepsy diagnosis was 19.4 years (SD 16.6) and 59 (52.2 %) of PWE reported having seizures in the last 30 days pre-SMART sessions. Among those with attendance data (N = 103), mean number of SMART groups attended was 5.7 (SD 2.3). Mean values for past 30-day seizure frequency, 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Inventory (GAD-7) and 10-item Quality of Life in Epilepsy Scale (QOLIE-10) for PWE that provided both pre and post SMART data were 7.6 (SD 15.8) vs 2.8 (SD 3.4) p = 0.3, 7.63 (SD 6.6) vs 6.3 (SD 5.7) p = 0.95, 6.6 (SD 5.7) vs 6.67(SD 5.3) p = 0.47 and 2.8 (SD 0.8) vs 2.7 (SD 1.0) p = 0.07 respectively. CONCLUSIONS Implementing ESM using a RE-AIM/Iterative RE-AIM framework links intervention developers and community partners. While PWE have substantial barriers to health, including frequent seizures, they are able engage in the SMART program. Although a major limitation to patient-level evaluation is challenges in collecting post-SMART follow-up data, preliminary findings suggest a trend for improved quality of life.
Collapse
Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Peggy Beem Jelley
- Epilepsy Association of Western and Central Pennsylvania, Pittsburgh, PA, USA
| | | | | | | | - Jessica Black
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Clara Adeniyi
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Richard Barigye
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joy Yala
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Farren Briggs
- Department of Public Health Sciences, Division of Epidemiology, Miller School of Medicine, University of Miami, Miami, FLA, USA
| |
Collapse
|
19
|
Ebert N, Schaeffner E, Seegmiller JC, van Londen M, Bökenkamp A, Cavalier E, Delanaye P, Derain-Dubourg L, Eriksen BO, Indridason OS, Palsson R, Shafi T, Christensson A, Bevc S, Carrara F, Courbebaisse M, Dalton RN, van der Giet M, Melsom T, Methven S, Nordin G, Pottel H, Rule AD, Trillini M, White CA. Iohexol plasma clearance measurement protocol standardization for adults: a consensus paper of the European Kidney Function Consortium. Kidney Int 2024:S0085-2538(24)00537-4. [PMID: 39097002 DOI: 10.1016/j.kint.2024.06.029] [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: 02/20/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 08/05/2024]
Abstract
International consensus supports the development of standardized protocols for measured glomerular filtration rate (mGFR) to facilitate the integration of mGFR testing in both clinical and research settings. To this end, the European Kidney Function Consortium convened an international group of experts with relevant experience in mGFR. The working group performed an extensive literature search to inform the development of recommendations for mGFR determination using 1-compartment plasma clearance models and iohexol as the exogenous filtration marker. Iohexol was selected as it is non-radio labeled, inexpensive, and safe, can be assayed at a central laboratory, and the other commonly used non-radio-labeled tracers have been (inulin) or are soon to be (iothalamate) discontinued. A plasma clearance model was selected over urine clearance as it requires no urine collection. A 1 compartment was preferred to 2 compartments as it requires fewer samples. The recommendations are based on published evidence complemented by expert opinion. The consensus paper covers practical advice for patients and health professionals, preparation, administration, and safety aspects of iohexol, laboratory analysis, blood sample collection and sampling times using both multiple and single-sample protocols, description of the mGFR mathematical calculations, as well as implementation strategies. Supplementary materials include patient and provider information sheets, standard operating procedures, a study protocol template, and support for mGFR calculation.
Collapse
Affiliation(s)
- Natalie Ebert
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Elke Schaeffner
- Charité Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany
| | - Jesse C Seegmiller
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, Centre Hospitalier Universitaire du Sart-Tilman, Liège, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, Centre Hospitalier Universitaire du Sart-Tilman, Liège (ULiege), Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Laurence Derain-Dubourg
- Service de Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France
| | - Bjørn O Eriksen
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali University Hospital, Reykavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Tariq Shafi
- Division of Kidney Diseases, Hypertension and Transplantation, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sebastjan Bevc
- Department of Nephrology, Department of Pharmacology, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Fabiola Carrara
- Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Marie Courbebaisse
- Université Paris Cité; Physiology Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Neil Dalton
- The WellChild Laboratory, Evelina London Children's Hospital, London, UK
| | - Markus van der Giet
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway and Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Shona Methven
- Department of Renal Medicine, Aberdeen Royal Infirmary, Scotland, UK
| | | | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Matias Trillini
- Clinical Research Center for Rare Diseases, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Christine A White
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
20
|
Sibley KM, Tittlemier B, Olarinde F, Leadbetter BK, Bouchard DR. Factors influencing older adult community fall prevention exercise implementation: a scoping review. Age Ageing 2024; 53:afae186. [PMID: 39171387 PMCID: PMC11339543 DOI: 10.1093/ageing/afae186] [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: 11/27/2023] [Revised: 05/27/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. OBJECTIVE To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. DESIGN Scoping review. METHODS We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). RESULTS We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. CONCLUSION The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.
Collapse
|
21
|
Winter S, Crocker S, Rolls T, Curtin D, Haratsis J, Szollosi I. Direct to psychology for sleep disorders: Innovating models of care in the hospital and health service. J Health Psychol 2024:13591053241267272. [PMID: 39104087 DOI: 10.1177/13591053241267272] [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: 08/07/2024] Open
Abstract
A 'Direct to Psychology Insomnia' pathway was developed for implementation within a multidisciplinary sleep disorders service in a tertiary hospital in Brisbane, Australia. The project was informed by implementation science principles and methodology to re-design the model of care (MoC). A consensus group workshop using the Nominal Group Technique (NGT) with 12 multidisciplinary staff was undertaken to develop the new MoC. The workshop explored inclusion and exclusion criteria for a Direct to Psychology pathway including patient flow and enablers. The team endorsed a MoC that was acceptable to stakeholders and addressed service-level imperatives. The findings highlighted that patient inclusion or exclusion should be overseen by the Sleep Physician team and an Advanced Psychologist with behavioural sleep medicine expertise. Continuum of care for patients referred via primary care providers was considered. Barriers and risks to the MoC changes were identified which informed the refinement of the MoC.
Collapse
Affiliation(s)
- Sara Winter
- The Prince Charles Hospital, Australia
- University of Queensland, Australia
| | | | | | | | - Jessica Haratsis
- The Prince Charles Hospital, Australia
- Metro South Addiction and Mental Health Services, Australia
| | - Irene Szollosi
- The Prince Charles Hospital, Australia
- University of Queensland, Australia
| |
Collapse
|
22
|
von Gerich H, Peltonen LM. Information Management in Hospital Unit Daily Operations: A Descriptive Study With Nurses and Physicians. Comput Inform Nurs 2024; 42:557-566. [PMID: 38787735 DOI: 10.1097/cin.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Operations management of a hospital unit is a shared activity involving nursing and medical professionals, characterized by suddenly changing situations, constant interruptions, and ad hoc decision-making. Previous studies have explored the informational needs affecting decision-making, but only limited information has been collected regarding factors affecting information management related to the daily operations of hospital units. The aim of this study was to describe the experiences of nursing and medical professionals of information management in the daily operations of hospital units. This qualitative study consists of interviews following the critical incidence technique. Twenty-six nurses and eight physicians working in operational leadership roles in hospital units were interviewed, and the data were subjected to thematic analysis. The data analysis showed that strengths of current systems were organizational operational procedures, general instruments supporting information management, and a digital operations dashboard, whereas opportunities for improvement included the information architecture, quality of information, and technology use. The study findings highlight that despite several decades of efforts to provide solutions to support information management in hospital daily operations, further measures need to be taken in developing and implementing information systems with user-centered strategies and systematic approaches to better support healthcare professionals.
