[Orientations de facilitation pour soutenir l'application de l'Algo dans les services de soutien à domicile des personnes aînées]

Comment soutenir le déploiement de connaissances coconstruites par des personnes cliniciennes, gestionnaires ou chercheures? Ce thème est abordé à partir de l'étude de l'application de l'Algo, un algorithme clinique décisionnel conçu pour la sélection des aides techniques visant à faciliter l'hygiène corporelle des personnes aînées vivant à domicile. L'objectif de cette note sur les politiques et les pratiques est de présenter les orientations de facilitation dégagées à la suite d'un devis mixte multiphases (2015-2019) mis en œuvre dans les services de soutien à domicile au Québec (Canada). Les orientations de facilitation centrée sur la tâche et holistique sont présentées en fonction des stades d'utilisation de l'Algo, afin de soutenir les personnes cliniciennes, gestionnaires et chercheures dans la poursuite de son application auprès des personnes aînées. De plus, cette note illustre l'apport des devis mixtes à la conduite et à la compréhension de l'application des connaissances coconstruites.

Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: a systematic scoping review and suggestions for future reporting and research

Strategies for dissemination (purposive distribution of a guideline to specific audiences) and implementation (actions to support the general public in meeting guideline recommendations/behavioural benchmarks) of national movement guidelines (physical activity (PA), sedentary behaviour, and sleep) have yet to be synthesized. The purpose of this systematic scoping review was to identify strategies for dissemination and implementation of national PA, sedentary behaviour, and/or sleep guidelines among community-dwelling adults (aged >18 years) and/or stakeholders in Canada and analogous countries. Five search approaches (e.g., published literature, grey literature, targeted web-based, custom Google, and content expert consultation) identified records (e.g., empirical studies, organizational reports, website pages, or guideline messages) that discussed and/or evaluated dissemination or implementation strategies for a prespecified list of guidelines. A modified strategy classification system was developed to chart the data. Forty-seven reports met inclusion criteria. Dissemination strategies (n = 42) were more frequently reported than implementation strategies (n = 24). Implementation strategies were more frequently evaluated (n = 13 vs. 7 dissemination strategies) and associated with positive outcomes. The 13 studies that evaluated strategies were at high or serious risk of bias. We identified limited information about the dissemination and implementation of national movement guidelines and identified strategies were rarely evaluated. Greater efforts are required to increase the impact of guidelines among the general public and stakeholders and to build the evidence base in this field. (Open Science Framework registration: https://osf.io/4tyw3.) Novelty An adapted movement guideline dissemination and implementation strategy classification framework is provided. Knowledge translation efforts should be documented and evaluated to advance science and practice in the movement guideline field.

Knowledge translation of the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: a collaborative movement guideline knowledge translation process

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings. Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.

A Multi-Intervention Campaign Lowers Pediatric and Young Adult Diabetic Ketoacidosis Hospitalizations in a Canadian Province

OBJECTIVES

The Newfoundland and Labrador diabetic ketoacidosis Project (NLdkaP) is a multi-intervention, province-wide project aimed at lowering rates of diabetic ketoacidosis (DKA) within the pediatric and young adult populations.

METHODS

The NLdkaP interventions were first selected, developed and implemented. We then conducted a retrospective study of hospitalization data over three 2-year periods: pre-, during and post-NLdkaP. Data included demographic factors, DKA hospitalizations and length of hospital stay.

RESULTS

There were 412 DKA hospitalizations over the study period. Before the NLdkaP, the provincial hospitalization rate of DKA for patients <25 years of age was 55.61 per 100,000. During the NLdkaP, the rate dropped to 38.48 per 100,000 (p<0.001). After the NLdkaP, the rate rose to 54.53 per 100,000 (p<0.001). Hospitalization rates were highest for females (p<0.001) and for those in the 19- to 24-year age group (p<0.001).

CONCLUSIONS

The NLdkaP was associated with decreased rates of DKA hospitalizations, but the rates remained relatively stable in both the pre- and postintervention periods. Although the approach and resources developed in the NLdkaP appear effective, continuous preventive efforts are needed to sustain reductions in DKA hospitalizations.

Impact of Clinical Practice Guidelines on Blood Glucose Test Strip Prescription Rates in Manitoba and Saskatchewan (Canada): An Interrupted Time-Series Analysis

OBJECTIVES

Our aim in this study was to assess the impact of the Diabetes Canada Dissemination & Implementation strategy on population-level prescription rates of blood glucose test strips.

