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Bentvelsen RG, Veldkamp KE, Chavannes NH. A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis. JMIR Res Protoc 2021; 10:e28314. [PMID: 33755026 PMCID: PMC8086777 DOI: 10.2196/28314] [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: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care-associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. OBJECTIVE The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. METHODS We will conduct a multicenter interrupted time-series analysis-a strong study design when randomization is not feasible-consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards' requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients' perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. RESULTS To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05. CONCLUSIONS Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care-related decision-making and to increase the quality of care. TRIAL REGISTRATION Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28314.
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Affiliation(s)
- Robbert Gerard Bentvelsen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.,Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Bentvelsen RG, van der Vaart R, Veldkamp KE, Chavannes NH. Systematic development of an mHealth app to prevent healthcare-associated infections by involving patients: ‘Participatient’. CLINICAL EHEALTH 2021. [DOI: 10.1016/j.ceh.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Laan BJ, Maaskant JM, Spijkerman IJB, Borgert MJ, Godfried MH, Pasmooij BC, Opmeer BC, Vos MC, Geerlings SE. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study. THE LANCET. INFECTIOUS DISEASES 2020; 20:864-872. [PMID: 32151333 DOI: 10.1016/s1473-3099(19)30709-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/29/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. METHODS In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. FINDINGS Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). INTERPRETATION Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. FUNDING Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Bart J Laan
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Jolanda M Maaskant
- Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjon J Borgert
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mieke H Godfried
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Berend C Pasmooij
- Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Brent C Opmeer
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Margreet C Vos
- Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Suzanne E Geerlings
- Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Bradley R, Harnett J, Cooley K, McIntyre E, Goldenberg J, Adams J. Naturopathy as a Model of Prevention-Oriented, Patient-Centered Primary Care: A Disruptive Innovation in Health Care. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E603. [PMID: 31540415 PMCID: PMC6780388 DOI: 10.3390/medicina55090603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 01/01/2023]
Abstract
Background and Objective: The concept of a "disruptive innovation," recently extended to health care, refers to an emerging technology that represents a new market force combined with a new value system, that eventually displaces some, or all, of the current leading "stakeholders, products and strategic alliances." Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization (WHO), emerging as a model of primary care. The objective here is to describe Naturopathy in the context of the criteria for a disruptive innovation. Methods: An evidence synthesis was conducted to evaluate Naturopathy as a potentially disruptive technology according to the defining criteria established by leading economists and health technology experts: (1) The innovation must cure disease; (2) must transform the way medicine is practiced; or (3) have an impact that could be disruptive or sustaining, depending on how it is integrated into the current healthcare marketplace. Results: The fact that Naturopathy de-emphasizes prescription drug and surgical interventions in favor of nonpharmacological health promotion and self-care could disrupt the present economic model that fuels health care costs. The patient-centered orientation of Naturopathy, combined with an emphasis on preventive behaviors and popular complementary and integrative health services like natural products, mind and body therapies, and other therapies not widely represented in current primary care models increase the likelihood for disruption. Conclusions: Because of its patient-centered approach and emphasis on prevention, naturopathy may disrupt or remain a durable presence in healthcare delivery depending on policymaker decisions.
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Affiliation(s)
- Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA.
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA.
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Joanna Harnett
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney NSW 2006, Australia.
| | - Kieran Cooley
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
- Department of Research and Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, ON M2K1E2, Canada.
- Transitional Doctorate Department, Pacific College of Oriental Medicine, San Diego, CA 92108, USA.
| | - Erica McIntyre
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA.
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Jon Adams
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
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Laan BJ, Geerlings SE. Non-antibiotic prevention strategies against catheter-associated urinary tract infections. THE LANCET. INFECTIOUS DISEASES 2019; 19:562-564. [PMID: 30987815 DOI: 10.1016/s1473-3099(18)30758-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bart J Laan
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, Netherlands.
