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Williams NJ, Ehrhart MG, Aarons GA, Esp S, Sklar M, Carandang K, Vega NR, Brookman-Frazee L, Marcus SC. Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial. Implement Sci 2024; 19:29. [PMID: 38549122 PMCID: PMC10976812 DOI: 10.1186/s13012-024-01356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Theory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI's hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI's effect on implementation climate, which in turn will (3) mediate LOCI's effect on MBC fidelity. METHODS Twenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders' implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses. RESULTS LOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI's effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI's effect on MBC fidelity during the same period (pm = 0.71, p = .045). CONCLUSIONS LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.
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Affiliation(s)
- Nathaniel J Williams
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA.
- School of Social Work, Boise State University, Boise, ID, 83725, USA.
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Susan Esp
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
- School of Social Work, Boise State University, Boise, ID, 83725, USA
| | - Marisa Sklar
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Nallely R Vega
- School of Social Work, Boise State University, Boise, ID, 83725, USA
| | | | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Sklar M, Ehrhart MG, Ramirez N, Carandang K, Kuhn N, Day A, Aarons GA, Williams NJ. Implementation leadership and implementation climate in context: A single organization intrinsic case study for implementation of digital measurement-based care. Implement Res Pract 2024; 5:26334895241236680. [PMID: 38550748 PMCID: PMC10976481 DOI: 10.1177/26334895241236680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Although studies have demonstrated that implementation leadership and climate are important constructs in predicting evidence-based practice (EBP) implementation, concrete descriptions of how they operate during organizational implementation efforts are lacking. This case study fills that gap through an in-depth description of an organization with effective implementation leadership that successfully built a strong implementation climate. This case study provides an illustration of implementation leadership and climate in tangible, replicable terms to assist managers, practitioners, and researchers in addressing the organizational context in their own implementation projects. Method A single organization, intrinsic case study was employed to paint a multifaceted picture of how one organization leveraged implementation leadership to strengthen a climate for the successful implementation of digital measurement-based care. The case was drawn from a cluster-randomized trial designed to test the effects of a leadership-focused implementation strategy on youth-level fidelity and clinical outcomes of digital measurement-based care. Following the completion of the trial, case study activities commenced. Descriptive summaries of multiple data sources (including quantitative data on implementation leadership and climate, coaching call and organizational alignment meeting recordings and notes, and development plans) were produced and revised iteratively until consensus was reached. Leadership actions were analyzed for corresponding dimensions of implementation leadership and climate. Results Specific actions organizational leaders took, as well as the timing specific strategies were enacted, to create a climate for implementation are presented, along with lessons learned from this experience. Conclusion This case study offers concrete steps organizational leaders took to create a consistent and aligned message that the implementation of a specific EBP was a top priority in the agency. The general approach taken to create an implementation climate provides several lessons for leaders, especially for EBPs that have broad implications across an organization.
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Affiliation(s)
- Marisa Sklar
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Mark G. Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Nallely Ramirez
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
| | | | | | - Ana Day
- Oregon Community Programs, Eugene, OR, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Nathaniel J. Williams
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
- School of Social Work, Boise State University, Boise, ID, USA
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Williams NJ, Marcus SC, Ehrhart MG, Sklar M, Esp SM, Carandang K, Vega N, Gomes AE, Brookman-Frazee L, Aarons GA. Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02239-6. [PMID: 38070868 DOI: 10.1016/j.jaac.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of mental health treatment in youth when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics. METHOD In a cluster randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation strategy plus training and technical assistance in MBC (k = 11, n = 117) or training and technical assistance only (k = 10, n = 117). Primary outcomes of MBC fidelity (assessed via electronic metadata) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youths (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Outcomes of each youth were assessed for 6 months following baseline. RESULTS A total of 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition in clinic, clinician, or youth characteristics. Youths in clinics using the Leadership and Organizational Change for Implementation strategy experienced significantly higher MBC fidelity compared with youths in control clinics (23.1% vs 3.4%, p = .014), and exhibited significantly greater reductions in symptoms from baseline to 6 months (d = 0.31, 95% CI: 0.04-0.58, p = .023). CONCLUSION Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services. CLINICAL TRIAL REGISTRATION INFORMATION Working to Implement and Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/; NCT04096274.
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Poole JL, Murphy SL, Foster ER, Sleight AG, Van Denend T, Asher A, Carandang K, Finlayson M, Fogelberg D, Jim HSL, Ledingham A, Packer T, Plow M, Preissner K, Wechsler S, Whibley D. Fatigue as an Understudied Barrier to Participation in Life Roles. OTJR (Thorofare N J) 2023; 43:583-591. [PMID: 37354021 DOI: 10.1177/15394492231180833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Fatigue is one of the most burdensome and disabling symptoms in numerous acute and chronic conditions and is associated with reduced participation in all aspects of daily life, for example, parenting, employment, and socialization. Historically, occupational practitioners played key roles in fatigue management by creating and implementing interventions. The American Occupational Therapy Foundation convened a Planning Grant Collective workshop with the goal to develop collaborative research ideas and proposals to advance the understanding and management of fatigue. Participants from occupational therapy and other disciplines, with expertise with fatigue or who were conducting research on fatigue, participated in a 3-day virtual workshop. Four main topics emerged: implementation science, treatment taxonomy, trial design and comparative effectiveness, and phenotyping. This white paper describes the proceedings, summarizes the discussions, and outlines recommendations from the PGC workshop on fatigue.
