Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems

2011 ◽  
Vol 19 (3) ◽  
pp. 504-514 ◽  
Author(s):  
Mariëtte M van Engen-Verheul ◽  
Hareld MC Kemps ◽  
Nicolette F de Keizer ◽  
Irene M Hellemans ◽  
Rick Goud ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Advisory Group ◽  
Routine Practice ◽  
Assessment Instruments ◽  
Assessment Procedure ◽  
Patient Needs ◽  
Clinical Algorithm ◽  
Implementation Problems

Background: Despite all available evidence of its effectiveness, cardiac rehabilitation and secondary prevention (CRSP) is still insufficiently implemented in current clinical practice. Based on an analysis of implementation problems, recently the Dutch clinical algorithm for the assessment of patient’s CRSP needs was revised. The purpose of this paper is to describe the revision process and its results to improve CRSP guideline implementation. Methods: The National Institute for Health and Clinical Excellence (NICE) guidelines manual for conducting guideline revisions was followed. Information on the use of the algorithm in practice was collected from electronic medical records and by conducting semi-structured interviews. Next, an expert advisory group identified the problems for use in daily practice and defined the scope for the revision. A multidisciplinary guideline development group subsequently wrote the revised algorithm. Results: A large variation in assessed patient needs was observed between CRSP clinics. Assessment based on clinical judgement was found to be a source of practice variation and is therefore avoided in the revised algorithm. It was decided to add assessment instruments for anxiety and depression, cardiovascular risk factors, stress, attitude of partner and lifestyle parameters. Conclusion: The Dutch clinical algorithm for assessing patient needs for CRSP was revised using a combination of patient data from routine practice, knowledge from academic experts and experience from field experts. The revised algorithm is a practical tool consisting of assessment instruments to improve CRSP guideline adherence in the Netherlands. This algorithm may also be useful for other Western countries to organize their CRSP needs assessment procedure.

Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

scholarly journals Determinants of successful guideline implementation: a national cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-hui Jin ◽  
Li-Ming Tan ◽  
Khalid S. Khan ◽  
Tong Deng ◽  
Chao Huang ◽  
...  
Keyword(s):  
Guideline Development ◽  
Guideline Implementation ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
The West ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Multi Stage ◽  
Geographical Regions ◽  
Tertiary Hospitals

Abstract Background CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China. Methods This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2–5 provinces were selected from each region. 2–3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P < 0.001; the west P = 0.02; the middle P < 0.001 compared with the east), hospital grades (P = 0.028), length of practitioners’ practice (P = 0.006), education background (Ph.D., P = 0.027; Master, P = 0.002), evidence-based medicine skills acquired in work unit (P = 0.012), and medical specialty of practitioner (General Practice, P = 0.006; Surgery, P = 0.043). Conclusion Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

2008 ◽  
Vol 17 (4) ◽  
pp. 358-368 ◽  
Author(s):  
Mirella Ruggeri ◽  
Antonio Lora ◽  
Domenico Semisa
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Guideline Implementation ◽  
Specific Treatment ◽  
Care Process ◽  
First Episode ◽  
Routine Practice ◽  
Nice Guidelines ◽  
Illness Onset

SUMMARYAims– To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs.Methods– The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management.Results– The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process.Conclusions– The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.Declaration of Interest: None.

scholarly journals Clinical Practice Guidelines andHelicobacter pyloriInfection in Children

1999 ◽  
Vol 13 (7) ◽  
pp. 560-562 ◽  
Author(s):  
Colin Macarthur ◽  
Liisa Jaakkimainen
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Key Steps ◽  
Evidence Based Guidelines ◽  
Care Costs

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

scholarly journals Determinants of successful guideline implementation: A national cross-sectional survey

2021 ◽  
Author(s):  
Yinghui Jin ◽  
Li-Ming Tan ◽  
Khalid S. Khan ◽  
Tong Deng ◽  
Chao Huang ◽  
...  
Keyword(s):  
Guideline Development ◽  
Guideline Implementation ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
The West ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Multi Stage ◽  
Geographical Regions ◽  
Tertiary Hospitals

Abstract Background: CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China.Methods: This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2-5 provinces were selected from each region. 2-3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results: The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P＜0.001; the west P=0.02; the middle P＜0.001 compared with the east), hospital grades(P=0.028), length of practitioners’ practice (P =0.006), education background (PhD, P=0.027; Master, P=0.002), evidence-based medicine skills acquired in work unit (P=0.012), and medical specialty of practitioner (General Practice, P=0.006; Surgery, P=0.043). Conclusion: Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

scholarly journals Methodology for the American Society of Hematology VTE guidelines: current best practice, innovations, and experiences

2020 ◽  
Vol 4 (10) ◽  
pp. 2351-2365 ◽  
Author(s):  
Wojtek Wiercioch ◽  
Robby Nieuwlaat ◽  
Elie A. Akl ◽  
Robert Kunkle ◽  
Kendall E. Alexander ◽  
...  
Keyword(s):  
Best Practice ◽  
Guideline Development ◽  
Advisory Group ◽  
Software Modeling ◽  
User Friendliness ◽  
The Past ◽  
Working Groups ◽  
Central Coordination ◽  
Complete Set ◽  
American Society

