scholarly journals Barriers and facilitators to reducing anticholinergic burden: a qualitative systematic review

2021 ◽  
Author(s):  
Carrie Stewart ◽  
Katie Gallacher ◽  
Athagran Nakham ◽  
Moira Cruickshank ◽  
Rumana Newlands ◽  
...  
Keyword(s):  
Systematic Review ◽  
Qualitative Research ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Barriers And Facilitators ◽  
Good Communication ◽  
Organisation Of Care ◽  
Anticholinergic Medications ◽  
Provider Perspectives ◽  
Anticholinergic Burden

AbstractBackground Despite common use, anticholinergic medications have been associated with serious health risks. Interventions to reduce their use are being developed and there is a need to understand their implementation into clinical care. Aim of review This systematic review aims to identify and analyse qualitative research studies exploring the barriers and facilitators to reducing anticholinergic burden. Methods Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms. Peer reviewed studies published in English presenting qualitative research in relation to the barriers and facilitators of deprescribing anticholinergic medications, involving patients, carers or health professionals were eligible. Normalization Process Theory was used to explore and explain the data. Results Of 1764 identified studies, two were eligible and both involved healthcare professionals (23 general practitioners, 13 specialist clinicians and 12 pharmacists). No studies were identified that involved patients or carers. Barriers to collaborative working often resulted in poor motivation to reduce anticholinergic use. Low confidence, system resources and organisation of care also hindered anticholinergic burden reduction. Good communication and relationships with patients, carers and other healthcare professionals were reported as important for successful anticholinergic burden reduction. Having a named person for prescribing decisions, and clear role boundaries, were also important facilitators. Conclusions This review identified important barriers and facilitators to anticholinergic burden reduction from healthcare provider perspectives which can inform implementation of such deprescribing interventions. Studies exploring patient and carer perspectives are presently absent but are required to ensure person-centeredness and feasibility of future interventions.

scholarly journals P04 Barriers and facilitators to medicines adherence in children: a systematic review

2020 ◽  
Vol 105 (9) ◽  
pp. e7.3-e8
Author(s):  
Mohammed Aldosari ◽  
Ana Oliveira ◽  
Sharon Conroy
Keyword(s):  
Systematic Review ◽  
Parental Education ◽  
Healthcare Professionals ◽  
Cochrane Collaboration ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Original Research ◽  
List Type ◽  
Inclusion Criteria ◽  
Good Communication

AimImproving adherence to medicines in children with chronic conditions may lead to significant economic and health benefits.1 To improve adherence, the multifactorial causes of poor adherence should be understood.1 A systematic review for barriers and facilitators to medicines adherence in children was conducted seven years ago.2 We updated this to identify barriers and facilitators to medicines adherence in children reported in the last ten years.MethodA systematic literature search was performed using PubMed, EMBASE, Medline, CINAHL, IPA and Cochrane library databases covering the period November 2008 to March 2019. Inclusion criteria were original research studies identifying barriers and/or facilitators of medicines adherence in children (aged 0–18 years) and included all countries and languages. Exclusion criteria included review articles, editorials, conference papers, reports and studies in adults only. As a reliability measure, 5% of titles and abstracts were assessed independently by a second researcher. Quality assessment was performed on all included studies using the STROBE checklist for observational studies and Cochrane collaboration tools for randomised controlled studies and was checked by a second researcher.ResultsOf 9,360 papers identified by the search, only 172 articles met the inclusion criteria. Most studies were conducted in the US (76), with 11 in the UK, six in Canada and the remaining 79 studies in various countries. Diseases studied included: HIV/AIDS (60), asthma (25), kidney or liver diseases and transplants (18), psychiatric disorders (12), inflammatory bowel disease (10), epilepsy (9) and others (38). Various tools were used to identify barriers and facilitators to medicines adherence. These included 131 studies which used individually designed questionnaires, 32 studies used validated questionnaires and the remaining 9 studies used patients’ medical data. Forgetfulness and fear of side effects were the most common reported barriers to medicines adherence. Others reported barriers to adherence included family conflict, weak patient-provider relationships, stigma and discrimination, drug regimen complexity and lack of support from families. Factors reported to facilitate high rates of adherence included the linking of medicine taking with daily life routines, using reminders to avoid forgetfulness, a higher level of caregivers and parental education and good communication between healthcare professionals, patients and parents.ConclusionThe main findings of this systematic review show that children faced many and varied barriers to medicines adherence with different diseases. Using reminders to avoid forgetfulness and good communication between healthcare professionals, patients and parents were the most common facilitators. To achieve optimal adherence, healthcare providers need to be aware of these barriers and to consider the most appropriate facilitators to encourage patients to take their medicines as prescribed.ReferencesBrown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304–14.Elliott RA, Watmough DE, Gray NJ, Conroy S, Lakhanpaul M, Pandya H, et al. Talking about medicines (TABS): a multi-method study to understand reasons for medicines non-adherence in children and young people with chronic illness, and to improve their contribution to managing their medicines. Natl Inst Heal Res 2012; 1–423.