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Affiliation(s)
| | | | | | | | | | - Arash Asher
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | | | | | - Tanya Packer
- Dalhousie University, Halifax, Nova Scotia, Canada
- Umeå University, Sweden
| | - Matthew Plow
- Case Western Reserve University, Cleveland, OH, USA
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Constien D, Chan KK, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips L“R, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:1299-1311. [PMID: 37227071 PMCID: PMC10947582 DOI: 10.1002/art.42507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R. England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | | | - Jennifer L. Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | - Carole V. Dodge
- University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY
| | | | | | | | | | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Chris Y. Lane
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, TN
| | | | | | | | | | - Louise Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Rubino S, Battistone MJ, Ardoin SP, Berlan ED, Carandang K, Chiseri K, Kavanaugh A, White W, Wise KA, Wong AL, Marston B, Clowse MEB. Bringing Reproductive Health Guidelines Into Fellowship Training: A National Survey of Adult and Pediatric Rheumatology Fellows and Program Directors. Arthritis Care Res (Hoboken) 2023. [PMID: 37489092 DOI: 10.1002/acr.25203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/05/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE This study seeks to assess rheumatology fellows' (RFs') and program directors' (PDs') interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease. METHODS Constructs were conceptualized in four dimensions: 1) RF and PD confidence in their current curriculum relating to the American College of Rheumatology (ACR) Reproductive Health Guidelines (RHGs), 2) personal interest in this topic, 3) opinions of the importance of this topic, and 4) interest in a range of learning materials and educational experiences. The final survey was distributed to 753 RFs and 179 PDs in the United States using the ACR Committee on Training and Workforce email list. RESULTS Response rates were 13% (n = 98) for RFs and 25% (n = 44) for PDs. Both groups indicated more interest in the topic than confidence in their curriculum and rated summary sheets, question banks, didactics, and online modules higher than nine other educational tools or methods. Despite interest in the topic, 38% of RF respondents and 24% of PD respondents were unaware of the recently published ACR RHGs. CONCLUSION RFs and PDs consider reproductive health very important and report high personal interest in this topic. In contrast, both groups indicated lower confidence in current curricula, and substantial proportions of both groups were unaware of recently published guidelines. RFs' and PDs' interests in specific educational modalities are aligned. Curriculum development efforts should prioritize summary sheets, question banks, didactics, and online modules. Efforts are needed to address the educational needs of practicing rheumatologists and other professionals caring for patients with rheumatic disease.
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Affiliation(s)
| | - Michael J Battistone
- University of Utah, George E. Wahlen Veterans Affairs, and Salt Lake City Health Care System, Salt Lake City, Utah
| | | | | | | | - Kate Chiseri
- American College of Rheumatology, Atlanta, Georgia
| | | | - Whitney White
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | | | - Andrew L Wong
- University of California Los Angeles Medical Center, Sylmar
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Chan KK, Constien D, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips LR, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023. [PMID: 37227116 DOI: 10.1002/acr.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | | | | | | | - Carole V Dodge
- University of Michigan Hospital and Health System, Ann Arbor
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | | | | | | | - Janet Lewis
- University of Virginia, Charlottesville, Virginia
| | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, California
| | | | - Neha Shah
- Stanford Health Care, Palo Alto, California
| | | | | | - Rawan AlHeresh
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | | | - Linda C Li
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, Tennesee
| | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Baker NA, Carandang K, Dodge C, Poole JL. Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023. [PMID: 37227065 DOI: 10.1002/acr.25122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/26/2023]
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Rapoport C, Wells C, Torres G, Ortiz-Maldonado R, Venkatachalam S, Stradford L, Gavigan K, Boyd-Floering B, Danila MI, Nowell WB, Carandang K. Balancing COVID-19 Risk With Physical and Mental Wellness: Perspectives of Patients With Autoimmune Rheumatic Diseases Throughout the Pandemic. ACR Open Rheumatol 2023. [PMID: 37170755 DOI: 10.1002/acr2.11551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Patients with autoimmune rheumatic diseases (ARDs) are at greater risk of COVID-19 infection and hospitalization, increasing the stress and uncertainty already associated with unpredictable conditions. These may be heightened for patients with ARDs from underrepresented minority backgrounds. This study aimed to explore patient experiences and ARD-related challenges during the first year of the pandemic. METHODS Between December 2020 and May 2021, 60-minute semistructured interviews were conducted with English- and Spanish-speaking adults, aged 18 years or older with self-reported diagnosis of ARD, via phone or videoconferencing using an interview guide on living with an ARD during the pandemic. Analysis combined methods of phenomenology and content analysis through three steps: 1) summarizing interviews, 2) iteratively refining units of meaning, and 3) axial and selective coding to determine cross-cutting themes. Study procedures were conducted by a multidisciplinary team, a majority also diagnosed with ARDs. RESULTS The research team interviewed 22 patients (39.8 ± 15.7 years old; 82.8% female; 31.8% Hispanic or Latino/a/x) with ARDs. Themes included 1) information access and understanding, 2) problem solving access to health care, 3) balancing risks, and 4) mental health implications. Within these themes, patients from underrepresented minority backgrounds faced unique challenges. CONCLUSION Patients with ARDs require direct and timely communication about their risk of COVID-19 morbidity and mortality and require increased support for psychosocial and ARD-related implications of the pandemic. Health care systems must consider ways to support patients who are balancing chronic disease management with risk reduction for contracting emerging COVID-19 variants.
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Affiliation(s)
- Chelsea Rapoport
- San Diego State University and University of California San Diego Joint Doctoral Program, San Diego, California
| | - Courtney Wells
- University of Wisconsin-River Falls, River Falls, Wisconsin, USA
| | - Guadalupe Torres
- University of Wisconsin-River Falls, River Falls, Wisconsin, USA
| | | | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Maria I Danila
- University of Alabama at Birmingham and Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Kristine Carandang
- Global Healthy Living Foundation, Upper Nyack, New York
- Young Patients' Autoimmune Research and Empowerment Alliance, University of Wisconsin-River Falls, River Falls, WI
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Chang JC, Sears C, Bitencourt N, Peterson R, Alperin R, Goh YI, Overbury RS, Sadun R, Smitherman E, White PH, Lawson EF, Carandang K. Implementation of Rheumatology Health Care Transition Processes and Adaptations to Systems Under Stress: A Mixed-Methods Study. Arthritis Care Res (Hoboken) 2023; 75:689-696. [PMID: 34806346 DOI: 10.1002/acr.24822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Despite poor health care transition outcomes among young adults with pediatric rheumatic diseases, adoption of transition best practices is low. We sought to understand how structured transition processes were operationalized within pediatric rheumatology practices and what factors were perceived to enable adaptations during a global pandemic. METHODS We conducted a mixed methods study of team leaders' experiences during an interim analysis of a pilot project to implement transition policy discussions at sites in the Childhood Arthritis and Rheumatology Research Alliance Transition Learning Collaborative. We combined quantitative assessments of organizational readiness for change (9 sites) and semistructured interviews of team leaders (8 sites) using determinants in the Exploration, Preparation, Implementation, Sustainment Framework. RESULTS Engagement of nursing and institutional improvement efforts facilitated decisions to implement transition policies. Workflows incorporating educational processes by nonphysicians were perceived to be critical for success. When the pandemic disrupted contact with nonphysicians, capacity for automation using electronic medical record (EMR)-based tools was an important facilitator, but few sites could access these tools. Sites without EMR-based tools did not progress despite reporting high organizational readiness to implement change at the clinic level. Lastly, educational processes were often superseded by acute issues, such that youth with greater medical/psychosocial complexity may not receive the intervention. CONCLUSION We generated several considerations to guide implementation of transition processes within pediatric rheumatology from the perspectives of team leaders. Careful assessment of institutional and nursing support is advisable before conducting complex transition interventions. Ideally, new strategies would ensure interventions reach youth with high complexity.
