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Atkins E, Birmpili P, Kellar I, Glidewell L, Cromwell DA. Documentary analysis of national and international guidance for community clinicians referring patients with suspected chronic limb-threatening ischaemia. BMJ Open Qual 2024; 13:e002784. [PMID: 38769026 PMCID: PMC11110609 DOI: 10.1136/bmjoq-2024-002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Delayed referral of patients with chronic limb-threatening ischaemia (CLTI) from the community to vascular services may increase risk of amputation due to delayed revascularisation. Lack of appropriate guidance for clinicians in the community may contribute to this problem. This documentary analysis investigated referral guidance available to primary care clinicians. METHODS National and international documents providing guidance on CLTI management were identified by searching sources including Medline, Embase, Guidelines International Network and College/Society websites. Data were extracted on referral recommendations, target audience and author groups. Recommendations were coded according to the Behaviour Change Technique Taxonomy. Clinical practice guideline quality and ease of implementation were assessed independently by two reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II and Guideline Implementability Appraisal (GLIA) tools, respectively. RESULTS 12 documents containing guidance on CLTI referrals were included. Five were clinical practice guidelines. Nine targeted clinicians in the community among their audience, yet only one included a primary care clinician in their author group. Recommendations on identification and referral of CLTI were often in non-specific language and frequently assumed specialist knowledge of vascular disease. Just 4 of the 93 behaviour change techniques were identified in the guidance documents. Three relevant domains of the AGREE II tool were scored for five clinical practice guidelines: stakeholder involvement (range 21.4%-52.4%, mean 42.9%), clarity of presentation (range 71.4%-92.9%, mean 82.9%) and applicability (25.0%-57.1%, mean 36.8%). The GLIA tool identified barriers to ease of implementation for all five clinical practice guidelines. CONCLUSIONS Most guidance for clinicians in the community on the management of CLTI has been written without their input and assumes knowledge of vascular disease, which may be lacking. Future guidance development should involve community clinicians, consider using additional behaviour change techniques, and improve the applicability and ease of implementation of recommendations.
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Affiliation(s)
- Eleanor Atkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Hull York Medical School, Hull, UK
| | | | | | - David A Cromwell
- Royal College of Surgeons of England, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Vignatelli L, Tontini V, Meletti S, Camerlingo M, Mazzoni S, Giovannini G, Pasini E, Michelucci R, Bisulli F, Tinuper P, Di Vito L. Clinical practice guidelines on the management of status epilepticus in adults: A systematic review. Epilepsia 2024. [PMID: 38606469 DOI: 10.1111/epi.17982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Status epilepticus (SE) is the second most common neurological emergency in adults. Despite improvements in the management of acute neurological conditions over the last decade, mortality is still durably high. Because a gap has emerged between SE management based on clinical practice guidelines (CPGs) and actual clinical practice, we conducted a systematic review of CPGs, assessing their quality, outlining commonalities and discrepancies in recommendations, and highlighting research gaps. METHODS We searched the PubMed and EMBASE databases and other gray literature sources (nine among guideline registries, evidence-based medicine databases, point-of-care tools; seven websites of governmental organizations and international neurologic societies) in December 2021 (updated in November 2023). The units of analysis were CPGs that included recommendations on the diagnostic and/or therapeutic management of SE in adults. The quality of the CPGs was assessed using the AGREE II tool. RESULTS Fifteen CPGs were included. The "Applicability" domain was assigned the lowest median score of 10%. The domains "Stakeholder Involvement", "Rigor of Development," and "Editorial Independence" were as well generally underrated. Recommendations on general and diagnostic management and on organizational interventions were fragmented and scattered. Recommendations on pre-hospital and hospital treatment of early-onset and refractory SE were broadly agreed, whereas there was less agreement on the treatment model and medications for established SE and super-refractory SE. SIGNIFICANCE The CPGs for the management of SE developed in recent years are flawed by several methodological issues and discrepancies in the coverage of important topics. The gap between CPG-based management of SE and actual clinical practice may be due in part to the inherent limitations of the CPGs produced so far.
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Affiliation(s)
- Luca Vignatelli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Valentina Tontini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Stefano Meletti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara, Modena, Italy
| | - Maria Camerlingo
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna, Bologna, Italy
| | - Stefania Mazzoni
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Giada Giovannini
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile Baggiovara, Modena, Italy
| | - Elena Pasini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Roberto Michelucci
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lidia Di Vito
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
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Abuelgasim KA, Jazieh AR. Quality Measures for Multidisciplinary Tumor Boards and Their Role in Improving Cancer Care. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:28-33. [PMID: 38406654 PMCID: PMC10887491 DOI: 10.36401/jqsh-23-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/09/2023] [Accepted: 10/13/2023] [Indexed: 02/27/2024]
Abstract
While multidisciplinary tumor boards (MTBs) are widely used in managing patients with cancer, their impact on patient care and outcome is not routinely measured in different settings. The authors conducted a literature review in Medline, Google Scholar, Embase, and Web of Science using the following keywords: cancer, multidisciplinary, tumor board, quality performance indicator, lung cancer, and lymphoma. Standards from various accreditation and professional organizations were reviewed to compile relevant standards for MTB. A list of quality performance indicators that can be used to improve MTBs' performance and impact was compiled. Specific examples for non-Hodgkin lymphoma and lung cancer MTBs were presented. Guidance was provided to help MTB team members select implement the appropriate quality measures. The functions and impact of MTBs should be monitored and evaluated by a set of measures that help guide MTBs to improve their performance and provide better care to their patients.
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O'Brien E, Walsh A, Boland F, Collins C, Harkins V, Smith SM, O'Herlihy N, Clyne B, Wallace E. GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study. BJGP Open 2023; 7:BJGPO.2023.0107. [PMID: 37442591 DOI: 10.3399/bjgpo.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND GPs aim to provide patient-centred care combining clinical evidence, clinical judgement, and patient priorities. Despite a recognition of the need to translate evidence to support patient care, barriers exist to the use of evidence in practice. AIM To ascertain the needs and preferences of GPs regarding evidence-based guidance to support patient care. The study also aimed to prioritise content and optimise structure and dissemination of future evidence-based guidance. DESIGN & SETTING This was a convergent parallel mixed-methods study in collaboration with the national GP professional body in the Republic of Ireland (Irish College of General Practitioners [ICGP]). Quantitative and qualitative findings were integrated at the interpretive level. METHOD A national GP survey was administered via the ICGP (December 2020) and seven GP focus groups were undertaken (April-May 2021). RESULTS Of 3496 GPs, a total of 509 responders (14.6%) completed the survey and 40 GP participants took part in focus groups. Prescribing updates, interpretation of test results, chronic disease management, and older person care were the preferred topics for future evidence-based guidance. GPs reported that they required rapid access to up-to-date and relevant evidence summaries online for use in clinical practice. Access to more comprehensive reviews for the purposes of continuing education and teaching was also a priority. Multimodal forms of dissemination were preferred to increase uptake of evidence in practice. CONCLUSION GPs indicated that rapid access to up-to-date, summarised evidence-based resources, available from their professional organisation, is preferred. Evidence should reflect the disease burden of the population and involve multifaceted dissemination approaches.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | | | - Barbara Clyne
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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Dolgoy ND, Al Onazi MM, Parkinson JF, Gudmundsson H, Radke LL, Dennett L, Campbell KL, Harris SR, Keast D, McNeely ML. The Appraisal of Clinical Practice Guidelines for Breast Cancer-Related Lymphedema. Lymphat Res Biol 2023; 21:469-478. [PMID: 37037029 DOI: 10.1089/lrb.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: Approaches to screening, assessment, and treatment of breast cancer-related lymphedema (BCRL) vary widely. We evaluated overall quality of clinical practice guidelines (CPGs) for managing BCRL using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) tool, and relevance of consensus recommendations for the Canadian health context. Methods and Results: We searched electronic databases, gray literature, national lymphedema frameworks, and expert opinions, to identify lymphedema CPGs, printed/published from January 2013 to October 2021. Using AGREE II, six health care professionals reviewed CPGs for consensus. Domain-specific AGREE II quality consensus scores were required (≥70% for Rigor of Development; ≥ 60% for Stakeholder Involvement and Editorial Independence; and ≥50% for Clarity of Presentation, Applicability, Scope, and Purpose). Results and overall recommendations from the CPGs were summarized and synthesized. Nine CPGs met inclusion criteria for review. Wide variability of evidence-based recommendations, and limited clinical considerations were found. Scope and Purpose, and Clarity of Presentation were adequate in six of nine CPGs; Stakeholder Involvement in seven of nine CPGs; and Editorial Independence in three of nine CPGs. Across all CPGs, Applicability was minimally reported. Only the Queensland Health CPG met quality consensus scores for Rigor and Development; however, the focus was limited to compression therapy. Conclusions: No CPG reviewed could be adopted for the Canadian health context. The proposed Canadian BCRL CPG will focus on stakeholder engagement, methodology, and implementation/evaluation. Using AGREE II allowed for assessment of quality of methods used to develop identified CPGs from other countries before consideration of adoption in a Canadian Context.
