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Beal EW, McNamara M, Owen M, McAlearney AS, Tsung A. Interventions to Improve Surveillance for Hepatocellular Carcinoma in High-Risk Patients: A Scoping Review. J Gastrointest Cancer 2024; 55:1-14. [PMID: 37328730 DOI: 10.1007/s12029-023-00944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is most often a sequela of chronic liver disease or chronic hepatitis B infection. Among high-risk patients, surveillance for HCC every 6 months is recommended by international guidelines. However, rates of HCC surveillance are suboptimal (11-64%). Barriers at the patient, provider, and healthcare delivery system levels have been identified. METHODS We performed a systemic scoping review to identify and characterize interventions to improve HCC surveillance that has previously been evaluated. Searches using key terms in PubMed and Embase were performed to identify studies examining interventions designed to improve the surveillance rate for HCC in patients with cirrhosis or chronic liver disease that were published in English between January 1990 and September 2021. RESULTS Included studies (14) had the following study designs: (1) randomized clinical trials (3, 21.4%), (2) quasi-experimental (2, 14.3%), (3) prospective cohort (6, 42.8%), and (4) retrospective cohort (3, 21.4%). Interventions included mailed outreach invitations, nursing outreach, patient education with or without printed materials, provider education, patient navigation, chronic disease management programs, nursing-led protocols for image ordering, automated reminders to physicians and nurses, web-based clinical management tools, HCC surveillance databases, provider compliance reports, radiology-led surveillance programs, subsidized HCC surveillance, and the use of oral medications. It was found that HCC surveillance rates increased after intervention implementation in all studies. CONCLUSION Despite improvements in HCC surveillance rates with intervention, compliance remained suboptimal. Further analysis of which interventions yield the greatest increases in HCC surveillance, design of multi-pronged strategies, and improved implementation are needed.
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Affiliation(s)
- Eliza W Beal
- Departments of Surgery and Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, Mailcode: HW04HO, Detroit, MI, 48201, USA.
| | - Molly McNamara
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Mackenzie Owen
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, University of Virginia, Charlottsville, VA, 22908, USA
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Boaz A, Baeza J, Fraser A, Persson E. 'It depends': what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice. Implement Sci 2024; 19:15. [PMID: 38374051 PMCID: PMC10875780 DOI: 10.1186/s13012-024-01337-z] [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: 11/01/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The gap between research findings and clinical practice is well documented and a range of strategies have been developed to support the implementation of research into clinical practice. The objective of this study was to update and extend two previous reviews of systematic reviews of strategies designed to implement research evidence into clinical practice. METHODS We developed a comprehensive systematic literature search strategy based on the terms used in the previous reviews to identify studies that looked explicitly at interventions designed to turn research evidence into practice. The search was performed in June 2022 in four electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched from January 2010 up to June 2022 and applied no language restrictions. Two independent reviewers appraised the quality of included studies using a quality assessment checklist. To reduce the risk of bias, papers were excluded following discussion between all members of the team. Data were synthesised using descriptive and narrative techniques to identify themes and patterns linked to intervention strategies, targeted behaviours, study settings and study outcomes. RESULTS We identified 32 reviews conducted between 2010 and 2022. The reviews are mainly of multi-faceted interventions (n = 20) although there are reviews focusing on single strategies (ICT, educational, reminders, local opinion leaders, audit and feedback, social media and toolkits). The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Furthermore, a lot of nuance lies behind these headline findings, and this is increasingly commented upon in the reviews themselves. DISCUSSION Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been identified. We need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of research perspectives (including social science) in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed.