Collapse
Affiliation(s)
- Hanna von Gerich
- Author Affiliations: Department of Nursing Science (Ms von Gerich and Dr Peltonen), University of Turku, and Turku University Hospital (Dr Peltonen), Finland
| | | |
Collapse
|
23
|
Dohrn A, Hoskins R, Collier L, Kennelty K. Evaluation of a Telehealth-Based Pharmacist Led Chronic Care Management Program. J Pharm Pract 2024; 37:933-939. [PMID: 37595956 DOI: 10.1177/08971900231196624] [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] [Indexed: 08/20/2023]
Abstract
Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed >4 CCM visits with a diagnosis of diabetes and/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP >130 mmHg. Average SBP at baseline was 141.0 mmHg and average SBP at 6 months was 130.2 mmHg, (P < .001). 76 patients had uncontrolled diabetes, A1c > 7%. Average A1c at baseline = 9.1% and average A1c at 6 months = 8.3%, (P < .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort "selling the program," potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.
Collapse
Affiliation(s)
- Ashley Dohrn
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Rachel Hoskins
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Lauren Collier
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| |
Collapse
|
24
|
Knudsen HK, Walker DM, Mack N, Kinnard EN, Huerta TR, Glasgow L, Gilbert L, Garner BR, Dasgupta A, Chandler R, Walsh SL, Tin Y, Tan S, Sprunger J, Sprague-Martinez L, Salsberry P, Saucier M, Rudorf M, Rodriguez S, Oser CB, Oga E, Nakayima J, Linas BS, Lefebvre RC, Kosakowski S, Katz RE, Hunt T, Holman A, Holloway J, Goddard-Eckrich D, Fareed N, Christopher M, Aldrich A, Adams JW, Drainoni ML. Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term®) communities study. Prev Med 2024; 185:108034. [PMID: 38857770 PMCID: PMC11269010 DOI: 10.1016/j.ypmed.2024.108034] [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: 02/14/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Scaling up overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD) is needed to reduce opioid overdose deaths, but barriers are pervasive. This study examines whether the Communities That HEAL (CTH) intervention reduced perceived barriers to expanding OEND and MOUD in healthcare/behavioral health, criminal-legal, and other/non-traditional venues. METHODS The HEALing (Helping End Addiction Long-Term®) Communities Study is a parallel, wait-list, cluster randomized trial testing the CTH intervention in 67 communities in the United States. Surveys administered to coalition members and key stakeholders measured the magnitude of perceived barriers to scaling up OEND and MOUD in November 2019-January 2020, May-June 2021, and May-June 2022. Multilevel linear mixed models compared Wave 1 (intervention) and Wave 2 (wait-list control) respondents. Interactions by rural/urban status and research site were tested. RESULTS Wave 1 respondents reported significantly greater reductions in mean scores for three outcomes: perceived barriers to scaling up OEND in Healthcare/Behavioral Health Venues (-0.26, 95% confidence interval, CI: -0.48, -0.05, p = 0.015), OEND in Other/Non-traditional Venues (-0.53, 95% CI: - 0.84, -0.22, p = 0.001) and MOUD in Other/Non-traditional Venues (-0.34, 95% CI: -0.62, -0.05, p = 0.020). There were significant interactions by research site for perceived barriers to scaling up OEND and MOUD in Criminal-Legal Venues. There were no significant interactions by rural/urban status. DISCUSSION The CTH Intervention reduced perceived barriers to scaling up OEND and MOUD in certain venues, with no difference in effectiveness between rural and urban communities. More research is needed to understand facilitators and barriers in different venues.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Department of Family and Community Medicine, Ohio State University, Suite 5000, 700 Ackerman Rd, Columbus, OH 43202, USA.
| | - Daniel M Walker
- Department of Family and Community Medicine, Ohio State University, Suite 5000, 700 Ackerman Rd, Columbus, OH 43202, USA.
| | - Nicole Mack
- Center for Official Statistics, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Elizabeth N Kinnard
- Section of Infectious Diseases, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, Department of Family and Community Medicine, Department of Biomedical Informatics, The Ohio State University, 540 W. Spring St., Columbus, OH 43215, USA.
| | - LaShawn Glasgow
- Center for Program and Policy Evaluation to Advance Community Health, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Louisa Gilbert
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - Bryan R Garner
- Department of Internal Medicine, The Ohio State University, 2050 Kenny Road Columbus, OH 43221, USA.
| | - Anindita Dasgupta
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - Redonna Chandler
- National Institute on Drug Abuse, 301 North Stonestreet Ave, Bethesda, MD 20892, USA.
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA.
| | - Yjuliana Tin
- General Internal Medicine, University of Colorado School of Medicine, 12631 E 17th Ave Aurora, CO 80045, USA.
| | - Sylvia Tan
- Center for Clinical Research, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Joel Sprunger
- Center for Addiction Research, University of Cincinnati College of Medicine, 3131 Harvey Ave, Suite 204, Cincinnati, OH 45229, USA.
| | | | - Pamela Salsberry
- College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA.
| | - Merielle Saucier
- Clinical Addiction Research and Evaluation Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Maria Rudorf
- General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Sandra Rodriguez
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, USA.
| | - Emmanuel Oga
- Center for Public Health Surveillance and Technology, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Julie Nakayima
- Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Beth S Linas
- Center for Public Health Surveillance and Technology, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - R Craig Lefebvre
- Communication Practice Area, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Sarah Kosakowski
- General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Rachel E Katz
- Addiction Services, Clinical & Support Options, 8 Atwood Dr Suite 201, Northampton, MA 01060, USA.
| | - Timothy Hunt
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - Ari Holman
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - JaNae Holloway
- Center for Clinical Research, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Dawn Goddard-Eckrich
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY 10027, USA.
| | - Naleef Fareed
- Biomedical Informatics, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA.
| | - Mia Christopher
- Center for Public Health Surveillance and Technology, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, The Ohio State University, Suite 5000, 700 Ackerman Rd, Columbus, OH 43202, USA.
| | - Joella W Adams
- Center for Public Health Surveillance and Technology, RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center, and Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA.
| |
Collapse
|
25
|
Bullo M, Kierszenowicz T, Acosta MC, Rolon MJ, Cecchini D, Rodriguez C, Scapellato P, Bottaro E, Losso MH. Telemedicine in HIV health care during the COVID-19 pandemic: An implementation research study in Buenos Aires, Argentina. HIV Med 2024; 25:927-934. [PMID: 38657752 DOI: 10.1111/hiv.13646] [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: 11/13/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. METHODS AND SETTING We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. RESULTS We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/μL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments. CONCLUSION It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future.
Collapse
Affiliation(s)
- Manuela Bullo
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
| | | | | | | | - Diego Cecchini
- Hospital General de Agudos C Argerich, Buenos Aires, Argentina
| | | | - Pablo Scapellato
- Hospital General de Agudos D Santojanni, Buenos Aires, Argentina
| | - Edgardo Bottaro
- Hospital General de Agudos D Santojanni, Buenos Aires, Argentina
| | - Marcelo H Losso
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
| |
Collapse
|
26
|
Seguin-Fowler RA, Graham ML, Demment M, Uribe ALM, Rethorst CD, Szeszulski J. Multilevel Interventions Targeting Obesity: State of the Science and Future Directions. Annu Rev Nutr 2024; 44:357-381. [PMID: 38885446 DOI: 10.1146/annurev-nutr-122123-020340] [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] [Indexed: 06/20/2024]
Abstract
A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity.
