scholarly journals Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective

2012 ◽  
Vol 21 (3) ◽  
pp. 237-240 ◽  
Author(s):  
E. Aakhus ◽  
S. A. Flottorp ◽  
A. D. Oxman
Keyword(s):  
Primary Care ◽  
Implementation Strategies ◽  
The Elderly ◽  
Evidence Based ◽  
Social Changes ◽  
Scientific Publications ◽  
Effective Implementation ◽  
Tailored Implementation ◽  
Evidence Based Guidelines ◽  
Selection Of

Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called ‘Tailored Implementation for Chronic Diseases’ (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.

The treatment of bipolar disorder in the elderly

2017 ◽  
Author(s):  
Gilberto Sousa Alves ◽  
Felipe Kenji Sudo ◽  
Johannes Pantel
Keyword(s):  
Bipolar Disorder ◽  
Gold Standard ◽  
Atypical Antipsychotics ◽  
Extended Release ◽  
Ethical Issues ◽  
The Elderly ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
First Line ◽  
Evidence Based Guidelines

Bipolar disorder (BD) is an extremely disabling condition characterized by mood switches, and cognitive and functional impairment. The current chapter discusses the updated review on pharmacological and non-pharmacological interventions targeting BD in the elderly. The risk of concurrent medical diseases (eg, metabolic syndrome) and relatively lower tolerability than young BD make the patient safety a major concern in most cases. Evidence-based guidelines, although useful for promoting rational and effective therapy, are generally lacking in elderly BD. Current recommendations for acute mania include atypical antipsychotics, careful use of lithium, and election of valproate as the gold-standard therapy. In acute BD depression, first-line agents in monotherapy may include lithium, lamotrigine, quetiapine, and quetiapine extended release (XR). Electroconvulsive therapy may be an option for severe/refractory cases. Family members or caregivers should be encouraged to support the patient, since potential ethical issues involving patrimony or profession may arise during the treatment.

Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care

Spine ◽  
2001 ◽  
Vol 26 (23) ◽  
pp. 2615-2622 ◽  
Author(s):  
Brian McGuirk ◽  
Wade King ◽  
Jayantilal Govind ◽  
John Lowry ◽  
Nikolai Bogduk
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Cost Effectiveness ◽  
Evidence Based ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Evidence Based Guidelines

scholarly journals Primary Care Clinician perspectives on ADHD care and suggestions for improvement initiatives

2020 ◽  
Author(s):  
Sean O'Dell ◽  
Matthew J. Gormley ◽  
Victoria Schlieder ◽  
Tracey Klinger ◽  
Kathy DeHart ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Treatment Guidelines ◽  
Behavioral Health Care ◽  
Screening Tools ◽  
Care Process ◽  
Future Research ◽  
Evidence Based ◽  
Evidence Based Guidelines ◽  
Current Practices

Abstract Background and Objectives: Despite efficacious treatments and evidence-based guidelines, youth coping with attention deficit hyperactivity disorder (ADHD) receive suboptimal care. Primary care clinicians (PCCs) are frontline providers of ADHD care; however, little is known about PCC perspectives regarding this care gap and how to effectively address it within health systems. We investigated PCC perspectives on determinants of pediatric ADHD care and considerations for improving adherence to evidence-based guidelines. Methods: Semi-structured qualitative interviews were conducted with 26 PCCs representing clinics within a health system on improving adherence to treatment guidelines for pediatric ADHD. Interview guides were based on the Pragmatic Robust Implementation and Sustainability Model (PRISM) to elicit PCC views regarding determinants of current practices and suggestions to guide improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants.Results: We identified 12 themes categorized into two broad domains: Status Quo of Pediatric ADHD Care and Supporting and Constraining Factors for Improvement Initiatives. PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs reported they face challenges at multiple steps in the care process, including mental health stigma, coordinating care across settings, clinical productivity pressures, access to behavioral health care, and insurance mandates regarding medications. PCCs recommended efficient continuing education trainings accompanied by improvements to the electronic health record to include validated screening tools and documentation templates.Conclusions: Future research triangulating these findings may help to more efficiently improve the quality of pediatric ADHD care in health systems.

scholarly journals TeamSTEPPS to Improve Collaboration in School Mental Health: Protocol for a Mixed-Method Hybrid Effectiveness-Implementation Study (Preprint)

