scholarly journals Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

2020 ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Thomas Rotter ◽  
Petra Bauer ◽  
Martin Müller
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Process Evaluation ◽  
Data Extraction ◽  
Complex Interventions ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Care Pathways ◽  
Perfect Agreement

Abstract Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. Trial registration : PROSPERO 2018 CRD42018087689

scholarly journals Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

2020 ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Thomas Rotter ◽  
Petra Bauer ◽  
Martin Müller
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Process Evaluation ◽  
Data Extraction ◽  
Complex Interventions ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Care Pathways ◽  
Perfect Agreement

Abstract Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good interprofessional communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience.

scholarly journals Health system interventions to integrate genetic testing in routine oncology services: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250379
Author(s):  
Rosie O’Shea ◽  
Natalie Taylor ◽  
Ashley Crook ◽  
Chris Jacobs ◽  
Yoon Jung Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Genetic Testing ◽  
Genetic Counselling ◽  
Implementation Research ◽  
Professional Education ◽  
Data Extraction ◽  
Complex Interventions ◽  
Implementation Strategies ◽  
Newcastle Ottawa Scale ◽  
Inner Setting

Background Integration of genetic testing into routine oncology care could improve access to testing. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology. Methods The search strategy results were reported using the PRISMA statement and four electronic databases were searched. Eligible studies included routine genetic testing for breast and ovarian cancer or uptake after universal tumour screening for colorectal or endometrial cancer. The titles and abstracts were reviewed and the full text articles screened for eligibility. Data extraction was preformed using a designed template and study appraisal was assessed using an adapted Newcastle Ottawa Scale. Extracted data were mapped to Proctor’s et al outcomes and the Consolidated Framework for Implementation Research and qualitatively synthesised. Results Twenty-seven studies, published up to May 2020, met the inclusion criteria. Twenty-five studies ranged from poor (72%), fair to good (28%) quality. Most interventions identified were complex (multiple components) such as; patient or health professional education, interdisciplinary practice and a documentation or system change. Forty-eight percent of studies with complex interventions demonstrated on average a 35% increase in access to genetic counselling and a 15% increase in testing completion. Mapping of study outcomes showed that 70% and 32% of the studies aligned with either the service and client or the implementation level outcome and 96% to the process or inner setting domains of the Consolidated Framework for Implementation Research. Conclusion Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services. Studies of sound methodological quality that explore a greater breadth of pre and post implementation outcomes and informed by theory are needed. Such research could inform future service delivery models for the integration of genetics into oncology services.

scholarly journals Does education of primary care professionals to support patient self-management improve patient outcomes in chronic disease management? updated systematic review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0186
Author(s):  
Claire Collins ◽  
Gillian Doran ◽  
Patricia Patton ◽  
Roisin Fitzgerald ◽  
Andree Rochfort
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Outcomes ◽  
Professional Training ◽  
Complex Interventions ◽  
Educational Interventions ◽  
Self Management ◽  
Cochrane Library ◽  
Web Searches ◽  
High Quality Research

BackgroundOur first systematic review included only two papers showing patient outcomes following health professional training for promoting patient self-management.AimTo present the updated review undertaken from September 2013 to August 2018.Design & settingA systematic review was undertaken using the PRISMA guidelines, following the methodology of the first review and is outlined in the PROSPERO registered protocol (Database registration number: CRD42013004418).MethodSix databases were searched - Cochrane Library, PubMed, ERIC, EMBASE, CINAHL and PsycINFO - in addition to Web searches, Hand searches and Bibliographies for articles published from September 1st, 2013 to August 31st 2018.ResultsOur updated systematic review showed more evidence is now available with 18 papers in the five year period from the 4,284 abstracts located. Twelve of these papers showed a difference between intervention and control groups. Of the 18 papers identified, 11 were assessed as having a low risk of bias and five overall were rated of weak quality. The educational interventions with health professionals spanned a range of techniques and modalities and many incorporated multiple interventions including patient components. There may be lack of adoption due to several challenges, including that complex interventions may not be delivered as planned and are difficult to assess, and due to patient engagement and the need for ongoing follow-up.DiscussionMore high quality research is needed on what methods work best and for which patients and what clinical conditions in the primary care setting. The practical implications of training healthcare professionals require specific attention.

scholarly journals Process evaluations of primary care interventions addressing chronic disease: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025127 ◽  
Author(s):  
Hueiming Liu ◽  
Alim Mohammed ◽  
Janani Shanthosh ◽  
Madeline News ◽  
Tracey-Lea Laba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Randomised Controlled Trials ◽  
Data Extraction ◽  
Complex Interventions ◽  
Controlled Trials ◽  
Theoretical Frameworks ◽  
Intervention Theory ◽  
Randomised Controlled ◽  
Process Evaluations