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Affiliation(s)
- Naomi D Dolgoy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Joanna F Parkinson
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Lori L Radke
- Rehabilitation Oncology, Holy Cross Site, Cancer Care Alberta, Alberta Health Services, Calgary, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Patient Representative, Vancouver, Canada
| | - David Keast
- Parkwood Institute Research, Lawson Health Research Institute, Parkwood Institute, St. Joseph's Health Care, London, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Cancer Care Alberta, Edmonton, Canada
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MacKinnon HM, Slayter KL, Comeau JL, King C, Black EK. Evaluating the impact of incorporating clinical practice guidelines for the management of infectious diseases into an electronic application (e-app). Infect Control Hosp Epidemiol 2023; 44:1417-1422. [PMID: 36594425 PMCID: PMC10507496 DOI: 10.1017/ice.2022.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To improve dissemination and accessibility of guidelines to healthcare providers at our institution, guidance for infectious syndromes was incorporated into an electronic application (e-app). The objective of this study was to compare empiric antimicrobial prescribing before and after implementation of the e-app. DESIGN This study was a before-and-after trial. SETTING A tertiary-care, public hospital in Halifax, Canada. PARTICIPANTS This study included pediatric patients admitted to hospital who were empirically prescribed an antibiotic for an infectious syndrome listed in the e-app. METHODS Data were collected from medical records. Prescribing was independently assessed considering patient-specific characteristics using a standardized checklist by 2 members of the research team. Assessments of antimicrobial prescribing were compared, and discrepancies were resolved through discussion. Empiric antimicrobial prescribing before and after implementation of the e-app was compared using interrupted time-series analysis. RESULTS In total, 237 patients were included in the preimplementation arm and 243 patients were included in the postimplementation arm. Pneumonia (23.8%), appendicitis (19.2%), and sepsis (15.2%) were the most common indications for antimicrobial use. Empiric antimicrobial use was considered optimal in 195 (81.9%) of 238 patients before implementation compared to 226 (93.0%) 243 patients after implementation. An immediate 15.5% improvement (P = .019) in optimal antimicrobial prescribing was observed following the implementation of the e-app. CONCLUSIONS Empiric antimicrobial prescribing for pediatric patients with infectious syndromes improved after implementation of an e-app for dissemination of clinical practice guidelines. The use of e-apps may also be an effective strategy to improve antimicrobial use in other patient populations.
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Affiliation(s)
- Holly M. MacKinnon
- Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- Lawton’s Drugs, Halifax, Canada
| | | | | | | | - Emily K. Black
- Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
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Lyu X, Li S. Professional medical education approaches: mobilizing evidence for clinicians. Front Med (Lausanne) 2023; 10:1071545. [PMID: 37575990 PMCID: PMC10419302 DOI: 10.3389/fmed.2023.1071545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.
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Affiliation(s)
- Xiafei Lyu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Division of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Ng JY, Liu H, Wang MC. Complementary and alternative medicine mention and recommendations in inflammatory bowel disease guidelines: systematic review and assessment using AGREE II. BMC Complement Med Ther 2023; 23:230. [PMID: 37434218 DOI: 10.1186/s12906-023-04062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Many patients with inflammatory bowel disease (IBD) use complementary and alternative medicine (CAM) for disease management. There is, however, a communication gap between patients and healthcare professionals regarding CAM use, where patients are hesitant to disclose CAM use to providers. The purpose of this study was to identify the quantity and assess the quality of CAM recommendations in IBD clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. METHODS MEDLINE, EMBASE, and CINAHL were systematically searched from 2011 to 2022 to find CPGs for the treatment and/or management of IBD. The Guidelines International Network (GIN) and National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs were assessed using the AGREE II instrument. RESULTS Nineteen CPGs made CAM recommendations for IBD and were included in this review. Average scaled domain percentages of CPGs were as follows (overall CPG, CAM section): scope and purpose (91.5%, 91.5%), clarity of presentation (90.3%, 64.0%), editorial independence (57.0%, 57.0%), stakeholder involvement (56.7%, 27.8%), rigour of development (54.7%, 45.9%), and applicability (14.6%, 2.1%). CONCLUSIONS The majority of CPGs with CAM recommendations were of low quality and their CAM sections scored substantially lower relative to other therapies in the overall CPG. In future updates, CPGs with low scaled-domain percentages could be improved in accordance with AGREE II and other guideline development resources. Further research investigating how CAM therapies can best be incorporated into IBD CPGs is warranted.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Henry Liu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle Chenghuazou Wang
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Kharel P, Zadro JR, Ferreira G, Howell M, Howard K, Wortley S, McLennan C, Maher CG. Can language enhance physical therapists' willingness to follow Choosing Wisely recommendations? A best-worst scaling study. Braz J Phys Ther 2023; 27:100534. [PMID: 37597492 PMCID: PMC10462803 DOI: 10.1016/j.bjpt.2023.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/18/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Choosing Wisely recommendations could reduce physical therapists' use of low-value care. OBJECTIVE To investigate whether language influences physical therapists' willingness to follow the Australian Physiotherapy Association's (APA) Choosing Wisely recommendations. DESIGN Best-worst Scaling survey METHODS: The six original APA Choosing Wisely recommendations were modified based on four language characteristics (level of detail, strength- qualified/unqualified, framing, and alternatives to low-value care) to create 60 recommendations. Physical therapists were randomised to a block of seven choice tasks, which included four recommendations. Participants indicated which recommendation they were most and least willing to follow. A multinomial logistic regression model was used to create normalised (0=least preferred; 10=most preferred) and marginal preference scores. RESULTS 215 physical therapists (48.5% of 443 who started the survey) completed the survey. Participants' mean age (SD) was 38.7 (10.6) and 47.9% were female. Physical therapists were more willing to follow recommendations with more detail (marginal preference score of 1.1) or that provided alternatives to low-value care (1.3) and less willing to follow recommendations with negative framing (-1.3). The use of qualified ('don't routinely') language (vs. unqualified - 'don't') did not affect willingness. Physical therapists were more willing to follow recommendations to avoid imaging for non-specific low back pain (3.9) and electrotherapy for low back pain (3.8) vs. recommendation to avoid incentive spirometry after upper abdominal and cardiac surgery. CONCLUSION Physical therapists were more willing to follow recommendations that provided more detail, alternatives to low-value care, and were positively framed. These findings can inform the development of future Choosing Wisely recommendations and could help reduce low-value physical therapy.
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Affiliation(s)
- Priti Kharel
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giovanni Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Howell
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sally Wortley
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Charlotte McLennan
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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van den Bulk S, Petrus AHJ, Willemsen RTA, Boogers MJ, Meeder JG, Rahel BM, van den Akker-van Marle ME, Numans ME, Dinant GJ, Bonten TN. Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP). BMJ Open 2023; 13:e071822. [PMID: 37290947 PMCID: PMC10255045 DOI: 10.1136/bmjopen-2023-071822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Chest pain is a common reason for consultation in primary care. To rule out acute coronary syndrome (ACS), general practitioners (GP) refer 40%-70% of patients with chest pain to the emergency department (ED). Only 10%-20% of those referred, are diagnosed with ACS. A clinical decision rule, including a high-sensitive cardiac troponin-I point-of-care test (hs-cTnI-POCT), may safely rule out ACS in primary care. Being able to safely rule out ACS at the GP level reduces referrals and thereby alleviates the burden on the ED. Moreover, prompt feedback to the patients may reduce anxiety and stress. METHODS AND ANALYSIS The POB HELP study is a clustered randomised controlled diagnostic trial investigating the (cost-)effectiveness and diagnostic accuracy of a primary care decision rule for acute chest pain, consisting of the Marburg Heart Score combined with a hs-cTnI-POCT (limit of detection 1.6 ng/L, 99th percentile 23 ng/L, cut-off value between negative and positive used in this study 3.8 ng/L). General practices are 2:1 randomised to the intervention group (clinical decision rule) or control group (regular care). In total 1500 patients with acute chest pain are planned to be included by GPs in three regions in The Netherlands. Primary endpoints are the number of hospital referrals and the diagnostic accuracy of the decision rule 24 hours, 6 weeks and 6 months after inclusion. ETHICS AND DISSEMINATION The medical ethics committee Leiden-Den Haag-Delft (the Netherlands) has approved this trial. Written informed consent will be obtained from all participating patients. The results of this trial will be disseminated in one main paper and additional papers on secondary endpoints and subgroup analyses. TRIAL REGISTRATION NUMBERS NL9525 and NCT05827237.
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Affiliation(s)
- Simone van den Bulk
- Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Annelieke H J Petrus
- Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Robert T A Willemsen
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mark J Boogers
- Cardiology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Joan G Meeder
- Cardiology, VieCuri Medisch Centrum voor Noord-Limburg, Venlo, The Netherlands
| | - Braim M Rahel
- Cardiology, VieCuri Medisch Centrum voor Noord-Limburg, Venlo, The Netherlands
| | | | - Mattijs E Numans
- Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
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11
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Baykan A, Lafreniere AS, Fraulin FO, Hartley R, Harrop AR, Love S, Ronksley P, Donald M. Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4896. [PMID: 36998534 PMCID: PMC10047613 DOI: 10.1097/gox.0000000000004896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/31/2023] [Indexed: 03/30/2023]
Abstract
We recently highlighted shortcomings in the care of pediatric hand fractures in our local context. The Calgary Kids’ Hand Rule (CKHR) was developed to predict hand fractures that require referral to a hand surgeon. The aims of this study were to identify barriers to a new care pathway for pediatric hand fractures, based on the CKHR and to generate tailored strategies to support its implementation.
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Affiliation(s)
- Altay Baykan
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ann-Sophie Lafreniere
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Frankie O.G. Fraulin
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Hartley
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alan Robertson Harrop
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannan Love
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Ronksley
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maoliosa Donald
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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12
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O'Brien E, Duffy S, Harkins V, Smith SM, O'Herlihy N, Walsh A, Clyne B, Wallace E. A scoping review of evidence-based guidance and guidelines published by general practice professional organizations. Fam Pract 2023:cmad015. [PMID: 36812366 DOI: 10.1093/fampra/cmad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making. OBJECTIVE To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination. METHODS Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed. RESULTS Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies. CONCLUSION The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization. PROTOCOL REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Duffy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin Ireland
| | | | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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13
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Iyngkaran P, Hespe C, Hanna F, Horowitz JD, Battersby M, Nelson C, Andrew S, de Courten MP. The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation. Curr Cardiol Rev 2023; 19:e120522204690. [PMID: 35549873 PMCID: PMC10201899 DOI: 10.2174/1573403x18666220512160737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research are conducted with multiple goals. The overarching goal is "optimized patient outcomes at maximum costeffectiveness". However, observations on patients can come with many variables; thus, we see differences in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus. METHODOLOGY 1) A preliminary literature review to identify a taxonomy for cardiovascular research, and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. A spectrum from observational to large randomized controlled trials to post-marketing studies were identified. DISCUSSION A brief discussion on traditional research and differences focusing on screening, mixed methods research concepts, and chronic diseases models of care. Six steps to facilitate this: 1) Research design; 2) Research application (translation) i. routine ii. challenges; 3. Transforming research to translational level; 4. Funding and infrastructure; 5. Clinical Centres of Research Excellence (CCRE) and collaboration; 6. Governance and cost-effectiveness. CONCLUSION Implementation research that aims to link research findings to improved patient outcomes in an efficient and effective way is a neglected area. Skills required to perform implementation research are complex. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a HF context.