Collapse
Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Meredith L Graham
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Margaret Demment
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | | | - Chad D Rethorst
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| | - Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture (IHA), College Station, Texas, USA;
| |
Collapse
|
27
|
Curtis K, Kennedy B, Considine J, Murphy M, Lam MK, Aggar C, Fry M, Shaban RZ, Kourouche S. Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation. Implement Sci 2024; 19:54. [PMID: 39075496 PMCID: PMC11285323 DOI: 10.1186/s13012-024-01383-7] [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: 02/28/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. AIM To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). METHODS An effectiveness-implementation hybrid design including a step-wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the 'how' and 'why' of quantitative results. RESULTS HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. CONCLUSION The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. TRIAL REGISTRATION ANZCTR, ACTRN12621001456842 . Registered 25 October 2021.
Collapse
Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia.
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Belinda Kennedy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Julie Considine
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Margaret Murphy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
- Western Sydney Local Health District, North Parramatta, NSW, 2141, Australia
| | - Mary K Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Christina Aggar
- Northern NSW Local Health District, Southern Cross University, Lismore, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
- Sydney Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
- Research and Education Network, Western Sydney Local Health District, Westmead, NSW, 2145, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, NSW, 2145, Australia
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, RC Mills Building, University of Sydney, Camperdown, NSW, 2006, Australia
| |
Collapse
|
28
|
Rubsam M, Hohl K, Smaller K, Lopez G, Rafferty M. Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series. Pediatr Phys Ther 2024:00001577-990000000-00103. [PMID: 39074207 DOI: 10.1097/pep.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders. SUMMARY OF KEY POINTS The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.
Collapse
Affiliation(s)
- Meaghan Rubsam
- Shirley Ryan AbilityLab (Dr Rubsam, Dr Hohl, Mr Smaller, Dr Lopez, and Dr Rafferty), Chicago, Illinois; Ph.D. Program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences (Dr Rubsam), University of Illinois, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Department of Psychiatry and Behavioral Science (Dr Rafferty), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | |
Collapse
|
29
|
Bekelman DB, Giannitrapani K, Linn KA, Langner P, Sudore RL, Rabin B, Lorenz KA, Foglia M, Glickman A, Pawlikowski S, Sloan M, Gamboa RC, McCaa MD, Hines A, Walling AM. Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic, sequential multiple assignment randomized trial. Contemp Clin Trials 2024; 145:107643. [PMID: 39074531 DOI: 10.1016/j.cct.2024.107643] [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: 03/14/2024] [Revised: 07/11/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Goals of care conversations explore seriously ill patients' values to guide medical decision making and often inform decisions about life sustaining treatments. Ideally, conversations occur before a health crisis between patients and clinicians in the outpatient setting. In the United States Veterans Affairs (VA) healthcare system, most conversations still occur in the inpatient setting. Strategies are needed to improve implementation of outpatient, primary care goals of care conversations. METHODS We plan a cluster randomized (clinician-level) sequential, multiple assignment randomized trial to evaluate the effectiveness of patient implementation strategies on the outcome of goals of care conversation documentation when delivered in combination with clinician implementation strategies. Across three VA healthcare system sites, we will enroll primary care clinicians with low rates of goals of care conversations and their patients with serious medical illness in the top 10th percentile of risk of hospitalization or death. We will compare the effectiveness of sequences of implementation strategies and explore how patient and site factors modify implementation strategy effects. Finally, we will conduct a mixed-methods evaluation to understand implementation strategy success or failure. The design includes two key innovations: (1) strategies that target both clinicians and patients and (2) sequential strategies with increased intensity for non-responders. CONCLUSION This study aims to determine the effect of different sequences and combinations of implementation strategies on primary care documentation of goals of care conversations. Study partners, including the VA National Center for Ethics in Health Care and Office of Primary Care, can consider policies based on study findings.
Collapse
Affiliation(s)
- David B Bekelman
- VA Eastern Colorado Health Care System, Aurora, CO, USA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Karleen Giannitrapani
- Center for Innovation to Implementation VA Palo Alto Healthcare System, USA; Stanford University School of Medicine, Primary Care and Population Health, Palo Alto, CA, USA
| | - Kristin A Linn
- Division of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paula Langner
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Rebecca L Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Borsika Rabin
- VA Eastern Colorado Health Care System, Aurora, CO, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA; UC San Diego ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation VA Palo Alto Healthcare System, USA; Stanford University School of Medicine, Primary Care and Population Health, Palo Alto, CA, USA
| | - Marybeth Foglia
- VA National Center for Ethics in Health Care, USA; Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Amanda Glickman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Scott Pawlikowski
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Marilyn Sloan
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Raziel C Gamboa
- Center for Innovation to Implementation VA Palo Alto Healthcare System, USA
| | - Matthew D McCaa
- Center for Innovation to Implementation VA Palo Alto Healthcare System, USA
| | - Anne Hines
- VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Anne M Walling
- University of California, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
30
|
Holtrop JS, Gurfinkel D, Nederveld A, Reedy J, Rubinson C, Kwan BM. What works in implementing shared medical appointments for patients with diabetes in primary care to enhance reach: a qualitative comparative analysis from the Invested in Diabetes study. Implement Sci Commun 2024; 5:82. [PMID: 39049078 PMCID: PMC11267890 DOI: 10.1186/s43058-024-00608-6] [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: 11/06/2023] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Diabetes is a serious public health problem affecting 37.3 million Americans. Diabetes shared medical appointments (SMAs) are an effective strategy for providing diabetes self-management support and education in primary care. However, practices delivering SMAs experience implementation challenges. This analysis examined conditions associated with successful practice implementation of diabetes SMAs in the context of participation in a pragmatic trial. METHODS Mixed methods study using qualitative and quantitative data collected from interviews, observations, surveys, and practice-reported data, guided by the practical, robust implementation and sustainability model (PRISM). Data were analyzed using qualitative comparative analysis (QCA). Successful implementation was defined as meeting patient recruitment targets (Reach) during the study period. Participants were clinicians and staff members from 22 primary care practices in Colorado and Missouri, USA. RESULTS The first necessary condition identified from the QCA was the presence of additional resources for patients with diabetes in the practice. Within practices that had these additional resources, we found that a sufficiency condition was the presence of an effective key person to make things happen with the SMAs. A second QCA was conducted to determine conditions underlying the presence of the effective key person (often performing functions of an implementation champion), which revealed factors including low or managed employee turnover, a strong baseline practice culture, and previous experience delivering SMAs. CONCLUSIONS Identification of key factors necessary and sufficient for implementation of new care processes is important to enhance patient access to evidence-based interventions. This study suggests that practice features and resources have important implications for implementation of diabetes SMAs. There may be opportunities to support practices with SMA implementation by enabling the presence of skilled implementation champions. TRIAL REGISTRATION Registered at clinicaltrials.gov under trial ID NCT03590041, registered on July 18, 2018.
Collapse
Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA.
| | - Dennis Gurfinkel
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Julia Reedy
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Claude Rubinson
- Department of Social Sciences, University of Houston-Downtown, 1 Main Street, Houston, TX, 77009, USA
| | - Bethany Matthews Kwan
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| |
Collapse
|
31
|
Gabbard JL, Brenes GA, Callahan KE, Dharod A, Bundy R, Foley KL, Moses A, Williamson JD, Pajewski NM. Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment. J Am Geriatr Soc 2024. [PMID: 39041185 DOI: 10.1111/jgs.19100] [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: 04/21/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI. DESIGN Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina. PARTICIPANTS Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available). INTERVENTION SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR. MAIN OUTCOMES Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes. RESULTS Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits. CONCLUSION These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.
