scholarly journals Cascade screening for beta-thalassaemia in Pakistan: relatives’ experiences of a decision support intervention in routine practice

2021 ◽  
Author(s):  
Shenaz Ahmed ◽  
Hussain Jafri ◽  
Muhammed Faran ◽  
Wajeeha Naseer Ahmed ◽  
Yasmin Rashid ◽  
...  
Keyword(s):  
Decision Support ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Routine Practice ◽  
Cascade Screening ◽  
Family Meeting ◽  
Middle Income ◽  
Support Intervention ◽  
Decision Support Intervention ◽  
Prevention Project

AbstractLow uptake of cascade screening for βeta-thalassaemia major (β-TM) in the ‘Punjab Thalassaemia Prevention Project’ (PTPP) in Pakistan led to the development of a ‘decision support intervention for relatives’ (DeSIRe). This paper presents the experiences of relatives of children with β-TM of the DeSIRe following its use by PTPP field officers (FOs) in routine clinical practice. Fifty-four semi-structured qualitative interviews were conducted (April to June 2021) with relatives in seven cities in the Punjab province (Lahore, Sheikhupura, Nankana Sahab, Kasur, Gujranwala, Multan and Faisalabad). Thematic analysis shows that participants were satisfied with the content of the DeSIRe and its delivery by the FOs in a family meeting. They understood that the main purpose of the DeSIRe was to improve their knowledge of β-TM and its inheritance, and to enable them to make decisions about thalassaemia carrier testing, particularly before marriage. Participants also raised concerns about the stigma of testing positive; however, they believed the DeSIRe was an appropriate intervention, which supported relatives to make informed decisions. Our findings show that the DeSIRe is appropriate for use by healthcare professionals in routine practice in a low-middle income country, and has the potential to facilitate shared decision making about cascade screening for thalassaemia. Further research is needed to prove the efficacy of the DeSIRe.

scholarly journals Cascade screening for beta-thalassemia in Pakistan: development, feasibility and acceptability of a decision support intervention for relatives

2021 ◽  
Author(s):  
Shenaz Ahmed ◽  
Hussain Jafri ◽  
Yasmin Rashid ◽  
Yasmin Ehsan ◽  
Shabnam Bashir ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Groups ◽  
Carrier Testing ◽  
Beta Thalassemia ◽  
Future Research ◽  
Routine Practice ◽  
Cascade Screening ◽  
Support Intervention ◽  
Decision Support Intervention ◽  
Informed Decisions

AbstractThe government-funded ‘Punjab Thalassaemia Prevention Project’ (PTPP) in Pakistan includes cascade screening for biological relatives of children with beta-Thalassaemia Major (β-TM). However, there is low uptake of cascade screening. This paper presents the (i) development of a paper-based ‘decision support intervention for relatives’ (DeSIRe) to enable PTPP Field Officers to facilitate informed decision making about carrier testing, and (ii) assessment of the feasibility and acceptability of the DeSIRe. The intervention was developed using the International Patient Decision Aids Standards quality criteria and Ottawa Decision Support Framework. Twelve focus groups were conducted (September and October 2020) to explore the views of healthcare professionals (HCPs) and relatives of children with β-TM, in six cities. The focus groups were attended by 117 participants (60 HCPs and 57 relatives). Thematic analysis showed that the DeSIRe was considered acceptable for supporting relatives to make informed decisions about cascade screening, and potentially feasible for use in clinical practice. Suggestions for changing some words, the structure and adding information about how carrier testing relates to consanguineous marriages will enable further development of the DeSIRe. Participants generally welcomed the DeSIRe; however, they highlighted the perceived need to use more directive language, hence showed a cultural preference for directive genetic counselling. The findings highlight challenges for researchers using western theories, frameworks, policies and clinical guidelines to develop decision support interventions for implementation more globally. Future research is needed to evaluate the use of the DeSIRe in routine practice and whether it enables relatives to make informed decisions.

An Electronic Decision Support Intervention Reduces Readmissions for Patients With Cirrhosis

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jeremy Louissaint ◽  
Katie Grzyb ◽  
Linda Bashaw ◽  
Rima A. Mohammad ◽  
Neehar D. Parikh ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Decision Support ◽  
Support Intervention ◽  
Decision Support Intervention

scholarly journals P036: A clinical decision support intervention to increase usage of probenecid in the ED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S90-S90
Author(s):  
S. Dowling ◽  
E. Lang ◽  
D. Wang ◽  
T. Rich
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Soft Tissue ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Soft Tissue Infections ◽  
Post Intervention ◽  
Support Intervention ◽  
Intervention Phase ◽  
Decision Support Intervention

