scholarly journals Optimising personal continuity for older patients in general practice: a study protocol for a cluster randomised stepped wedge pragmatic trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lex J. J. Groot ◽  
Henk J. Schers ◽  
Jako S. Burgers ◽  
Francois G. Schellevis ◽  
Martin Smalbrugge ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Continuity Of Care ◽  
Older Patients ◽  
Pragmatic Trial ◽  
Complex Interventions ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Stepped Wedge ◽  
Cluster Randomised

Abstract Background Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. Methods Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. Discussion This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. Trial registration number Netherlands Trial Register, trial NL8132. Registered 2 November 2019.

Effectiveness of an Ambient Intelligent Geriatric Management system (AmbIGeM) to prevent falls in older people in hospitals: protocol for the AmbIGeM stepped wedge pragmatic trial

2017 ◽  
Vol 25 (3) ◽  
pp. 157-165 ◽  
Author(s):  
Renuka Visvanathan ◽  
Damith C Ranasinghe ◽  
Anne Wilson ◽  
Kylie Lange ◽  
Joanne Dollard ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Older Patients ◽  
Pragmatic Trial ◽  
Falls Prevention ◽  
Secondary Outcome ◽  
Stepped Wedge ◽  
Clinical Trial Registry ◽  
Injury Rates ◽  
Ambient Intelligent

BackgroundAlthough current best practice recommendations contribute to falls prevention in hospital, falls and injury rates remain high. There is a need to explore new interventions to reduce falls rates, especially in geriatric and general medical wards where older patients and those with cognitive impairment are managed.Design and methodsA three-cluster stepped wedge pragmatic trial, with an embedded qualitative process, of the Ambient Intelligent Geriatric Management (AmbIGeM) system (wearable sensor device to alert staff of patients undertaking at-risk activities), for preventing falls in older patients compared with standard care. The trial will occur on three acute/subacute wards in two hospitals in Adelaide and Perth, Australia.ParticipantsPatients aged >65 years admitted to study wards. A waiver (Perth) and opt-out of consent (Adelaide) was obtained for this study. Patients requiring palliative care will be excluded.OutcomesThe primary outcome is falls rate; secondary outcome measures are: (1) proportion of participants falling; (2) rate of injurious inpatient falls/1000 participant bed-days; (3) acceptability and safety of the interventions from patients and clinical staff perspectives; and (4) hospital costs, mortality and use of residential care to 3 months postdischarge.DiscussionThis study investigates a novel technological approach to preventing falls in hospitalised older people. We hypothesise that the AmbIGeM intervention will reduce falls and injury rates, with an economic benefit attributable to the intervention. If successful, the AmbIGeM system will be a useful addition to falls prevention in hospital wards with high proportions of older people and people with cognitive impairment.Trial registration numberAustralian and New Zealand Clinical Trial Registry: ACTRN 12617000981325; Pre-results.

scholarly journals Making shoulder pain simple in general practice: implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e051656
Author(s):  
Ole Marius Ekeberg ◽  
Stein Jarle Pedersen ◽  
Bård Natvig ◽  
Jens Ivar Brox ◽  
Eva Kristin Biringer ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Shoulder Pain ◽  
Indirect Costs ◽  
Hybrid Design ◽  
Evidence Based ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Evidence Based Guideline

IntroductionResearch suggests that current care for shoulder pain is not in line with the best available evidence. This project aims to assess the effectiveness, cost-effectiveness and the implementation of an evidence-based guideline for shoulder pain in general practice in Norway.Methods and analysisA stepped-wedge, cluster-randomised trial with a hybrid design assessing clinical effectiveness, cost-effectiveness and the effect of the implementation strategy of a guideline-based intervention in general practice. We will recruit at least 36 general practitioners (GPs) and randomise the time of cross-over from treatment as usual to the implemented intervention. The intervention includes an educational outreach visit to the GPs, a computerised decision tool for GPs and a self-management application for patients. We will measure outcomes at patient and GP levels using self-report questionnaires, focus group interviews and register based data. The primary outcome measure is the patient-reported Shoulder Pain and Disability Index measured at 12 weeks. Secondary outcomes include the EuroQol Quality of Life Measure (EQ5D-5L), direct and indirect costs, patient’s global perceived effect of treatment outcome, Pain Self-Efficacy and Brief Illness Perception Questionnaire. We will evaluate the implementation process with focus on adherence to guideline treatment. We will do a cost–minimisation analysis based on direct and selected indirect costs and a cost–utility analysis based on EQ5D-5L. We will use mixed effect models to analyse primary and secondary outcomes.Ethics and disseminationEthics approval was granted by the Regional Committee for Medical and Health Research Ethics-South East Norway (ref. no: 2019/104). Trial results will be submitted for publication in a peer-reviewed medical journal in accordance with Consolidated Standards of Reporting Trials.Trial registration numberNCT04806191.