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Affiliation(s)
- Annette Boaz
- Health and Social Care Workforce Research Unit, The Policy Institute, King's College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE, UK.
| | - Juan Baeza
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Alec Fraser
- King's Business School, King's College London, 30 Aldwych, London, WC2B 4BG, UK
| | - Erik Persson
- Federal University of Santa Catarina (UFSC), Campus Universitário Reitor João Davi Ferreira Lima, Florianópolis, SC, 88.040-900, Brazil
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3
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Naar S, Fernandez MI, Todd L, Green SKS, Budhwani H, Carcone A, Coyle K, Aarons GA, MacDonell K, Harper GW. Understanding implementation completion of tailored motivational interviewing in multidisciplinary adolescent HIV clinics. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231164585. [PMID: 37091536 PMCID: PMC10068499 DOI: 10.1177/26334895231164585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Background Understanding the barriers and facilitators of implementation completion is critical to determining why some implementation efforts fail and some succeed. Such studies provide the foundation for developing further strategies to support implementation completion when scaling up evidence-based practices (EBPs) such as Motivational Interviewing. Method This mixed-methods study utilized the Exploration, Preparation, Implementation, and Sustainment framework in an iterative analytic design to compare adolescent HIV clinics that demonstrated either high or low implementation completion in the context of a hybrid Type III trial of tailored motivational interviewing. Ten clinics were assigned to one of three completion categories (high, medium, and low) based on percentage of staff who adhered to three components of implementation strategies. Comparative analysis of staff qualitative interviews compared and contrasted the three high-completion clinics with the three low-completion clinics. Results Results suggested several factors that distinguished high-completion clinics compared to low-completion clinics including optimism, problem-solving barriers, leadership, and staff stress and turnover. Conclusions Implementation strategies targeting these factors can be added to EBP implementation packages to improve implementation success. Plain Language Summary While studies have begun to address adherence to intervention techniques, this is one of the first studies to address organizational adherence to implementation strategies. Youth HIV providers from different disciplines completed interviews about critical factors in both the inner and outer context that can support or hinder an organization's adherence to implementation strategies. Compared to less adherent clinics, more adherent clinics reported more optimism, problem-solving, and leadership strengths and less staff stress and turnover. Implementation strategies addressing these factors could be added to implementation packages to improve implementation success.
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Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA
| | - M. Isabel Fernandez
- Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern
University, Fort Lauderdale, FL, USA
| | - Lisa Todd
- Department of Family Medicine and Public Health Sciences, Wayne State University School of
Medicine, Detroit, MI, USA
| | - Sara K. Shaw Green
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA
| | - Henna Budhwani
- Department of Health Care Organization and Policy, School of Public
Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - April Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of
Medicine, Detroit, MI, USA
| | | | - Gregory A. Aarons
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, UC San Diego,
La Jolla, CA, USA
- Child and Adolescent Services Research
Center, San Diego, CA, USA
| | - Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of
Medicine, Detroit, MI, USA
| | - Gary W. Harper
- Department of Health Behavior and Health Education, School of Public
Health, University of Michigan School of Public
Health, Ann Arbor, MI, USA
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Paulus MP, Kuplicki R, Victor TA, Yeh HW, Khalsa SS. Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial. BMC Psychiatry 2021; 21:582. [PMID: 34798853 PMCID: PMC8603485 DOI: 10.1186/s12888-021-03583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adherence to treatment, i.e. the extent to which a patient's therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram. METHODS Twenty participants with moderate to severe depression were 1-1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes. RESULTS First, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables. CONCLUSIONS These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS. GOV IDENTIFIER NCT03388164 , registered on 01/02/2018.