METHODS

We extracted all diabetes-related drugs and test strip claims in Manitoba and Saskatchewan between January 1, 2000 and September 30, 2015 from the Canadian Institute for Health Information's National Prescription Drug Utilization Information System. The primary outcome was the proportion of the cohort in each quarter who had been dispensed strips in accordance with the Diabetes Canada 2013 guidelines. We conducted an interrupted time-series analysis examining prescribing trends overall and by drug groups.

RESULTS

The overall average sample size per quarter was 57,576 (standard deviation [SD]=12,320) and 49,533 (SD=10,206) individuals; the average age was 62.1 (SD=0.3) and 63.8 (SD=0.3) years, and the average proportion of total beneficiaries in the sample was 12.7% (SD=1.9%) and 12.6% (SD=1.7%) for Manitoba and Saskatchewan, respectively. On average preintervention, 27.9% (SD=0.68%, Manitoba) and 31.9% (SD=0.73%, Saskatchewan) of the sampled patients used strips according to the guidelines. On average postintervention, 26.5% (SD=0.29%, Manitoba) and 30.6% (SD=0.53%, Saskatchewan) of the patients used strips according to the guidelines. None of the interrupted time-series models reached statistical significance (p values ranging from 0.44 to 0.98 for Manitoba and 0.13 to 0.81 for Saskatchewan, depending on drug group).

CONCLUSIONS

The guideline and its Dissemination & Implementation strategy did not change strip prescribing. Potential reasons include complexity of the recommendations, lack of penetrance to primary care physicians and/or disagreement with recommendations.

Environmental Scan on Canadian Interactive Knowledge Translation Tools to Prevent Diabetes Complications in Patients With Diabetes

In this study, we identify existing interactive knowledge translation tools that could help patients and health-care professionals to prevent diabetes complications in the Canadian context. We conducted an environmental scan in collaboration with researchers and 4 patient partners across Canada. We conducted searches among the research team members, their networks and Twitter, and through searches in databases and Google. To be included, interactive knowledge translation tools had to meet the following criteria: used to prevent diabetes complications; used in a real-life setting; used any instructional method or material; had relevance in the Canadian context, written in English or French; developed and/or published by experts in diabetes complications or by a recognized organization; created in 2013 or after; and accessibility online or on paper. Two reviewers independently screened each record for selection and extracted the following data: authorship, objective(s), patients' characteristics, type of diabetes complications targeted, type of knowledge users targeted and tool characteristics. We used simple descriptive statistics to summarize our results. Thirty-one of the 1,700 potentially eligible interactive knowledge translation tools were included in the scan. Tool formats included personal notebook, interactive case study, risk assessment tool, clinical pathway, decision support tool, knowledge quiz and checklist. Diabetes complications targeted by the tools included foot-related neuropathy, cardiovascular diseases, mental disorders and distress and any complications related to diabetes and kidney disease. Our results inform Canadian stakeholders interested in the prevention of diabetes complications to avoid unnecessary duplication, identify gaps in knowledge and support implementation of these tools in clinical and patients' decision-making.

Factors Associated with Publication of Research Projects from a Canadian Master of Science Degree Programme in Physical Therapy

Purpose: The purpose of this study was to describe the nature and extent of publications and to evaluate whether lead advisor role and experience, data collection tool, sample size, and research topic predict publication for research projects completed as part of a Canadian Master of Science in Physical Therapy (MScPT) programme. Method: We conducted a quantitative, cross-sectional, retrospective review of projects completed between 2003 and 2015 and confirmed publication status through citations of published work, a literature search, and a survey of advisors. We used descriptive statistics to describe the nature and extent of publications and logistic regression to analyze potential predictor variables. Results: Between 2003 and 2015, 44.5% of the 218 projects completed were associated with at least one peer-reviewed journal publication, and there was a seven-fold increase in annual publication rate. Projects led by a scientist or researcher ([OR] = 3.09; 95% CI: 1.15, 8.35), qualitative projects with 10 or more participants ([OR] 6.22; 95% CI: 1.96, 19.78), and quantitative projects with more than 50 participants ([OR] = 2.29; 95% CI: 1.14, 4.63) were associated with an increased likelihood of publication. Conclusions: MScPT research is published at a moderate rate, and annual publication rates increased between 2003 and 2015. Encouragement to obtain adequate sample sizes and additional support for clinician-led projects may enhance publication rates and, ultimately, bridge gaps in research-to-practice integration.