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Jiménez-Díaz G, Aune A, Elizarrarás-Rivas J, Gierman LM, Keitsch M, Marcuzzi A, Infanti JJ. Neonatal jaundice detection in low-resource Mexican settings: possibilities and barriers for innovation with mobile health. BMC Health Serv Res 2024; 24:671. [PMID: 38807158 PMCID: PMC11134921 DOI: 10.1186/s12913-024-11141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders' perspectives in that context. METHODS Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research. RESULTS The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs' expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants' desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs. CONCLUSIONS The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
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Affiliation(s)
- Gabriela Jiménez-Díaz
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
- Picterus AS, Trondheim, Norway.
| | - Anders Aune
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Picterus AS, Trondheim, Norway
- Department of Pediatrics, St Olav's University Hospital, Trondheim, Norway
| | - Jesús Elizarrarás-Rivas
- Health Research Coordination, Mexican Institute of Social Security, IMSS, Oaxaca, Mexico
- Faculty of Medicine and Surgery, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca City, México
| | | | - Martina Keitsch
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Marcuzzi
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway
| | - Jennifer J Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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Perepech ND, Tregubov AV, Mikhailova IE. [Physicians' Adherence to Clinical Guidelines on the Chronic Heart Failure Diagnosis and Treatment: Changes Over 2 Years of the Document's Existence]. KARDIOLOGIIA 2024; 64:43-50. [PMID: 38462803 DOI: 10.18087/cardio.2024.2.n2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 03/12/2024]
Abstract
AIM To study how physicians' commitment to the basic provisions of clinical guidelines (CGs) for the diagnosis and treatment of chronic heart failure (CHF) has changed over the two years of the document existence. MATERIAL AND METHODS An anonymous survey was performed for 263 physicians (204 cardiologists, 46 internists and 13 other specialists) who were trained in advanced training programs in 2022. The questionnaire included questions regarding self-assessment of the respondents' professional knowledge, their attitude to the role of CGs in everyday practice and ideas about methods for treatment of CHF. RESULTS Respondents gave 60.6 % correct answers to questions related to the treatment of CHF. More than 70% correct answers were given by 42.7% of cardiologists and 17.4% of internists. Compared to 2020, the proportion of cardiologists who gave more than 70 % correct answers increased significantly (p<0.05). CGs were considered mandatory by 26.2% and important or sometimes useful by 71.5% of respondents. Cardiologists considered CGs mandatory more frequently than internists (29.9 and 15.2 %, respectively; p=0.04). The mean number of correct answers was greater in the subgroup of respondents who considered CGs mandatory (p<0.001). More than 70% correct answers were given by only 43.8% of cardiologists, who considered themselves fully informed and able to advise colleagues on complex issues of diagnosis and treatment of CHF, and 40.6% of physicians who considered their knowledge acceptable for managing patients with CHF. CONCLUSION The majority of physician consider CGs an important methodological document but only a little more than 25 % are aware that CGs are mandatory. Cardiologists are better informed than internists about the principal provisions of National Clinical Guidelines for the diagnosis and treatment of CHF, but the average level of physician knowledge remains low.
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Al-Maskari A, Al-Maamari Q, Al-Abdali M, Al-Shaaibi H, Nadar SK. Adherence to Medications in Patients with Ischaemic Heart Disease in Oman. Sultan Qaboos Univ Med J 2024; 24:109-114. [PMID: 38434452 PMCID: PMC10906756 DOI: 10.18295/squmj.7.2023.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/25/2023] [Accepted: 07/02/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives This study aimed to evaluate the level of adherence to medication among patients with ischaemic heart disease (IHD) in Oman and assess the related factors. Methods This cross-sectional questionnaire-based study among patients with IHD attending the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman, was performed between January and December 2021. Results A total of 105 patients (mean age = 49.9 ± 11.1 years, 78.1% male) were recruited. Most of the patients (80%) reported taking the medications by themselves; 77 (73.3%) patients said that over the preceding 2 weeks, they had missed at least 3 doses of their medication. The reasons for missing the medications included forgetting (100%), having to take too many tablets (57%), feeling that the tablets are not effective (48%) and having to take the tablets too often each day (23%). The factors responsible for patients failing to take medications could not be identified. Conclusion Medication adherence was low among patients with IHD in Oman, with high pill burden being the most common reason for non-adherence. Physicians must bear this in mind when reviewing patients.