ObjectiveProcess evaluations (PEs) alongside randomised controlled trials of complex interventions are valuable because they address questions of for whom, how and why interventions had an impact. We synthesised the methods used in PEs of primary care interventions, and their main findings on implementation barriers and facilitators.DesignSystematic review using the UK Medical Research Council guidance for PE as a guide.Data sourcesAcademic databases (MEDLINE, SCOPUS, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Global Health) were searched from 1998 until June 2018.Eligibility criteriaWe included PE alongside randomised controlled trials of primary care interventions which aimed to improve outcomes for patients with non-communicable diseases.Data extraction and synthesisTwo independent reviewers screened and conducted the data extraction and synthesis, with a third reviewer checking a sample for quality assurance.Results69 studies were included. There was an overall lack of consistency in how PEs were conducted and reported. The main weakness is that only 30 studies were underpinned by a clear intervention theory often facilitated by the use of existing theoretical frameworks. The main strengths were robust sampling strategies, and the triangulation of qualitative and quantitative data to understand an intervention’s mechanisms. Findings were synthesised into three key themes: (1) a fundamental mismatch between what the intervention was designed to achieve and local needs; (2) the required roles and responsibilities of key actors were often not clearly understood; and (3) the health system context—factors such as governance, financing structures and workforce—if unanticipated could adversely impact implementation.ConclusionGreater consistency is needed in the reporting and the methods of PEs, in particular greater use of theoretical frameworks to inform intervention theory. More emphasis on formative research in designing interventions is needed to align the intervention with the needs of local stakeholders, and to minimise unanticipated consequences due to context-specific barriers.PROSPERO registration numberCRD42016035572.

scholarly journals Bayesian factor analysis in primary care: a systematic review protocol

2020 ◽  
Author(s):  
Hao Zhang ◽  
Tibor Schuster
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Factor Analysis ◽  
Search Strategy ◽  
Data Extraction ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Care Family ◽  
Bayesian Factor ◽  
Bayesian Factor Analysis

Abstract Background: Bayesian factor analysis allows for efficient use of preliminary data and information that corresponds to the increasing needs of questionnaire construct validation in primary care research. This systematic review will summarise evidence on the current use of Bayesian factor analysis in primary care.Methods: We will adopt a comprehensive search strategy to identify relevant literature (research studies in primary care) indexed in PubMed, Medline, Scopus, EMBASE, CINAHL and Cochrane Library. The search strategy will include terms (and synonyms) for Bayesian statistics, factor analysis and primary care. We will conduct forward and backward searches manually on the references of articles that meet the inclusion and exclusion criteria to further identify eligible studies. Multiple reviewers will conduct data extraction independently. The analyses will include descriptive synthesis summarizing features about the use and reporting of the respective Bayesian factor analysis approach.Discussion: This systematic review will provide a bird view of the current use of Bayesian factor analysis in primary care and provide recommendations for its proper future use in primary care and beyond. Systematic review registration : PROSPERO registration number: CRD42018114978 Keywords: Bayesian, factor analysis, primary care, family medicine

scholarly journals Bayesian factor analysis in primary care: a systematic review protocol

2020 ◽  
Author(s):  
Hao Zhang ◽  
Tibor Schuster
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Factor Analysis ◽  
Search Strategy ◽  
Data Extraction ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Comprehensive Overview ◽  
Bayesian Factor ◽  
Bayesian Factor Analysis

Abstract Background: Bayesian factor analysis allows for efficient use of preliminary data and information that corresponds to the increasing needs of questionnaire construct validation in primary care research. This systematic review will summarise evidence on the current use of Bayesian factor analysis in primary care.Methods: A comprehensive search strategy will be adopted to identify relevant literature (research studies in primary care) indexed in Medline, Scopus, EMBASE, CINAHL and Cochrane Library. The search strategy includes terms and synonyms for Bayesian statistics, factor analysis and primary care. Forward and backward searches will be conducted manually on the references of articles that meet the inclusion and exclusion criteria to further identify eligible studies. Multiple reviewers will conduct data extraction independently. The analyses will include descriptive synthesis summarizing features about the use and reporting of the respective Bayesian factor analysis approach in primary care. Discussion: This systematic review will provide a comprehensive overview of the current use of Bayesian factor analysis in primary care and provide recommendations for its proper future use in primary care and beyond.Systematic review registration: PROSPERO registration number: CRD42018114978

scholarly journals Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis—a systematic review

2021 ◽  
Author(s):  
Franziska Köhler ◽  
Anne Hendricks ◽  
Carolin Kastner ◽  
Sophie Müller ◽  
Kevin Boerner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Laparoscopic Appendectomy ◽  
Data Extraction ◽  
Open Appendectomy ◽  
Cochrane Library ◽  
Pubmed Database ◽  
Uncomplicated Appendicitis ◽  
Absence From Work