Collapse
Affiliation(s)
- Jennifer L Gabbard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gretchen A Brenes
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn E Callahan
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristie L Foley
- Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas M Pajewski
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
32
|
Demedis J, Reedy J, Miller K, Hu J, Klosky JL, Dorsey Holliman B, Peterson PN, Chow EJ, Studts C. Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol. PLoS One 2024; 19:e0305677. [PMID: 39038011 PMCID: PMC11262696 DOI: 10.1371/journal.pone.0305677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Approximately 20-50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. METHODS This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design (NCT05524610). The trial will enroll 86 AYA-CCS (ages 15-39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. IMPLICATIONS Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention.
Collapse
Affiliation(s)
- Jenna Demedis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
- Center for Cancer and Blood Disorders at Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Julia Reedy
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kristen Miller
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Junxiao Hu
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - James L. Klosky
- Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Brooke Dorsey Holliman
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Pamela N. Peterson
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Denver Health Medical Center, Denver, Colorado, United States of America
| | - Eric J. Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Washington, DC, United States of America
| | - Christina Studts
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
| |
Collapse
|
33
|
Winkler K, McKinney J, Reale C, Anders S, Rubenstein M, Cavagnini L, Crowe R, Ward MJ. A Qualitative Analysis of Barriers to Evidence-Based Care in the Prehospital Management of Patients with Suspected Acute Coronary Syndrome. PREHOSP EMERG CARE 2024:1-9. [PMID: 38981118 DOI: 10.1080/10903127.2024.2372817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Prehospital electrocardiogram (ECG) and administration of aspirin are evidence-based strategies for patients with acute coronary syndrome (ACS). However, emergency medical services (EMS) compliance in patients with suspected ACS varies widely. We sought to understand the barriers to prehospital ECG acquisition and aspirin administration for patients with suspected ACS. METHODS In this qualitative study, we interviewed EMS clinicians at three geographically diverse United States (U.S.)-based EMS agencies. We interviewed practicing clinicians and quality and operations leaders at these agencies. Based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, interviews were recorded, transcribed, and analyzed using a grounded qualitative approach with open coding. The Systems Engineering Initiative for Patient Safety (SEIPS) framework and a constant comparison technique were used to identify and refine themes. RESULTS Twenty-five paramedics and 20 additional agency personnel participated. Median age was 41 (IQR: 34-51) years and 13 (29%) were female. Themes were organized using SEIPS and longitudinally through four phases of an EMS call. During the pre-arrival phase, staffing challenges, training quality, and dispatch may anchor EMS clinicians on a diagnosis. During the diagnosis and treatment phase, safety and communication barriers may take priority over care delivery. Additionally, EMS clinicians must allocate assets (e.g. whether to send an advanced life support unit) and financial resources; veteran EMS clinicians identified their experience whereas newer clinicians cited their recent education when making these decisions. Also, diagnostic uncertainty due to increasing patient complexity and atypical presentations contributed to diagnostic errors. During the response and transport phase, the scope of practice limits the use and interpretation of the ECG, with clinicians reporting that liberal use of ECG led to more rapid decision-making. Finally, in the after phase, personnel reported the "psychologically taxing" nature of the job contributing to biases, bad habits, and burnout. Performance feedback was desired for personal development, though currently perceived as infrequent and punitive. CONCLUSIONS Multiple, interrelated themes underscored the complexities of delivering evidence-based care to prehospital patients with ACS. Education in ECG interpretation, resource allocation, bias, and enhancing feedback may serve as strategies to address the identified barriers.
Collapse
Affiliation(s)
- Kailey Winkler
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared McKinney
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa Rubenstein
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren Cavagnini
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee
| |
Collapse
|
34
|
Claessens D, Vervloet M, Boudewijns EA, Keijsers LCEM, Gidding-Slok AHM, van Schayck OCP, Winkens B, van Dijk L. Process evaluation of the implementation of the assessment of burden of chronic conditions tool in Dutch primary care - lessons from a qualitative implementation study. BMC Health Serv Res 2024; 24:827. [PMID: 39033106 PMCID: PMC11264986 DOI: 10.1186/s12913-024-11270-y] [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: 04/03/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The Assessment of Burden of Chronic Conditions (ABCC-)tool is developed to facilitate a personalized approach to care in the patient-healthcare provider (HCP) conversation based on shared decision-making and individualized care plans. An effectiveness study highlighted its effect on the perceived quality of care and patient activation. Successful implementation of novel interventions necessitates an understanding of the user's actual application, user experiences and an evaluation of implementation outcomes. This study aims to evaluate the implementation of the ABCC-tool by HCPs in Dutch primary care. METHODS This study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll's framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework. RESULTS Seventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2-6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support. CONCLUSIONS HCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.
Collapse
Affiliation(s)
- Danny Claessens
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands.
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
| | - Lotte C E M Keijsers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Department of Pharmacotherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
35
|
Jimenez EE, Rosland AM, Stockdale SE, Reddy A, Wong MS, Torrence N, Huynh A, Chang ET. Implementing evidence-based practices to improve primary care for high-risk patients: study protocol for the VA high-RIsk VETerans (RIVET) type III effectiveness-implementation trial. Implement Sci Commun 2024; 5:75. [PMID: 39010160 PMCID: PMC11251253 DOI: 10.1186/s43058-024-00613-9] [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: 05/30/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Patients with significant multimorbidity and other factors that make healthcare challenging to access and coordinate are at high risk for poor health outcomes. Although most (93%) of Veterans' Health Administration (VHA) patients at high risk for hospitalization or death ("high-risk Veterans") are primarily managed by primary care teams, few of these teams have implemented evidence-based practices (EBPs) known to improve outcomes for the high-risk patient population's complex healthcare issues. Effective implementation strategies could increase adoption of these EBPs in primary care; however, the most effective implementation strategies to increase evidence-based care for high-risk patients are unknown. The high-RIsk VETerans (RIVET) Quality Enhancement Research Initiative (QUERI) will compare two variants of Evidence-Based Quality Improvement (EBQI) strategies to implement two distinct EBPs for high-risk Veterans: individual coaching (EBQI-IC; tailored training with individual implementation sites to meet site-specific needs) versus learning collaborative (EBQI-LC; implementation sites trained in groups to encourage collaboration among sites). One EBP, Comprehensive Assessment and Care Planning (CACP), guides teams in addressing patients' cognitive, functional, and social needs through a comprehensive care plan. The other EBP, Medication Adherence Assessment (MAA), addresses common challenges to medication adherence using a patient-centered approach. METHODS We will recruit and randomize 16 sites to either EBQI-IC or EBQI-LC to implement one of the EBPs, chosen by the site. Each site will have a site champion (front-line staff) who will participate in 18 months of EBQI facilitation. ANALYSIS We will use a mixed-methods type 3 hybrid Effectiveness-Implementation trial to test EBQI-IC versus EBQI-LC versus usual care using a Concurrent Stepped Wedge design. We will use the Practical, Robust Implementation and Sustainability Model (PRISM) framework to compare and evaluate Reach, Effectiveness, Adoption, Implementation, and costs. We will then assess the maintenance/sustainment and spread of both EBPs in primary care after the 18-month implementation period. Our primary outcome will be Reach, measured by the percentage of eligible high-risk patients who received the EBP. DISCUSSION Our study will identify which implementation strategy is most effective overall, and under various contexts, accounting for unique barriers, facilitators, EBP characteristics, and adaptations. Ultimately this study will identify ways for primary care clinics and teams to choose implementation strategies that can improve care and outcomes for patients with complex healthcare needs. TRIAL REGISTRATION ClinicalTrials.gov, NCT05050643. Registered September 9th, 2021, https://clinicaltrials.gov/study/NCT05050643 PROTOCOL VERSION: This protocol is Version 1.0 which was created on 6/3/2020.