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Affiliation(s)
- Pupalan Iyngkaran
- Heart Failure & Cardiac Imaging, University of Notre Dame, Werribee Mercy Sub School, School of Medicine Sydney; Research Fellow Mitchell Institute, Victoria University, Victoria, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, Sydney, The University of Notre Dame Australia, 160 Oxford St, Darlinghurst, NSW 2010, PO Box 944 Broadway, NSW 2007, Australia
| | - Fahad Hanna
- Program of Public Health, Department of Health, Torrens University Australia, Australia
| | | | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University Mental Health Program Lead, Flinders Health and Medical Research Institute, Southern Adelaide Local Health Network Mental Health Service, Melbourne, Australia
| | - Craig Nelson
- Division of Chronic and Complex Care and the Director of Nephrology, Melbourne, Australia
| | - Sharon Andrew
- Adjunct Professor of Nursing, Institute Health and Sport, Victoria University, PO Box 14428 Melbourne, Victoria 8001, Australia
| | - Maximilian P. de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne 3000, Australia
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14
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Dugard A, Tavernier E, Caille A, Dechartres A, Hoang A, Giraudeau B, Dibao-Dina C. Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study. BMC Med Res Methodol 2022; 22:329. [PMID: 36550405 PMCID: PMC9773496 DOI: 10.1186/s12874-022-01815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many clinical practice guidelines are based on randomised controlled trials conducted in secondary or tertiary care setting and general practitioners frequently question their relevance for primary care patients. Our aim was to compare the intervention effect estimates between primary care setting randomised controlled trials (PC-RCTs) and secondary or tertiary care setting randomised controlled trials (ST-RCTs). METHODS Meta-epidemiological study of meta-analyses (MAs) of a binary outcome including at least one PC-RCT and one ST-RCT. PC-RCTs were defined as trials recruiting patients in general practices, primary care practices, family practices, community centers or community pharmacies. ST-RCTs were defined as trials recruiting in hospitals, including hospitalized patients, hospital outpatients and patients from emergency departments. For each MA, we estimated a ratio of odds ratio (ROR) by using random-effects meta-regression, with an ROR less than 1 indicating lower estimates of the intervention effect in PC-RCTs than ST-RCTs. Finally, we estimated a combined ROR across MAs by using a random-effects meta-analysis. We performed subgroup analyses considering the type of outcomes (objective vs subjective), type of experimental intervention (pharmacological vs non-pharmacological), and control group (active vs inactive) as well as analyses adjusted on items of the Cochrane Risk of Bias tool. RESULTS Among 1765 screened reviews, 76 MAs with 230 PC-RCTs and 384 ST-RCTs were selected. The main medical fields were pneumology (13.2%) and psychiatry or addictology (38.2%). Intervention effect estimates did not significantly differ between PC-RCTs and ST-RCTs (ROR = 0.97, 95% confidence interval 0.88 to 1.08), with moderate heterogeneity across MAs (I2 = 45%). Subgroup and adjusted analyses led to consistent results. CONCLUSION We did not observe any significant difference in intervention effect estimates between PC-RCTs and ST-RCTs. Nevertheless, most of the medical fields in this meta-epidemiological study were not representative of the pathologies encountered in primary care. Further studies with pathologies more frequently encountered in primary care are needed.
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Affiliation(s)
- Amandine Dugard
- grid.12366.300000 0001 2182 6141University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
| | - Elsa Tavernier
- grid.12366.300000 0001 2182 6141University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France ,grid.411167.40000 0004 1765 1600INSERM CIC1415, CHRU de Tours, Tours, France
| | - Agnès Caille
- grid.12366.300000 0001 2182 6141University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France ,grid.411167.40000 0004 1765 1600INSERM CIC1415, CHRU de Tours, Tours, France
| | - Agnès Dechartres
- grid.457361.2Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé PubliqueAP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, F75013 Paris, France
| | - Adeline Hoang
- grid.12366.300000 0001 2182 6141Department of General Practice, University of Tours, Tours, France
| | - Bruno Giraudeau
- grid.12366.300000 0001 2182 6141University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
| | - Clarisse Dibao-Dina
- grid.12366.300000 0001 2182 6141University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France ,grid.12366.300000 0001 2182 6141Department of General Practice, University of Tours, Tours, France
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15
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Variation of caesarean section rates in Palestinian governmental hospitals. BMC Pregnancy Childbirth 2022; 22:943. [PMID: 36526974 PMCID: PMC9756638 DOI: 10.1186/s12884-022-05275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, the increased use of cesarean sections has become prevalent in high-income and low and middle-income countries. In Palestine, the rate had risen from 20.3% in 2014 to 25.1% in 2018. We have rates as high as 35.8% in some governmental hospitals and some as low as 15%. This study aimed to understand better why there is a variation in cesarean rates in governmental hospitals that use the same guidelines. METHODS A qualitative and quantitative research approach was used. In-depth interviews were conducted with 27 specialists, obstetrics and gynecologists, and midwives in five government hospitals. The hospitals were selected based on the 2017 Annual Health Report reported cesarean section rates. The interview guide was created with the support of specialists and researchers and was piloted. Questions focused mainly on adherence to the obstetric guidelines and barriers to the use, sources of information, training for healthcare providers, the hospital system, and the factors that affect decision-making. Each hospital's delivery records for one month were analyzed to determine the reason for each cesarean section. RESULTS The results indicated that each governmental hospital at the system level had a different policy on cesarean sections. The National Guidelines were found to be interpreted differently among hospitals. One obstetrician-gynecologist decided on a cesarean section at high-rate hospitals, while low-rate hospitals used collective decision-making with empowered midwives. At the professional level, all hospitals urged the importance of a continuous training program to refresh the medical team knowledge, in-house training of new members joining the hospital, and discussion of cases subjective to obstetrician-gynecologists interpretations. CONCLUSION Several institutional factors were identified to strengthen the implementation of the national obstetric guidelines. For example, encouraging collective decision-making between obstetrician-gynecologists and midwives, promoting the use of a second opinion, and mandatory training.
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16
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Reid N, Shanley DC, Logan J, White C, Liu W, Hawkins E. International Survey of Specialist Fetal Alcohol Spectrum Disorder Diagnostic Clinics: Comparison of Diagnostic Approach and Considerations Regarding the Potential for Unification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15663. [PMID: 36497738 PMCID: PMC9737886 DOI: 10.3390/ijerph192315663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental condition. Despite FASD being recognized as a clinical disorder there is no globally agreed set of diagnostic criteria. Accurate and timely diagnosis of FASD is imperative to inform clinical care, optimize outcomes for individuals accessing assessments and their families, as well as for research and prevention strategies. To inform movement towards a unified approach, the present study aimed to capture an international perspective on current FASD diagnostic criteria, as well as potential barriers and facilitators to unification. An online survey was created using REDCap and sent to clinics identified and contacted via internet searches. Quantitative data were presented using descriptive statistics and open-ended questions analysed using content analysis. The survey captured information about each clinic's current diagnostic approach, whether they would support a unified method, and the barriers and facilitators for a consistent international FASD diagnostic approach. Fifty-five (37.4%) of 147 FASD clinics identified worldwide participated. The majority (n = 50, 90.9%) of respondents supported a unified approach. Content analysis identified a lack of collaboration as a key barrier, while strong leadership in guideline creation and implementation emerged as a central facilitator. These barriers and facilitators can be used to guide future collaborative efforts towards implementing consistent diagnostic criteria.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Dianne C. Shanley
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jayden Logan
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Codi White
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Wei Liu
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Erinn Hawkins
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
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17
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Frantsve-Hawley J, Abt E, Carrasco-Labra A, Dawson T, Michaels M, Pahlke S, Rindal DB, Spallek H, Weyant RJ. Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. J Am Dent Assoc 2022; 153:1041-1052. [PMID: 36127176 DOI: 10.1016/j.adaj.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.
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18
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Lamers-Johnson E, Kelley K, Knippen KL, Feddersen K, Sánchez DM, Parrott JS, Colin C, Papoutsakis C, Jimenez EY. A quasi-experimental study provides evidence that registered dietitian nutritionist care is aligned with the Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines for type 1 and 2 diabetes. Front Nutr 2022; 9:969360. [PMID: 36172522 PMCID: PMC9511164 DOI: 10.3389/fnut.2022.969360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background One previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG). Objectives To describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics' EBNPG for Type 1 and Type 2 diabetes and examine impact of a midpoint training on care alignment with the guideline. Methods In this 2-year, quasi-experimental study, 19 RDNs providing outpatient medical nutrition therapy to adults with diabetes (n = 562) documented 787 initial and follow-up encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores. Results Most patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85 and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training (n = 19 RDNs, 519 encounters pre-training; n = 14 RDNs, 204 encounters post-training; β = −0.06, SE = 0.04; 95% CI: −0.14, 0.03). Conclusions Most RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.
