Implementation research - its importance and application in primary care

[Bibliometric map of research carried out in Primary Care in Spain during the period 2013-2017]

Objetivo

Describir la producción científica española de atención primaria durante 2013-2017, analizando su distribución geográfica, factor de impacto, áreas de investigación y participación de diferentes sectores institucionales.

Diseño

Estudio observacional bibliométrico.

Participantes

Publicaciones indexadas en Medline.

Mediciones principales

Revista y año de publicación, primer/último autor, centro de trabajo y comunidad autónoma. Se clasificaron los artículos según su contenido. El factor de impacto fue obtenido de la base de análisis bibliométrico Journal Citation Reports.

Resultados

Incluidos 980 documentos. El índice de transitoriedad fue 78,8%. La mayoría de los artículos (43,2%) procedía de centros de salud, originados en unidades o institutos de investigación, desde 14,9% en 2013 hasta 19,1% en 2017. El 63,3% se clasificaron como «aspectos clínicos». El 19,3% fueron publicados en la revista Atención Primaria, el 40,6% en revistas extranjeras y el 72,4% en revistas con factor de impacto, siendo esta proporción significativamente inferior (p <0,001) en los procedentes de centros de salud (59,6%) o de unidades docentes/gerencias/servicios de salud (70,0%) respecto a los originados en unidades/institutos de investigación (93,1%) o en universidades (89,0%). En relación al número de habitantes (documentos/100.000 habitantes), las comunidades más productivas fueron Cataluña (4,2), Aragón (3,9) e Islas Baleares (3,3).

Conclusiones

En las publicaciones de atención primaria existe gran diversidad tanto en áreas de investigación como en las revistas donde se publican. La mayoría proceden de centros de salud, tratan aspectos clínicos y se publican en revistas españolas. Se observan diferencias en el volumen de producción científica entre comunidades autónomas.

Using Concept Maps to compare obesity knowledge between policy makers and primary care researchers in Canada

Objective

Knowledge transfer is the process of information sharing between researchers, knowledge users and policy makers. Globally, public policies about obesity do not reflect the complexity of what is known about the cause and effects of obesity. We used Concept Maps, a qualitative method that represents mental models, to compare the understanding of obesity between policy makers in a Canadian province and local primary care researchers. Eight participants were interviewed during which a Concept Map was developed using “C-map Tools” software. Maps were then colour-coded to identify themes and concepts in the maps. Finally, the team synthesised the findings from each of the maps and presented them back to each of the participants.

Results

All participants had mental models with rich details on the complexity of obesity for individuals, community, and at the policy level. Clinician-researchers had more focus on medical management than policy makers although most participants lacked concepts on the role of primary care in obesity management. A shared understanding of obesity could assist researchers and policy makers in developing a relevant and effective strategy. Concept Mapping provides a novel and creative way to visually compare different understandings of health-related topics.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-4042-x) contains supplementary material, which is available to authorized users.

The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: a Delphi study

BACKGROUND

As Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers.

METHODS

A three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥ 70% agreement on a four-point Likert scale was determined to have reached consensus.

RESULTS

Consensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the "BarrierS To the Application and Conduct of rEsearch" (oBSTACLES) instrument.

CONCLUSION

This study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum.

Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care

Introduction

Adverse pregnancy outcomes are more common among Aboriginal and Torres Strait Islander populations than non-Indigenous populations in Australia. Later in life, most of the difference in life expectancy between Aboriginal and Torres Strait Islander women and non-Indigenous women is due to non-communicable diseases (NCDs). Most Aboriginal and Torres Strait Islander women attend health services regularly during pregnancy. Providing high-quality care within these appointments has an important role to play in improving the current and future health of women and babies.

Aim

This study engaged stakeholders in a theory-informed process to use aggregated continuous quality improvement (CQI) data to identify 1) priority evidence-practice gaps in Aboriginal and Torres Strait Islander maternal health care, 2) barriers and enablers to high-quality care, and 3) strategies to address identified priorities.

Methods

Three phases of reporting and feedback were implemented using de-identified CQI data from 91 health services between 2007 and 2014 (4,402 client records). Stakeholders (n = 172) from a range of professions and organisations participated.

Results

Stakeholders identified four priority areas relating to NCDs: smoking, alcohol, psychosocial wellbeing and nutrition. Barriers or enablers to high-quality care included workforce support, professional development, teamwork, woman-centred care, decision support, equipment and community engagement. Strategies to address the priorities included upskilling staff to provide best practice care in priority areas, advocating for availability of healthy food, housing and local referral options, partnering with communities on health promotion projects, systems to facilitate continuity of care and clear referral pathways.

Conclusions

This novel use of large-scale aggregate CQI data facilitated stakeholder input on priority evidence-practice gaps in maternal health care in Australia. Evidence-practice gaps relating to NCD risk factors and social determinants of health were prioritised, and stakeholders suggested both healthcare-focussed initiatives and approaches involving the community and the wider health sector. The findings can inform health service planning, advocacy, inter-agency strategies, and future research.

On the road to value co-creation in health care: the role of consumers in defining the destination, planning the journey and sharing the drive

The role of consumers is now extending beyond being passive health care recipients and even active participants in their own care to involvement in innovation and value co-creation in health care - from being "users and choosers" to becoming "makers and shapers" of services. For active dialogue to occur in co-creation, consumers must become equal partners with health care organisations and providers, with the focus on areas of interest to all parties. The use of value co-creation in health care involves embedding the approach across the whole health care system - from the microsystem level to the mesosystem and the entire macrosystem.