2020 ◽  
Author(s):  
Aparajita Kuriyan ◽  
Grace Kinkler ◽  
Zuleyha Cidav ◽  
Christina Kang-Yi ◽  
Ricardo Eiraldi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Administrative Data ◽  
School Mental Health ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Team Science ◽  
Implementation Study ◽  
Tailored Implementation

BACKGROUND Public schools in the United States are the main provider of mental health services to children but are often ill-equipped to provide quality mental health care, especially in low-income, urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) have the potential to improve treatment implementation and collaboration within schools. OBJECTIVE The objective of the study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. METHODS Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Then, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In Aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. Primary outcome measures include feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of inter-professional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at 3 time-points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed-methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. RESULTS Recruitment for the study has begun. Goals for Aim 1 are expected to be completed in Spring 2021. CONCLUSIONS The current study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate may ready both mental health and school systems for implementation of evidence-based mental health practices. CLINICALTRIAL This project has been registered with ClinicalTrials.gov (ID NCT04440228)

scholarly journals Health professionals’ adherence to evidence-based obesity guidelines: a cohort study.

2019 ◽  
Author(s):  
Nuria Trujillo Garrido ◽  
Mariangeles Bernal ◽  
Maria José Santi Cano
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Medical Records ◽  
Scientific Evidence ◽  
Behavioural Change ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Practice Methods ◽  
Evidence Based Guidelines

Abstract BACKGROUND The prevalence of obesity is on the increase worldwide and yet scientific evidence shows that primary care professionals are not adequately addressing overweight and obesity. In this study, we evaluate how obesity guidelines are being implemented in routine clinical practice. METHODS The study obtained the following data on a cohort of 209 obese patients attending primary care consultations: electronic medical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether or not their health professional adhered to obesity evidence-based guidelines. RESULTS 57.9% of the participants were women and their average age was 65.8 ± 12.7 years. Only 25.4% of the medical records met all the criteria established in the therapeutic guidelines regarding diet prescription. This percentage was significantly higher in males than females (36.4% vs 17.4, p = 0.002). 1.4% met the criteria for physical activity and 1.5% for behavioural change activities. In the multivariate analysis, the variable associated with the most favourable BMI and WC figures, after adjusting for age, was a follow up by health professionals on physical activity (β=0.347, p=0.027, CI=0.429-6.868; β=0.367, p=0.024, CI=1.256-17.556) during routine check-ups with women. CONCLUSIONS We detected low adherence to the evidence-based guidelines among professionals. Recording dietetic prescription and physical exercise in the patient's medical record is associated with a better control of obesity. This data suggest that primary health care should be improved for obese patient.

scholarly journals Guidance for conducting feasibility and pilot studies for implementation trials

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Nicole Pearson ◽  
Patti-Jean Naylor ◽  
Maureen C. Ashe ◽  
Maria Fernandez ◽  
Sze Lin Yoong ◽  
...  
Keyword(s):  
Trial Design ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Behavioural Science ◽  
Pilot Studies ◽  
Effective Implementation ◽  
Pilot Trials ◽  
Pilot Implementation ◽  
Design And Methods ◽  
Hybrid Trial

Abstract Background Implementation trials aim to test the effects of implementation strategies on the adoption, integration or uptake of an evidence-based intervention within organisations or settings. Feasibility and pilot studies can assist with building and testing effective implementation strategies by helping to address uncertainties around design and methods, assessing potential implementation strategy effects and identifying potential causal mechanisms. This paper aims to provide broad guidance for the conduct of feasibility and pilot studies for implementation trials. Methods We convened a group with a mutual interest in the use of feasibility and pilot trials in implementation science including implementation and behavioural science experts and public health researchers. We conducted a literature review to identify existing recommendations for feasibility and pilot studies, as well as publications describing formative processes for implementation trials. In the absence of previous explicit guidance for the conduct of feasibility or pilot implementation trials specifically, we used the effectiveness-implementation hybrid trial design typology proposed by Curran and colleagues as a framework for conceptualising the application of feasibility and pilot testing of implementation interventions. We discuss and offer guidance regarding the aims, methods, design, measures, progression criteria and reporting for implementation feasibility and pilot studies. Conclusions This paper provides a resource for those undertaking preliminary work to enrich and inform larger scale implementation trials.

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