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Affiliation(s)
- Martin P. Paulus
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
| | - Rayus Kuplicki
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Teresa A. Victor
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA
| | - Hung-Wen Yeh
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.239559.10000 0004 0415 5050Health Services & Outcomes Research, Children’s Mercy Hospital, Kansas City, MO USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 8863Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326 USA ,grid.267360.60000 0001 2160 264XOxley College of Health Sciences, The University of Tulsa, Tulsa, OK USA
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5
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Glowacki K, Zumrawi D, Michalak E, Faulkner G. Evaluation of health care providers' use of the 'Exercise and Depression Toolkit': a case study. BMC Psychiatry 2021; 21:243. [PMID: 33964899 PMCID: PMC8105951 DOI: 10.1186/s12888-021-03248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise is now recommended as a primary treatment for mild-moderate depression in Canada. The 'Exercise and Depression Toolkit' was developed to help health care providers (HCP) integrate these treatment guidelines into practice. The purpose of this study was to evaluate acceptability and perceived effectiveness of the toolkit in practice by HCPs working with individuals with depression. METHODS A case study design was utilized. The toolkit was given to 6 HCPs to use in practice for 4 weeks. Pre- and post-intervention phone interviews were conducted, and weekly logs were provided to track use and satisfaction of interactions with individuals with depression when using the toolkit. The study was conceptually guided by a hybrid theoretical approach using the Diffusion of Innovation Theory and the Theoretical Framework of Acceptability. RESULTS All HCPs used the toolkit at least once. Participants viewed their interactions when using the toolkit to be successful (considering individuals' receptiveness, its usefulness and general satisfaction.) The average success score for all participants was 5.5/7. HCPs found the toolkit to be acceptable. All participants (n = 6) viewed the toolkit as having relative advantage in helping them to discuss exercise with individuals with depression, and as relatively simple and easy to use (not complex) and adaptable to their practice needs (having trialability). Participants liked the toolkit and had mostly positive things to say about it. Participants had mixed feelings about whether changes in the people they worked with (such as mood and activity levels) could be observed (observability) and whether the toolkit changed their belief in their ability to recommend or discuss exercise (self-efficacy). Recommended dissemination strategies were adopted in promoting the toolkit. CONCLUSIONS Future work should address observability and the ability for health care providers to see other providers using it, as well as effectiveness considering outcomes for people with depression such as mood and activity changes. The results of this initial evaluation seem promising for uptake and future adoption of the toolkit by health care providers working with adults with depression in Canada.
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Affiliation(s)
- Krista Glowacki
- Department of Kinesiology, Faculty of Education, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.
| | - Daniah Zumrawi
- grid.17091.3e0000 0001 2288 9830Department of Kinesiology, Faculty of Education, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1 Canada
| | - Erin Michalak
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, Mood Disorders Centre, Faculty of Medicine, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Guy Faulkner
- grid.17091.3e0000 0001 2288 9830Department of Kinesiology, Faculty of Education, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1 Canada
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6
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Rogal SS, Yakovchenko V, Gonzalez R, Park A, Beste LA, Rozenberg-Ben-Dror K, Bajaj JS, Scott D, McCurdy H, Comstock E, Sidorovic M, Gibson S, Lamorte C, Nobbe A, Chartier M, Ross D, Dominitz JA, Morgan TR. The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance. Cancers (Basel) 2021; 13:cancers13092251. [PMID: 34067177 PMCID: PMC8125814 DOI: 10.3390/cancers13092251] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Liver cancer is a growing problem that largely impacts people with cirrhosis. This article describes the Veterans Health Administration’s national cirrhosis quality improvement program and its focus on early detection of liver cancer. Abstract After implementing a successful hepatitis C elimination program, the Veterans Health Administration’s (VHA) Hepatic Innovation Team (HIT) Collaborative pivoted to focus on improving cirrhosis care. This national program developed teams of providers across the country and engaged them in using systems redesign methods and population health approaches to improve care. The HIT Collaborative developed an Advanced Liver Disease (ALD) Dashboard to identify Veterans with cirrhosis who were due for surveillance for hepatocellular carcinoma (HCC) and other liver care, promoted the use of an HCC Clinical Reminder in the electronic health record, and provided training and networking opportunities. This evaluation aimed to describe the VHA’s approach to improving cirrhosis care and identify the facility factors and HIT activities associated with HCC surveillance rates, using a quasi-experimental design. Across all VHA facilities, as the HIT focused on cirrhosis between 2018–2019, HCC surveillance rates increased from 46% (IQR 37–53%) to 51% (IQR 42–60%, p < 0.001). The median HCC surveillance rate was 57% in facilities with high ALD Dashboard utilization compared with 45% in facilities with lower utilization (p < 0.001) and 58% in facilities using the HCC Clinical Reminder compared with 47% in facilities not using this tool (p < 0.001) in FY19. Increased use of the ALD Dashboard and adoption of the HCC Clinical Reminder were independently, significantly associated with HCC surveillance rates in multivariate models, controlling for other facility characteristics. In conclusion, the VHA’s HIT Collaborative is a national healthcare initiative associated with significant improvement in HCC surveillance rates.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
- Departments of Medicine and Surgery, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15240, USA
- Correspondence: ; Tel.: +1-412-360-6177
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA 01730, USA;
| | - Rachel Gonzalez
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA 94523, USA;
| | - Angela Park
- Office of Healthcare Transformation, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA;
| | - Lauren A. Beste
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA;
- General Medicine Service, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Karine Rozenberg-Ben-Dror
- Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, 11301 W Cermak Road, Ste 810, Westchester, IL 60154, USA;
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA 23298, USA;
- Division of Gastroenterology, Central Virginia Veterans Affairs Healthcare System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA
| | - Dawn Scott
- Department of Medicine, Central Texas Veterans Healthcare System, 1901 Veterans Memorial Drive, Temple, TX 76504, USA;
| | - Heather McCurdy
- VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA;
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore VA Medical Center, 10 N Greene Street, Baltimore, MD 21201, USA;
| | - Michael Sidorovic
- Salisbury VA Medical Center, 1601 Brenner Avenue, Salisbury, NC 28144, USA;
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
| | - Anna Nobbe
- Digestive Disease Section, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA;
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA; (M.C.); (D.R.)