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Affiliation(s)
- Joyce C Chang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and Boston Children's Hospital, Boston, Massachusetts
| | - Cora Sears
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Rosemary Peterson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and Dell Children's Medical Center, Austin, Texas
| | | | - Y Ingrid Goh
- The Hospital for Sick Children, Toronto, Ontario, Canada, and SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Rebecca Sadun
- Duke University Medical Center, Durham, North Carolina
| | | | - Patience H White
- Got Transition, The National Alliance to Advance Adolescent Health, and School of Medicine and Health Sciences, George Washington University, Washington, DC
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Kuhn KA, Stahly A, Konig MF, Carandang K, Herndon C, Backman C, Callahan LF, Schulert G, Fraenkel L, Ogdie A. Impact of the COVID-19 Pandemic on Early Career Investigators in Rheumatology: Recommendations to Address Challenges to Early Research Careers. Arthritis Care Res (Hoboken) 2022; 75:947-955. [PMID: 36342380 PMCID: PMC9877547 DOI: 10.1002/acr.25055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has impacted the careers of trainees and early career investigators (ECIs). We sought to assess how the American College of Rheumatology (ACR) and the Rheumatology Research Foundation (RRF) can address the needs of those pursuing research careers. METHODS The Committee on Research created a survey to assess the impact of COVID-19 and identify topics for the ACR and the RRF to address. In fall of 2020, we surveyed postdoctoral trainees and ECIs within 9 years of terminal training. Responses were analyzed using descriptive statistics and qualitative content analysis. RESULTS Twenty-one percent of invitees responded to the survey (n = 365); of these, 60% were pursuing careers in academic research. Seventy-five percent of respondents in academic research career paths placed their primary projects on hold during the pandemic. The number of individuals pursuing a research career from 2020 to 2021 decreased by 5%. Respondents reported funding, caregiving, and lack of preliminary data as significant challenges. Suggested impactful interventions included increased funding, funding process reform, and expanding mentoring and networking resources. CONCLUSION Major stressors identified during the pandemic included increased caregiving responsibilities and difficulty obtaining data and funding, for which respondents suggested increases and changes in funding programs as well as more mentoring and networking opportunities. Based on these, the Committee on Research proposes 3 priorities: 1) flexible funding mechanisms for ECIs and additional support for those impacted by caregiving; 2) virtual and in-person programs for career development and networking; and 3) curated content relevant to building a research career available on demand.
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Affiliation(s)
| | - Andrew Stahly
- University of Colorado Anschutz Medical CampusAurora
| | | | - Kristine Carandang
- Young Patients' Autoimmune Research & Empowerment Alliance and University of Wisconsin‐River FallsRiver Falls
| | | | - Catherine Backman
- The University of British Columbia and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | | | - Grant Schulert
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of MedicineCincinnatiOhio
| | - Liana Fraenkel
- Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of MedicineNew HavenConnecticut
| | - Alexis Ogdie
- Perelman School of Medicine, University of PennsylvaniaPhiladelphia
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Bitencourt N, Lawson E, Bridges J, Carandang K, Chintagunta E, Chiraseveenuprapund P, DeQuattro K, Goh YI, Lee TC, Moore KF, Peterson RG, Roberts JE, Ronis T, Sadun RE, Smitherman EA, Stringer E, White PH, Chang JC. Pediatric to Adult Transition Literature: Scoping Review and Rheumatology Research Prioritization Survey Results. J Rheumatol 2022; 49:1201-1213. [PMID: 35914787 DOI: 10.3899/jrheum.220262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
The transition from pediatric to adult care is the focus of growing research. It is important to identify how to direct future research efforts for maximum effect. Our goals were to perform a scoping review of the transition literature, highlight gaps in transition research, and offer stakeholder guidance on the importance and feasibility of research questions designed to fill identified gaps. The transition literature on rheumatic diseases and other common pediatric-onset chronic diseases was grouped and summarized. Based on the findings, a survey was developed and disseminated to pediatric rheumatologists and young adults with rheumatic diseases as well as their caregivers. The transitional care needs of patients, healthcare teams, and caregivers is well described in the literature. While various transition readiness scales exist, no longitudinal posttransfer study confirms their predictive validity. Multiple outcome measures are used alone or in combination to define a successful transition or intervention. Multimodal interventions are most effective at improving transition-related outcomes. How broader health policy affects transition is poorly studied. Research questions that ranked highest for importance and feasibility included those related to identifying and tracking persons with psychosocial vulnerabilities or other risk factors for poor outcomes. Interventions surrounding improving self-efficacy and health literacy were also ranked highly. In contrast to healthcare teams (n = 107), young adults/caregivers (n = 23) prioritized research surrounding improved work, school, or social function. The relevant transition literature is summarized and future research questions prioritized, including the creation of processes to identify and support young adults vulnerable to poor outcomes.
