Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) Model in developing competencies among healthcare professionals: a mixed methods systematic review protocol

Abstract Background The Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals’ competencies in the management of chronic and complex health conditions. While data on the impact of the ECHO model is increasingly available in the literature, what influences the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise, and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the ECHO Model effectiveness and the experiences/views of ECHO’s participants about what influences the development of competencies in healthcare professionals. Methods The proposed systematic review was inspired by the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in six databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and gray literature will be searched as well. Retrieved citations will independently be screened by two reviewers. Disagreements will be resolved through discussion until a consensus is reached or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity. Discussion This MMSR will fulfill important gaps in the current literature on the ECHO Model as the first to provide estimates on its effectiveness and consider simultaneously the experiences/views of ECHO’s participants. As each replication of the ECHO Model greatly varies depending on the context, topic, and targeted professionals, a better understanding of what influences the model effectiveness in developing healthcare professionals’ competencies is crucial to inform future implementation. Systematic review registration PROSPERO CRD42020197579

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Effectiveness of the Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education and influence of key learning conditions on the development of competencies in healthcare professionals: Protocol for a mixed methods systematic review

10.21203/rs.3.rs-334821/v1 ◽

2021 ◽

Author(s):

Gabrielle Chicoine ◽

José Côté ◽

Jacinthe Pepin ◽

Guillaume Fontaine ◽

Marc-André Maheu-Cadotte ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Systematic Reviews ◽

Healthcare Professionals ◽

Grey Literature ◽

Publication Date ◽

Healthcare Outcomes ◽

Community Healthcare ◽

Learning Conditions ◽

Development Of Competencies

Abstract BackgroundThe Extension for Community Healthcare Outcomes (ECHO) Model of continuing tele-education is an innovative guided-practice model aiming at amplifying healthcare professionals’ competencies in the management of chronic and complex health conditions. While data on the effectiveness of the ECHO Model is increasingly available in the literature, the influence of key learning conditions on the model effectiveness remains unclear. Therefore, the overarching aim of this systematic review is to identify, appraise and synthesize the available quantitative (QUAN) and qualitative (QUAL) evidence regarding the effectiveness of the ECHO Model and the influence of key learning conditions on the development of competencies in healthcare professionals.MethodsThis proposed systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for Mixed Methods Systematic Reviews (MMSR) and will follow a convergent segregated approach. A systematic search will be undertaken using QUAN, QUAL and mixed methods (MM) studies of ECHO-affiliated programs identified in five databases. A publication date filter will be applied to find the articles published from 2003 onwards. Sources of unpublished studies and grey literature will be searched as well. Retrieved citations will be screened by two review authors independently. Disagreements will be resolved through discussion until a consensus is reached, or by including a third reviewer. Studies meeting the predefined inclusion criteria will be assessed on methodological quality and the data will be extracted using standardized data extraction forms. Separate QUAN and QUAL synthesis will be performed, and findings will be integrated using a matrix approach for the purpose of comparison and complementarity.DiscussionThis MMSR will fulfill important gaps in the current literature on the ECHO Model, as the first to provide estimates on its effectiveness and consider simultaneously the influence of key learning conditions on the development of competencies in healthcare professionals. As implementations of the ECHO Model greatly vary depending on the context, topic and targeted professional group, a better understanding of the conditions that contribute to competencies’ development in healthcare professionals is crucial to inform the design and implementation of the model.Systematic review registration:This MMSR protocol is pending registration in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (submitted October 21, 2020; ID Number: 197579).

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Screening strategies for hypertension: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025043 ◽

2019 ◽

Vol 9 (1) ◽

pp. e025043 ◽

Cited By ~ 3

Author(s):

Bey-Marrié Schmidt ◽

Solange Durão ◽

Ingrid Toews ◽

Charlotte M Bavuma ◽

Joerg J Meerpohl ◽

...