| | - David Ross
- HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA; (M.C.); (D.R.)
| | - Jason A. Dominitz
- Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA;
- Division of Gastroenterology, Department of Medicine, RR-512, Health Sciences Building, University of Washington School of Medicine, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, 5901 E 7th Street, Long Beach, CA 90822, USA;
- Division of Gastroenterology, Department of Medicine, University of California, 333 City Blvd. West, Suite 400, Orange, CA 92868, USA
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Rodie DJ, Fitzgibbon K, Perivolaris A, Crawford A, Geist R, Levinson A, Mitchell B, Oslin D, Sunderji N, Mulsant BH. The primary care assessment and research of a telephone intervention for neuropsychiatric conditions with education and resources study: Design, rationale, and sample of the PARTNERs randomized controlled trial. Contemp Clin Trials 2021; 103:106284. [PMID: 33476774 DOI: 10.1016/j.cct.2021.106284] [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: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
While most patients with depression, anxiety, or at-risk drinking receive care exclusively in primary care settings, primary care providers experience challenges in diagnosing and treating these common problems. Over the past two decades, the collaborative care model has addressed these challenges. However, this model has been adopted very slowly due to the high costs of care managers; inability to sustain their role in small practices; and the perceived lack of relevance of interventions focused on a specific psychiatric diagnosis. Thus, we designed an innovative randomized clinical trial (RCT), the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs). This RCT compared the outcomes of enhanced usual care and a novel model of collaborative care in primary care patients with depressive disorders, generalized anxiety, social phobia, panic disorder, at-risk drinking, or alcohol use disorders. These conditions were selected because they are present in almost a third of patients seen in primary care settings. Innovations included assigning the care manager role to trained lay providers supported by computer-based tools; providing all care management centrally by phone - i.e., the intervention was delivered without any face-to-face contact between the patient and the care team; and basing patient eligibility and treatment selection on a transdiagnostic approach using the same eligibility criteria and the same treatment algorithms regardless of the participants' specific psychiatric diagnosis. This paper describes the design of this RCT and discusses the rationale for its main design features.
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Affiliation(s)
- David J Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Levinson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, United States of America
| | - Nadiya Sunderji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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8
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Yoong SL, Hall A, Stacey F, Grady A, Sutherland R, Wyse R, Anderson A, Nathan N, Wolfenden L. Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews. Implement Sci 2020; 15:50. [PMID: 32611354 PMCID: PMC7329401 DOI: 10.1186/s13012-020-01011-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews. METHODS As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework. SYNTHESIS The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects. RESULTS Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76). CONCLUSIONS This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change. TRIAL REGISTRATION This review was not prospectively registered.