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Affiliation(s)
- Erin Lamers-Johnson
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- *Correspondence: Erin Lamers-Johnson
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Kerri Lynn Knippen
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH, United States
| | | | - Damien M. Sánchez
- Organization, Information, and Learning Sciences, University of New Mexico, Albuquerque, NM, United States
| | - J. Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Blackwood, NJ, United States
| | - Casey Colin
- Nutrition and Dietetics Department, University of North Florida, Jacksonville, FL, United States
| | | | - Elizabeth Yakes Jimenez
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico, Albuquerque, NM, United States
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19
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Morikawa T, Sakuma M, Nakamura T, Sonoyama T, Matsumoto C, Takeuchi J, Ohta Y, Kosaka S, Morimoto T. Effectiveness of a computerized clinical decision support system for prevention of glucocorticoid-induced osteoporosis. Sci Rep 2022; 12:14967. [PMID: 36056121 PMCID: PMC9440130 DOI: 10.1038/s41598-022-19079-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
Glucocorticoids are widely used for a variety of diseases, but the prevention of glucocorticoid-induced osteoporosis is sometimes neglected. Therefore, the effectiveness of a computerized clinical decision support system (CDSS) to improve the performance rate of preventive care for glucocorticoid-induced osteoporosis was evaluated. We conducted a prospective cohort study of outpatients who used glucocorticoids for three months or longer and who met the indication for preventive care based on a guideline. The CDSS recommended bisphosphonate (BP) prescription and bone mineral density (BMD) testing based on the risk of osteoporosis. The observation period was one year (phase 1: October 2017-September 2018) before implementation and the following one year (phase 2: October 2018-September 2019) after implementation of the CDSS. Potential alerts were collected without displaying them during phase 1, and the alerts were displayed during phase 2. We measured BP prescriptions and BMD testing for long-term prescription of glucocorticoids. A total of 938 patients (phase 1, 457 patients; phase 2, 481 patients) were included, and the baseline characteristics were similar between the phases. The median age was 71 years, and men accounted for 51%. The primary disease for prescription of glucocorticoids was rheumatic disease (28%), followed by hematologic diseases (18%). The prevalence of patients who needed an alert for BP prescription (67% vs. 63%, P = 0.24) and the acceptance rate of BP prescription (16% vs. 19%, P = 0.33) were similar between the phases. The number of patients who had orders for BMD testing was significantly increased (4% vs. 24%, P < 0.001) after CDSS implementation. The number of patients who needed an alert for BMD testing was significantly decreased from 93% in phase 1 to 87% in phase 2 (P = 0.004). In conclusion, the CDSS significantly increased BMD testing in patients with a higher risk of glucocorticoid-induced osteoporosis, but did not increase BP prescription.
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Affiliation(s)
- Toru Morikawa
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
- Department of General Medicine, Nara City Hospital, Nara, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tsukasa Nakamura
- Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Tomohiro Sonoyama
- Department of Pharmacy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Chisa Matsumoto
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University, Tokyo, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ohta
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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20
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Kocken PL, van Kesteren NMC, van Zoonen R, Reijneveld SA. Availability and implementation of guidelines in European child primary health care: how can we improve? Eur J Public Health 2022; 32:670-676. [PMID: 36006035 PMCID: PMC9527973 DOI: 10.1093/eurpub/ckac114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical guidelines are important for providing high-quality child primary health care. We aimed to assess the availability, use and achieved delivery of guidelines in the European Union (EU). METHODS We used a case study design to ascertain expert views on guidelines in six countries representing the EU. The experts completed an online questionnaire (response 49%), asking about their perception of guideline availability and implementation regarding three topics that represent prevention and care, i.e. vaccination, assessment of mental health and asthma care. RESULTS According to the respondents all countries had guidelines available for asthma care. For vaccination and mental health assessment respondents agreed to a lesser degree that guidelines were available. Implementation of guidelines for vaccination was mostly perceived as intended, but implementation of the guidelines for mental health assessment and asthma care was limited. Notable barriers were complexity of performance, and lack of training of professionals and of financial resources. Important facilitators for guideline implementation were the fit with routine practice, knowledge and skills of professionals and policy support. We found no clear relationship of guideline availability and implementation with type of child primary health care system of countries, but strong governance and sufficient financial resources seemed important for guideline availability. CONCLUSIONS Availability and implementation of clinical guidelines in child primary health care vary between EU countries. Implementation conditions can be strongly improved by adequate training of professionals, stronger governance and sufficient financial resources as facilitating factors. This can yield major gains in child health across Europe.
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Affiliation(s)
- Paul L Kocken
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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Vengalasetti YV, Narayan AK, Brown CA, Boakye-Ansa N, Strigel RM, Elezaby MA, Martin MD, Woods RW, Flores EJ, Miles RC. Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey. Acad Radiol 2022; 30:1101-1106. [PMID: 35965156 DOI: 10.1016/j.acra.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. METHODS Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. RESULTS 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). CONCLUSION Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.
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Affiliation(s)
- Y V Vengalasetti
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - A K Narayan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - C A Brown
- School of Medicine, Meharry Medical College, Nashville, TN
| | - N Boakye-Ansa
- School of Medicine, Meharry Medical College, Nashville, TN
| | - R M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M A Elezaby
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M D Martin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - R W Woods
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - E J Flores
- Department of Radiology, Harvard Medical School, Harvard University, Boston, MA
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22
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Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159515. [PMID: 35954872 PMCID: PMC9367745 DOI: 10.3390/ijerph19159515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We evaluated the guidelines using a validated AGREE II instrument with four raters; we used multiple linear regressions to identify the predictors of quality; and two focus groups, including guideline developers, to further explore the guideline development process. The majority of the guidelines (N = 74) were developed by medical societies. The guidelines’ quality was rated low: the median standardized AGREE II score was low, 36% (IQR 28–42), and so were the overall-assessments. The aspects of the guidelines that were rated best were the “clarity of presentation” and the “scope and purpose” (median ≥ 59%); however, the other four domains received very low scores (15–33%). Overall, the guideline quality did not improve over time. The guidelines that were developed by medical societies scored significantly worse than those developed by governmental, or unofficial working groups (12–43% per domain). In focus group discussions, inadequate methodology, a lack of implementation systems in place, a lack of awareness about editorial independence, and broader expertise/perspectives in working groups were identified as factors behind the low scores. The factors identified as affecting the quality of the national guidelines may help stakeholders who are developing interventions and education programs aimed at improving guideline quality worldwide.
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Gupta S, Tang R, Petricca K, Florez ID, Kastner M. The Guideline Language and Format Instrument (GLAFI): development process and international needs assessment survey. Implement Sci 2022; 17:47. [PMID: 35854368 PMCID: PMC9295534 DOI: 10.1186/s13012-022-01219-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Successful guideline implementation depends both on factors extrinsic to guidelines and their intrinsic features. In the Guideline Implementability for Decision Excellence Model (GUIDE-M), “communicating” content (language and format) is one of three core determinants of intrinsic implementability, but is seldom addressed. Our aims were to develop a tool that could be used by guideline developers to optimize language and format during development; identify gaps in this type of guidance in existing resources; and evaluate the perceived need for and usefulness of such a tool among guideline developers. Methods Our mixed-methods design consisted of (1) content development (selection and organization of evidence-based constructs from the GUIDE-M into a prototype Guideline Language and Format Instrument (GLAFI), followed by face validation with guideline developers); (2) document analysis (duplicate) of seven existing guideline tools to measure coverage of GLAFI items and identify new items; and (3) an international survey of guideline developers (corresponding authors of recent Canadian Medical Association or Guidelines International Network database guidelines) to measure perceived importance of language and format, quality of existing resources, and usefulness of a language and format tool. Results GLAFI items were organized into 4 language and 4 format subdomains. In face validation with guideline developers (17 clinicians, 1 methodologist), all agreed that the tool would improve guideline implementability and 93% indicated a desire for regular use. In the existing guideline tool document analysis, only 14/44 (31.8%) GLAFI items were operationalized in at least one tool. We received survey responses from 148/674 (22.0%) contacted guideline authors representing 45 organizations (9 countries). Language was rated as “extremely important” or “important” in determining uptake by 94% of respondents, and format by 84%. Correspondingly, 72% and 70% indicated that their organization would likely use such a tool. Conclusions Optimal language and format are fundamental to guideline implementability but often overlooked. The GLAFI tool operationalizes evidence-based constructs, most of which are absent in existing guideline tools. Guideline developers perceive these concepts to be important and express a willingness to use such a tool. The GLAFI should be further tested and refined with guideline developers and its impact on end-users measured. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01219-2.
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Affiliation(s)
- Samir Gupta
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Rosalind Tang
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Geriatrics, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's Health Partners, King's College London, London, UK
| | - Kadia Petricca
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Medellín, Colombia.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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Key Stakeholder Priorities for the Review and Update of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105823. [PMID: 35627361 PMCID: PMC9140557 DOI: 10.3390/ijerph19105823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 12/04/2022]
Abstract
Since the 2016 release of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder (FASD), considerable progress has been made in the identification and diagnosis of the disorder. As part of a larger process to review and update the Guide, the aim of this study was to identify review priorities from a broad range of stakeholders involved in the assessment and diagnosis of FASD. Sixty-two stakeholders, including healthcare practitioners, researchers, other specialists, individuals with cultural expertise, lived experience and consumer representatives completed an online survey asking them to describe up to five priorities for the review of the Australian Guide to the Diagnosis of FASD. A total of 267 priorities were described. Content analysis of responses revealed priority areas relating to diagnostic criteria (n = 82, 30.7%), guideline content (n = 91, 34.1%), guideline dissemination (n = 15, 5.6%) and guideline implementation (n = 63, 23.6%). Other considerations included prevention and screening of FASD (n = 16, 6%). Engaging stakeholders in setting priorities will ensure the revised Australian Guide can be as relevant and meaningful as possible for the primary end-users and that it meets the needs of individuals with lived experience who will be most affected by the diagnosis.
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Pilbeam C, Tonkin-Crine S, Martindale AM, Atkinson P, Mableson H, Lant S, Solomon T, Sheard S, Gobat N. How do Healthcare Workers 'Do' Guidelines? Exploring How Policy Decisions Impacted UK Healthcare Workers During the First Phase of the COVID-19 Pandemic. QUALITATIVE HEALTH RESEARCH 2022; 32:729-743. [PMID: 35094621 PMCID: PMC8801764 DOI: 10.1177/10497323211067772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We describe how COVID-19-related policy decisions and guidelines impacted healthcare workers (HCWs) during the UK's first COVID-19 pandemic phase. Guidelines in healthcare aim to streamline processes, improve quality and manage risk. However, we argue that during this time the guidelines we studied often fell short of these goals in practice. We analysed 74 remote interviews with 14 UK HCWs over 6 months (February-August 2020). Reframing guidelines through Mol's lens of 'enactment', we reveal embodied, relational and material impacts that some guidelines had for HCWs. Beyond guideline 'adherence', we show that enacting guidelines is an ongoing, complex process of negotiating and balancing multilevel tensions. Overall, guidelines: (1) were inconsistently communicated; (2) did not sufficiently accommodate contextual considerations; and (3) were at times in tension with HCWs' values. Healthcare policymakers should produce more agile, acceptable guidelines that frontline HCWs can enact in ways which make sense and are effective in their contexts.