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Affiliation(s)
- Nicole Bitencourt
- N. Bitencourt, MD, Department of Pediatrics, Loma Linda University Medical Center, Loma Linda, California, USA;
| | - Erica Lawson
- E. Lawson, MD, Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, California, USA
| | - John Bridges
- J. Bridges, MD, MS, Division of Pediatric Rheumatology/Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristine Carandang
- K. Carandang, PhD, OTR/L, Patients' Autoimmune Research & Empowerment Alliance, University of Wisconsin-River Falls, River Falls, Wisconsin, USA
| | - Ela Chintagunta
- E. Chintagunta, Patient Partner, Childhood Arthritis Rheumatology Research Alliance, Washington, DC, USA
| | - Peter Chiraseveenuprapund
- P. Chiraseveenuprapund, MD, Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, and Kawasaki Disease, University of California, San Diego, San Diego, California, USA
| | - Kimberly DeQuattro
- K. DeQuattro, MD, MM, Department of Medicine, Division of Rheumatology, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania, USA
| | - Y Ingrid Goh
- Y.I. Goh, PhD, Division of Rheumatology, The Hospital for Sick Children; Child Health Evaluative Services, SickKids Research Institute, Toronto, Ontario, Canada
| | - Tzielan C Lee
- T.C. Lee, MD, Pediatric Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Katharine F Moore
- K.F. Moore, MD, Section of Pediatric Rheumatology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rosemary G Peterson
- R.G. Peterson, MD, MSCE, Department of Pediatrics, Division of Pediatric Rheumatology, Dell Medical School at UT Austin, Austin, Texas, USA
| | - Jordan E Roberts
- J.E. Roberts, MD, J.C. Chang, MD, MSCE, Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tova Ronis
- T. Ronis, MDCM, Pediatric Rheumatology, Children's National Hospital, Department of Pediatrics, George Washington University, Washington DC, USA
| | - Rebecca E Sadun
- R.E. Sadun, MD, PhD, Department of Pediatric and Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily A Smitherman
- E.A. Smitherman, MD, MS, Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Stringer
- E. Stringer, MD, MSc, FRCPC, Associate Professor of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patience H White
- P.H. White, MD, MA, Got Transition National Center, National Alliance to Advance Adolescent Health, Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Joyce C Chang
- J.E. Roberts, MD, J.C. Chang, MD, MSCE, Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
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Pyatak EA, Carandang K, Rice Collins C, Carlson M. Optimizing Occupations, Habits, and Routines for Health and Well-Being With Lifestyle Redesign®: A Synthesis and Scoping Review. Am J Occup Ther 2022; 76:23905. [PMID: 36053733 DOI: 10.5014/ajot.2022.049269] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Lifestyle Redesign® originated as a preventive occupational therapy intervention for healthy older adults, and it was found to be both effective and cost effective in the Well Elderly Studies initiated in the 1990s. Building on that empirical foundation, the scope of Lifestyle Redesign has been greatly expanded as a general intervention framework addressing prevention and chronic condition management in a wide range of populations, settings, and conditions. Yet until now, its full scope, defining characteristics, and supporting evidence have not been clearly and succinctly described, limiting its potential reach and impact. OBJECTIVE To outline the definition and key characteristics of Lifestyle Redesign, provide a scoping review of its evidence base and future directions for research, describe its current applications, and make recommendations for its use in clinical practice. EVIDENCE REVIEW We searched PubMed and CINAHL, tables of contents of 10 occupational therapy journals, and citations in two seminal Lifestyle Redesign publications to identify articles published in 1997-2020 that described quantitative outcomes (for n ≥ 20) of interventions meeting the defining characteristics of Lifestyle Redesign. FINDINGS Our scoping review yielded 12 publications providing supportive evidence for Lifestyle Redesign's positive impact on a range of health and well-being outcomes among both well populations and those with chronic conditions. CONCLUSIONS AND RELEVANCE Lifestyle Redesign has the potential to meet a growing need in clinical and community settings for health care services that address prevention, health promotion, and chronic disease management. What This Article Adds: Current evidence supports the use of Lifestyle Redesign to improve health and well-being for a range of client populations. This review outlines its defining characteristics and current applications to improve its implementation in clinical practice and expand related research efforts.
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Affiliation(s)
- Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDCES, DipACLM, FAOTA, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Kristine Carandang
- Kristine Carandang, PhD, OTR/L, is Research Scientist, San Diego, CA, and Co-Lead, Young Patients' Autoimmune Research and Empowerment Alliance, River Falls, WI
| | - Chantelle Rice Collins
- Chantelle Rice Collins, OTD, OTR/L, CDCES, is Associate Professor of Clinical Occupational Therapy, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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El Mikati IK, Khabsa J, Harb T, Khamis M, Agarwal A, Pardo-Hernandez H, Farran S, Khamis AM, El Zein O, El-Khoury R, Schünemann HJ, Akl EA, Alonso-Coello P, Alper BS, Amer YS, Arayssi T, Barker JM, Bouakl I, Boutron I, Brignardello-Petersen R, Carandang K, Chang S, Chen Y, Cuker A, El-Jardali F, Florez I, Ford N, Grove J, Guyatt GH, Hazlewood GS, Kredo T, Lamontagne F, Langendam MW, Lewin S, Macdonald H, McFarlane E, Meerpohl J, Munn Z, Murad MH, Mustafa RA, Neumann I, Nieuwlaat R, Nowak A, Pardo JP, Qaseem A, Rada G, Righini M, Rochwerg B, Rojas-Reyes MX, Siegal D, Siemieniuk R, Singh JA, Skoetz N, Sultan S, Synnot A, Tugwell P, Turner A, Turner T, Venkatachalam S, Welch V, Wiercioch W. A Framework for the Development of Living Practice Guidelines in Health Care. Ann Intern Med 2022; 175:1154-1160. [PMID: 35785533 DOI: 10.7326/m22-0514] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Living practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence. OBJECTIVE To develop a framework that characterizes the processes of development of living practice guidelines in health care. DESIGN First, 3 background reviews were conducted: a scoping review of methods papers, a review of handbooks of guideline-producing organizations, and an analytic review of selected living practice guidelines. Second, the core team drafted the first version of the framework. Finally, the core team refined the framework through an online survey and online discussions with a multidisciplinary international group of stakeholders. SETTING International. PARTICIPANTS Multidisciplinary group of 51 persons who have experience with guidelines. MEASUREMENTS Not applicable. RESULTS A major principle of the framework is that the unit of update in a living guideline is the individual recommendation. In addition to providing definitions, the framework addresses several processes. The planning process should address the organization's adoption of the living methodology as well as each specific guideline project. The production process consists of initiation, maintenance, and retirement phases. The reporting should cover the evidence surveillance time stamp, the outcome of reassessment of the body of evidence (when applicable), and the outcome of revisiting a recommendation (when applicable). The dissemination process may necessitate the use of different venues, including one for formal publication. LIMITATION This study does not provide detailed or practical guidance for how the described concepts would be best implemented. CONCLUSION The framework will help guideline developers in planning, producing, reporting, and disseminating living guideline projects. It will also help research methodologists study the processes of living guidelines. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Ibrahim K El Mikati
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon (I.K.M., J.K.)
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon (I.K.M., J.K.)
| | - Tarek Harb
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon (T.H.)
| | - Mohamed Khamis
- Emergency Medicine Department, American University of Beirut, Beirut, Lebanon (M.K.)
| | - Arnav Agarwal
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada, and MAGIC Evidence Ecosystem Foundation, Oslo, Norway (A.A.)
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, and CIBER Epidemiología y Salud Pública, Madrid, Spain (H.P.)
| | - Sarah Farran
- Clinical Pathology Department, American University of Beirut, Beirut, Lebanon (S.F.)
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom (A.M.K.)
| | - Ola El Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon (O.E.)
| | - Rayane El-Khoury
- Infectious Disease Epidemiology Group and World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar (R.E.)
| | - Holger J Schünemann
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (H.J.S.)
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (E.A.A.)