Keyword(s):

Systematic Review ◽

Latin American ◽

Data Extraction ◽

Controlled Trials ◽

Publication Date ◽

Cochrane Central Register ◽

Systematic Review Protocol ◽

Screening Strategies ◽

Review Protocol ◽

The Impact

IntroductionIt is unclear whether early detection of hypertension, through screening, leads to healthier behaviours and better control of blood pressure levels. There is a need to learn from studies that have assessed the impact of different screening approaches on patient important outcomes. This systematic review protocol outlines the methods that will be used to assess the comparative effectiveness of different screening strategies (mass, targeted or opportunistic) for hypertension to reduce morbidity and mortality associated with hypertension.Methods and analysisWe will primarily search Cochrane Central Register of Controlled Trials, Medline, Embase and Latin American and Caribbean Health Sciences Literature (LILACS). Relevant randomised controlled trials, controlled before and after, interrupted time series and prospective analytic cohort studies regardless of publication date, language and geographic location, will be included. We are interested in clinical, adverse event and health system outcomes. Two reviewers will independently screen titles, abstracts and full-text articles against inclusion criteria; perform data extraction and assess risk of bias in included studies. We will assess the certainty of the overall evidence using the Grading of Recommendations Assessment, Development and Evaluation approach and report findings accordingly.Ethics and disseminationNo ethics approval will be sought, as only secondary studies will be used. Findings will be disseminated through peer-reviewed publication and conference presentations.PROSPERO registration numberCRD42018093046.

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The impact of electronic prescribing systems on healthcare professionals’ working practices in the hospital setting: a systematic review and narrative synthesis

BMC Health Services Research ◽

10.1186/s12913-019-4554-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Soomal Mohsin-Shaikh ◽

Dominic Furniss ◽

Ann Blandford ◽

Monsey McLeod ◽

Tiantian Ma ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Healthcare Professionals ◽

Electronic Prescribing ◽

Inpatient Setting ◽

Narrative Synthesis ◽

Qualitative Approaches ◽

Communication Time ◽

Working Practices ◽

The Impact

Abstract Background The aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of electronic prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research. Methods We searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804). Results Searches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most (n = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative. Conclusion There is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.

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Effectiveness of serious games and impact of design elements on engagement and educational outcomes in healthcare professionals and students: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2017-019871 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019871 ◽

Cited By ~ 25

Author(s):

Marc-André Maheu-Cadotte ◽

Sylvie Cossette ◽

Véronique Dubé ◽

Guillaume Fontaine ◽

Tanya Mailhot ◽

...

Keyword(s):

Systematic Review ◽

Educational Outcomes ◽

Serious Games ◽

Healthcare Professionals ◽

Science Studies ◽

Data Extraction ◽

Meta Analysis ◽

Medical Subject Headings ◽

Design Elements ◽

The Impact

IntroductionSerious games (SGs) are interactive and entertaining digital software with an educational purpose. They engage the learner by proposing challenges and through various design elements (DEs; eg, points, difficulty adaptation, story). Recent reviews suggest the effectiveness of SGs in healthcare professionals’ and students’ education is mixed. This could be explained by the variability in their DEs, which has been shown to be highly variable across studies. The aim of this systematic review is to identify, appraise and synthesise the best available evidence regarding the effectiveness of SGs and the impact of DEs on engagement and educational outcomes of healthcare professionals and students.Methods and analysisA systematic search of the literature will be conducted using a combination of medical subject headings terms and keywords in Cumulative Index of Nursing and Allied Health, Embase, Education Resources Information Center, PsycInFO, PubMed and Web of Science. Studies assessing SGs on engagement and educational outcomes will be included. Two independent reviewers will conduct the screening as well as the data extraction process. The risk of bias of included studies will also be assessed by two reviewers using the Effective Practice and Organisation of Care criteria. Data regarding DEs in SGs will first be synthesised qualitatively. A meta-analysis will then be performed, if the data allow it. Finally, the quality of the evidence regarding the effectiveness of SGs on each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationAs this systematic review only uses already collected data, no Institutional Review Board approval is required. Its results will be submitted in a peer-reviewed journal by the end of 2018.PROSPERO registration numberCRD42017077424.