Collapse
Affiliation(s)
- Elvira E Jimenez
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
- Department of Neurology, David Gefen School of Medicine, University of California Los Angeles (UCLA), 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, 1 University Dr, Pittsburgh, PA, 15240, USA
- Caring for Complex Chronic Conditions Research Center & Division of General Internal Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Ashok Reddy
- Department of Medicine, Division of General Internal Medicine, Harborview Medical Center, University of Washington, 325 Ninth Ave, Box 359780, Seattle, WA, 98104, USA
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Michelle S Wong
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Natasha Torrence
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, 1 University Dr, Pittsburgh, PA, 15240, USA
- Caring for Complex Chronic Conditions Research Center & Division of General Internal Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Alexis Huynh
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Evelyn T Chang
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
- Division of General Internal Medicine, Department of Medicine, David Gefen School of Medicine, UCLA, 740 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| |
Collapse
|
36
|
Haun JN, Melillo C, Schneider T, McDaniel J, McMahon-Grenz J, Benzinger RC, Nakase-Richardson R, Pugh MJV, Skop KM, Friedman Y, Sandoval R, Sabangan J, Samson K, Picon LM, Kean J. A Partner-Engaged Approach to Developing an Implementation Research Logic Model for a Traumatic Brain Injury-Intensive Evaluation and Treatment Program. J Head Trauma Rehabil 2024:00001199-990000000-00182. [PMID: 39038102 DOI: 10.1097/htr.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND A partnered evaluation project with Veterans Health Administration Physical Medicine and Rehabilitation program office uses a partner-engaged approach to characterize and evaluate the national implementation of traumatic brain injury (TBI)Intensive Evaluation and Treatment Program (IETP). OBJECTIVE This paper illustrates a partner-engaged approach to contextualizing the IETP within an implementation research logic model (IRLM) to inform program sustainment and spread. SETTING The project was conducted at five IETP sites: Tampa, Richmond, San Antonio, Palo Alto, and Minneapolis. PARTICIPANTS Partners included national and site program leaders, clinicians, Department of Defense Referral Representatives, and researchers. Participants included program staff (n = 46) and Service Members/Veterans (n = 48). DESIGN This paper represents a component of a larger participatory-based concurrent mixed methods quality improvement project. MAIN MEASURES Participant scripts and demographic surveys. METHODS Datasets were analyzed using rapid iterative content analysis; IETP model was iteratively revised with partner feedback. Each site had an IETP clinical team member participate. The IRLM was contextualized within the Consolidated Framework for Implementation Research (CFIR); systematic consensus building expert reviewed implementation strategies; RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance); and Implementation Outcomes Framework (IOF). RESULTS Analyses and partner feedback identified key characteristics, determinants, implementation strategies, mechanisms, and outcomes. CONCLUSIONS This partner-engaged IRLM informs implementation and sustainment of a rehabilitation program for individuals with TBI. Findings will be leveraged to examine implementation, standardize core outcome measurements, and inform knowledge translation.
Collapse
Affiliation(s)
- Jolie N Haun
- Author Affiliations: Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Haun, Melillo, and Schneider, and Mss McMahon-Grenz and Benzinger); Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah (Dr Haun); College of Public Health, University of South Florida, Tampa, Florida (Dr Schneider); School of Human Sciences, Southern Illinois University, Carbondale, Illinois (Dr McDaniel); Pulmonary/Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, Florida (Dr Nakase-Richardson); James A. Haley Veterans' Hospital, Associate Chief of Staff Office, Tampa, Florida (Dr Nakase-Richardson); VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah (Dr Pugh); Post-deployment Rehabilitation and Evaluation Program, Physical Medicine and Rehabilitation Services, James A Haley Veterans' Hospital, Tampa, Florida (Dr Skop and Ms Friedman); School of Physical Therapy, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Skop); Post-deployment Acceleration Comprehensive Evaluation and Rehabilitation Program Polytrauma System of Care, South Texas Veterans Health Care System, Audie L. Murphy VAMC, San Antonio, Texas (Dr Sandoval); Intensive Evaluation & Treatment Program (IETP), Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, California (Drs Sabangan and Samson); Office of Rehabilitation and Prosthetic Services, Department of Veterans Affairs, Washington, District of Columbia (Ms Picon); and VA Salt Lake City Health Care System, VA Informatics and Computing Infrastructure, Salt Lake City, Utah (Dr Kean)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Stevens J, Scherrens AL, Pype P, Deliens L, De Vleminck A, Pardon K. Experiences with implementing advance care planning (ACP-GP) in Belgian general practice in the context of a cluster RCT: a process evaluation using the RE-AIM framework. BMC PRIMARY CARE 2024; 25:247. [PMID: 38971761 PMCID: PMC11227713 DOI: 10.1186/s12875-024-02510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND General practice is often recommended as an ideal setting to initiate advance care planning (ACP), but uptake of ACP in this setting is low. ACP-GP is a complex intervention to facilitate ACP for patients with chronic, life-limiting illness in Belgian general practice. It aims to increase patient ACP engagement and general practitioner (GP) ACP self-efficacy. In a cluster-randomized controlled trial, the intervention was not superior to control in increasing these outcomes. A parallel process evaluation aimed to enhance understanding of how the intervention was implemented, and which factors might have influenced trial results. METHODS We conducted a mixed-methods process evaluation following the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources include recruitment and implementation monitoring, questionnaires for patients and GPs, and semi-structured (focus group) interviews with patients and GPs. Questionnaire data were analyzed descriptively. Qualitative data were first analyzed inductively; themes were then assigned deductively to RE-AIM dimensions. RESULTS Thirty-five GPs and 95 patients were recruited to the trial; GP reach was low. Sixteen GPs and 46 patients provided questionnaire data at 3 months post-baseline; qualitative data were transcribed for 14 GPs and 11 patients. Adoption of intervention components was moderate to good, with the exception of the documentation template for GPs. Interviews revealed varying patient attitudes towards ACP, but patients nonetheless emphasized that conversations made them feel reassured. GPs especially valued a positive framing of ACP. When adopted, the intervention was well-implemented and participant satisfaction was high. However, intention for maintenance was moderate, with GPs raising questions of how to sustainably implement ACP conversations in the future. CONCLUSIONS Implementing the complex ACP-GP intervention in general practice is feasible, and can be successful. However, the implementation process is challenging and the sustainability is suboptimal. Our findings will guide future research and recommendations for facilitating and implementing ACP in general practice. TRIAL REGISTRATION ISRCTN12995230; prospectively registered on 19/06/2020.
Collapse
Affiliation(s)
- Julie Stevens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium.
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium.
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium.
| | - Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Koen Pardon
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| |
Collapse
|
38
|
Brown AGM, Adas S, de Jesus J, Farmer N, Fisher R, Pratt CA. Bridging the Gap: The Need to Implement Dietary Guidance to Address Cardiovascular Health. Nutrients 2024; 16:2125. [PMID: 38999873 PMCID: PMC11243232 DOI: 10.3390/nu16132125] [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: 05/28/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the U.S. and globally. Research demonstrates that diet is a leading contributor to the development of CVD, its prevention and management, and the overall promotion of cardiovascular health. This article describes the current state of the evidence, including research on the DASH and Mediterranean diets to promote cardiovascular health and prevent CVD. The article suggests approaches to implement evidence-based diets and federal dietary guidance to promote the adoption and integration of these interventions in both community and clinical settings. It highlights the current U.S. federal interest in "Food is Medicine" and its importance in addressing diet-related chronic diseases and promoting cardiovascular health.