scholarly journals The Effect of Implementing an Aseptic Practice Bundle for Anaesthetists to Reduce Postoperative Infections. Protocol for a Stepped Wedge, Cluster Randomised, Multi-Site Trial. The Anaesthetists Be Cleaner (ABC) Study

2019 ◽  
Author(s):  
Alan Merry ◽  
Derryn A. Gargiulo ◽  
Ian Bissett ◽  
David Cumin ◽  
Kerry English ◽  
...  
Keyword(s):  
New Zealand ◽  
Hand Hygiene ◽  
Postoperative Infection ◽  
Clinical Intervention ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Stepped Wedge ◽  
Postoperative Infections ◽  
Financial Costs ◽  
Cluster Randomised

Abstract Background Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical aspects of care and on antibiotic prophylaxis, but recent research shows that anaesthesia providers may also have an impact on infection transmission. These providers sometimes exhibit imperfect hand hygiene and frequently transfer the blood or saliva of their patients to their work environment. In addition, intravenous medications may become contaminated while being drawn up and administered to patients. Working with relevant practitioners and other experts, we have developed an evidence-informed bundle to improve key aseptic practices by anaesthetists with the aim of reducing postoperative infection. The key elements of the bundle are the filtering of compatible drugs, context-relevant hand hygiene practices, and enhanced maintenance of clean work surfaces. Methods We will seek support for implementation of the bundle from senior anaesthesia and hospital leadership and departmental “champions”. Anaesthetic teams and recovery room staff will be educated about the bundle and its potential benefits through presentations, written material, and exemplar videos. We will implement the bundle in operating rooms where hip or knee arthroplasty or cardiac surgery procedures are undertaken in a five-site, stepped wedge, cluster randomised, quality improvement design. We will compare outcomes between approximately 5,000 cases before and 5,000 cases after implementation of our bundle. Outcome data will be collected from existing national and hospital databases. Our primary outcome will be days alive and out of hospital to 90 days, which is expected to reflect all serious postoperative infections. Our secondary outcome will be the rate of surgical site infection. Aseptic practice will be observed in sampled cases in each cluster before and after implementation of the bundle. Discussion If effective, our bundle may offer a practical clinical intervention to reduce postoperative infection and its associated substantial human and financial costs. Trial registration Australian New Zealand Clinical Trials Network Registry: ACTRN12618000407291

scholarly journals Does accreditation of general practice promote patient-reported quality of care? A natural cluster randomised experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034465
Author(s):  
Helle Riisgaard ◽  
Frans Boch Waldorff ◽  
Merethe Kirstine Andersen ◽  
Line Bjørnskov Pedersen
Keyword(s):  
General Practice ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
General Practitioner ◽  
Outcome Measures ◽  
Negative Relationship ◽  
Secondary Outcome ◽  
Cluster Randomised ◽  
Patient Reported

ObjectiveTo investigate whether accreditation of general practice in Denmark promotes patient-reported quality of care and patient satisfaction.DesignA national cluster randomised case control study based on an online version of the Danish Patients Evaluate Practice questionnaire. Mixed effects ordered logit regression models taking account of clustering of patients in different municipalities were used in the analyses.SettingGeneral practice in Denmark.ParticipantsA representative sample of the Danish population.Primary and secondary outcome measuresThe primary outcome measure was patient-reported quality of care, and patient satisfaction with general practice and patient satisfaction with the general practitioner served as secondary outcome measures.ResultsIn total, 3609 respondents answered the survey. We found no statistically significant relationships between patient-reported quality of care and practice accreditation (2016: OR=0.89, 95% CI 0.73 to 1.07 and 2017: OR=0.85, 95% CI 0.71 to 1.02) and between patient satisfaction with the general practitioner and accreditation (2016: OR=0.93, 95% CI 0.76 to 1.13 and 2017: OR=0.86, 95% CI 0.70 to 1.04). However, there was a statistically significant negative relationship between patient satisfaction with the general practice and recent practice accreditation compared with satisfaction with practices not yet accredited (OR=0.81, 95% CI 0.67 to 0.97) but no significant relationship between patient satisfaction with the general practice and previous accreditation (OR=0.91, 95% CI 0.76 to 1.09).ConclusionAccreditation does not promote patient-reported quality of care or patient satisfaction. On the contrary, patient satisfaction with the general practice decreases when general practice is recently accredited.

scholarly journals The effect of implementing an aseptic practice bundle for anaesthetists to reduce postoperative infections. Protocol for a stepped wedge, cluster randomised, multi-site trial. The Anaesthetists Be Cleaner (ABC) Study.