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Affiliation(s)
- Caitlin Pilbeam
- Nuffield Department of Primary Care
Health Sciences, University of
Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care
Health Sciences, University of
Oxford, Oxford, UK
- NIHR Health Protection Research
Unit in Healthcare Associated Infections and Antimicrobial Resistance,
University of
Oxford, Oxford, UK
| | | | - Paul Atkinson
- Institute of Population Health,
University
of Liverpool, Liverpool, UK
| | - Hayley Mableson
- Institute of Infection, Veterinary
and Ecological Sciences, University of
Liverpool, Liverpool, UK
| | - Suzannah Lant
- Institute of Infection, Veterinary
and Ecological Sciences, University of
Liverpool, Liverpool, UK
| | - Tom Solomon
- Institute of Infection, Veterinary
and Ecological Sciences, University of
Liverpool, Liverpool, UK
| | - Sally Sheard
- Institute of Population Health,
University
of Liverpool, Liverpool, UK
| | - Nina Gobat
- Nuffield Department of Primary Care
Health Sciences, University of
Oxford, Oxford, UK
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26
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations. HRB Open Res 2022; 4:53. [PMID: 35233505 PMCID: PMC8866908 DOI: 10.12688/hrbopenres.13268.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/09/2023] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner's clinical decision making to benefit patient care.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Noirin O'Herlihy
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
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27
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance and guidelines published by general practitioner professional organisations. HRB Open Res 2022; 4:53. [PMID: 35233505 PMCID: PMC8866908 DOI: 10.12688/hrbopenres.13268.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centered approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. In order to achieve this standard of care, GPs require relevant, up to date and high quality evidence. Currently there is a gap in the literature regarding the role of GP professional organisations internationally in producing and publishing evidence based guidance and clinical guidelines for GPs. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally in terms of topic content, the structure and methods used to develop guidance and ways of disseminating this guidance, to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will examine current practice internationally regarding the role of General Practice professional organisations in producing and publishing clinical guidelines and evidence based guidance to support general practitioner’s clinical decision making to benefit patient care.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
| | - Noirin O'Herlihy
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, D02XR68, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, D02H903, Ireland
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Akiyama N, Okamura T, Yoshida M, Kimura SI, Yano S, Yoshida I, Kusaba H, Takahashi K, Fujita H, Fukushima K, Iwasaki H, Tamura K, Saeki T, Takamatsu Y, Zenda S. Difference of compliance rates for the recommendations in Japanese Guideline on Febrile Neutropenia according to respondents’ attributes: the second report on a questionnaire survey among hematology-oncology physicians and surgeons. Support Care Cancer 2022; 30:4327-4336. [PMID: 35094140 PMCID: PMC8942955 DOI: 10.1007/s00520-022-06834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose The Japanese Society of Medical Oncology (JSMO) published a guideline (GL) on febrile neutropenia (FN) in 2017. This study aims to identify promoting factors and disincentives for complying with GL recommendations according to attributes of doctors providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for physician members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed according to the respondents’ attributes. Result Seven hundred eighty-eight out of retrieved 801 responses were available for analysis. Multivariable analysis demonstrated that the percentage of GL users was higher among women and Japanese Society of Clinical Oncology members. The overall compliance rate was higher among women, JSMO members, and board-certified medical oncologists. Internists emphasized the significance of collecting blood cultures at FN onset, and surgeons stressed the importance of G-CSF prophylaxis. Hematologists were less likely to adhere to recommendations on risk assessment of FN by the Multinational Association of Supportive Care in Cancer score and administration of gammaglobulin products. However, those are acceptable due to the characteristics of their practice. Eight recommendations had no difference in compliance rates between users and non-users, some of whose statements were ambiguous and discretionary. Conclusion Women were more likely to use and adhere to GL. The recommendations should be developed considering the characteristics of specialty and subspecialty and avoiding ambiguity and discretionary statements. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06834-9.
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Affiliation(s)
- Nobu Akiyama
- Department of Internal Medicine, School of Medicine, Teikyo University, Kaga 2-11-1, Itabashi ward, Tokyo, 173-8605, Japan.
| | - Takuho Okamura
- Department of Breast Surgery, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
| | - Minoru Yoshida
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Isao Yoshida
- Department of Hematologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hitoshi Kusaba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kosuke Takahashi
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiromichi Iwasaki
- Department of Infection Control and Prevention, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Kazuo Tamura
- Professor Emeritus, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasushi Takamatsu
- Department of Hematology, Oncology, Endocrinology and Infectious Disease, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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29
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Mill D, Page A, Johnson J, Lee K, Salter SM, Seubert L, Clifford R, D'Lima D. Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework. BMC Health Serv Res 2022; 22:71. [PMID: 35031027 PMCID: PMC8760715 DOI: 10.1186/s12913-021-07358-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. Aim To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. Methods Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. Results A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. Conclusion(s) The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.
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Affiliation(s)
- Deanna Mill
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.
| | - Amy Page
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.,Pharmacy Department, The Alfred, Melbourne, Victoria, Australia.,Centre for Medicines Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Jacinta Johnson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Liza Seubert
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rhonda Clifford
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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30
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Rodríguez-Núñez N, Ruano-Raviña A, Lama A, Ferreiro L, Ricoy J, Álvarez-Dobaño JM, Suárez-Antelo J, Toubes ME, Rábade C, Golpe A, Riveiro V, Casal A, Abelleira R, González-Barcala FJ, González-Juanatey JR, Valdés L. Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study. J Thorac Dis 2021; 13:5373-5382. [PMID: 34659804 PMCID: PMC8482338 DOI: 10.21037/jtd-21-595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/16/2021] [Indexed: 11/06/2022]
Abstract
Background An integrated care pathway (ICP) is intended to improve the management of prevalent resource-consuming, life-threatening diseases. The purpose of this study was to determine whether the quality of patient care improved with the establishment of a dedicated unit for pulmonary embolism (PE). Methods A quasi-experimental pre-post study (pre: years 2010–2013; post: 2015–2020; year 2014, “washing” period) of PE patients ≥18 years (January 2010–June 2020). The intervention involved the implementation of an ICP for PE. Results The sample was composed of 1,142 patients (510 pre-intervention and 612 post-intervention) without significant differences between the two populations. In the post-intervention period, significant reductions were observed in the median length of hospital stay (LOS) (8 vs. 6 days); time to start of oral anticoagulation therapy (4.5 vs. 3.5 days; P<0.001); and the percentage of patients with high-risk PE in whom recanalization was not contraindicated (66.7% vs. 96%; P=0.009). In-hospital and 30-day mortality decreased, although not significantly (4.5% vs. 2.8%; P=0.188; 6.1% vs. 5.2%; P=0.531, respectively). Multivariate logistic regression analysis showed that the median LOS intervention decreased significantly according to the service where patients were referred to, and with the use of the simplified PESI. During follow-up, lifelong anticoagulation was prescribed to a higher proportion of patients in the post-intervention period (30.7% vs. 69.3%; P<0.001). Conclusions Although an ICP for PE does not reduce mortality significantly, it improves the quality of patient care.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.,Group C013, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adriana Lama
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - José M Álvarez-Dobaño
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - José R González-Juanatey
- Service of Cardiology, Spanish Network-Center for Cardiovascular Biomedical Research (CIBERCV), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
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Kamps T, Kregel M, Kuipers S, Xi T, Oever JT. Concordance of local guidelines with national guidelines on perioperative antibiotic and antiseptic prophylaxis in elective oral and maxillofacial surgery: A cross-sectional survey in the Netherlands. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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Givron H, Desseilles M. The role of emotional competencies in predicting medical students' attitudes towards communication skills training. PATIENT EDUCATION AND COUNSELING 2021; 104:2505-2511. [PMID: 33741231 DOI: 10.1016/j.pec.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to investigate whether stress, depression and emotional competencies can help to predict medical students' attitudes towards communication skills training (CST). Anxiety and negative attitudes towards CST have been shown to be linked. Conversely, emotional competencies (EC) were associated with positive attitudes. Exploring these psycho(patho)logical variables therefore seems to be a promising approach to better understanding, or even modifying, attitudes towards CST. METHODS 179 third year medical students were asked to complete the Communication Skills Attitude Scale (CSAS), the Perceived Stress Scale (PSS), the Montgomery-Asberg Depression Rating Scale Self-assessment (MADRS-S) and the Profile of Emotional Competence (PEC). RESULTS 168 students completed the entire questionnaire. The stepwise regression model first revealed that, taken together, intrapersonal EC "Utilization" and interpersonal EC "Expression" account for 17% of the variance in positive attitudes. Secondly, taken together, intrapersonal EC "Utilization" and interpersonal EC "Expression" account for 16% of the variance in negative attitudes. CONCLUSION The more competent a student is in "Utilization" and "Expression", the more positive attitudes and the less negative attitudes he/she has towards CST. In addition, measuring a large set of bio-psycho-social factors might be a way of capturing more variance in attitudes towards CST. PRACTICE IMPLICATIONS In the study of variables influencing attitudes towards CST, emotional competencies cannot be ignored. The context of the medical consultation encourages the discussion of various emotions felt by the patient. As educationalists, we should prepare the student for this by integrating the notion of EC within the CST.