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Affiliation(s)
- Sze Lin Yoong
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Alix Hall
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
| | - Fiona Stacey
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
| | - Alice Grady
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Rebecca Wyse
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Amy Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
| | - Nicole Nathan
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
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9
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Martin J, Viprey M, Castagne B, Merle B, Giroudon C, Chapurlat R, Schott AM. Interventions to improve osteoporosis care: a systematic review and meta-analysis. Osteoporos Int 2020; 31:429-446. [PMID: 31993718 DOI: 10.1007/s00198-020-05308-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022]
Abstract
Osteoporosis (OP) is a major public health concern, but still OP care does not meet guidelines. Interventions have been developed to improve appropriate OP management. The objective of the present study was to systematically review the current literature to ascertain the efficacy of interventions to improve OP care and characterize interventions taking into account elements related to their potential cost and feasibility. Studies published from 2003 to 2018 were retrieved from PubMed/MEDLINE, Science Direct, Web of Science, Cochrane, and Wiley Online Library databases. Screening of references and quality assessment were independently performed by two reviewers. We classified interventions into three types according to the target of the intervention: health system (structural interventions), healthcare professional (HCP), and patient. Meta-analysis was performed by type of intervention and their effect on two outcomes: prescription of BMD measurement and prescription of OP therapy. A total of 4268 records were screened; 32 studies were included in the qualitative analysis and 29 studies in the quantitative analysis. Structural interventions strongly and significantly improved prescription of BMD measurement (OR = 9.99, 95% CI 2.05; 48.59) and treatment prescription (OR = 3.82, 95% CI 2.16; 6.75). The impact of HCP-centered interventions on BMD measurement prescription did not reach statistical significance (OR = 2.19, 95% CI 0.84; 5.73) but significantly improved treatment prescription (OR = 3.82, 95% CI 2.16; 6.75). Interventions involving patients significantly improved the prescription of BMD measurement (OR = 2.16, 95% CI 1.62; 2.89) and treatment prescription (OR = 1.70, 95% CI 1.35; 2.14). Interventions to improve OP management had a significant positive impact on prescription of BMD measurement but a more limited impact on treatment prescription.
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Affiliation(s)
- J Martin
- Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, 69003, Lyon, France
| | - M Viprey
- Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, 69003, Lyon, France
| | - B Castagne
- Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France
- Department of Rheumatology, CHU Gabriel Montpied, 63000, Clermont-Ferrand, France
| | - B Merle
- INSERM UMR1033, Lyon, France
| | - C Giroudon
- Centre de documentation, Hospices Civils de Lyon, Lyon, France
| | - R Chapurlat
- INSERM UMR1033, Lyon, France
- Service de Rhumatologie et de Pathologie Osseuse, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - A-M Schott
- Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
- Hospices Civils de Lyon, Pôle de Santé Publique, 69003, Lyon, France.
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10
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Belsher BE, Beech EH, Kelber MS, Hempel S, Evatt DP, Smolenski DJ, Campbell MS, Otto JL, Morgan MA, Workman DE, Stewart L, Morgan RL, Khusid M, Edwards-Stewart A, O’Gallagher K, Bush N. Establishing an Evidence Synthesis Capability For Psychological Health Topics in the Military Health System. Med Care 2019; 57 Suppl 10 Suppl 3:S265-S271. [PMID: 31517798 PMCID: PMC6750155 DOI: 10.1097/mlr.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To promote evidence-based health care, clinical providers and decision makers rely on scientific evidence to inform best practices. Evidence synthesis (ES) is a key component of this process that serves to inform health care decisions by integrating and contextualizing research findings across studies. OBJECTIVE This paper describes the process of establishing an ES capability in the Military Health System dedicated to psychological health topics. RESEARCH DESIGNS The goal of establishing the current ES capability was to facilitate evidence-based decision-making among clinicians, clinic managers, research funders, and policymakers, through the production and dissemination of trustworthy ES reports. We describe how we developed this capability, provide an overview of the types of evidence syntheses products we use to respond to different stakeholders, and detail the procedures established for selecting and prioritizing synthesis topics. RESULTS We report on the productivity, acceptability, and impact of our efforts. Our reports were used by a variety of stakeholders and working groups, briefed to major committees, included in official reports and policies, and cited in clinical practice guidelines and the peer-reviewed literature. CONCLUSIONS Our experiences thus far suggest that the current ES capability offers a needed service within our health system. Our framework may help inform other agencies interested in developing or sponsoring a similar capability.