2019 ◽  
Author(s):  
Alan F Merry ◽  
Derryn Gargiulo ◽  
Ian Bissett ◽  
David Cumin ◽  
Kerry English ◽  
...  
Keyword(s):  
New Zealand ◽  
Hand Hygiene ◽  
Postoperative Infection ◽  
Clinical Intervention ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Stepped Wedge ◽  
Postoperative Infections ◽  
Financial Costs ◽  
Cluster Randomised

Abstract Background Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical aspects of care and on antibiotic prophylaxis, but recent research shows that anaesthesia providers may also have an impact on infection transmission. These providers sometimes exhibit imperfect hand hygiene and frequently transfer the blood or saliva of their patients to their work environment. In addition, intravenous medications may become contaminated while being drawn up and administered to patients. Working with relevant practitioners and other experts, we have developed an evidence-informed bundle to improve key aseptic practices by anaesthetists with the aim of reducing postoperative infection. The key elements of the bundle are the filtering of compatible drugs, context-relevant hand hygiene practices, and enhanced maintenance of clean work surfaces. Methods We will seek support for implementation of the bundle from senior anaesthesia and hospital leadership and departmental “champions”. Anaesthetic teams and recovery room staff will be educated about the bundle and its potential benefits through presentations, written material, and exemplar videos. We will implement the bundle in operating rooms where hip or knee arthroplasty or cardiac surgery procedures are undertaken in a five-site, stepped wedge, cluster randomised, quality improvement design. We will compare outcomes between approximately 5,000 cases before and 5,000 cases after implementation of our bundle. Outcome data will be collected from existing national and hospital databases. Our primary outcome will be days alive and out of hospital to 90 days, which is expected to reflect all serious postoperative infections. Our secondary outcome will be the rate of surgical site infection. Aseptic practice will be observed in sampled cases in each cluster before and after implementation of the bundle. Discussion If effective, our bundle may offer a practical clinical intervention to reduce postoperative infection and its associated substantial human and financial costs. Trial registration Australian New Zealand Clinical Trials Network Registry: ACTRN12618000407291

scholarly journals The Effect of Implementing an Aseptic Practice Bundle for Anaesthetists to Reduce Postoperative Infections. Protocol for a Stepped Wedge, Cluster Randomised, Multi-Site Trial. The Anaesthetists Be Cleaner (ABC) Study

2018 ◽  
Author(s):  
Alan Merry ◽  
Derryn A. Gargiulo ◽  
Ian Bissett ◽  
David Cumin ◽  
Kerry English ◽  
...  
Keyword(s):  
New Zealand ◽  
Hand Hygiene ◽  
Postoperative Infection ◽  
Clinical Intervention ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Stepped Wedge ◽  
Postoperative Infections ◽  
Financial Costs ◽  
Cluster Randomised

Abstract Background: Postoperative infection is a serious problem in New Zealand, and internationally with considerable human and financial costs. Also, in New Zealand, certain factors that contribute to postoperative infection are more common in Māori and Pacific populations. To date, most efforts to reduce postoperative infection have focused on surgical aspects of care and on antibiotic prophylaxis, but recent research shows that anaesthesia providers may also have an impact on infection transmission. These providers sometimes exhibit imperfect hand hygiene and frequently transfer the blood or saliva of their patients to their work environment. In addition, intravenous medications may become contaminated while being drawn up and administered to patients. Working with relevant practitioners and other experts, we have developed an evidence-informed bundle to improve key aseptic practices by anaesthetists with the aim of reducing postoperative infection. The key elements of the bundle are the filtering of compatible drugs, context-relevant hand hygiene practices, and enhanced maintenance of clean work surfaces. Methods: We will seek support for implementation of the bundle from senior anaesthesia and hospital leadership and departmental “champions”. Anaesthetic teams and recovery room staff will be educated about the bundle and its potential benefits through presentations, written material, and exemplar videos. We will implement the bundle in operating rooms where hip or knee arthroplasty or cardiac surgery procedures are undertaken in a five-site, stepped wedge, cluster randomised, quality improvement design. We will compare outcomes between approximately 5,000 cases before and 5,000 cases after implementation of our bundle. Outcome data will be collected from existing national and hospital databases. Our primary outcome will be days alive and out of hospital to 90 days, which is expected to reflect all serious postoperative infections. Our secondary outcome will be the rate of surgical site infection. Aseptic practice will be observed in sampled cases in each cluster before and after implementation of the bundle. Discussion: If effective, our bundle may offer a practical clinical intervention to reduce postoperative infection and its associated substantial human and financial costs.