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Affiliation(s)
- Hélène Givron
- Department of Psychology, Faculty of Medicine, University of Namur, Namur, Belgium; Transitions Institute, University of Namur, Namur, Belgium.
| | - Martin Desseilles
- Department of Psychology, Faculty of Medicine, University of Namur, Namur, Belgium; Transitions Institute, University of Namur, Namur, Belgium; Alexien Brothers Psychiatry Clinic, Henri-Chappelle, Belgium.
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Wood S, Foy R, Willis TA, Carder P, Johnson S, Alderson S. General practice responses to opioid prescribing feedback: a qualitative process evaluation. Br J Gen Pract 2021; 71:e788-e796. [PMID: 33979300 PMCID: PMC8407857 DOI: 10.3399/bjgp.2020.1117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/27/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. An evidence-based bimonthly feedback intervention to reduce opioid prescribing was developed and implemented, targeting 316 general practices in West Yorkshire over 1 year. AIM To understand how general practice staff received and responded to the feedback intervention. DESIGN AND SETTING Qualitative process evaluation involving semi-structured interviews, guided by Normalisation Process Theory (NPT), of primary care healthcare professionals targeted by feedback. METHOD Participants were purposively recruited according to baseline opioid prescribing levels and degree of change following feedback. Interview data were coded to NPT constructs, and thematically analysed. RESULTS Interviews were conducted with 21 staff from 20 practices. Reducing opioid prescribing was recognised as a priority. While high achievers had clear structures for quality improvement, feedback encouraged some less structured practices to embed changes. The non-prescriptive nature of the feedback reports allowed practices to develop strategies consistent with their own ways of working and existing resources. Practice concerns were allayed by the credibility of the reports and positive experiences of reducing opioid prescribing. The scale, frequency, and duration of feedback may have ensured a good overall level of practice population reach. CONCLUSION The intervention engaged general practice staff in change by targeting an issue of emerging concern, and allowing adaption to different ways of working. Practice efforts to reduce opioid prescribing were reinforced by regular feedback, credible comparative data showing progress, and shared experiences of patient benefit.
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Affiliation(s)
- Su Wood
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Paul Carder
- West Yorkshire Research & Development, NHS Bradford District and Craven CCG, Bradford
| | - Stella Johnson
- West Yorkshire Research & Development, NHS Bradford District and Craven CCG, Bradford
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds
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Dagard J, Mazille-Orfanos N, Georgi N, Dechicha I, Carrault G, Pladys P, Beuchée A. Criteria for assessing the quality of clinical practice guidelines in paediatrics and neonatology: a mixed-method study. BMC Med Inform Decis Mak 2021; 21:269. [PMID: 34548068 PMCID: PMC8456649 DOI: 10.1186/s12911-021-01628-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 09/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Evidenced-based practice is a key component of quality care. This study aims to explore users’ expectations concerning paediatric local clinical practice guidelines. Methods A mixed method approach was applied, including material from quantitative questionnaire and semi-structured interviews. Data were analysed using descriptive statistics and qualitative content analysis. Data were analysed with constant comparative method. Qualitative data were parsed and categorized to identify themes related to decision-making. Results A total of 83 physicians answered the survey (response rate 83%). 98% of the participants wanted protocols based on international guidelines, 80% expected a therapeutic content. 24 semi-structured interviews were conducted to understand implementation processes, barriers and facilitators. Qualitative analysis revealed 5 emerging themes: improvement of local clinical practice guidelines, patterns of usage, reasons for non-implementation, alternative sources and perspectives. Conclusion Some criteria should be considered for the redaction of local clinical practice guidelines: focus on therapeutic, ease of access, establish local clinical practice guidelines based on international guidelines adapted to the local setting, document references and include trainees such as residents in the redaction. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01628-1.
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Affiliation(s)
- Joanna Dagard
- Department of Pediatrics/Neonatology, CHU Rennes, 35033, Rennes, France.
| | | | - Nawras Georgi
- LTSI-UMR_S 1099, Univ Rennes, Inserm, 35000, Rennes, France
| | | | - Guy Carrault
- LTSI-UMR_S 1099, Univ Rennes, Inserm, 35000, Rennes, France
| | - Patrick Pladys
- Department of Pediatrics/Neonatology, CHU Rennes, 35033, Rennes, France.,LTSI-UMR_S 1099, Univ Rennes, Inserm, 35000, Rennes, France
| | - Alain Beuchée
- Department of Pediatrics/Neonatology, CHU Rennes, 35033, Rennes, France.,LTSI-UMR_S 1099, Univ Rennes, Inserm, 35000, Rennes, France
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Itaya T, Shimizu S, Hara T, Matsuoka Y, Fukuhara S, Yamamoto Y. Association between facility-level adherence to phosphorus management guidelines and mortality in haemodialysis patients: a prospective cohort study. BMJ Open 2021; 11:e051002. [PMID: 34531214 PMCID: PMC8449959 DOI: 10.1136/bmjopen-2021-051002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To examine the association between facility-level adherence to phosphorus management guidelines and mortality among patients with haemodialysis, and to explore the facility-related factors associated with facility-level guideline adherence. DESIGN Prospective cohort study. SETTING The Dialysis Outcomes and Practice Pattern Study, which included 57 representative dialysis facilities in Japan between 2012 and 2015. PARTICIPANTS A total of 2054 adult patients who received maintenance haemodialysis were included. We defined exposure according to the following four categories, depending on whether facility-level target ranges of serum phosphorus concentration adhered to the Japanese clinical practice guidelines: adherence group (lower limit ≥3.5 mg/dL and upper limit ≤6.0 mg/dL), low-target group (lower limit <3.5 and upper limit ≤6.0), wide-target group (lower limit <3.5 and upper limit >6.0) and high-target group (lower limit ≥3.5 and upper limit >6.0). PRIMARY OUTCOME MEASURE The primary outcome was the patient all-cause mortality rate. RESULTS The mortality rate among the patients was 7.3 per 100 person-years; 27 facilities (47%) set targets according to the guidelines. HRs for mortality with reference to the adherence group were 1.04 (95% CI 0.76 to 1.43) in the low-target group, 1.11 (95% CI 0.68 to 1.81) in the wide-target group and 1.95 (95% CI 1.12 to 3.38) in the high-target group. Involvement of dieticians in dialysis treatment was associated with facility-level guideline adherence (OR 4.51; 95% CI 1.15 to 17.7). CONCLUSIONS A higher facility-level target range for phosphorus was associated with increased patient mortality. Among facilities that set the target according to the guidelines, dieticians tended to be involved in dialysis care. These findings suggest the importance of reviewing facilities' treatment policies in relation to updated guidelines and the need to work with relevant professionals.
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Affiliation(s)
- Takahiro Itaya
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Takashi Hara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Yoshinori Matsuoka
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRCLE), Fukushima Medical University, Fukushima, Japan
- Shirakawa STAR for General Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Kataria Golestaneh A, Clarke JM, Appelbaum N, Gonzalvez CR, Jose AP, Philip R, Poulter NR, Beaney T. The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians' perspectives and experiences. BMC Health Serv Res 2021; 21:767. [PMID: 34344382 PMCID: PMC8336017 DOI: 10.1186/s12913-021-06782-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians' perceptions and implementation of hypertension guidelines exists, mostly focussed on higher income settings. This study aims to explore how hypertension guidelines are used by clinicians across different resource settings, and the factors influencing their use. METHODS A qualitative approach was employed using convenience sampling and in-depth semi-structured interviews. Seventeen medical doctors were interviewed over video or telephone call from March to August 2020. Two clinicians worked in low-income countries, ten in middle-income countries, and five in high-income countries. Interviews were recorded, transcribed, and coded inductively. Reflexive thematic analysis was used. RESULTS Themes were generated at three levels at which clinicians perceived influencing factors to be operating: healthcare worker, healthcare worker interactions with patients, and the wider health system. Within each level, influencing factors were described as barriers to and facilitators of guideline use. Variation in factors occurred across income settings. At the healthcare worker level, usability of guidelines, trust in guidelines, attitudes and views about guidelines' purpose, and relevance to patient populations were identified as themes. Influencing factors at the health system level were accessibility of equipment and medications, workforce, and access to healthcare settings. Influences at the patient level were clinician perceived patient motivation and health literacy, and access to, and cost of treatment, although these represented doctors' perceptions rather than patient perceived factors. CONCLUSIONS This study adds a high level global view to previous studies investigating clinician perspectives on hypertension guideline use. Guidelines should be evidence-based, regularly updated and attention should be given to increasing applicability to LMICs and a range of healthcare professionals.
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Affiliation(s)
- Amelia Kataria Golestaneh
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Nicholas Appelbaum
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Arun P Jose
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Richu Philip
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, W6 8RP, London, UK.
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Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument. Int Urogynecol J 2021; 32:2899-2912. [PMID: 34148114 PMCID: PMC8536555 DOI: 10.1007/s00192-021-04848-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Introduction and hypothesis Variations in guidelines may result in differences in treatments and potentially poorer health-related outcomes. We aimed to systematically review and evaluate the quality of national and international guidelines and create an inventory of CPG recommendations on CPP. Methods We searched EMBASE and MEDLINE databases from inception till August 2020 as well as websites of professional organizations and societies. We selected national and international CPGs reporting on the diagnosis and management of female CPP. We included six CPGs. Five researchers independently assessed the quality of included guidelines using the AGREE II tool and extracted recommendations. Results Two hundred thirty-two recommendations were recorded and grouped into six categories: diagnosis, medical treatment, surgical management, behavioural interventions, complementary/alternative therapies and education/research. Thirty-nine (17.11%) recommendations were comparable including: a comprehensive pain history, a multi-disciplinary approach, attributing muscular dysfunction as a cause of CPP and an assessment of quality of life. Two guidelines acknowledged sexual dysfunction associated with CPP and recommended treatment with pelvic floor exercises and behavioural interventions. All guidelines recommended surgical management; however, there was no consensus regarding adhesiolysis, bilateral salpingo-oophorectomy during hysterectomy, neurectomy and laparoscopic uterosacral nerve ablation. Half of recommendations (106, 46.49%) were unreferenced or made in absence of good-quality evidence or supported by expert opinion. Based on the AGREE II assessment, two guidelines were graded as high quality and recommended without modifications (EAU and RCOG). Guidelines performed poorly in the “Applicability”, “Editorial Independence” and “Stakeholder Involvement” domains. Conclusion Majority of guidelines were of moderate quality with significant variation in recommendations and quality of guideline development. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04848-1.