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15
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Carandang K, Wells CK, Guglielmo D, Melcher K, Trimble M, Ardoin SP, Chira P. Adolescents' and Young Adults' Recommendations for Implementing Healthcare Transition in Rheumatology: A Mixed Methods Study. Arthritis Care Res (Hoboken) 2022; 75:1228-1237. [PMID: 35771592 DOI: 10.1002/acr.24977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal was to elicit adolescents' and young adults' (AYAs) perspectives about how to implement the Six Core Elements of Healthcare Transition within rheumatology care. METHODS AYAs (ages 16-28 years old) with self-reported rheumatic conditions were recruited through patient organizations and social media. In Phase One (qualitative [QUAL]), 90-minute focus groups were facilitated to elicit AYAs' reactions to Six Core Elements content. In Phase Two (quantitative; QUAN), a national survey was conducted to determine generalizability of recommendations extracted from Phase One. Mixed methods analyses were conducted by a multidisciplinary team of social science researchers, pediatric rheumatologists, and patients. RESULTS Although focus group participants (n = 39) were previously unfamiliar with the Six Core Elements, they reacted favorably to its format and content. Participants provided suggestions for how to logistically execute each component in the clinic. Additionally, 3 overarching recommendations emerged that focused on motivating AYAs to engage: 1) frame health care transition as an opportunity for empowerment; 2) implement a structured education plan; and 3) consider the role of parents. In line with qualitative findings, survey participants (n = 137) reported that they would prefer to learn most transitional skills from and discuss developmentally specific topics with their rheumatology team. Participants reported they would likely complete programs to learn transitional skills from allied professionals, via patient portals, or in group settings. CONCLUSION Incorporating patient perspectives into research and clinical practice is an opportunity to strengthen educational programs. AYAs emphasized the importance of gaining independence and becoming empowered through the health care transition process with structured support from their rheumatology teams.
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Affiliation(s)
- Kristine Carandang
- University of California San Diego, La Jolla, and Child and Adolescent Services Research Center, San Diego, California
| | | | - Dana Guglielmo
- Independent Researcher/Data Analyst, Los Angeles, California
| | | | | | - Stacy P Ardoin
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Peter Chira
- University of California San Diego, La Jolla
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Poole JL, Connolly D, Carandang K. POS1509-HPR CHANGES IN SELF-EFFICACY AND USE OF ENERGY CONSERVATION STRATEGIES FOLLOWING PARTICIPATION IN THE FATIGUE MANAGEMENT EDUCATION FOR INDIVIDUALS WITH SYSTEMIC SCLEROSIS (FAME-iSS). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFatigue is one of the most prevalent and disabling symptom of systemic sclerosis (SSc). No fatigue specific programs exist for people with SSc despite the negative impact on daily life activities. However, recent literature has shown that using pacing and other energy conservation strategies, has been associated with reduction in fatigue.ObjectivesThe purpose of this pilot study was to evaluate changes in self-efficacy and use of energy conservation strategies after participation in Fatigue and Activity Management Education for Individuals with Systemic Sclerosis (FAME-iSS).MethodsAdult participants were recruited from the Scleroderma Foundation chapters and social media to participate in a 6-week, virtual group program focused on SSc-related fatigue. Inclusion criteria: ≥18 years of age, access to device with videoconferencing capabilities, and at least moderate fatigue determined by degree, severity, and distress (scales: 1-10). The program, led by occupational therapists included sessions on factors related to fatigue, management of energy, pain, stress, physical activity and nutrition. At baseline, participants completed a demographic questionnaire, the Self-Efficacy for Performing Energy Conservation Strategies Assessment (SEPESCA) to measure confidence using energy conservation strategies. At post-intervention and 3-month follow-up, participants also completed the Energy Conservation Strategies Survey (ECSS) to identify use and effectiveness of 14 energy conservation strategies (e.g. changing body positions, planning and prioritizing, communicating needs) and a qualitative interview to contextualize their responses. Descriptive statistics (means, standard deviations) were used to analyze quantitative data.ResultsThe sample for the pilot study included 18 participants (89% women; age 52 ± 11.6 years) with established SSc (disease duration= 13.7 ± 14.5 years). 83% participants completed 100% of FAME-iSS sessions.Directly following the program all 14 energy conservation strategies were used by at least seven (39%) participants. The most frequently used strategy was “planned day to balance rest and activity” which was used by 17 participants post-intervention. (see Table 1). At the three-month follow-up the there was a decline in use for 50% of the strategies and an increase in use for the other 50%. Of those who reported not using energy conservation strategies, the most frequent reason provided by participants was that they were already using the strategy prior to attending FAME-iSS. The mean strategy effectiveness scores varied at both time points with “adjusting priorities” the most effective strategy at T2 and “delegating activities” the most effective at T3. While not statistically significant, participants trended towards improved self-efficacy scores for energy conservation strategies (baseline: 6.8 (2) post-intervention: 8.1 (1.4); 3-month follow-up: 8.4 (2.8) Participants qualitatively reported that FAME-iSS led to the sharing of new fatigue management strategies and increased attention to their daily activities.ConclusionThis pilot study showed that FAME-iSS resulted in increased self-efficacy in use of energy conservation strategies in participants with established SSc. New behaviors were adapted that participants felt reduced their fatigue. The virtual format allowed for sharing of strategies and availability to more people.Disclosure of InterestsNone declared
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Carandang K, Poole J, Connolly D. Fatigue and activity management education for individuals with systemic sclerosis: Adaptation and feasibility study of an intervention for a rare disease. Musculoskeletal Care 2022; 20:593-604. [PMID: 35124888 PMCID: PMC9544914 DOI: 10.1002/msc.1617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 01/01/2023]
Abstract
Purpose Fatigue is an overlooked symptom for musculoskeletal diseases, including rare conditions like systemic sclerosis (SSc). The purpose of this study were the following: (1) to adapt the content and delivery method of an existing fatigue intervention, and (2) to determine the feasibility of Fatigue and Activity Management Education in Systemic Sclerosis (FAME‐iSS). Methods In Phase 1 adaptations were recorded using the Framework for Modification and Adaptations. In Phase 2, participants completed the 6‐week FAME‐iSS intervention and baseline, post‐intervention, and 3‐month follow‐up assessments measuring fatigue levels, fatigue impact, mental health, self‐efficacy, and use of energy conservation strategies. Qualitative data included a post‐intervention focus group and 3‐month follow‐up interviews. Results Three main changes were made to the original intervention: (1) the content was adapted from management of Lupus‐related fatigue to management of SSc‐related fatigue, (2) context for delivery from Ireland to United States, and (3) in‐person to online format. Participants (n = 4) were 51.8 ± 12.1 years old, had been diagnosed with SSc for 12.0 ± 8.0 years, were receiving disability support, and had college degrees. All participants had 100% attendance and completed all study activities. Participants had positive comments about the programme format, content, and implementation. Post‐intervention, improvements were observed in most measures. Moderate effect sizes were noted in fatigue and self‐efficacy scores. Conclusion Participants' positive responses supported the need for FAME‐iSS for people with SSc. Even with the small sample, FAME‐iSS led to improvements in fatigue and use of energy conservation strategies. The online format allowed for participation and sharing of ideas, especially during the global pandemic.