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Affiliation(s)
| | | | - Mariya Al-Abdali
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Hajer Al-Shaaibi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sunil K. Nadar
- Department of Medicine, Sultan Qaboos University Hospital
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Ghobadi M, Behzadi A, Sabermahani A. The Outcomes, Barriers, and Facilitators of Implementing Clinical Practice Guidelines in Iran: A Comprehensive Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:323-334. [PMID: 38894831 PMCID: PMC11182465 DOI: 10.18502/ijph.v53i2.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/18/2023] [Indexed: 06/21/2024]
Abstract
Background Clinical practice guideline (CPGs) are highly valuable in enhancing healthcare efficiency as they lead to the selection of the best medical methods and reduction of their costs. Nevertheless, implementing CPGs in practice can be quite challenging, as they require alterations at individual, organizational, and health system levels. Therefore, we aimed to identify the outcomes, barriers, and facilitators associated with CPG implementation. Methods We conducted an extensive search using Web of Science, PubMed, Scopus, Embase, and various non-English databases to gather quantitative, qualitative, and review studies on the implementation of CPGs from Jan 1, 1990, to Dec 26, 2022. Our analysis focused on the outcomes, barriers, and facilitators of CPG implementation, which categorized into four groups: policy-making, health system and hospitals, professional experts, and clinical guidelines. Results After conducting a thorough review of 37 studies, the most significant outcomes were found to be reduced costs and enhanced quality of care. However, certain challenges, such as inadequate support, insufficient education, high work pressure, tight schedules, and a lack of unified and clear guidelines, hindered these improvements. To overcome these barriers, it is essential to prioritize effective leadership, improve work conditions, allocate necessary resources, create a structured framework for the guidelines, and simplify their content to fit the clinical circumstances. Conclusion It is crucial to identify the outcomes and barriers associated with implementing CPGs to enhance professional performance, elevate the quality of care, and foster patient satisfaction. Developing effective strategies hinges on this awareness.
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Affiliation(s)
- Maliheh Ghobadi
- Department of Health Management, Policy, and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asma Sabermahani
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Abdellatif HM, Al-Muallem A, Almansoof AS, AlRohaily SA, Alzahrani A, AlGhodaier H, Saeedi M, AlAzemi N, Hassan I. Clinical Practice Guidelines in an Era of Accountability, Saudi Arabia: A Call for Action. J Epidemiol Glob Health 2023; 13:391-396. [PMID: 37450240 PMCID: PMC10469134 DOI: 10.1007/s44197-023-00135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Clinical Practice Guidelines (CPGs) development and implementation in the Kingdom of Saudi Arabia are suboptimal. The Kingdom's Vision 2030 envisages a transformational change to achieve an effective, integrated, value-based ecosystem focused on patient health. OBJECTIVES This study aimed to develop a CPG appraisal tool that will support the realization of the Kingdom's Vision 2030 through the development of high-quality and highly implementable CPGs. To maximize its impact, all vital healthcare paradigms, such as systems thinking, value-based healthcare, and information technology, will robustly be incorporated in the tool. METHODS The Saudi Health Council through its National Center of Evidence-Based Medicine (NCEBM) embarked on a program to develop this appraisal tool. A taskforce of experts was selected based on their experience in evidence-based practice and training. The task force, through a methodology of extensive literature review, deliberation, outside experts' feedback, and Delphi and consensus voting, developed a prototype appraisal tool that was named the Holistic Appraisal Tool for CPGs (HAT-CPG). RESULTS The HAT-CPG was developed comprising three sections: an initial basic information section, an internal validity section, and an external validity section with a total of 13 section items and 73 reporting elements. CONCLUSION It is envisaged that the Holistic Appraisal Tool will support CPG developers and users in Saudi Arabia in realizing the objectives for which it was developed.