Introduction: In certain circumstances, skin and soft tissue infections are managed with intravenous (IV) antibiotics. In our center, patients initiated on outpatient IV antibiotics are followed up by a home parental therapy program the following day. A significant number of these patients require a repeat visit to the ED because of clinic hours. Probenecid is a drug that can prolong the half-life of certain antibiotics (such as cefazolin) and can therefore avoid a repeat ED visit, reducing health care costs and improve ED capacity. Our goal was to increase probenecid usage in the ED in order to optimize management of skin and soft tissue infections (SSTI) in the ED. The primary outcome was to compare the usage of probenecid in the pre and post-intervention phase. Secondary outcomes were to compare revisit rates between patients receiving cefazolin alone vs cefazolin + probenecid. Methods: Using administrative data merged with Computerized Physician Order Entry (CPOE), we extracted data 90 days pre- and 90 post-intervention (February 11, 2015 to August 11, 2015). The setting for the study is an urban center (4 adult ED’s with an annual census of over 320,000 visits per year). Our CPOE system is fully integrated into the ED patient care. The multi-faceted intervention involved modifying all relevant SSTI order sets in the CPOE system to link any cefazolin order with an order for probenecid. Physicians and nurses were provided with a 1 page summary of probenecid (indications, contra-indications, pharmacology), as well as decision support with the CPOE. Any patients who were receiving outpatient cefazolin therapy were included in the study. Results: Our analysis included 2512 patients (1148 and 1364 patients in the pre/post phases) who received cefazolin in the ED and were discharged during the 180 day period. Baseline variables (gender, age, % admitted) and ED visits were similar in both phases. In the pre-intervention phase 30.2% of patients received probenecid and in the post-intervention phase 43.0%, for a net increase of 12.8% (p=<0.0001). Patients who received probenecid had a 2.2% (11.4% vs 13.6%, p=0.014) lower re-visit rate in the following 72H. Conclusion: We have implemented a CPOE based clinical decision support intervention that demonstrated significant increase in probenecid usage by emergency physician and resulted in a decrease in ED revisits. This intervention would result in health care cost-savings.

Re-inventing model-based decision support with Australian dryland farmers. 1. Changing intervention concepts during 17 years of action research

2009 ◽  
Vol 60 (11) ◽  
pp. 1017 ◽  
Author(s):  
R. L. McCown ◽  
P. S. Carberry ◽  
Z. Hochman ◽  
N. P. Dalgliesh ◽  
M. A. Foale
Keyword(s):  
Decision Support ◽  
Systems Thinking ◽  
Management Practice ◽  
Simulation Models ◽  
Third Party ◽  
Support Intervention ◽  
Decision Support Intervention ◽  
Systems Research ◽  
Local Soil ◽  
Starting Point

The idea that simulation models of agricultural production can serve as tools for farmers remains a compelling idea even after 3 decades of mostly disappointing development efforts. This paper is the first in a series that reports on 17 years of systems research that used models differently from the Decision Support System idea that has dominated the field. The starting point of FARMSCAPE (Farmers’, Advisers’, Researchers’, Monitoring, Simulation, Communication And Performance Evaluation) was finding whether farmers could value simulation when conditions for appreciation were improved by (a) specifying the simulator for individual paddocks in question and (b) delivering customised simulation to decision makers as a supporting service rather than software as a decision support product. The first aim of the program has been to learn how to effectively intervene in farm management practice using complex, abstract models of croplands, specified with local soil, climate, and management data. The second aim has been to learn how a resulting service that farmers value can be delivered cost effectively by a third party. This first paper deals with an aspect of the first aim, i.e. valued decision support intervention. In the terms used by Checkland (1981), the activities that served this systems practice aim were guided by ‘what we thought we were doing’ in intervening in farmers’ practice, i.e. our systems thinking. This first paper concerns FARMSCAPE systems thinking and how it evolved over 17 years as we learned successively through discovery of a new concept or representation in the literature to overcome limitations of the then-current conceptual framework. Subsequent papers deal with customising scientific monitoring and simulation for farmers, communication as engagement in situations of practice, understanding decision support intervention as facilitation of personal knowledge construction, and piloting commercial delivery of a simulation-based service to farmers and their advisers.

Informed Choice Assistance for Women Making Uterine Fibroid Treatment Decisions: A Practical Clinical Trial

2009 ◽  
Vol 30 (4) ◽  
pp. 444-452 ◽  
Author(s):  
Leif I. Solberg ◽  
Stephen E. Asche ◽  
Karen Sepucha ◽  
N. Marcus Thygeson ◽  
Joan E. Madden ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Support ◽  
Uterine Fibroid ◽  
Treatment Options ◽  
Treatment Decision ◽  
Informed Choice ◽  
Knowledge Score ◽  
Support Intervention ◽  
Decision Support Intervention ◽  
Mailed Survey

Background. There is limited evidence about how to ensure that patients are helped to make informed medical care decisions. Objective. To test a decision support intervention for uterine fibroid treatments. Design and Setting. Practical clinical trial to test informed choice assistance in 4 randomly assigned gynecology clinics compared to 5 others providing a pamphlet. Patients. Three hundred women facing a treatment decision for fibroids over a 13-month period. Intervention. Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit. Measurements. Mailed survey 6 to 8 weeks later asking about knowledge, preferences, and satisfaction with decision support. Results. In total, 244 surveys were completed for an adjusted response rate of 85.4%. On a 5-point scale, intervention subjects reported more treatment options being mentioned (3.0 v. 2.4), had a higher knowledge score (3.3 v. 2.8), and were more likely to report being adequately informed (4.4 v. 4.0), and their decision was both more satisfactory (4.3 v. 4.0) and more consistent with their personal values (4.5 v. 4.2). Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions. Limitations. Implementation of intervention may not have been well timed to the decision for some patients, limiting their use of the materials and counseling. Conclusion. It is difficult to integrate structured decision support consistently into practice. Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance.

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