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Affiliation(s)
- Kristine Carandang
- Child and Adolescent Services Research Center, San Diego, California, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Fraenkel L, Bathon JM, England BR, St.Clair EW, Arayssi T, Carandang K, Deane KD, Genovese M, Huston KK, Kerr G, Kremer J, Nakamura MC, Russell LA, Singh JA, Smith BJ, Sparks JA, Venkatachalam S, Weinblatt ME, Al-Gibbawi M, Baker JF, Barbour KE, Barton JL, Cappelli L, Chamseddine F, George M, Johnson SR, Kahale L, Karam BS, Khamis AM, Navarro-Millán I, Mirza R, Schwab P, Singh N, Turgunbaev M, Turner AS, Yaacoub S, Akl EA. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:924-939. [PMID: 34101387 PMCID: PMC9273041 DOI: 10.1002/acr.24596] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. METHODS We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). CONCLUSION This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.
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Affiliation(s)
- Liana Fraenkel
- Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of Medicine, New Haven, Connecticut
| | - Joan M. Bathon
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York
| | - Bryant R. England
- University of Nebraska Medical Center and VA Nebraska–Western Iowa Health Care System, Omaha, Nebraska
| | | | | | | | | | - Mark Genovese
- Stanford University Medical Center, Palo Alto, California
| | - Kent Kwas Huston
- The Center for Rheumatic Disease/Allergy and Immunology, Kansas City, Missouri
| | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University, Washington, DC
| | - Joel Kremer
- Albany Medical College and The Center for Rheumatology, Albany, New York
| | | | | | - Jasvinder A. Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Benjamin J. Smith
- State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | - Jeffrey A. Sparks
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Joshua F. Baker
- Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jennifer L. Barton
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | | | | | | | - Sindhu R. Johnson
- Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lara Kahale
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Reza Mirza
- University of Toronto, Toronto, Ontario, Canada
| | - Pascale Schwab
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | | | | | | | | | - Elie A. Akl
- American University of Beirut, Beirut, Lebanon
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Fraenkel L, Bathon JM, England BR, St Clair EW, Arayssi T, Carandang K, Deane KD, Genovese M, Huston KK, Kerr G, Kremer J, Nakamura MC, Russell LA, Singh JA, Smith BJ, Sparks JA, Venkatachalam S, Weinblatt ME, Al-Gibbawi M, Baker JF, Barbour KE, Barton JL, Cappelli L, Chamseddine F, George M, Johnson SR, Kahale L, Karam BS, Khamis AM, Navarro-Millán I, Mirza R, Schwab P, Singh N, Turgunbaev M, Turner AS, Yaacoub S, Akl EA. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 2021; 73:1108-1123. [PMID: 34101376 DOI: 10.1002/art.41752] [Citation(s) in RCA: 279] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop updated guidelines for the pharmacologic management of rheumatoid arthritis. METHODS We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. A voting panel comprising clinicians and patients achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The guideline addresses treatment with disease-modifying antirheumatic drugs (DMARDs), including conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs, use of glucocorticoids, and use of DMARDs in certain high-risk populations (i.e., those with liver disease, heart failure, lymphoproliferative disorders, previous serious infections, and nontuberculous mycobacterial lung disease). The guideline includes 44 recommendations (7 strong and 37 conditional). CONCLUSION This clinical practice guideline is intended to serve as a tool to support clinician and patient decision-making. Recommendations are not prescriptive, and individual treatment decisions should be made through a shared decision-making process based on patients' values, goals, preferences, and comorbidities.
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Affiliation(s)
- Liana Fraenkel
- Berkshire Medical Center, Pittsfield, Massachusetts, and Yale University School of Medicine, New Haven, Connecticut, United States
| | - Joan M Bathon
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, United States
| | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, United States
| | | | | | | | | | - Mark Genovese
- Stanford University Medical Center, Palo Alto, California, United States
| | - Kent Kwas Huston
- The Center for Rheumatic Disease/Allergy and Immunology, Kansas City, Missouri, United States
| | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University, Washington, DC, United States
| | - Joel Kremer
- Albany Medical College and The Center for Rheumatology, Albany, New York, United States
| | | | - Linda A Russell
- Hospital for Special Surgery, New York, New York, United States
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States
| | - Benjamin J Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | | | - Michael E Weinblatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | | | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jennifer L Barton
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon, United States
| | - Laura Cappelli
- Johns Hopkins Medicine, Baltimore, Maryland, United States
| | | | | | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lara Kahale
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Reza Mirza
- University of Toronto, Toronto, Ontario, Canada
| | - Pascale Schwab
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon, United States
| | | | - Marat Turgunbaev
- American College of Rheumatology, Atlanta, Georgia, United States
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia, United States
| | | | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
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Sklar M, Reeder K, Carandang K, Ehrhart MG, Aarons GA. An observational study of the impact of COVID-19 and the rapid implementation of telehealth on community mental health center providers. Implement Sci Commun 2021; 2:29. [PMID: 33706815 PMCID: PMC7948664 DOI: 10.1186/s43058-021-00123-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has remarkably altered community mental health service delivery through the rapid implementation of telehealth. This study reports provider perspectives on the impact that COVID-19 and the transition to telehealth had on their work and their ability to deliver evidence-based practices (EBPs). METHODS Providers (n = 93) completed online surveys with quantitative measures and open-ended items exploring their reactions to COVID-19 and to the transition to providing services via telehealth. RESULTS Perceptions of personal risk and rumination around COVID-19 were low, while telehealth was viewed positively by providers. Three major themes emerged regarding the major impacts of COVID-19 on work: (1) the altered nature of interactions between patient/client and provider due to telehealth implementation, (2) changes in provider expectations regarding productivity, and (3) challenges maintaining work-life balance. In regard to the major impacts of COVID-19 on EBP delivery, three themes emerged: (1) increased difficulty delivering certain therapies via telehealth, (2) potential limitations to session confidentiality, and (3) challenge of engaging children in telehealth. CONCLUSIONS In the context of the COVID-19 pandemic, community mental health providers continued to engage with clients and deliver EBPs while navigating a number of changes related to the rapid transition to and implementation of telehealth. This study highlights the need for further work on what supports providers need to effectively engage with clients and deliver EBPs via telehealth, and has implications for how telehealth is sustained or de-implemented post-COVID-19.