scholarly journals Delivering and implementing child and adolescent mental health training for mental health and allied professionals: a systematic review and qualitative meta-aggregation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily Banwell ◽  
Neil Humphrey ◽  
Pamela Qualter
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Qualitative Research ◽  
Mental Health Professionals ◽  
Synthesis Method ◽  
Barriers And Facilitators ◽  
Youth Workers ◽  
Mental Health Training ◽  
Health Training ◽  
Starting Point

Abstract Background The increasing prevalence of mental health difficulties among children and young people (CYP) suggests that early intervention is vital. A comprehensive system of care and support requires the involvement of mental health professionals, including psychologists and psychiatrists, and allied professionals, including teachers, police, and youth workers. A critical starting point is the provision of effective training, in order that these professionals can better support the mental health needs of the CYP that they encounter. Objectives Given the primacy of training in the CYP mental health support system, understanding the factors that maximise potential gains and facilitate uptake is pertinent. The current review therefore located and explored qualitative research evidence, to identify the barriers and facilitators underpinning successful delivery and implementation of training focussed on the mental health of CYP, for both mental health and allied professionals. Methods A systematic review and qualitative meta-aggregation were conducted. Systematic searches were carried out using ASSIA, EMBASE, MEDLINE, NICE Evidence, PsycINFO, and Scopus databases, for papers published between 2000 and 2020. Twelve thousand four hundred forty-eight records were identified, of which 39 were eligible for review. The records were appraised for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, and synthesised using the qualitative meta-aggregation method. Results One hundred eighty-two raw findings were extracted from the 39 papers, which were condensed into 47 sub-categories, 19 categories, and finally 5 synthesis statements. These synthesis statements reflected the barriers and facilitators influencing the training delivery process (“support”; “content, design, and planning”), and the implementation of training into the workplace (“context”; “perceived value”; “organisational factors”). Conclusions The synthesis statements and underlying categories provide practical recommendations for those designing, delivering, or implementing CYP mental health training. Recommendations ranged from facilitating peer support during training, to the idea that training will be better implemented when perceived need is high. The review provides a robust evidence-based foundation to “common-sense” principles, drawing them into a coherent and organised framework using a synthesis method grounded in pragmatism. Protocol registration number PROSPERO reference ID: CRD42020162876.

scholarly journals Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20210004
Author(s):  
Harriet Nalubega Kisembo ◽  
Ritah Nassanga ◽  
Faith Ameda Ameda ◽  
Moses Ocan ◽  
Alison A Kinengyere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Systematic Reviews ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Information Source ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Clinical Imaging

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

Factors affecting patient and physician engagement in remote healthcare for heart failure: a systematic review (Preprint)

2021 ◽  
Author(s):  
Ahmed Al-Naher ◽  
Jennifer Downing ◽  
Kathryn A Scott ◽  
Munir Pirmohamed
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Health Outcomes ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Disease Process ◽  
Ease Of Use ◽  
Cochrane Library ◽  
User Engagement ◽  
Remote Care