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Affiliation(s)
- Hoda M. Abdellatif
- Preventive Dental Sciences, College of Dentistry—Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Public Health Sciences, Texas A&M University College of Dentistry, Dallas, TX USA
| | - Amani Al-Muallem
- Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Afaf Saleh Almansoof
- Rehabilitation, King Abdullah Specialized Children Hospital, Ministry of National Guard—Health Affairs, Riyadh, Saudi Arabia
| | | | - Abdullah Alzahrani
- National Center for Evidence-Based Medicine, Saudi Health Council, Riyadh, Saudi Arabia
| | - Hussah AlGhodaier
- National Center for Evidence-Based Medicine, Saudi Health Council, Riyadh, Saudi Arabia
| | - Mohammad Saeedi
- National Center for Evidence-Based Medicine, Saudi Health Council, Riyadh, Saudi Arabia
| | | | - Imad Hassan
- Department of Medical Protocol, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Almazrou SH, Almoajil H, Alghamdi S, Althenyan G, Alqahtani A, Amer YS. Assessing Barriers and Facilitators for Implementing Clinical Practice Guidelines in Middle Eastern and North African Region: Delphi Study. J Clin Med 2023; 12:5113. [PMID: 37568515 PMCID: PMC10419468 DOI: 10.3390/jcm12155113] [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: 06/24/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA). METHODS A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected. RESULTS We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.
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Affiliation(s)
- Saja H. Almazrou
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Hajar Almoajil
- Physical Therapy Department, College of Applied Medical Sciences, Imam Abdulrahamn bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Sara Alghamdi
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Ghadeer Althenyan
- College of Pharmacy, King Saud University, Riyadh 14511, Saudi Arabia; (S.A.); (G.A.)
| | - Abdulhadi Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Yasser Sami Amer
- Pediatrics Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia;
- Clinical Practice Guidelines & Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh 11362, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh 11421, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria 5424041, Egypt
- Guidelines International Network, Perth PH16 5BU, UK
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Al Sada D, Husain YI, Al Misbah Z. Assessing Adherence to Clinical Practice Guidelines Among Primary Care Physicians in Bahrain: A Cross-sectional Study. Oman Med J 2023; 38:e527. [PMID: 37720341 PMCID: PMC10500093 DOI: 10.5001/omj.2023.84] [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: 05/28/2022] [Accepted: 12/18/2022] [Indexed: 09/19/2023] Open
Abstract
Objectives To assess the adherence to clinical practice guidelines (CPGs) and explore the barriers to their implementation among primary care physicians (PCPs) in Bahrain. Methods A cross-sectional study was conducted using an online survey among physicians working in 20 randomly selected public sector primary health centers in Bahrain. Private-sector physicians and family medicine residents were excluded. Outcome measures were assessing the extent of adherence to CPGs, describing the results in association with work roles, gender, level of formal training, and years of working experience, and investigating the barriers to adhering to CPGs. Results The subjects were 149 PCPs (consultants, specialists, and general practitioners) working in government primary health centers. The vast majority (98.0%) reported that they implemented CPGs in their daily practice. The most commonly cited reason (79.2%) for implementation was that the CPGs were evidence-based. The most implemented guidelines pertained to diabetes (91.3%), hypertension (81.2%), and hyperlipidemia (69.8%). The least implemented ones were screening of women (38.9%) and postnatal care (45.6%). The level of formal medical training was associated with the implementation of CPGs on preventive care, antenatal and postnatal care, and children and women screening (p < 0.05). Hypertension and bronchial asthma guidelines were implemented more by male physicians (p < 0.05) while female physicians were more adherent to CPGs on antenatal and postnatal care, and women and child screening (p < 0.05). The main barrier reported by the physicians was that they wished to know more about CPGs before applying them (mean ± SD = 3.8 ± 0.9). The perception that managers or directors are non-cooperative towards the application of CPGs was associated with years of experience (p = 0.008) and the position of the physician (p = 0.028). General practitioners were more likely to consider non-cooperation from patients as a barrier (p = 0.025). Conclusions Most PCPs in Bahrain are adherent to CPGs in their daily practice and encounter minimal barriers. Identifying and resolving barriers can help develop unified and standardized guidelines that promote better consistency in patient management, minimize medical errors, and conserve resources.