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Affiliation(s)
- Marisa Sklar
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
| | - Kendal Reeder
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- University of California Los Angeles Department of Psychology, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563 USA
| | - Kristine Carandang
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Mark G. Ehrhart
- University of Central Florida Department of Psychology, P.O. Box 161390, Orlando, FL 32816-1390 USA
| | - Gregory A. Aarons
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
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21
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Hatch MR, Carandang K, Moullin JC, Ehrhart MG, Aarons GA. Barriers to Implementing Motivational Interviewing in Addiction Treatment: A Nominal Group Technique Process Evaluation. Implement Res Pract 2021; 2. [PMID: 35211677 DOI: 10.1177/26334895211018400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders' perceptions of each barrier's influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness.
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Affiliation(s)
- Mellissa R Hatch
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | | | - Joanna C Moullin
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
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22
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Carandang K, Mruk V, Ardoin SP, Huynh B, Clowse MEB, Berlan ED, Edens C. Reproductive health needs of adolescent and young adult women with pediatric rheumatic diseases. Pediatr Rheumatol Online J 2020; 18:66. [PMID: 32807193 PMCID: PMC7433038 DOI: 10.1186/s12969-020-00460-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify reproductive health knowledge gaps and topics that concern adolescent and young adult (AYA) women with pediatric rheumatic diseases and their parents. METHODS Data collection occurred in two cohorts. In the first cohort, young women (15-20 years old) with pediatric-onset rheumatic conditions and their parents were recruited from a single, academic pediatric rheumatology center. In the second cohort, young women (18-25 years old) with pediatric-onset rheumatic conditions were recruited from a national conference for families with pediatric rheumatic diseases. This resulted in 20 adolescents and young adults (18.3 ± 2.4 years old), and 7 parent focus group participants. Focus group leaders facilitated discussions centered on reproductive health topics that participants identified as important, their sources of knowledge, and preferences for patient education and ongoing follow-up. Data were summarized independently by 4 researchers to reduce potential bias and subsequently analyzed using rapid qualitative analysis. RESULTS All participants, regardless of diagnosis, medication, current sexual activity, or current intention to have children, expressed concern about the effect of their rheumatic condition and medications on fertility, risks to mother and child during and after pregnancy, and obtaining safe and effective contraception. Additionally, some participants discussed the burden of disease and its potential impact on motherhood. Finally, participants raised concern around the effect of disease and medication on routine reproductive health care, such as menstrual cycles, feminine self-care, and preventive exams. Three themes emerged: 1) participants had been advised to avoid unplanned pregnancy, however reported receiving inadequate explanation to support this instruction, 2) participants conceptualized reproductive health as tied to rheumatic disease management and thus suggested ways to include family members in discussion, and 3) rheumatology practitioners were not considered a resource of reproductive health information. CONCLUSIONS Young women and their parents reported dissatisfaction with the availability, quantity, and quality of reproductive health information they received, particularly when related to their pediatric-onset rheumatic disease. These findings provide an initial step in understanding the patient perspective of reproductive health in rheumatology, and how to address these concerns in the care of young women with rheumatic diseases.
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Affiliation(s)
- Kristine Carandang
- Department of Psychiatry, University of California, La Jolla, San Diego, California, USA. .,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, California, 92123, USA.
| | - Veronica Mruk
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Stacy P. Ardoin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Brittany Huynh
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
| | - Megan E. B. Clowse
- grid.189509.c0000000100241216Duke University Medical Center, Durham, North Carolina USA
| | - Elise D. Berlan
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Cuoghi Edens
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL USA
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Sklar M, Reeder K, Carandang K, Ehrhart MG, Aarons GA. An Observational Study of the Impact of COVID-19 and the Transition to Telehealth on Community Mental Health Center Providers. Res Sq 2020. [PMID: 32793893 PMCID: PMC7402050 DOI: 10.21203/rs.3.rs-48767/v1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: The COVID-19 pandemic has swiftly and remarkably altered community mental health service delivery and evidence-based practice (EBP) implementation. This study reports provider perspectives on the impact that COVID-19 had on their work and EBP implementation. Methods: Providers (n = 93) completed online surveys with quantitative measures and open-ended items targeting their responses and/or reactions to COVID-19, and to the transition to providing services via telehealth. Results: Perceptions of personal risk and rumination around COVID-19 were low, while telehealth was viewed positively by providers. Three major themes emerged regarding the major impacts of COVID-19 on work: 1) the altered nature of interactions between patient/client and provider, 2) changes in provider expectations regarding productivity, and 3) challenges maintaining work-life balance. In regard to the major impacts of COVID-19 on EBP implementation, three themes emerged: 1) increased difficulty delivering certain therapies via telehealth, 2) potential limitations to session confidentiality, and 3) challenge of engaging children in telehealth. Conclusions: In the context of the COVID-19 pandemic, community mental health providers continued to engage with clients and implement EBPs while navigating a number of changes related to the transition to telehealth. This study highlights the need for further work on what supports providers need to effectively engage with clients and deliver EBPs via telehealth and has implications for how telehealth is sustained or de-implemented in response to COVID-19.
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24
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Salvy SJ, Carandang K, Vigen CL, Concha-Chavez A, Sequeira PA, Blanchard J, Diaz J, Raymond J, Pyatak EA. Effectiveness of social media (Facebook), targeted mailing, and in-person solicitation for the recruitment of young adult in a diabetes self-management clinical trial. Clin Trials 2020; 17:664-674. [PMID: 32627589 DOI: 10.1177/1740774520933362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Research is needed to identify promising recruitment strategies to reach and engage diverse young adults in diabetes clinical research. The aim of this study was to examine the relative strengths and weaknesses of three recruitment strategies used in a diabetes self-management clinical trial: social media advertising (Facebook), targeted mailing, and in-person solicitation of clinic patients. METHODS Strategies were compared in terms of (1) cost-effectiveness (i.e. cost of recruitment/number of enrolled participants), (2) ability to yield participants who would not otherwise be reached by alternative strategies, and (3) likelihood of participants recruited through each strategy to adhere to study procedures. We further explored the appeal (overall and among age and gender subgroups) of social media advertisement features. RESULTS In-person recruitment of clinic patients was overall the most cost-effective strategy. However, differences in demographic, clinical, and psychosocial characteristics of participants recruited via different strategies suggest that the combination of these approaches yielded a more diverse sample than would any one strategy alone. Once successfully enrolled, there was no difference in study completion and intervention adherence between individuals recruited by the three recruitment strategies. CONCLUSIONS Ultimately, the utility of a recruitment strategy is defined by its ability to effectively attract people representative of the target population who are willing to enroll in and complete the study. Leveraging a variety of recruitment strategies appears to produce a more representative sample of young adults, including those who are less engaged in diabetes care.