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Impact of a videoconferencing educational programme for the management of concurrent disorders on nurses’ competency development and clinical practice: protocol for a convergent mixed methods study

BMJ Open ◽

10.1136/bmjopen-2020-042875 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042875

Author(s):

Gabrielle Chicoine ◽

José Côté ◽

Jacinthe Pépin ◽

Pierre Pluye ◽

Louise Boyer ◽

...

Keyword(s):

Clinical Practice ◽

Mixed Methods ◽

Continuing Professional Development ◽

Ethics Committee ◽

Mixed Methods Study ◽

Healthcare Outcomes ◽

Competency Development ◽

Concurrent Disorders ◽

Community Healthcare ◽

The Impact

IntroductionExtension for Community Healthcare Outcomes (Project ECHO©) is an innovative model for continuing professional development that uses videoconferencing technology to support and train general practitioners remotely. The model has been replicated to a variety of settings and locations for capacity building in healthcare professionals caring for patients with chronic and complex health conditions. Limited research has been conducted so far on the impact of ECHO in the field of concurrent mental health and substance use disorders (ie, concurrent disorders (CDs)). Therefore, this mixed methods study aims to develop a comprehensive understanding of an ECHO programme impact for CD management on nurses’ competency development and clinical practice.Methods and analysisThe proposed mixed methods study, based on a convergent parallel design, will be conducted in the province of Quebec, Canada, to collect, analyse and interpret quantitative (QUAN) and qualitative (QUAL) data from a specific ECHO Program on CDs. In the QUAN component, an observational prospective cohort study will be conducted over a 12-month period. All nurses who participated in the programme between 2018 and 2020 and who consent to research will be recruited to collect data on the extent of their learning and practice outcomes at three time points. Alongside the surveys, nurses will be invited to participate in individual semistructured interviews. In-depth QUAL data will be subjected to a thematic analysis and will assist in exploring how and in which conditions nurses developed and mobilised their competencies in clinical practice. A comparison-of-results strategy will be used in the final integration component of the study.Ethics and disseminationThis study protocol was approved by the Ethics Committee of the Université de Montréal Hospital Center (#19.295) and the Université de Montréal Ethics Committee (CERSES-20–017 R). We aim to disseminate the findings through international academic conferences, international peer-reviewed journals and professional media.

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Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-047283 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047283

Author(s):

Rosalind Gittins ◽

Louise Missen ◽

Ian Maidment

Keyword(s):

Systematic Review ◽

Substance Misuse ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Opioid Analgesics ◽

Physical And Mental Health ◽

Qualitative Synthesis ◽

Treatment Services ◽

The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

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Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol

BJR|Open ◽

10.1259/bjro.20210004 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20210004

Author(s):

Harriet Nalubega Kisembo ◽

Ritah Nassanga ◽

Faith Ameda Ameda ◽

Moses Ocan ◽

Alison A Kinengyere ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Systematic Reviews ◽

Financial Incentives ◽

Healthcare Professionals ◽

Information Source ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Cochrane Library ◽

Clinical Imaging

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

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Cancer services during the COVID-19 pandemic: systematic review of patients' and caregivers' experiences

10.1101/2021.03.19.21253949 ◽

2021 ◽

Author(s):

Symran Dhada ◽

Derek Stewart ◽

Ejaz Cheema ◽

Muhammed Abdul Hadi ◽

Vibhu Paudyal

Keyword(s):