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Aleksovska K, Bassetti CLA, Berger T, Carvalho V, Costa J, Deuschl G, Frederiksen KS, Jaarsma J, Kobulashvili T, Leone MA, Pavlakova L, Romoli M, Vignatelli L. Guidelines should be guidelines: Time to leave the terms "consensus" and "position" for other purposes. Eur J Neurol 2021; 28:2461-2466. [PMID: 34022083 DOI: 10.1111/ene.14933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Affiliation(s)
| | - Katina Aleksovska
- European Academy of Neurology, Vienna, Austria.,Department of Neurology, Ss. Cyril and Methodius University, Skopje, N. Macedonia
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Vanessa Carvalho
- Matosinhos Local Health Unit, Department of Neurology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Institute of Molecular Medicine, Lisbon, Portugal
| | - Günther Deuschl
- Department of Neurology, Christian Albrecht University, Kiel, Germany
| | - Kristian Steen Frederiksen
- Department of Neurology, Danish Dementia Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, affiliated partner of the European Reference Network EpiCARE, Salzburg, Austria
| | - Maurizio A Leone
- Neurology Unit, Department of Emergency and Critical Care, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | | | - Michele Romoli
- Neurology Unit, Maurizio Bufalini Hospital, Cesena, Italy.,Neurology Clinic, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Paniccia M, Provvidenza C, Kingsnorth S, Ippolito C, Zemek R, Reed N. Engaging target users to appraise and refine clinical practice guidelines in pediatric concussion: An integrated knowledge translation approach. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211017405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Clinical practice guidelines are systematically developed statements that assist clinicians in making evidence informed decisions regarding patient care. Within pediatric concussion, the Ontario Neurotrauma Foundation released the Guidelines for Diagnosing and Managing Pediatric Concussion in 2014. The purpose of this study was to evaluate the 2014 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool, in addition to a brief knowledge translation survey, and to utilize the collected feedback from end users to inform improvements to support an updated version. An integrated knowledge translation approach was employed using clinical experts as guideline appraisers. Methods A purposive sample of researchers, physicians, allied health professionals, policy makers, educators and knowledge translation experts involved in updating the guidelines (N = 31) completed the AGREE II Likert scale survey regarding the 2014 guideline, and provided written justifications for their ratings. Domain and item AGREE II scaled scores were reported stratified by demographic factors, and written justifications were synthesized using content analysis to determine areas of improvement for the 2014 guideline. Results Appraisers scored the editorial independence (88.9%) and scope and purpose (80.8%) domains the highest, indicating high quality. The guidelines scored the lowest in the applicability domain (69.3%). Participants with less than 10 years of experience in their respective disciplines, as well as physicians and allied health professionals consistently provided higher ratings across domains compared to other professions. Conclusions The process of evaluating the 2014 guideline resulted in these important outcomes: (1) identified areas of the guideline that may have affected the lack of previous clinical uptake while abiding by a clinical practice guideline development framework; (2) shared and informed decision making regarding content and format of the revised clinical practice guideline; and (3) targeted content, clinical questions and dissemination strategies, which are key to clinical uptake.
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Affiliation(s)
- Melissa Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christine Provvidenza
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Shauna Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christina Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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O'Brien E, Clyne B, Smith SM, O'Herlihy N, Harkins V, Wallace E. A scoping review protocol of evidence-based guidance published by general practitioner professional organisations. HRB Open Res 2021; 4:53. [DOI: 10.12688/hrbopenres.13268.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: General practitioners (GPs) strive to use a patient centred approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will identify the role of GP professional organisations in generating, endorsing and/or disseminating evidence-based guidance for supporting general practitioner’s clinical decision making to benefit patient care.
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Tsopra R, Frappe P, Streit S, Neves AL, Honkoop PJ, Espinosa-Gonzalez AB, Geroğlu B, Jahr T, Lingner H, Nessler K, Pesolillo G, Sivertsen ØS, Thulesius H, Zoitanu R, Burgun A, Kinouani S. Reorganisation of GP surgeries during the COVID-19 outbreak: analysis of guidelines from 15 countries. BMC FAMILY PRACTICE 2021; 22:96. [PMID: 34000985 PMCID: PMC8127252 DOI: 10.1186/s12875-021-01413-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND General practitioners (GPs) play a key role in managing the COVID-19 outbreak. However, they may encounter difficulties adapting their practices to the pandemic. We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the pandemic from 15 countries. METHODS A network of GPs collaborated together in a three-step process: (i) identification of key recommendations of GP surgery reorganisation, according to WHO, CDC and health professional resources from health care facilities; (ii) collection of key recommendations included in the guidelines published in 15 countries; (iii) analysis, comparison and synthesis of the results. RESULTS Recommendations for the reorganisation of GP surgeries of four types were identified: (i) reorganisation of GP consultations (cancelation of non-urgent consultations, follow-up via e-consultations), (ii) reorganisation of GP surgeries (area partitioning, visual alerts and signs, strict hygiene measures), (iii) reorganisation of medical examinations by GPs (equipment, hygiene, partial clinical examinations, patient education), (iv) reorganisation of GP staff (equipment, management, meetings, collaboration with the local community). CONCLUSIONS We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the COVID-19 outbreak from 15 countries. These guidelines focus principally on clinical care, with less attention paid to staff management, and the area of epidemiological surveillance and research is largely neglected. The differences of guidelines between countries and the difficulty to apply them in routine care, highlight the need of advanced research in primary care. Thereby, primary care would be able to provide recommendations adapted to the real-world settings and with stronger evidence, which is especially necessary during pandemics.
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Affiliation(s)
- Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006, Paris, France. .,Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
| | - Paul Frappe
- Department of general practice, Faculty of medicine Jacques Lisfranc, University of Lyon, Saint-Etienne, France.,Inserm UMR 1059, Sainbiose DVH, University of Lyon, Saint-Etienne, France.,Inserm CIC-EC 1408, University of Lyon, Saint-Etienne, France.,College of General Practice / Collège de la Médecine Générale, Paris, France
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Center for Health Technology and Services Research / Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Berk Geroğlu
- İzmir Karşıyaka District Health Directorate, İzmir, Turkey
| | - Tobias Jahr
- Medizinische Hochschule Hannover, OE 5430, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Heidrun Lingner
- Medizinische Hochschule Hannover, Medizinische Psychologie, OE 5430, Hannover, Germany.,Member of the German Center for Lung Research (DZL)/ BREATH - Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland.,Vasco da Gama Movement, Wonca Europe, Kraków, Poland
| | | | - Øyvind Stople Sivertsen
- Torshovdalen Health Center, Oslo, Norway.,Editor of the Journal of the Norwegian Medical Association, Oslo, Norway
| | | | - Raluca Zoitanu
- National Federation of Family Medicine Employers in Romania (FNPMF), București, Romania
| | - Anita Burgun
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006, Paris, France.,Department of Medical Informatics, Hôpital Européen Georges-Pompidou & Necker Children's Hospital, AP-HP, Paris, France
| | - Shérazade Kinouani
- INSERM, Bordeaux Population Health Research Center, team HEALTHY, UMR 1219, university of Bordeaux, F-33000, Bordeaux, France.,Department of General Practice, University of Bordeaux, 146 rue Léo Saignat, F-33000, Bordeaux, France
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Abstract
Clinical practice guidelines in oncology provide an evidence-based roadmap for most cancer care delivery but often lack directions for specific patient factors and disease conditions. Clinical pathways serve as a real-time clinical decision support system to translate guidelines to clinical practice. Pathways allow for the creation of a standardized, multidimensional roadmap for the continuum of care that can support clinical decision-making, maintain optimal outcomes, and limit unnecessary variation in cancer care. Here we describe the process to develop and implement clinical pathways in the electronic health record. This process includes building the appropriate foundation for a clinical pathways team with supports in the institutional ecosystem, creating visual representations of care paths, formalizing the pathway approval process, and translating clinical pathways into an electronic health record-integrated clinical decision support tool.
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Nordstrom M, Landman G, Pfaff N, Kaiser SV. Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Children's Hospital. Hosp Pediatr 2021; 11:374-379. [PMID: 33785518 DOI: 10.1542/hpeds.2020-003673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Maintenance intravenous fluids (IVFs) are routinely used in the care of hospitalized children. The American Academy of Pediatrics (AAP) published clinical practice guidelines in November 2018 that recommended the use of isotonic maintenance IVF. Our primary aim was to increase the proportion of hospital days pediatric inpatients were exclusively administered isotonic maintenance IVF to ≥80% by May 2020 at our institution. METHODS We conducted a single-center quality improvement (QI) study as part of an AAP collaborative. An interdisciplinary team led QI interventions including providing targeted education to clinicians, integrating guideline recommendations into the electronic medical record, engaging hospital leaders, and providing performance data to clinicians. Our study population included children ages 28 days to 18 years admitted to inpatient wards. Our primary outcome was the proportion of hospital days with exclusive isotonic maintenance IVF use. Balancing measures included transfers to the ICU, ordering of serum sodium laboratory tests, and adverse events. Data were analyzed by using statistical process control. RESULTS We analyzed 500 hospital admissions and found a significant increase in exclusive isotonic IVF use (63% to 95%) within 9 months of starting our QI intervention. We found no significant changes in balancing measures (serum sodium laboratory tests [24% to 25%], ICU transfer [0.3% to 1%], adverse events [0.3% to 1%]). CONCLUSIONS Our interdisciplinary QI team led interventions that were associated with significant improvements in isotonic IVF use, in accordance with AAP clinical practice guidelines. With our study, we provide detailed guidance on successful interventions for implementing this evidence-based guideline.