Background: Methods for the development of clinical guidelines have advanced dramatically over the past 2 decades to strive for trustworthiness, transparency, user-friendliness, and rigor. The American Society of Hematology (ASH) guidelines on venous thromboembolism (VTE) have followed these advances, together with application of methodological innovations. Objective: In this article, we describe methods and methodological innovations as a model to inform future guideline enterprises by ASH and others to achieve guideline standards. Methodological innovations introduced in the development of the guidelines aim to address current challenges in guideline development. Methods: We followed ASH policy for guideline development, which is based on the Guideline International Network (GIN)-McMaster Guideline Development Checklist and current best practices. Central coordination, specialist working groups, and expert panels were established for the development of 10 VTE guidelines. Methodological guidance resources were developed to guide the process across guidelines panels. A methods advisory group guided the development and implementation of methodological innovations to address emerging challenges and needs. Results: The complete set of VTE guidelines will include &gt;250 recommendations. Methodological innovations include the use of health-outcome descriptors, online voting with guideline development software, modeling of pathways for diagnostic questions, application of expert evidence, and a template manuscript for publication of ASH guidelines. These methods advance guideline development standards and have already informed other ASH guideline projects. Conclusions: The development of the ASH VTE guidelines followed rigorous methods and introduced methodological innovations during guideline development, striving for the highest possible level of trustworthiness, transparency, user-friendliness, and rigor.

scholarly journals Determinants of depression in patients with comorbid depression following cardiac rehabilitation

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000973 ◽  
Author(s):  
Serdar Sever ◽  
Alexander Stephen Harrison ◽  
Su Golder ◽  
Patrick Doherty
Keyword(s):  
Cardiac Rehabilitation ◽  
Physical Inactivity ◽  
Depression Scale ◽  
Binary Logistic Regression ◽  
Patient Characteristics ◽  
Male Gender ◽  
Prior History ◽  
Routine Practice ◽  
Comorbid Depression ◽  
Baseline Characteristics

BackgroundA prior history of depression, at the point patients start cardiac rehabilitation (CR), is associated with poor outcomes; however, little is known about which factors play a part in determining the extent of benefit following CR. Therefore, we aim to identify and evaluate determinants of CR depression outcomes in patients with comorbid depression.MethodsAn observational study of routine practice using the British Heart Foundation National Audit of Cardiac Rehabilitation data between April 2012 and March 2017. Baseline characteristics were examined with independent samples t-test and χ2 test. A binary logistic regression was used to predict change in depression outcome following CR.ResultsThe analysis included 2715 CR participants with depression history. The determinants of Hospital Anxiety and Depression Scale (HADS) depression measurement post-CR were higher total number of comorbidities (OR 0.914, 95% CI 0.854 to 0.979), a higher HADS anxiety score (OR 0.883, 95% CI 0.851 to 0.917), physical inactivity (OR 0.707, 95% CI 0.514 to 0.971), not-smoking at baseline (OR 1.774, 95% CI 1.086 to 2.898) and male gender (OR 0.721, 95% CI 0.523 to 0.992).ConclusionBaseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and these related patient characteristics associated with better CR outcomes.

Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium?

2008 ◽  
Vol 17 (4) ◽  
pp. 270-277 ◽  
Author(s):  
Mirella Ruggeri
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Potential Role ◽  
Scientific Evidence ◽  
Guideline Implementation ◽  
Routine Practice ◽  
Daily Work ◽  
Italian Context ◽  
Key Aspects

SUMMARYThis paper discusses some key aspects of the debate on the difficulties of incorporating scientific evidence into the daily work of clinicians in mental health services (MHS). It highlights the topics of: the utility of guidelines in this field, the ethical principles that should guide their utilisation, their limitations, obstacles impeding the diffusion of guidelines in psychiatry, and strategies that can be useful for overcoming the barriers to guideline implementation. The SIEP-DIRECT's ((DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) Project's potential role in fostering this advancement is discussed in detail. This Project developed a set of 103 indicators that operationalised the NICE clinical guidelines for schizophrenia recommendations and tested them in 19 MHS in Italy. A multi-step design was used to assess recommendation and indicator acceptability in the Italian context; provide an assessment of any current discrepancies between routine practice and guideline recommendations in the treatment of schizophrenia; and understand the reasons for any discrepancies that might emerge. This process, moreover, was instrumental in keeping the debate arising during conduction of this Project far from the excesses of hostility - and excesses of “bright-eyed enthusiasm” - that frequently influence discussion on topic. This Project therefore showed potential to serve in the search for a happy medium, that can facilitate the pursuit of a fundamental advancement in guideline implementation in mental health services.Declaration of Interest: None.

Factors affecting the embedding of integrated primary–secondary care into a health district

2020 ◽  
Vol 26 (3) ◽  
pp. 216 ◽  
Author(s):  
Geoffrey K. Mitchell ◽  
Charlotte E. Young ◽  
Tina Janamian ◽  
Kylie M. Beaver ◽  
Joanne L. K. Johnson ◽  
...  
Keyword(s):  
Health Service ◽  
Integrated Care ◽  
Process Evaluation ◽  
Information Exchange ◽  
Secondary Care ◽  
Advisory Group ◽  
Routine Practice ◽  
Care Providers ◽  
Specialist Care ◽  
Structured Interviews

With the aging population, the tide of chronic disease is rising with attendant increases in health service need. Integrated care and patient-centred approaches, which established partnerships between a regional Hospital and health service (HHS), the local primary health network and local general practitioners (GPs), were identified as exemplars of an approach needed to support growing community health needs. This paper summarises the findings from a process evaluation of four GP–specialist care integration programs with the aim of identifying recommendations for embedding integrated GP–specialist care into routine practice within the HHS. The process evaluation of the integration programs drew on input from a multidisciplinary expert advisory group and data collected through face-to-face semi-structured interviews with key stakeholders, as well as surveys of participating GPs and patients. Overarching findings were identified and grouped under six themes: interdisciplinary teamwork; communication and information exchange; the use of shared care guidelines or pathways; training and education; access and accessibility; and funding. Within each theme, key challenges and enablers emerged. The findings of this study highlight benefits and challenges associated with the establishment of integrated care between primary and secondary care providers, leading to the development of key recommendations for routine integration.

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