Systematic Review ◽

Cancer Screening ◽

Cancer Patients ◽

English Language ◽

Resource Constraints ◽

Data Extraction ◽

Psychological Wellbeing ◽

Cancer Services ◽

Data Extraction Form ◽

The Impact

Background Cancer patients have faced intersecting crises in the face of COVID-19 pandemic. This review aimed to examine patients' and caregivers' experiences of accessing cancer services during the COVID-19 pandemic and perceived impact of the pandemic on their psychological wellbeing. Methods A protocol-led (CRD42020214906) systematic review was conducted by searching six databases including EMBASE, MEDLINE and CINAHL for articles published in English-language between 1/2020-12/2020. Data were extracted using a pilot-tested, structured data extraction form. Thematic synthesis of data was undertaken and reported as per the PRISMA guideline. Results A total of 1110 articles were screened of which 19 studies met the inclusion criteria. Studies originated from 10 different countries including the US, UK, India and China. Several themes were identified which were categorised into seven categories. Postponement and delays in cancer screening and treatment, drug shortages and inadequate nursing care were commonly experienced by patients. Hospital closures, resource constraints, national lockdowns and patient reluctance to use health services because of infection worries contributed to the delay. Financial and social distress, isolation; and spiritual distress due to the uncertainty of rites as well as fulfilment of last wishes were also commonly reported. Caregivers felt anxious about infecting cancer patients with COVID-19. Conclusions Patients and caregivers experienced extensive impact of COVID-19 on cancer screening, treatment and care, and their own psychological wellbeing. Patient and caregiver views and preferences should be incorporated in ensuring resilient cancer services that can minimise the impact of ongoing and future pandemic on cancer care and mitigate patient fears.

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Housing with support for older people: a mixed-methods systematic review protocol

HRB Open Research ◽

10.12688/hrbopenres.13124.2 ◽

2020 ◽

Vol 3 ◽

pp. 64

Author(s):

Camille Coyle ◽

Sarah Buggy ◽

Olivia Cagney ◽

Louise Farragher ◽

Caitriona Lee ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Mixed Methods ◽

Older People ◽

Grey Literature ◽

Qualitative And Quantitative ◽

Ovid Medline ◽

The Impact ◽

People’S Perceptions

Background: The implementation of housing with support is rapidly expanding, particularly as life expectancy is increasing throughout the world. This expansion is likely to intensify in the context of coronavirus disease 2019 (COVID-19), which has revealed the risks of relying primarily on nursing homes. This mixed-methods systematic review aims to: 1) explore older people’s perceptions and experiences of housing with support and 2) examine the impact of providing housing with support for older people on their quality of life. Methods: The databases Ovid Medline, Ovid Social Policy & Practice, EBSCO CINAHL, and EBSCO SOCIndex will be searched, and grey literature will also be identified. Quality assessment will be carried out using Joanna Briggs Institute’s Critical Appraisal Checklist for Qualitative Research as well as a tool from the National Institutes of Health for observational cohort studies. This review will employ convergent parallel design; as such, qualitative and quantitative findings will be synthesised separately in the initial stage of analysis. The results from the qualitative and quantitative syntheses will then be integrated in the final stage of the analysis. Conclusion: This systematic review will synthesise the evidence regarding older people’s perceptions and experiences of housing with support and the impact of providing housing with support for older people on their quality of life.

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Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-And- Lower Middle-Income Countries

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.155 ◽

2021 ◽

Author(s):

Giuliano Russo ◽

Tiago Silva Jesus ◽

Kevin Deane ◽

Abdinasir Yusuf Osman ◽

David McCoy

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Inclusion Criteria ◽

Middle Income ◽

Middle Income Countries ◽

Premature Deaths ◽

Trade Offs ◽

Mother And Child ◽

New Research ◽

The Impact

Background: The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children’s health in low-and-lower-middle-income countries. Methods: A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between November 1st-10th 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on low-and-lower-middle-income countries, addressed impacts on women and child’s health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute’s critical appraisal tools were used to assess the quality of the studies, and the PRISMA guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design. Results: The review process identified 46 papers meeting the inclusion criteria from 17 countries whichall focussed on the COVID-19 and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women is well-established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods are disrupted, and poverty levels increase. Conclusion: Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

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