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Affiliation(s)
| | - Geri Landman
- Sutter East Bay Medical Group, Berkeley, California
| | | | - Sunitha V Kaiser
- Departments of Pediatrics and.,Epidemiology and Biostatistics and.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; and
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Sprogis SK, Currey J, Jones D, Considine J. Understanding the pre-medical emergency team tier of a mature rapid response system: A content analysis of guidance documents. Aust Crit Care 2021; 34:427-434. [PMID: 33685780 DOI: 10.1016/j.aucc.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/10/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The pre-medical emergency team (pre-MET) tier of rapid response systems (RRSs) includes extended activation criteria to identify earlier clinical deterioration and a ward-based patient review that is undertaken by the affected patient's admitting team or covering doctors. There is limited understanding of the structure and processes of the pre-MET RRS tier that are expected to guide clinicians' actions and subsequent patient safety outcomes. OBJECTIVE The aim of the study was to describe the structure and processes of the pre-MET RRS tier in one acute care setting. METHODS An exploratory descriptive design involving document analysis was used. Guidance documents (policies, procedures, guidelines, charts, educational materials) were obtained from one health service with a mature, multitiered RRS in Melbourne, Australia. Documents were analysed using content analysis. Concept- and data-driven approaches were used to construct a coding frame. RESULTS Nineteen guidance documents supporting the pre-MET RRS tier on general wards were analysed. The coding frame consisted of seven main categories: Defining the Pre-MET RRS Tier, Essential Resources for Operationalisation, Recognising Pre-MET Events, Pathways for Activation, Exceptions to the Rule, Clinician Responses to Pre-MET Events, and Recording Pre-MET Events. The structures and processes of the pre-MET RRS tier were largely consistent with national guidelines, but there were internal inconsistencies in pre-MET activation criteria and unclear recommendations for modifying criteria. Pathways for activating the pre-MET RRS tier were complex and involved many steps, including validation processes before escalation of care to doctors. Responses to pre-MET events were seldom aligned to specific clinician types or groups, with nurses and allied health clinicians being under-represented. CONCLUSIONS We identified opportunities to improve guidance documents supporting the pre-MET RRS tier that may assist other health services engaged in planning or evaluating pre-MET strategies. Further research is needed to understand clinicians' use of the pre-MET RRS tier to inform targeted strategies to optimise its design and implementation.
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Affiliation(s)
- Stephanie K Sprogis
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Judy Currey
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia; School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Julie Considine
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria, 3128, Australia.
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Ariza-Cardiel G, Del Cura-González II, Polentinos-Castro E, López-Rodríguez JA, Gil-Moreno JC, Martín-Fernández J. [Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain]. Aten Primaria 2021; 53:101941. [PMID: 33592535 PMCID: PMC7893431 DOI: 10.1016/j.aprim.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/07/2020] [Accepted: 08/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task. MATERIAL AND METHODS Design: Cross-sectional descriptive study with analytical approach. PARTICIPANTS Training Units in Spain (N=94). MAIN MEASUREMENTS Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG. RESULTS 45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units. CONCLUSIONS The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs.
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Affiliation(s)
- Gloria Ariza-Cardiel
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Móstoles, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - I Isabel Del Cura-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - Elena Polentinos-Castro
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Juan Antonio López-Rodríguez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Centro de Salud General Ricardos, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Juan Carlos Gil-Moreno
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Jesús Martín-Fernández
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Móstoles, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Lau YZ, Widdows K, Roberts SA, Khizar S, Stephen GL, Rauf S, Heazell AEP. Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies' lives care bundle to reduce stillbirth. BMJ Open Qual 2021; 9:bmjoq-2019-000756. [PMID: 32327423 PMCID: PMC7254132 DOI: 10.1136/bmjoq-2019-000756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction The UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff. Methods Seventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales. Results Unit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations. Conclusion To successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations. In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.
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Affiliation(s)
- Yu Zhen Lau
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK
| | - Kate Widdows
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK
| | - Stephen A Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Sheher Khizar
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Gillian L Stephen
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Saima Rauf
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexander E P Heazell
- St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK .,Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK
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47
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Trawick E, Pecoriello J, Quinn G, Goldman KN. Guidelines informing counseling on female age-related fertility decline: a systematic review. J Assist Reprod Genet 2021; 38:41-53. [PMID: 33188440 PMCID: PMC7822973 DOI: 10.1007/s10815-020-01967-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline. METHODS Searched electronic database records from January 1, 2006, to September 10, 2018, and professional society websites. The search terms included iterations of "guideline," "counseling," "preconception," "age-related fertility decline," and "reproductive life planning." English-language professional organization guidelines addressing patient counseling on age-specific reproductive health topics were included. Assessed the methodological quality of included guidelines using the AGREE II instrument. Guidelines were categorized as high quality or low quality based on AGREE II scores. Extracted age-specific reproductive health recommendations of high-quality guidelines. RESULTS The search identified 2918 records. Nineteen records addressed counseling on age-related fertility decline; only 6 focused only on reproductive aging, with the remaining 13 covering related topics. Eleven met criteria for high quality. All high-quality guidelines had high "rigor of development" scores on AGREE II. Ten high-quality guidelines stated an age at which female fertility declines, ranging from 30 to "late 30s." One recommended a specific age at which patients should be counseled. Five of eleven high-quality guidelines did not discuss the obstetric and perinatal risks of advanced maternal age. CONCLUSIONS Few high-quality guidelines address counseling on female age-related fertility decline, and existing guidance on reproductive aging counseling is inconsistent and incomplete. Greater rigor of development and incorporation of age-specific counseling recommendations into clinical practice guidelines could lead to improved patient anticipatory guidance and more informed reproductive choices.
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Affiliation(s)
- Emma Trawick
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA
| | - Jillian Pecoriello
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Gwendolyn Quinn
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Kara N Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA.
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Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach MA, McVaney C, Morrell P, Asnes AG. Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments. Acad Emerg Med 2021; 28:70-81. [PMID: 32931628 DOI: 10.1111/acem.14132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months. METHODS We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan-do-study-act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high-risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS). RESULTS Evidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8-month period, the CPT was consulted for a mean of 47.5% of children with high-risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high-risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%. CONCLUSION Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high-risk injuries. Such interventions may improve recognition of physical abuse.
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Affiliation(s)
- Gunjan Tiyyagura
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Beth Emerson
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Julie R. Gaither
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Kirsten Bechtel
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - John M. Leventhal
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Heather Becker
- the Department of Emergency Medicine Bridgeport Hospital Bridgeport CTUSA
| | | | - Thomas Balga
- and the Department of Emergency Medicine Yale New Haven Hospital New Haven CT USA
| | - Bonnie Mackenzie
- and the Department of Emergency Medicine Lawrence and Memorial Hospital Norwich CTUSA
| | - May Shum
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Eugene D. Shapiro
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Marc A. Auerbach
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Caitlin McVaney
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Patricia Morrell
- and the Department of Surgery Yale New Haven Hospital New Haven CT USA
| | - Andrea G. Asnes
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
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Wang Z, Bero L, Grundy Q. Understanding professional stakeholders' active resistance to guideline implementation: The case of Canadian breast screening guidelines. Soc Sci Med 2020; 269:113586. [PMID: 33333377 DOI: 10.1016/j.socscimed.2020.113586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/04/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
Health guidelines aim to improve patient outcomes through the promotion of evidence-based practice. Yet, when a guideline's recommendations significantly differ from, or threaten the interests, values and preferred practices of end-users, organised and often very public resistance to guideline implementation may result. To explore this phenomenon, we theorise a case study consisting of the public discourse following the update to a primary care breast screening guideline in Canada in 2018. Informed by sociological perspectives on the professions and evidence-based medicine, this paper aims to explore: [1] why professional stakeholders form active resistances to the implementation of some clinical guidelines; and, [2] how professional values, perspectives, interests and/or experiences influence the stakeholders' stance. Current understandings have taken a reductive approach in conceptualising the exclusion of experts and their resistance as "conflict of interest." Rather, we suggest that resistance is the product of multiple areas of contention, stemming from tensions related to clinical and professional autonomy, medical jurisdiction, and the role of medical elites. We highlight considerations for future guideline development and implementation process changes to mitigate and resolve issues related to active resistance. These considerations include understanding resistance as a political strategy, increasing transparency of public input and coalition building as a part of the public response to active resistance.
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Affiliation(s)
- Zhicheng Wang
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia.
| | - Lisa Bero
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia; University of Colorado School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, USA.
| | - Quinn Grundy
- Charles Perkins Centre, The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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50
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Patseadou M, Pfarrwaller E, Haller DM. Clinical preventive guidelines for school-aged children and adolescents in primary care: a protocol for a systematic review. BMJ Open 2020; 10:e037396. [PMID: 33303432 PMCID: PMC7733204 DOI: 10.1136/bmjopen-2020-037396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Guidelines for clinical preventive services targeting school-aged children and adolescents in primary care are limited, often inconsistent and difficult to apply in clinical contexts. This publication describes the protocol concerning a comprehensive systematic review that primarily aims to collect and synthesise available guidelines for prevention in primary care focused on school-aged children living in high-income regions. A second objective is to assess the quality of identified documents. METHODS AND ANALYSIS We will search for reports providing clinical practice guidelines or consensus or expert opinion on preventive actions in paediatric primary care. We will use the WHO definition of prevention. We will focus on children aged 6-18 years living in the European region, the USA, Canada and Australia. We will search PubMed, Embase, Web of Science and Cochrane Library and guidelines-specific databases from 1 January 2010. We will also explore the grey literature using web search engines (Google and Google Scholar). We will finally obtain unpublished information through personal contact with national paediatric societies. We will summarise all identified documents as well as their potential methodological bias. We will further use the Appraisal of Guidelines Research and Evaluation Instrument, version II tool to critically appraise their quality. ETHICS AND DISSEMINATION Our findings will contribute to the identification of clinical preventive guidelines for which implementation in routine paediatric primary care should be considered. We intend to disseminate our results through publication in peer-reviewed journals and conference proceedings.PROSPERO registration numberCRD42020163184.
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Affiliation(s)
- Magdalini Patseadou
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Woman, Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Pfarrwaller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
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