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Affiliation(s)
- Dhabya Al Sada
- Family Medicine Clinic, NBB Arad Health Center, Ministry of Health, Sanabis, Bahrain
| | - Yusra Irshad Husain
- Family Medicine Clinic, Muharraq Health Center, Ministry of Health, Sanabis, Bahrain
| | - Zainab Al Misbah
- Family Medicine Clinic, Muharraq Health Center, Ministry of Health, Sanabis, Bahrain
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Gittus M, Chong J, Sutton A, Ong ACM, Fotheringham J. Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review. Orphanet J Rare Dis 2023; 18:140. [PMID: 37286999 DOI: 10.1186/s13023-023-02667-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/11/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Rare diseases present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases from existing literature. METHODS A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Web of Science and Cochrane library from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search was performed. The Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, informed by 57 potential determinants was selected as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies. RESULTS Forty-four studies were included, most of which were conducted in the United States (54.5%). There were 168 barriers across 36 determinants (37 studies) and 52 facilitators across 22 determinants (22 studies). Fifteen diseases were included across eight WHO ICD-11 disease categories. Together individual health professional factors and guideline factors formed the majority of the reported determinants (59.5% of barriers and 53.8% of facilitators). Overall, the three most reported individual barriers were the awareness/familiarity with the recommendation, domain knowledge and feasibility. The three most reported individual facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Resource barriers to implementation included technology costs, ancillary staff costs and more cost-effective alternatives. There was a paucity of studies reporting influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation. CONCLUSIONS Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.
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Affiliation(s)
- Matthew Gittus
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK.
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK.
| | - Jiehan Chong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Albert C M Ong
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Sultan M, Waganew W, Kassaye M, Beza L, Waleligh M, Azazh A, Yifru S, Redae B, Ataro D, Fisseha A, Ashagre A, Baru A. Facilitators and Barriers to National COVID 19 Guideline Adherence among Healthcare Providers in Ethiopia. Ethiop J Health Sci 2023; 33:183-192. [PMID: 37484189 PMCID: PMC10358374 DOI: 10.4314/ejhs.v33i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 07/25/2023] Open
Abstract
Background Evidence-base practice needs to be supported by guidelines and decision-making protocols. This study aimed to look into the barriers and facilitators of adherence to national protocols in Ethiopia. Methods Exploratory qualitative method was implemented to explore adherence to protocol. The national COVID-19 case management guideline was used as this study's prototype reference. A total of five FGDS were conducted among 26 healthcare providers. A total of 14 physicians and 12 nurses participated in the FGDs. Semi-structured focus group discussions guides were used to facilitate the discussion among healthcare workers involved in COVID-19 case management. The FGDs were audio recorded, transcribed and analyzed thematically. Results Three broad themes have emerged from the content analysis. These include individual factors, environmental factors and system factors. System factors barriers to utilization include unclear guidelines, discordant guidelines and a lack of live national guidelines, while the main facilitator was supportive management. The environmental factors that were barriers to adherence included limited infrastructure and shortages of drugs suggested in the protocols. Conclusion Outdated and discordant guidelines and a shortage of suggested managements were barriers. Future similar works should consider the identified barriers and need regular updates to facilitate effective implementation.
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Affiliation(s)
| | | | | | | | | | | | - Sisay Yifru
- Saint Paul's hospital millennium medical college
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Goodarzi B, Seijmonsbergen-Schermers A, Cronie D, van Laerhoven H, van den Akker T, van Kaam AH, de Jonge A. (Un)warranted variation in local hospital protocols for neonatal referral to the pediatrician: An explorative study in the Netherlands. Birth 2023; 50:215-233. [PMID: 36373864 DOI: 10.1111/birt.12690] [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: 06/23/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium-stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth. METHODS We conducted a nationwide cross-sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments. RESULTS There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and/or lack of adherence to these guidelines. CONCLUSIONS To reduce unwarranted variation in local protocols, evidence-based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence-based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anna Seijmonsbergen-Schermers
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Doug Cronie