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Affiliation(s)
- Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | | | - Cheryl Lp Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
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Carandang K, Poole J. Exploring the Impact of Fatigue on Occupational Engagement of Young Adults With Rheumatic Conditions. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-po4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/05/19
This presentation reports on a qualitative study that explored the impact of fatigue on the occupational engagement of young adults with rheumatic conditions. Young adult participants reported limited success in reducing fatigue, which often interfered with their ability to balance career, home life, and social participation. Results of this study will inform the development of an occupation-based fatigue management intervention tailored to young adults’ age-specific needs.
Primary Author and Speaker: Kristine Carandang
Additional Authors and Speakers: Janet Poole
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Affiliation(s)
| | - Janet Poole
- University of New Mexico, Albuquerque, NM, USA
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26
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Haywood C, Martinez G, Pyatak EA, Carandang K. Engaging Patient Stakeholders in Planning, Implementing, and Disseminating Occupational Therapy Research. Am J Occup Ther 2019; 73:7301090010p1-7301090010p9. [DOI: 10.5014/ajot.2019.731001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Patients1 are experts on their own lives and the ways in which an illness, injury, or disability affects their health, activity, and quality of life. With its longstanding foundations in participatory action research, patient engagement has been gaining momentum across health care and related research. This momentum is supported by investments from several key research and federal policy–related organizations, including the Patient-Centered Outcomes Research Institute, National Institutes of Health, and Agency for Healthcare Research and Quality. Occupational therapy practitioners are uniquely positioned to champion patient collaborations. In this article, we discuss ways in which patient perspectives can be embraced in occupational therapy research, and we share insights from a research planning collaborative with adolescents and young adults that was led by occupational therapy researchers.
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Affiliation(s)
- Carol Haywood
- Carol Haywood, PhD, OTR/L, is Postdoctoral Fellow in Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. At the time of this work, she was a PhD Candidate, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles.
| | - Gabriela Martinez
- Gabriela Martinez, BA, is Patient Research Partner, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Elizabeth A. Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDE, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Kristine Carandang
- Kristine Carandang, PhD, OTR/L, was PhD Candidate, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, at the time of this work
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Vigen CLP, Carandang K, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL, Pyatak EA. Psychosocial and Behavioral Correlates of A1C and Quality of Life Among Young Adults With Diabetes. Diabetes Educ 2018; 44:489-500. [PMID: 30295170 DOI: 10.1177/0145721718804170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate relationships between behavioral and psychosocial constructs, A1C, and diabetes-dependent quality of life (DQoL) among low-socioeconomic status, ethnically diverse young adults with diabetes. METHODS Using baseline data of 81 participants in the Resilient, Empowered, Active Living (REAL) randomized controlled trial, behavioral, cognitive, affective, and experiential variables were correlated with A1C and DQoL while adjusting for demographic characteristics, and these relationships were examined for potential effect modification. RESULTS The data indicate that depressive symptoms and satisfaction with daily activities are associated with both A1C and DQoL, while diabetes knowledge and participation in daily activities are associated with neither A1C nor DQoL. Two constructs, diabetes distress and life satisfaction, were associated with DQoL and were unrelated to A1C, while 2 constructs, self-monitoring of blood glucose and medication adherence, were associated with A1C but unrelated to DQoL. These relationships were largely unchanged by adjusting for demographic characteristics, while numerous effect modifications were found. CONCLUSION The data suggest that when tailoring interventions, depressive symptoms and satisfaction with daily activities may be particularly fruitful intervention targets, as they represent modifiable risk factors that are associated with both A1C and DQoL.
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Affiliation(s)
- Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California
| | - Donna Spruijt-Metz
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | | | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
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Pyatak EA, Carandang K, Vigen CLP, Blanchard J, Diaz J, Concha-Chavez A, Sequeira PA, Wood JR, Whittemore R, Spruijt-Metz D, Peters AL. Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial. Diabetes Care 2018; 41:696-704. [PMID: 29351961 PMCID: PMC5860833 DOI: 10.2337/dc17-1634] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/17/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A1c [HbA1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests. RESULTS Intent-to-treat analyses showed that IG participants showed significant improvement in HbA1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported. CONCLUSIONS The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.
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Affiliation(s)
- Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Alyssa Concha-Chavez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, CA
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, CA
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Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemp Clin Trials 2017; 54:8-17. [PMID: 28064028 DOI: 10.1016/j.cct.2016.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023]
Abstract
OVERVIEW This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist. METHODS In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study's primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity. RESULTS At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrated clinically significant diabetes distress and 27.2% reported symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence. DISCUSSION Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.
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Affiliation(s)
- Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA.
| | - Kristine Carandang
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Cheryl Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, USA
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, Rm. 115, Los Angeles, CA 90033, USA
| | - Jamie R Wood
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, Rm. 115, Los Angeles, CA 90033, USA; Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS # 61, Los Angeles, CA 90027, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, MC 9239, Los Angeles, CA 90089, USA
| | - Robin Whittemore
- Yale School of Nursing, 100 Church Street South, P.O. Box 9740, New Haven, CT 06536-0740, USA
| | - Anne L Peters
- Division of Endocrinology, University of Southern California, 9033 Wilshire Blvd. Suite 406, Beverly Hills, CA 90211, USA
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Abstract
OBJECTIVE In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category. METHOD Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons. RESULTS Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs. CONCLUSION Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.
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Affiliation(s)
- Kristine Carandang
- Kristine Carandang, OTR/L, is PhD Candidate, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDE, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Research Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Pyatak EA, Carandang K, Davis S. Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes. OTJR (Thorofare N J) 2015; 35:187-94. [PMID: 26594741 PMCID: PMC4801110 DOI: 10.1177/1539449215584310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.
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Affiliation(s)
| | | | - Shain Davis
- Achieve Beyond Pediatric Therapy and Autism Services, Whittier, CA, USA
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