Towards rational prescribing of antibiotics for acute rhinosinusitis: evaluation of the impact and costs of implementation strategies based on a multidisciplinary evidence-based guideline

2012 ◽  
Author(s):  
Marc De Meyere
Keyword(s):  
Implementation Strategies ◽  
Evidence Based ◽  
Acute Rhinosinusitis ◽  
Rational Prescribing ◽  
Evidence Based Guideline ◽  
The Impact

NICE LESSONS TO BE LEARNED

2001 ◽  
Vol 17 (2) ◽  
pp. 222-235 ◽  
Author(s):  
Jane Farmer ◽  
Rosemary Chesson
Keyword(s):  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Relevant Information ◽  
Policy Implications ◽  
Health Board ◽  
Evidence Based ◽  
Apparent Lack ◽  
Information Centre ◽  
Two Stages ◽  
The Impact

Objectives: This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998.Methods: Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages.Results: Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies.Conclusions: New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies.Policy Implications: It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.

scholarly journals The Effectiveness of Two Implementation Strategies for Improving Teachers’ Delivery of an Evidenced-based HIV Prevention Program

2020 ◽  
Author(s):  
Bo Wang ◽  
Lynette Deveaux ◽  
Lesley Cottrell ◽  
Xiaoming Li ◽  
Richard Adderley ◽  
...  
Keyword(s):  
Sex Education ◽  
Self Efficacy ◽  
Implementation Strategies ◽  
Implementation Fidelity ◽  
Evidence Based ◽  
Principal Support ◽  
Hiv Intervention ◽  
Evidenced Based ◽  
Intervention Curriculum ◽  
The Impact

Abstract Background: Effective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers’ implementation of an evidenced-based HIV intervention.Methods: Using our 7-item Pre-Implementation School Screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets middle and high school youth. After completing a two-day curriculum workshop, 84 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the intervention curriculum for nearly two months. This optimization trial examines the impact of two implementation strategies including biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. General linear model was used to examine the association of the implementation strategies with implementation fidelity.Results: BMF and SAM were significantly associated with teachers’ implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities, followed by teachers who received either BMF or SAM. Teachers who did not receive BMF or SAM taught the lowest numbers of core activities (15.0 vs. 7.9 vs. 6.9 vs. 4.1, p< 0.001). Teachers’ confidence in implementing five core activities, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ fidelity of implementation. Teacher full attendance at the training workshop and teachers’ sustained implementation of FOYC in the prior school year were related to increased implementation fidelity. Conclusion: BMF and SAM are effective in promoting teachers’ implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers’ attitudes towards sex education, perceived principal support and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.

scholarly journals Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review

2019 ◽  
Vol 7 (7) ◽  
pp. 76 ◽  
Author(s):  
Blackshaw ◽  
Chhour ◽  
Stepto ◽  
Lim
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Ovary Syndrome ◽  
Lifestyle Management ◽  
Increased Risk ◽  
Evidence Based Guideline

Polycystic ovary syndrome (PCOS) is a complex condition that involves metabolic, psychological and reproductive complications. Insulin resistance underlies much of the pathophysiology and symptomatology of the condition and contributes to long term complications including cardiovascular disease and diabetes. Women with PCOS are at increased risk of obesity which further compounds metabolic, reproductive and psychological risks. Lifestyle interventions including diet, exercise and behavioural management have been shown to improve PCOS presentations across the reproductive, metabolic and psychological spectrum and are recommended as first line treatment for any presentation of PCOS in women with excess weight by the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. However, there is a paucity of research on the implementation lifestyle management in women with PCOS by healthcare providers. Limited existing evidence indicates lifestyle management is not consistently provided and not meeting the needs of the patients. In this review, barriers and facilitators to the implementation of evidence-based lifestyle management in reference to PCOS are discussed in the context of a federally-funded health system. This review highlights the need for targeted research on the knowledge and practice of PCOS healthcare providers to best inform implementation strategies for the translation of the PCOS guidelines on lifestyle management in PCOS.

scholarly journals Looking into mechanisms of change: Evaluation of a multifaceted implementation strategy to change pain management behavior of care workers

2020 ◽  
Author(s):  
Thekla Brunkert ◽  
Michael Simon ◽  
Franziska Zúñiga
Keyword(s):  
Pain Management ◽  
Nursing Homes ◽  
Pain Assessment ◽  
Self Efficacy ◽  
Implementation Strategies ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Mixed Effect ◽  
Care Workers ◽  
The Impact