Collapse
Affiliation(s)
- Alison G M Brown
- National Heart Lung and Blood Institute, Division of Cardiovascular Sciences, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Samantha Adas
- Office of Nutrition Research, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, MD 20852, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Rachel Fisher
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, MD 20852, USA
| | - Charlotte A Pratt
- National Heart Lung and Blood Institute, Division of Cardiovascular Sciences, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| |
Collapse
|
39
|
Tunje A, Persson HÅ, Jerene D, Hallstrom I. Intervention fidelity and factors affecting the process of implementing a mobile phone text messaging intervention among adolescents living with HIV: a convergent mixed-methods study in southern Ethiopia. BMJ Open 2024; 14:e077128. [PMID: 38960459 PMCID: PMC11227767 DOI: 10.1136/bmjopen-2023-077128] [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: 06/26/2023] [Accepted: 05/15/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE To assess the intervention fidelity and explore contextual factors affecting the process of implementing a mobile phone text messaging intervention in improving adherence to and retention in care among adolescents living with HIV, their families and their healthcare providers in southern Ethiopia. DESIGN A convergent mixed-methods design guided by the process evaluation theoretical framework and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework was used alongside a randomised controlled trial to examine the fidelity and explore the experiences of participants in the intervention. SETTING Six hospitals and five health centres provide HIV treatment and care to adolescents in five zones in southern Ethiopia. PARTICIPANTS Adolescents (aged 10-19), their families and their healthcare providers. INTERVENTION Mobile phone text messages daily for 6 months or standard care (control). RESULTS 153 participants were enrolled in the process evaluation. Among the 153 enrolled in the intervention arm, 78 (49.02%) were male and 75 (43.8%) were female, respectively. The mean and SD age of the participants is 15 (0.21). The overall experiences of implementing the text messages reminder intervention were described as helpful in terms of treatment support for adherence but had room for improvement. During the study, 30 700 text messages were sent, and fidelity was high, with 99.4% successfully delivered text messages during the intervention. Barriers such as failed text messages delivery, limitations in phone ownership and technical limitations affected fidelity. Technical challenges can hinder maintenance, but a belief in the future of digital communication permeates the experiences of the text message reminders. CONCLUSIONS Overall fidelity was high, and participants' overall experiences of mobile phone text messages were expressed as helpful. Contextual factors, such as local telecommunications networks and local electric power, as well as technical and individual factors must be considered when planning future interventions. TRIAL REGISTRATION NUMBER PACTR202107638293593.
Collapse
Affiliation(s)
- Abayneh Tunje
- Department of Health Sciences, Lund University Faculty of Medicine, Lund, Sweden
- Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Helene Åvik Persson
- Department of Health Sciences, Lund University Faculty of Medicine, Lund, Sweden
| | - Degu Jerene
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | - Inger Hallstrom
- Department of Health Sciences, Lund University Faculty of Medicine, Lund, Sweden
| |
Collapse
|
40
|
Lyleroehr MJ, Webster KA, Perry LM, Patten EA, Cantoral J, Smith JD, Cella D, Penedo FJ, Garcia SF. A mixed methods evaluation of patient perspectives on the implementation of an electronic health record-integrated patient-reported symptom and needs monitoring program in cancer care. J Patient Rep Outcomes 2024; 8:66. [PMID: 38954112 PMCID: PMC11219691 DOI: 10.1186/s41687-024-00742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND As cancer centers have increased focus on patient-centered, evidenced-based care, implementing efficient programs that facilitate effective patient-clinician communication remains critical. We implemented an electronic health record-integrated patient-reported symptom and needs monitoring program ('cPRO' for cancer patient-reported outcomes). To aid evaluation of cPRO implementation, we asked patients receiving care in one of three geographical regions of an academic healthcare system about their experiences. METHODS Using a sequential mixed-methods approach, we collected feedback in two waves. Wave 1 included virtual focus groups and interviews with patients who had completed cPRO. In Wave 2, we administered a structured survey to systematically examine Wave 1 themes. All participants had a diagnosed malignancy and received at least 2 invitations to complete cPRO. We used rapid and traditional qualitative methods to analyze Wave 1 data and focused on identifying facilitators and barriers to cPRO implementation. Wave 2 data were analyzed descriptively. RESULTS Participants (n = 180) were on average 62.9 years old; were majority female, White, non-Hispanic, and married; and represented various cancer types and phases of treatment. Wave 1 participants (n = 37) identified facilitators, including cPRO's perceived value and favorable usability, and barriers, including confusion about cPRO's purpose and various considerations for responding. High levels of clinician engagement with, and patient education on, cPRO were described as facilitators while low levels were described as barriers. Wave 2 (n = 143) data demonstrated high endorsement rates of cPRO's usability on domains such as navigability (91.6%), comprehensibility (98.7%), and relevance (82.4%). Wave 2 data also indicated low rates of understanding cPRO's purpose (56.7%), education from care teams about cPRO (22.5%), and discussing results of cPRO with care teams (16.3%). CONCLUSIONS While patients reported high value and ease of use when completing cPRO, they also reported areas of confusion, emphasizing the importance of patient education on the purpose and use of cPRO and clinician engagement to sustain participation. These results guided successful implementation changes and will inform future improvements.
Collapse
Affiliation(s)
- Madison J Lyleroehr
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
| | - Kimberly A Webster
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
| | - Laura M Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
| | - Elijah A Patten
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
| | - Jackelyn Cantoral
- Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Justin D Smith
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, 84108, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 675 N. St. Clair St. Fl 21 Ste 100, Chicago, IL, 60611, USA
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, 33124, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 675 N. St. Clair St. Fl 21 Ste 100, Chicago, IL, 60611, USA.
| |
Collapse
|
41
|
Jenssen BP, DiFiore G, Powell M, Luberti A, Rapposelli A, Lawton G, Dalembert G, Wood S, Ford CA, Biggs L, Fiks AG. Accelerating Innovation in Primary Care to Support Adolescent Health Discussions. Pediatrics 2024; 154:e2023064285. [PMID: 38836314 DOI: 10.1542/peds.2023-064285] [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: 09/11/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescent strengths and risks are not routinely captured in systematized and actionable ways in pediatric primary care. To address this problem, we developed a comprehensive adolescent health questionnaire (AHQ) integrated within the electronic health record and evaluated the AHQ's impact on collection of information on prioritized health-related domains. METHODS We developed and pilot tested the AHQ. We then scaled and assessed the AHQ's impact on data collection. AHQ development used innovation methods and measured feasibility and acceptability outcomes. Scaling and postscaling outcomes included Reach, Effectiveness, Adoption, Implementation, Maintenance and Sustainability measures: Reach (total questionnaires completed), Effectiveness (capture of key information across health domains pre- vs post-AHQ scaling), Adoption (proportion of practices that adopted the AHQ), Implementation (proportion of eligible adolescents who completed the AHQ), and Maintenance (monthly completion rates). RESULTS AHQ development led to a tool that was feasible and acceptable for use. During scaling (October 2020-December 2021), 22 147 questionnaires were completed by 20 749 unique adolescents aged 13 to 21 years at their preventive visit. Comparing pre- versus post-AHQ scaling data, use of the AHQ increased collection of information across domains, especially for strengths, gun safety, substance use, sexual activity, sexual orientation, and gender identity, from ranges of 0%-25% to 92%-95%. All 31 practices adopted the AHQ with completion at 88.7% of visits (n = 24 968). Two years postscaling, completion rates were >91% per month. CONCLUSIONS We successfully developed, scaled, and maintained an AHQ in a widely-used electronic health record system, a model for improving adolescent care and foundation for developing future interventions.