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rotterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands.,Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Cross AJ, Haines TP, Ooi CE, La Caze A, Karavesovska S, Lee EJ, Siu S, Sareen S, Jones C, Steeper M, Bell JS. Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review. BMJ Qual Saf 2023; 32:286-295. [PMID: 36746617 DOI: 10.1136/bmjqs-2022-015595] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Poor translation of clinical practice guidelines (CPGs) into clinical practice is a barrier to the provision of consistent and high-quality evidence-based care. The objective was to systematically review the roles and effectiveness of knowledge brokers (KBs) for translating CPGs in health-related settings. METHODS MEDLINE, Embase, PsycINFO and CINAHL Plus were searched from 2014 to June 2022. Randomised controlled trials (RCTs), controlled and uncontrolled preintervention and postintervention studies involving KBs, either alone or as part of a multicomponent intervention, that reported quantitative postintervention changes in guideline implementation in a healthcare setting were included. A KB was defined as an intermediary who facilitated knowledge translation by acting in at least two of the following core roles: knowledge manager, linkage agent or capacity builder. Specific activities undertaken by KBs were deductively coded to the three core roles, then common activities were inductively grouped. Screening, data extraction, quality assessment and coding were performed independently by two authors. RESULTS 16 studies comprising 6 RCTs, 8 uncontrolled precomparisons-postcomparisons, 1 controlled precomparison-postcomparison and 1 interrupted time series were included. 14 studies (88%) were conducted in hospital settings. Knowledge manager roles included creating and distributing guideline material. Linkage agent roles involved engaging with internal and external stakeholders. Capacity builder roles involved audit and feedback and educating staff. KBs improved guideline adherence in 10 studies (63%), had mixed impact in 2 studies (13%) and no impact in 4 studies (25%). Half of the RCTs showed KBs had no impact on guideline adherence. KBs acted as knowledge managers in 15 (94%) studies, linkage agents in 11 (69%) studies and capacity builders in all studies. CONCLUSION Knowledge manager and capacity builder roles were more frequently studied than linkage agent roles. KBs had mixed impact on translating CPGs into practice. Further RCTs, including those in non-hospital settings, are required. PROSPERO REGISTRATION NUMBER CRD42022340365.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Sara Karavesovska
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Eu Jin Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Samuel Siu
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Sagar Sareen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Carlos Jones
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - Michelle Steeper
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
| | - John Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville Campus, Parkville, Victoria, Australia
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Leung T, Cai Y, Cao J, He Q, Wang X, Lu Y, Liang H, Xu D, Liao J. The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China. J Med Internet Res 2022; 24:e40082. [PMID: 36459416 PMCID: PMC9758641 DOI: 10.2196/40082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. OBJECTIVE This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. METHODS Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. RESULTS Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. CONCLUSIONS There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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Affiliation(s)
| | - Yiyuan Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Jin Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Lu
- Department of Preventive Medicine & Maternal and Child Health, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Huijuan Liang
- Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, China
| | - Dong Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.,ACACIA Lab for Implementation Research, Southern Medical University Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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13
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Pogosova NV, Isakova SS, Sokolova OY, Ausheva AK, Zhetisheva RA, Arutyunov AA. [Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings]. KARDIOLOGIIA 2022; 62:33-44. [PMID: 35692172 DOI: 10.18087/cardio.2022.5.n1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/24/2021] [Indexed: 06/15/2023]
Abstract
Aim To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working conditions, and emotional exhaustion (a component of professional burnout), older age of patients and their excessive alcohol consumption.
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Affiliation(s)
- N V Pogosova
- National Medical Research Center of Cardiology, Moscow
| | | | - O Y Sokolova
- National Medical Research Center of Cardiology, Moscow
| | - A K Ausheva
- National Medical Research Center of Cardiology, Moscow
| | | | - A A Arutyunov
- National Medical Research Center of Cardiology, Moscow
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Uwizeye CB, Zomahoun HTV, Bussières A, Thomas A, Kairy D, Massougbodji J, Rheault N, Tchoubi S, Philibert L, Abib Gaye S, Khadraoui L, Ben Charif A, Diendéré E, Langlois L, Dugas M, Légaré F. Implementation strategies for knowledge products in primary healthcare: a systematic review of systematic reviews (Preprint). Interact J Med Res 2022; 11:e38419. [PMID: 35635786 PMCID: PMC9315889 DOI: 10.2196/38419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.