Abstract BackgroundUnderutilization of evidence-based pain management in nursing homes is common. Evidence towards effective approaches to improve adoption of evidence-based practices in nursing homes is limited. To get a better understanding of the impact of our multi-faceted implementation strategies, care worker training workshops and the introduction of trained pain champions, this study explored the underlying mechanisms of the implementation strategies using behavioral theory.MethodsWe conducted a mixed-methods evaluation alongside an implementation- effectiveness study in four Swiss nursing homes. Based on an a priori contextual analysis in the participating homes implementation strategies were developed. Furthermore, we developed a conceptual framework describing hypotheses concerning determinants of implementation and mechanisms of change underlying our implementation strategies.Care workers’ questionnaire surveys were conducted at baseline (n=136), after three (n= 99) and six months (n=83) to assess self-efficacy in pain management and self-reported guideline adoption. We computed linear mixed-effect models to assess changes over time in self-efficacy and logistic regressions to assess associations between self-efficacy and guideline adoption. Concurrently, we conducted focus groups with care workers (n=8) to explore their response to the implementation strategies and to gain a deeper understanding of the potential mechanisms. After transcription, interview data was analyzed using content analysis.ResultsOverall, there was a significant increase in self-efficacy after three and six months (p<0.001). Self-reported adoption of guideline components ranged between 44% and 73% depending on the component. We found significant associations between self-efficacy and adoption of two guideline components, i.e. performing a comprehensive pain assessment and using an observational pain assessment tool in cognitively impaired residents.Qualitative findings showed that the training workshops and pain champions were received positively by care workers. Focus group participants reported to be more attentive to residents` pain experience and to assess and document pain more frequently and with more detail than before.ConclusionsOur findings highlight the importance of continuous commitment of an implementation facilitator, e.g., a pain champion, within an organization. Regarding persistent implementation challenges, a theory-based conceptual model contributes to the overall understanding.Trial registrationClinicalTrials.gov (NCT03471390)

scholarly journals Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability

10.2196/14990 ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. e14990 ◽  
Author(s):  
Aaron R Lyon ◽  
Sean A Munson ◽  
Brenna N Renn ◽  
David C Atkins ◽  
Michael D Pullmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Implementation Strategy ◽  
Relative Effectiveness ◽  
Implementation Strategies ◽  
Psychosocial Interventions ◽  
Evidence Based ◽  
Human Centered Design ◽  
Patient Reported ◽  
The Impact

Background This paper presents the protocol for the National Institute of Mental Health (NIMH)–funded University of Washington’s ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation of evidence-based psychosocial interventions (EBPIs). We propose that usability—the degree to which interventions and implementation strategies can be used with ease, efficiency, effectiveness, and satisfaction—is a fundamental, yet poorly understood determinant of implementation. Objective We present a novel Discover, Design/Build, and Test (DDBT) framework to study usability as an implementation determinant. DDBT will be applied across Center projects to develop scalable and efficient implementation strategies (eg, training tools), modify existing EBPIs to enhance usability, and create usable and nonburdensome decision support tools for quality delivery of EBPIs. Methods Stakeholder participants will be implementation practitioners/intermediaries, mental health clinicians, and patients with mental illness in nonspecialty mental health settings in underresourced communities. Three preplanned projects and 12 pilot studies will employ the DDBT model to (1) identify usability challenges in implementing EBPIs in underresourced settings; (2) iteratively design solutions to overcome these challenges; and (3) compare the solution to the original version of the EPBI or implementation strategy on usability, quality of care, and patient-reported outcomes. The final products from the center will be a streamlined modification and redesign model that will improve the usability of EBPIs and implementation strategies (eg, tools to support EBPI education and decision making); a matrix of modification targets (ie, usability issues) that are both common and unique to EBPIs, strategies, settings, and patient populations; and a compilation of redesign strategies and the relative effectiveness of the redesigned solution compared to the original EBPI or strategy. Results The UWAC received institutional review board approval for the three separate studies in March 2018 and was funded in May 2018. Conclusions The outcomes from this center will inform the implementation of EBPIs by identifying cross-cutting features of EBPIs and implementation strategies that influence the use and acceptability of these interventions, actively involving stakeholder clinicians and implementation practitioners in the design of the EBPI modification or implementation strategy solution and identifying the impact of HCD-informed modifications and solutions on intervention effectiveness and quality. Trial Registration ClinicalTrials.gov NCT03515226 (https://clinicaltrials.gov/ct2/show/NCT03515226), NCT03514394 (https://clinicaltrials.gov/ct2/show/NCT03514394), and NCT03516513 (https://clinicaltrials.gov/ct2/show/NCT03516513). International Registered Report Identifier (IRRID) DERR1-10.2196/14990

The Impact of TimeSlips on Undergraduate Students in Service Learning With Older Adults

2020 ◽  
pp. 1-8
Author(s):  
Sabine Heuer
Keyword(s):  
Older Adults ◽  
Service Learning ◽  
Undergraduate Students ◽  
Attitude Scale ◽  
Evidence Based ◽  
Attitudes Toward Older Adults ◽  
Students Attitudes ◽  
Attitude Shift ◽  
The Impact ◽  
Journal Entries

Purpose Future speech-language pathologists are often unprepared in their academic training to serve the communicative and cognitive needs of older adults with dementia. While negative attitudes toward older adults are prevalent among undergraduate students, service learning has been shown to positively affect students' attitudes toward older adults. TimeSlips is an evidence-based approach that has been shown to improve health care students' attitudes toward older adults. The purpose of this study is to explore the change in attitudes in speech-language pathology students toward older adults using TimeSlips in service learning. Method Fifty-one students participated in TimeSlips service learning with older adults and completed the Dementia Attitude Scale (DAS) before and after service learning. In addition, students completed a reflection journal. The DAS data were analyzed using nonparametric statistics, and journal entries were analyzed using a qualitative analysis approach. Results The service learners exhibited a significant increase in positive attitude as indexed on the DAS. The reflective journal entries supported the positive change in attitudes. Conclusions A noticeable attitude shift was indexed in reflective journals and on the DAS. TimeSlips is an evidence-based, patient-centered approach well suited to address challenges in the preparation of Communication Sciences and Disorders students to work with the growing population of older adults.

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.

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