Collapse
Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Department of Biomedical and Health Informatics
| | | | | | - Anthony Luberti
- The Possibilities Project
- Department of Biomedical and Health Informatics
- Digital Health Team
| | | | | | - George Dalembert
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
| | - Sarah Wood
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carol A Ford
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Department of Biomedical and Health Informatics
| |
Collapse
|
42
|
Pfahl J, Thompson JS, Matlock DD, Allen LA, Dionne-Odom JN, Bakitas MA, McIlvennan CK. ENABLE-LVAD: Development and Implementation of a Novel Training Program for Clinicians Supporting Family Caregivers of Patients With a Left Ventricular Assist Device. J Cardiovasc Nurs 2024; 39:E136-E139. [PMID: 37974325 DOI: 10.1097/jcn.0000000000001065] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite significant family caregiver (FCG) burnout, there are currently no tested interventions to support the FCG role after left ventricular assist device (LVAD) implantation or formalized training for clinicians to support FCGs. OBJECTIVE We adapted the existing ENABLE (Educate, Nurture, Advise Before Life Ends) intervention to LVAD clinicians and FCGs and assessed clinical implementation and dissemination. METHODS ENABLE-LVAD is an interactive, self-paced clinician training coupled with FCG-facing guidebooks and resources. Implementation and dissemination were evaluated by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. RESULTS As of May 2023, 187 clinicians registered for the training, and 41 completed all modules (22.0% completion rate). Of those who completed the training and responded to a 6-month survey, one-third (n = 10, 33.3%) used ENABLE-LVAD with FCGs, and 100% of those planned to continue using it. The primary barrier to completing the training was time. CONCLUSIONS The ENABLE-LVAD clinician training was successfully disseminated and implemented as a useful resource to support LVAD FCGs.
Collapse
|
43
|
King B, Hook M, Brown R, Mahoney J, Steege L. Implementation of MOVIN by a Nurse-Led Clinical Team: A Multiple Methods Evaluation Using the RE-AIM Framework. Res Gerontol Nurs 2024; 17:189-201. [PMID: 39047229 DOI: 10.3928/19404921-20240621-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To evaluate the implementation of MOVIN, a multicomponent mobility intervention, by a nurse-led team and measure the effectiveness on unit-level outcomes. METHOD A pragmatic quasi-experimental study was conducted on an inpatient adult medical unit. Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Interviews with 13 organizational partners were conducted to understand barriers and facilitators to adoption. Thematic analysis was used to analyze the data. Quantitative data to determine effectiveness on distance of patient ambulation and percent of patients ambulated by nursing staff were analyzed using an interrupted time series. RESULTS A significant increase in total weekly distances for patient ambulation and percent of patients ambulated by nursing staff occurred between preintervention, intervention, and postintervention periods. Themes for adoption included: Value, Immediate Feedback, Inclusive Implementation, Resource Needs, and Lack of Organizational Evidence. The nurse-led team demonstrated high fidelity to maintaining the core components of MOVIN. CONCLUSION A nurse-led team can successfully launch a multicomponent mobility intervention and sustain impact. RE-AIM supported assessments of key partners at multiple organizational levels, capturing critical unit level outcomes. Multiple methods for data collection and analysis yielded rich results to inform future dissemination of MOVIN. [Research in Gerontological Nursing, 17(4), 189-201.].
Collapse
|
44
|
Kohl F, Schröder UB, Stegmann R, Wegewitz U, Hander N, Hansmann M, Angerer P, Erim Y, Hondong S, Kröger C, Mulfinger N, Waldman T, Herrmann K, Weber J. [Implementation of psychotherapeutic consultation at work (PT-A): expectations, announcement, and use : Results of the friaa-study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:796-805. [PMID: 38896150 PMCID: PMC11230975 DOI: 10.1007/s00103-024-03909-2] [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: 12/20/2023] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Psychotherapeutic consultation at work (PT-A) offers easily accessible, short-term support for employees experiencing psychological stress. The aim of the study was to evaluate aspects of the implementation regarding announcement, access, and use of the PT‑A. METHODS The study was conducted as part of a randomized controlled trial (RCT) called "Early Intervention in the Workplace". Forty-six company actors answered a questionnaire about how the companies announced the PT‑A to their employees, the barriers in the announcement of the PT‑A, and the beneficial factors of using the PT‑A. The access routes of the 550 participating employees were used from the baseline data of the RCT. Seven company actors were qualitatively interviewed about their expectations of the PT‑A and 22 participants of the RCT were interviewed about their experiences accessing and using the PT‑A. RESULTS The company actors hoped that the PT‑A would have an impact on all levels of prevention. Most companies announced the PT‑A centrally (e.g., flyers and intranet) as well as through individual recommendations (e.g., through the company's social counselling and occupational health professionals). Employees appreciated the opportunity to participate anonymously in the central announcement. Advantages of the supportive access were seen in the accessibility of employees without treatment experience, employees with high levels of suffering, and employees who have not yet recognized their own need for treatment. DISCUSSION The results suggest that it is useful to announce the PT‑A centrally to all employees but also to recommend it personally to affected employees. By using both methods, different PT‑A target groups can be reached and the advantages of anonymous participation are retained.
Collapse
Affiliation(s)
- Fiona Kohl
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Ute B Schröder
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland.
| | - Ralf Stegmann
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland
| | - Uta Wegewitz
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland
| | - Nicole Hander
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Marieke Hansmann
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Deutschland
| | - Peter Angerer
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Yesim Erim
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Sinja Hondong
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Christoph Kröger
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Deutschland
| | - Nadine Mulfinger
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Tamara Waldman
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Kristin Herrmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Jeannette Weber
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| |
Collapse
|
45
|
Balis LE, Porter G, Grocke-Dewey M. Demonstration Projects to Test Built Environment Changes: A Systematic Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:490-500. [PMID: 37713643 DOI: 10.1097/phh.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
CONTEXT Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes. OBJECTIVE To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment. DESIGN Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources. MAIN OUTCOME MEASURES Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility). RESULTS Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment. CONCLUSIONS Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools.
Collapse
Affiliation(s)
- Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska (Dr Balis); University of Nebraska Medical Center, Omaha, Nebraska (Dr Porter); and Montana State University, Bozeman, Montana (Dr Grocke-Dewey)
| | | | | |
Collapse
|
46
|
Mizelle E, Modly LA, Smith DJ. Farmworker Acceptability of Backpack Hydration Systems. J Agromedicine 2024; 29:477-485. [PMID: 38704610 PMCID: PMC11160487 DOI: 10.1080/1059924x.2024.2349022] [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: 05/06/2024]
Abstract
OBJECTIVE To improve water access while working and contribute to fewer heat-related illnesses (HRI), backpack hydration systems were provided to over 200 farmworkers to use during the 2022 growing season. Acceptability of the water intake intervention was assessed among farmworkers in eastern North Carolina, USA. METHODS With a pre-established community-university partnership, the acceptability of the intervention was assessed using a cross-sectional survey. The backpack brand selected included a 3-liter water bladder and attached drinking hose. Data analysis included descriptive and correlation statistics. RESULTS Among 47 male, migrant farmworkers, most (90%) reported the hydration backpack to be acceptable or completely acceptable to workplace fluid intake. Most (53%) reported using the backpack some of the time, compared to 28% who used it often. The participants reported an average of 4.8 (SD 2.2) liters of water intake from the backpack on a typical workday. Most reported the backpack improved the quantity and frequency of their water consumption. CONCLUSION This study was an important first step in implementation of hydration backpack systems as an HRI-preventative intervention among farmworkers. Future interventional studies could assess the efficacy of the backpacks on health outcomes, including incidence of dehydration and symptoms of HRI.