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Laan BJ, Nieuwkerk PT, Geerlings SE. Patients knowledge and experience with urinary and peripheral intravenous catheters. World J Urol 2019; 38:57-62. [PMID: 30680418 PMCID: PMC6954151 DOI: 10.1007/s00345-018-02623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/29/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Inappropriate use of urinary and intravenous catheters is still frequent. The use of catheters is associated with some serious complications, such as health care associated infections (HAIs). An efficient way to reduce HAIs is to avoid inappropriate use of catheters, but the role for patients in quality improvement initiatives is unclear. The aim of this study is to investigate patients knowledge and experience with catheters, to design patient interventions to reduce inappropriate catheter use. Methods We assessed patient’s knowledge and experience with catheters using a self report questionnaire, and included patients with a urinary and/or peripheral intravenous catheter (PIVC) during the baseline measurements of a quality improvement project to reduce inappropriate catheters use. Results A total number of 82 patients completed the questionnaire, of which 49 had a urinary catheter and 72 a PIVC. Patients were unaware about the indication for their urinary catheter in 20.9% and PIVC in 19.5%. Nevertheless, 65.3% reported symptoms due to urinary catheters and 37.5% for PIVCs. Interestingly, only 25.5% and 22.4% reported that they would ask their doctor if the catheter could be removed. Conclusions There is a lack of knowledge about the indication for having a urinary and peripheral intravenous catheter in a substantial part of patients. Although catheters cause symptoms, patients in general do not ask if the catheter could be removed. Doctors should give more information and ask more questions about catheters to their patients. Quality improvement initiatives stimulating patients to actively participate in their treatment are needed. Electronic supplementary material The online version of this article (10.1007/s00345-018-02623-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bart J Laan
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Pythia T Nieuwkerk
- Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam, Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.
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Bourgault AM, Upvall MJ. De-implementation of tradition-based practices in critical care: A qualitative study. Int J Nurs Pract 2019; 25:e12723. [PMID: 30656794 DOI: 10.1111/ijn.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/25/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022]
Abstract
AIM To explore the process of tradition-based practice (TBP) de-implementation by critical care nurses. BACKGROUND Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De-implementation (termination) of potentially harmful, ineffective, or non cost-effective TBP is necessary to facilitate evidence-based practice (EBP) in the clinical setting. DESIGN Descriptive qualitative inquiry guided this study. METHODS Twenty-two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. RESULTS Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De-implementation processes and strategies appeared to replicate implementation processes. CONCLUSION More research is needed to evaluate de-implementation processes and strategies used for de-implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.
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Affiliation(s)
- Annette M Bourgault
- Department of Nursing Systems, College of Nursing, Academic Health Sciences Center, University of Central Florida, USA.,Center for Nursing Research, Orlando Health, Orlando, Florida, USA
| | - Michele J Upvall
- Department of Nursing Systems, College of Nursing, Academic Health Sciences Center, University of Central Florida, USA
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Abstract
AIM The purpose of this concept analysis is to explore the meaning of de-implementation and provide a definition that can be used by researchers and clinicians to facilitate evidence-based practice. BACKGROUND De-implementation is a relatively unknown process overshadowed by the novelty of introducing new ideas and techniques into practice. Few studies have addressed the challenge of de-implementation and the cognitive processes involved when terminating harmful or unnecessary practices. Also, confusion exists regarding the myriad of terms used to describe de-implementation processes. DESIGN Walker and Avant's method (2011) for describing concepts was used to clarify de-implementation. DATA SOURCE A database search limited to academic journals yielded 281 publications representing basic research, study protocols, and editorials/commentaries from implementation science experts. After applying exclusion criterion of English language only and eliminating overlap between databases, 41 articles were selected for review. REVIEW METHODS Literature review and synthesis provided a concept analysis and a distinct definition of de-implementation. RESULTS De-implementation was defined as the process of identifying and removing harmful, non-cost-effective, or ineffective practices based on tradition and without adequate scientific support. CONCLUSIONS The analysis provided further refinement of de-implementation as a significant concept for ongoing theory development in implementation science and clinical practice.
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