Abstract Background Over the last years, laparoscopic appendectomy has progressively replaced open appendectomy and become the current gold standard treatment for suspected, uncomplicated appendicitis. At the same time, though, it is an ongoing discussion that antibiotic therapy can be an equivalent treatment for patients with uncomplicated appendicitis. The aim of this systematic review was to determine the safety and efficacy of antibiotic therapy and compare it to the laparoscopic appendectomy for acute, uncomplicated appendicitis. Methods The PubMed database, Embase database, and Cochrane library were scanned for studies comparing laparoscopic appendectomy with antibiotic treatment. Two independent reviewers performed the study selection and data extraction. The primary endpoint was defined as successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and incidence of complications. Results No studies were found that exclusively compared laparoscopic appendectomy with antibiotic treatment for acute, uncomplicated appendicitis. Conclusions To date, there are no studies comparing antibiotic treatment to laparoscopic appendectomy for patients with acute uncomplicated appendicitis, thus emphasizing the lack of evidence and need for further investigation.

scholarly journals Prevalence of retinopathy in prediabetes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040997
Author(s):  
Varo Kirthi ◽  
Paul Nderitu ◽  
Uazman Alam ◽  
Jennifer Evans ◽  
Sarah Nevitt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Data Extraction ◽  
Meta Analysis ◽  
International Diabetes Federation ◽  
Current Data ◽  
Risk Of Bias ◽  
Fundus Photography ◽  
Primary Data ◽  
Cochrane Library

IntroductionThere is growing evidence of a higher than expected prevalence of retinopathy in prediabetes. This paper presents the protocol of a systematic review and meta-analysis of retinopathy in prediabetes. The aim of the review is to estimate the prevalence of retinopathy in prediabetes and to summarise the current data.Methods and analysisThis protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive electronic bibliographic search will be conducted in MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and the Cochrane Library. Eligible studies will report prevalence data for retinopathy on fundus photography in adults with prediabetes. No time restrictions will be placed on the date of publication. Screening for eligible studies and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. Disagreements between the reviewers will be resolved by discussion, and if required, a third (senior) reviewer will arbitrate.The primary outcome is the prevalence of any standard features of diabetic retinopathy (DR) on fundus photography, as per International Clinical Diabetic Retinopathy Severity Scale (ICDRSS) classification. Secondary outcomes are the prevalence of (1) any retinal microvascular abnormalities on fundus photography that are not standard features of DR as per ICDRSS classification and (2) any macular microvascular abnormalities on fundus photography, including but not limited to the presence of macular exudates, microaneurysms and haemorrhages. Risk of bias for included studies will be assessed using a validated risk of bias tool for prevalence studies. Pooled estimates for the prespecified outcomes of interest will be calculated using random effects meta-analytic techniques. Heterogeneity will be assessed using the I2 statistic.Ethics and disseminationEthical approval is not required as this is a protocol for a systematic review and no primary data are to be collected. Findings will be disseminated through peer-reviewed publications and presentations at national and international meetings including Diabetes UK, European Association for the Study of Diabetes, American Diabetes Association and International Diabetes Federation conferences.PROSPERO registration numberCRD42020184820.

scholarly journals Effectiveness of Antalgic Therapies in Patients with Vertebral Bone Metastasis: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 3991
Author(s):  
Antonio Jose Martin-Perez ◽  
María Fernández-González ◽  
Paula Postigo-Martin ◽  
Marc Sampedro Pilegaard ◽  
Carolina Fernández-Lao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Metastasis ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Pharmacological Intervention ◽  
Vertebral Metastasis ◽  
Randomized Controlled Clinical Trials

There is no systematic review that has identified existing studies evaluating the pharmacological and non-pharmacological intervention for pain management in patients with bone metastasis. To fill this gap in the literature, this systematic review with meta-analysis aims to evaluate the effectiveness of different antalgic therapies (pharmacological and non-pharmacological) in the improvement of pain of these patients. To this end, this protocol has been written according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and registered in PROSPERO (CRD42020135762). A systematic search will be carried out in four international databases: Medline (Via PubMed), Web of Science, Cochrane Library and SCOPUS, to select the randomized controlled clinical trials. The Risk of Bias Tool developed by Cochrane will be used to assess the risk of bias and the quality of the identified studies. A narrative synthesis will be used to describe and compare the studies, and after the data extraction, random effects model and a subgroup analyses will be performed according to the type of intervention, if possible. This protocol aims to generate a systematic review that compiles and synthesizes the best and most recent evidence on the treatment of pain derived from vertebral metastasis.

scholarly journals Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001647
Author(s):  
Andréa Marques ◽  
Eduardo Santos ◽  
Elena Nikiphorou ◽  
Ailsa Bosworth ◽  
Loreto Carmona
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Inflammatory Arthritis ◽  
Data Extraction ◽  
Management Strategies ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Self Management ◽  
Cochrane Library ◽  
Management Interventions

ObjectiveTo perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).MethodsThe SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.ResultsFrom a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive–behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.ConclusionsThe findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.

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