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Affiliation(s)
- Bradley E. Belsher
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Erin H. Beech
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Marija S. Kelber
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Susanne Hempel
- RAND Corporation, Evidence-based Practice Center (EPC), Santa Monica, CA
| | - Daniel P. Evatt
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Derek J. Smolenski
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Marjorie S. Campbell
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Jean L. Otto
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Maria A. Morgan
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Don E. Workman
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Lindsay Stewart
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Marina Khusid
- Department of Family Medicine, University of Illinois, Chicago, IL
| | - Amanda Edwards-Stewart
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Kevin O’Gallagher
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
| | - Nigel Bush
- Defense Health Agency, Psychological Health Center of Excellence (PHCoE), Falls Church, VA
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11
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Wakida EK, Obua C, Musisi S, Rukundo GZ, Ssebutinde P, Talib ZM, Akena D, Okello ES. Implementing clinical guidelines to promote integration of mental health services in primary health care: a qualitative study of a systems policy intervention in Uganda. Int J Ment Health Syst 2019; 13:49. [PMID: 31346348 PMCID: PMC6636121 DOI: 10.1186/s13033-019-0304-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/10/2019] [Indexed: 01/09/2023] Open
Abstract
Background Clinical practice guidelines (CPG) are developed based on a synthesis of evidence regarding the best options for the assessment, diagnosis and treatment of diseases and are recognized as essential quality improvement tools. However, despite growing availability of CPG, research evaluating their use for mental disorders in Uganda is lacking. For a successful implementation of CPG to be achieved, a number of considerations need to be put in place. Objective This study aimed to assess the feasibility and acceptability of the educational intervention that we developed towards improvement of the primary health care providers (PHCPs) uptake of the Uganda Clinical Guidelines (UCG) in integrating mental health services into PHC in Mbarara district, southwestern Uganda. Methods This was a descriptive cross-sectional qualitative study with a semi-structured in-depth interview guide. The educational intervention we were assessing had four components: (i) summarized UCG on common mental disorders; (ii) modified Health Management Information System (HMIS) registers to include mental health; (iii) clinician's checklist outlining the steps to be followed; and iv) support supervision/training. Results Six themes emerged from the study while the components of the intervention formed the apriori subthemes. Key results based on the subthemes show: (i) summarized UCG: the participants liked the packaging stating that it eased their work, was time saving and user friendly; (ii) modified register: participants appreciated the modifications made to the register updating the existing record in the Health Management Information System (HMIS) registers to include mental health disorders; (iii) TRAINING and support supervision: the PHCPs attributed the success in using the summarized UCG to the training they received, and they further expressed the need to regularize the training in assessment for mental health and support by the mental health specialists. Conclusion Our study demonstrates that the use of summarized UCG, modified HMIS registers to include mental health, training and support supervision by mental health specialists in implementing the UCG in integrating mental health at PHC settings is feasible and acceptable by the PHCPs in Mbarara district, southwestern Uganda. Given the need for improved mental health care in Uganda, this intervention could be rigorously evaluated for effectiveness, scalability and generalizability.
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Affiliation(s)
- Edith K Wakida
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Celestino Obua
- 2Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Seggane Musisi
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Godfrey Z Rukundo
- 4Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Ssebutinde
- Mbarara District Local Goverment, Directorate of Health Services, Mbarara, Uganda
| | - Zohray M Talib
- Department of Medical Education, California University of Science and Medicine, San Bernardino, USA.,7Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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12
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Jarrar M, Al‐Bsheish M, Dardas LA, Meri A, Sobri Minai M. Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status. Int J Health Plann Manage 2019; 35:104-119. [DOI: 10.1002/hpm.2822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mu'taman Jarrar
- Vice Deanship for Quality and Development, College of MedicineImam Abdulrahman Bin Faisal University Dammam Saudi Arabia
- Medical--> Education DepartmentKing Fahd Hospital of the University Al‐Khobar Saudi Arabia
| | - Mohammad Al‐Bsheish
- Healthcare Administration DepartmentBatterjee Medical College Jeddah Saudi Arabia
| | - Latefa Ali Dardas
- Community Mental Health Nursing Department, School of NursingThe University of Jordan Amman Jordan
| | - Ahmed Meri
- Department of Medical Instrumentation Techniques EngineeringAl‐Hussain University College Karbala Iraq
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