BACKGROUND Adult chronic heart failure mainly affects an elderly population with multiple co-morbidities that often require frequent medical visits to prevent poor health outcomes. However the heart failure disease process reduces their independence by reducing mobility, exercise tolerance and cognitive decline. Remote care technologies can bridge the gap in care for these patients by allowing them to be followed up within the comfort of their home and encourage their self-care. However, patients, carers and healthcare professionals need to engage with the technology for it to be useful. OBJECTIVE This systematic review explored qualitative primary studies of remote care technologies used in heart failure, to determine the factors that affect user engagement with the technology. This is explored from the perspective of patients, carers, and healthcare professionals. METHODS Relevant studies published between 1/1/1990 – 19/9/2020 were identified from EMBASE, Ovid MEDLINE, Pubmed, Cochrane library and Scopus. These studies were then synthesized using thematic analysis. Relevant user experiences with remote care were extracted using line-by-line coding. These codes were summarised into secondary codes and core concepts, which were further merged into overarching themes that encapsulate user experience with remote care. RESULTS The review included 47 studies, which led to the generation of 5 overarching themes which affect engagement: (a) ‘Convenience’ relates to time saved by the intervention; (b) ‘Clinical Care’ relates to perceived quality of care and health outcomes; (c) ‘Communication’ involves feedback and interaction between patients, staff and carers; (d) ‘Education’ concerns the tailored information provided; and (e) ‘Ease of Use’ relates to accessibility and technical barriers to engagement. Each theme was applied to each user base of patient, carer and healthcare professional in a different manner. CONCLUSIONS The 5 themes identified highlight aspects of remote care that facilitate engagement, and should be considered in both future design and trials evaluating these technologies.

scholarly journals What is good communication for people living with dementia? A mixed-methods systematic review

2017 ◽  
Vol 29 (11) ◽  
pp. 1785-1800 ◽  
Author(s):  
Sarah Alsawy ◽  
Warren Mansell ◽  
Phil McEvoy ◽  
Sara Tai
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Family Caregivers ◽  
Interpersonal Relationships ◽  
Healthcare Professionals ◽  
Eligibility Criteria ◽  
Good Communication ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

ABSTRACTBackground:Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included.Methods:A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases.Results:After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, “open exploration,” or through examining experiences of strategies, “exploration of strategies.” A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication.Conclusions:The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.

scholarly journals m-Health adoption by healthcare professionals: a systematic review

2015 ◽  
Vol 23 (1) ◽  
pp. 212-220 ◽  
Author(s):  
Marie-Pierre Gagnon ◽  
Patrice Ngangue ◽  
Julie Payne-Gagnon ◽  
Marie Desmartis
Keyword(s):  
Systematic Review ◽  
Healthcare Professionals ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
Barriers And Facilitators ◽  
Health Utilization ◽  
Privacy And Security ◽  
Security Issues

Abstract Objective The aim of this systematic review was to synthesize current knowledge of the factors influencing healthcare professional adoption of mobile health (m-health) applications. Methods Covering a period from 2000 to 2014, we conducted a systematic literature search on four electronic databases (PubMed, EMBASE, CINAHL, PsychInfo). We also consulted references from included studies. We included studies if they reported the perceptions of healthcare professionals regarding barriers and facilitators to m-health utilization, if they were published in English, Spanish, or French and if they presented an empirical study design (qualitative, quantitative, or mixed methods). Two authors independently assessed study quality and performed content analysis using a validated extraction grid with pre-established categorization of barriers and facilitators. Results The search strategy led to a total of 4223 potentially relevant papers, of which 33 met the inclusion criteria. Main perceived adoption factors to m-health at the individual, organizational, and contextual levels were the following: perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management). Conclusion This systematic review provides a set of key elements making it possible to understand the challenges and opportunities for m-health utilization by healthcare providers.

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