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Affiliation(s)
- Claude Bernard Uwizeye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
| | - Dahlia Kairy
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Réseau Provincial de recherche en Adaptation-Réadaptation (REPAR), Montreal, QC, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montreal, QC, Canada
| | - José Massougbodji
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Nathalie Rheault
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Sébastien Tchoubi
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada
| | - Leonel Philibert
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- Faculty of Nursing, Laval University, Québec, QC, Canada
| | - Serigne Abib Gaye
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
| | - Lobna Khadraoui
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Ali Ben Charif
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Québec, QC, Canada
- CubecXpert, Québec, QC, Canada
| | - Ella Diendéré
- Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Léa Langlois
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - France Légaré
- Learning Health System Component of the Québec Strategy for Patient-Oriented Research (SPOR) - Support for People and Patient-Oriented and Trials (SUPPORT) Unit, Québec, QC, Canada
- VITAM Research Center on Sustainable Health, Laval University, Québec, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
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Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda. Antibiotics (Basel) 2022; 11:antibiotics11020199. [PMID: 35203802 PMCID: PMC8868487 DOI: 10.3390/antibiotics11020199] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
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AL Qamariat Z, Alkhalifah K, Alqarni S. Extent and feasibility of the application of the clinical pathway, clinical guideline, and practice protocol in eastern province Saudi Arabian Hospitals: A cross-sectional survey study. JOURNAL OF NATURE AND SCIENCE OF MEDICINE 2022. [DOI: 10.4103/jnsm.jnsm_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pereira MA, Marques RC, Ferreira DC. An Incentive-Based Framework for Analyzing the Alignment of Institutional Interventions in the Public Primary Healthcare Sector: The Portuguese Case. Healthcare (Basel) 2021; 9:healthcare9070904. [PMID: 34356282 PMCID: PMC8305205 DOI: 10.3390/healthcare9070904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Over the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, where understanding the incentives behind the actors of the inherent institutional interventions and how they are aligned with the governing health policies is paramount for reformative success. With the purpose of acknowledging the alignment of the primary healthcare sector's institutional interventions from an incentive-based perspective, we propose a framework resting on a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which was built in cooperation with a panel of decision-making actors from the Portuguese Ministry of Health. In the end, we derive possible policy implications and strategies. This holistic approach highlighted the positive impact of the primary healthcare reform in the upgrade of physical resources and human capital but stressed the geosocial asymmetries and the lack of intra- and inter-sectorial coordination. The proposed framework serves also as a guideline for future primary healthcare reforms, both national- and internationally.
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Affiliation(s)
- Miguel Alves Pereira
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
- Correspondence: ; Tel.: +351-968105420
| | - Rui Cunha Marques
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
| | - Diogo Cunha Ferreira
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
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Martínez-Gimeno ML, Fernández-Martínez N, Escobar-Aguilar G, Moreno-Casbas MT, Brito-Brito PR, Caperos JM. SUMAMOS EXCELENCIA ® Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS). Healthcare (Basel) 2021; 9:374. [PMID: 33800670 PMCID: PMC8066682 DOI: 10.3390/healthcare9040374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
The use of certain strategies for the implementation of a specific recommendation yields better results in clinical practice. The aim of this study was to assess the effectiveness of an evidence-based model using clinical audits (GRIP model), for the implementation of recommendations in pain and urinary incontinence management as well as fall prevention, in the Spanish National Health System during the period 2015-2018. A quasi-experimental study has been conducted. The subjects were patients treated in hospitals, primary care units and nursing home centers. There were measures related to pain, fall prevention and urinary incontinence. Measurements were taken at baseline and at months 3, 6, 9, and 12. The sample consisted of 22,114 patients. The frequency of pain assessment increased from 59.9% in the first cycle to a mean of 71.6% in the last cycle, assessments of risk of falling increased from 56.8% to 87.8% in the last cycle; and finally, the frequency of assessments of urinary incontinence increased from a 43.4% in the first cycles to a mean of 62.2% in the last cycles. The implementation of specific evidence-based recommendations on pain, fall prevention, and urinary incontinence using a model based on clinical audits improved the frequency of assessments and their documentation.
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Affiliation(s)
- María-Lara Martínez-Gimeno
- San Juan de Dios Foundation, San Rafael-Nebrija Health Sciences Center, Nebrija University, 28036 Madrid, Spain;
- SALBIS Research Group, Faculty of Health Sciences, University of Leon, 24401 Ponferrada, Spain
| | - Nélida Fernández-Martínez
- Department of Biomedical Sciences, Faculty of Veterinary Medicine, University of León, 24071 Leon, Spain;
| | - Gema Escobar-Aguilar
- San Juan de Dios Foundation, San Rafael-Nebrija Health Sciences Center, Nebrija University, 28036 Madrid, Spain;
| | - María-Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investen-isciii), Carlos III Health Institute, 28029 Madrid, Spain;
| | - Pedro-Ruyman Brito-Brito
- Training and Research in Care, Primary Care Management of Tenerife, The Canary Islands Health Service, 38204 Santa Cruz de Tenerife, Spain;
- Department of Nursing, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Jose-Manuel Caperos
- UNINPSI, Department of Psychology, Universidad Pontificia Comillas, 28015 Madrid, Spain;
- Fundación San Juan de Dios, 28036 Madrid, Spain
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