Collapse
Affiliation(s)
| | - Lori A. Modly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Daniel J. Smith
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| |
Collapse
|
47
|
Baker A, Cornwell P, Gustafsson L, Lannin NA. Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation. Disabil Rehabil 2024; 46:3116-3127. [PMID: 37551867 DOI: 10.1080/09638288.2023.2243589] [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: 12/20/2022] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation. MATERIALS AND METHODS This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months. RESULTS Environmental context and resources, the clinician's social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals' capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation. CONCLUSIONS A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting.
Collapse
Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane, Australia
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| |
Collapse
|
48
|
Stackpole KM, Kharofa RY, Tucker JM, Novick MB, Fals AM, Bernier AV, Tammi EM, Khoury PR, Siegel R, Paul S, Naramore SK, Moore JM. Telehealth Use in a National Pediatric Weight Management Sample During the COVID-19 Pandemic. Child Obes 2024; 20:309-320. [PMID: 37440173 PMCID: PMC11302192 DOI: 10.1089/chi.2023.0041] [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] [Indexed: 07/14/2023]
Abstract
Background: This study aimed to assess the implementation and access to telehealth-delivered pediatric weight management (PWM) during the initial phase of the COVID-19 pandemic at six US PWM programs (PWMP) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Methods: The COVID-19 period (COVID) was defined in this retrospective, multisite study as the time when each site closed in-person care during 2020. The Pre-COVID period (Pre-COVID) was an equivalent time frame in 2019. Patients were stratified by visit completion status. Patient characteristics for COVID and Pre-COVID were compared to examine potential changes/disparities in access to care. Results: There were 3297 unique patients included across the six sites. On average, telehealth was initiated 4 days after in-person clinic closure. Compared with Pre-COVID, COVID (mean duration: 9 weeks) yielded fewer total completed visits (1300 vs. 2157) and decreased revenue (mean proportion of nonreimbursed visits 33.30% vs. 16.67%). Among the completed visits, COVID included a lower proportion of new visits and fewer patients who were male, non-English speaking, Hispanic, or Asian and more patients who were Black or lived ≥20 miles from the program site (p < 0.05 for all). Among no-show/canceled visits, COVID included more patients who had private insurance, older age, or a longer time since the last follow-up. Conclusion: Rapid implementation of telehealth during COVID facilitated continuity of PWM care. Clinic volume and reimbursement were lower during COVID and differences in the patient population reached by telehealth emerged. Further characterization of barriers to telehealth for PWM is needed.
Collapse
Affiliation(s)
- Kristin M.W. Stackpole
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Roohi Y. Kharofa
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jared M. Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Marsha B. Novick
- Department of Pediatrics and Family and Community Medicine, Rush Medical College, Chicago, IL, USA
- Healthy Weight Program for Children and Teens, Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Angela M. Fals
- AdventHealth for Children/AdventHealth Medical Group Pediatric Weight and Wellness, Orlando, FL, USA
| | - Angelina V. Bernier
- Metabolic & Obesity Program, Pediatric Endocrinology, UF Health Shands Hospital, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Erin M. Tammi
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Philip R. Khoury
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Robert Siegel
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Suzanne Paul
- Department of Pediatrics, Section of Nutrition, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Sara K. Naramore
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, IN, USA
- Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Jaime M. Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
49
|
Bartels S, Levison JH, Trieu HD, Wilson A, Krane D, Cheng D, Xie H, Donelan K, Bird B, Shellenberger K, Cella E, Oreskovic NM, Irwin K, Aschbrenner K, Fathi A, Gamse S, Holland S, Wolfe J, Chau C, Adejinmi A, Langlois J, Reichman JL, Iezzoni LI, Skotko BG. Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial. BMC Public Health 2024; 24:1705. [PMID: 38926810 PMCID: PMC11201789 DOI: 10.1186/s12889-024-18835-w] [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: 11/20/2023] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). METHODS A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021-3/31/2021) and fidelity scores (baseline: 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. RESULTS GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). CONCLUSION Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .
Collapse
Affiliation(s)
- Stephen Bartels
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA.
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
| | - Hao D Trieu
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA
| | - Haiyi Xie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor, HB 7261, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Bruce Bird
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | | | - Elizabeth Cella
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Nicolas M Oreskovic
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
| | - Kelly Irwin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Ahmed Fathi
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Stefanie Gamse
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Sibyl Holland
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Jessica Wolfe
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Adeola Adejinmi
- Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA
| | | | | | - Lisa I Iezzoni
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
| |
Collapse
|
50
|
Kania-Richmond A, Beaupre LA, Jessiman-Perreault G, Tribo D, Martyn J, Hart DA, Robert J, Slomp M, Jones CA. Participants' perceived benefits from the GLA:D™ program for individuals living with hip and knee osteoarthritis: a qualitative study. J Patient Rep Outcomes 2024; 8:62. [PMID: 38922491 PMCID: PMC11208368 DOI: 10.1186/s41687-024-00740-w] [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: 03/22/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The Good Life with osteoArthritis: Denmark (GLA:D™), an evidence-based education and exercise program designed for conservative management of knee and hip osteoarthritis (OA), has been shown to benefit participants by reducing pain, improving function, and quality of life. Standardized reporting in the GLA:D databases enabled the measurement of self-reported and performance-based outcomes. There is a paucity of qualitative research on the participants' perceptions of this program, and it is important to understand whether participants' perceptions of the benefits of the program align with reported quantitative findings. METHODS We conducted semi-structured telephone interviews with individuals who participated in the GLA:D program from January 2017 to December 2018 in Alberta, Canada. Data were analyzed using an interpretive description approach and thematic analysis to identify emergent themes and sub-themes associated with participants perceived benefits of the GLA:D program. We analyzed the data using NVivo Pro software. Member checking and bracketing were used to ensure the rigour of the analysis. RESULTS 30 participants were interviewed (70% female, 57% rural, 73% knee OA). Most participants felt the program positively benefited them. Two themes emerged from the analysis: wellness and self-efficacy. Participants felt the program benefited their wellness, particularly with regard to pain relief, and improvements in mobility, strength, and overall well-being. Participants felt the program benefited them by promoting a sense of self-efficacy through improving the confidence to perform exercise and routine activities, as well as awareness, and motivation to manage their OA symptoms. Twenty percent of participants felt no benefits from the program due to experiencing increased pain and feeling their OA was too severe to participate. DISCUSSION The GLA:D program was viewed as beneficial to most participants, this study also identified factors (e.g., severe OA, extreme pain) as to why some participants did not experience meaningful improvements. Early intervention with the GLA:D program prior to individuals experiencing severe OA could help increase the number of participants who experience benefits from their participation. CONCLUSION As the GLA:D program expands across jurisdictions, providers of the program may consider recruitment earlier in disease progression and targeting those with mild and moderate OA.
Collapse
Affiliation(s)
- Ania Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Danika Tribo
- Rockyview General Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Martyn
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - David A Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|