scholarly journals Is training policy for general practitioners in China charting the right path forward? a mixed methods analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038173
Author(s):  
Jianwei Shi ◽  
Qingfeng Du ◽  
Xin Gong ◽  
Chunhua Chi ◽  
Jiaoling Huang ◽  
...  
Keyword(s):  
General Practice ◽  
Quantitative Analysis ◽  
Qualitative Analysis ◽  
General Practitioners ◽  
Secondary Outcome ◽  
Chinese Government ◽  
Community Healthcare ◽  
Outpatient Visits ◽  
Training Programmes ◽  
Gp Training

ObjectivesSince 2010, the Chinese government has gradually increased its investment in the training of general practitioners (GPs) to support their role as ‘gatekeepers’ in the healthcare system. However, this training is still organised from the perspective of specialist care. We aimed to assess the appropriateness of the principal GP admission training programme curricula in China, including Residents Training for GPs (RTGP), Residents Training for Assistant GPs (RTAGP) and Training for Specialists with General Practice interest (TSGP).SettingThe study focussed on GP training programmes in Shanghai, China.ParticipantsData on disease competences developed in three GP clinical training programmes (RTGP, RTAGP and TSGP) were derived from official programme training manuals. Data on the proportion of outpatient visits for each disease were taken from the Shanghai community healthcare centres grassroots outpatient database.Primary and secondary outcome measuresWe first conducted a quantitative analysis by comparing the structure of current training curricula with actual outpatient utilisation patterns across all community healthcare institutions in Shanghai from 2014 to 2018. Qualitative analysis was then conducted to evaluate GP training programmes based on Donabedian’s model.ResultsQuantitative analysis showed that the distribution of diseases for which competences were taught did not match the composition of outpatient visits in community healthcare institutions. Concerns identified through qualitative analysis included teachers who were mostly specialists, lack of equipment for differential diagnosis in community healthcare institutions, insufficient teaching of referral standards and GP training in large hospitals that consistently neglected communication skills.ConclusionsThe establishment and implementation of admission training programmes for GPs in China lacks a focus on general practice training and may be improved by adopting an evidence-based general perspective aligned with the medical needs of the community.

scholarly journals Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care (STARSHIP): a factorial stepped-wedge cluster randomised controlled trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028270
Author(s):  
Berthe A M van der Geest ◽  
Johanna P de Graaf ◽  
Loes C M Bertens ◽  
Marten J Poley ◽  
Erwin Ista ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Phase Iii ◽  
Total Serum ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Randomised Controlled

IntroductionJaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although commonly applied, visual inspection is ineffective in identifying severe hyperbilirubinaemia. We aim to investigate whether among babies cared for in primary care: (1) transcutaneous bilirubin (TcB) screening can help reduce severe hyperbilirubinaemia and (2) primary care-based (versus hospital-based) phototherapy can help reduce hospital admissions.Methods and analysisA factorial stepped-wedge cluster randomised controlled trial will be conducted in seven Dutch primary care birth centres (PCBC). Neonates born after 35 weeks of gestation and cared for at a participating PCBC for at least 2 days within the first week of life are eligible, provided they have not received phototherapy before. According to the stepped-wedge design, following a phase of ‘usual care’ (visual assessment and selective total serum bilirubin (TSB) quantification), either daily TcB measurement or, if indicated, phototherapy in the PCBC will be implemented (phase II). In phase III, both interventions will be evaluated in each PCBC. We aim to include 5500 neonates over 3 years.Primary outcomes are assessed at 14 days of life: (1) the proportion of neonates having experienced severe hyperbilirubinaemia (for the TcB screening intervention), defined as a TSB above the mean of the phototherapy and the exchange transfusion threshold and (2) the proportion of neonates having required hospital admission for hyperbilirubinaemia treatment (for the phototherapy intervention in primary care).Ethics and disseminationThis study has been approved by the Medical Research Ethics Committee of the Erasmus MC Rotterdam, the Netherlands (MEC-2017-473). Written parental informed consent will be obtained. Results from this study will be published in peer-reviewed journals and presented at (inter)national meetings.Trial registration numberNTR7187.

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