Barriers and facilitators to participant adherence of dietary recommendations within comprehensive cardiac rehabilitation programmes: a systematic review

Objective: To identify individual-, provider- and system/environmental-level barriers and facilitators affecting cardiac rehabilitation (CR) participants’ adherence to dietary recommendations. Design: A systematic review of the medical literature was conducted. Six databases were searched from inception through March 2021: APA PsycInfo, CINAHL, Embase, Emcare, Medline and PubMed. Only those studies referring to barriers and facilitators reported by CR participants were considered. Pilot and case report studies, non-peer-reviewed literature and studies published in a language other than English, Portuguese or Spanish were excluded. Results: Data were extracted and analysed on the basis of individual-, provider- and system/environmental-level factors. Of 2083 initial citations, sixteen studies were included, with nine being qualitative and seven observational in design. From these, ten multi-level barriers and seven multi-level facilitators were identified. Dietary recommendations included developing healthy eating habits, transitioning to vegetarian-rich diets and increasing fish oil and n-3 intake. Only one study reported on all of the nutrition education programme factors recommended by the Workgroup for Intervention Development and Evaluation Research. Conclusion: To the best of our knowledge, this review is the first to summarise specific barriers and facilitators to recommendation adherence among CR participants. Few of the studies offered any conclusions regarding programme design that could facilitate improved dietary adherence practices. Future studies should aim to explore patient perspectives on the nutritional patterns and recommendations outlined in the Mediterranean Diet, the Dietary Approaches to Stop Hypertension Diet, Vegetarian or Vegan diets and the Portfolio Diet.

Are Online Patient Reviews Associated With Health Care Outcomes? A Systematic Review of the Literature

Although online patient reviews (OPRs) are ubiquitous, there has been debate about whether OPRs are associated with measures of health care outcomes. The majority of patients search for online information about a hospital or provider before scheduling an encounter, therefore, the extent to which OPRs are valid information is important. We conducted a systematic review of the literature to examine the extent to which OPRs are associated with measures of patient experience, clinical quality, and other outcomes. We searched Medline, CINAHL, Web of Science, and PsycInfo, which yielded 32 studies. There were consistent positive correlations between OPRs and patient experience at both the organization and individual provider levels of analysis. However, associations between OPRs and quality measures were mixed. Organizational level OPRs may be more reliable than individual provider OPRs. In addition, the strength of association could be affected by the type of encounter setting, specialty, and specific measures.

An examination of individual provider characteristics in the dissemination and uptake of cognitive-behavioral conjoint therapy for posttraumatic stress disorder

Support for the use of evidence-based psychological practice in Canada is growing, but there remains a large gap between psychotherapy research and real-world psychotherapy practice. There also exists a chasm between the number of clinicians who attend psychotherapy trainings and those who implement the training material into their clinical practice. The present study examined individual provider characteristics in the uptake of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder. There was a trend for an interaction between attitudes toward manualized treatments and attitudes toward the use of couple therapy to treat individuals with PTDS. Specifically, as attitudes in each area were more positive, piecemeal uptake of the protocol decreased. Contrary to hypothesis, prior training in couple therapy or in cognitive-behavioural therapy for PTDS, years since the highest degree was completed, and therapeutic orientation were not associated with uptake.

An examination of individual provider characteristics in the dissemination and uptake of cognitive-behavioral conjoint therapy for posttraumatic stress disorder

Support for the use of evidence-based psychological practice in Canada is growing, but there remains a large gap between psychotherapy research and real-world psychotherapy practice. There also exists a chasm between the number of clinicians who attend psychotherapy trainings and those who implement the training material into their clinical practice. The present study examined individual provider characteristics in the uptake of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder. There was a trend for an interaction between attitudes toward manualized treatments and attitudes toward the use of couple therapy to treat individuals with PTDS. Specifically, as attitudes in each area were more positive, piecemeal uptake of the protocol decreased. Contrary to hypothesis, prior training in couple therapy or in cognitive-behavioural therapy for PTDS, years since the highest degree was completed, and therapeutic orientation were not associated with uptake.

Impact of a built-in electronic medical record prompt on guideline-recommended prophylactic antiviral usage in patients with multiple myeloma receiving proteasome inhibitors.

248 Background: Guidelines support the use of prophylactic antivirals to prevent reactivation of herpes varicella in patients with multiple myeloma (MM) on proteasome inhibitors (PI). In our network of five oncology practices spanning over 100 clinic sites, one practice has a built-in prompt for acyclovir use in patients receiving a PI, while the other four practices do not. We used this natural experiment to determine the impact of this prompt on appropriate prophylactic antiviral usage in this patient population. Methods: We retrospectively identified all patients in our network with MM beginning a regimen containing a PI between 1/1/19 and 5/28/20. Of these patients, we identified those with documentation of a prescription for acyclovir or valacyclovir before or within 2 days of the first PI dose. We compared prophylactic usage across five practices. Practice 1 had built a prompt for the prescription of acyclovir in regimens containing bortezomib or carfilzomib within the electronic medical record (EMR) which both reminded physicians and nurses and simplified the prescribing process. No other practices had similar EMR prompts. Results: We identified 583 patients with MM who received a PI during the study period. Wide variation in rates of prophylactic antiviral usage existed across the five practices (range 21%-94%). The highest rate of prophylactic antiviral usage was practice 1 (94%). This was the only practice with a built-in EMR prompt for acyclovir usage in PI regimens. We found no association between use of prophylactic antivirals and individual provider-level volume of patients with MM. Conclusions: Use of prophylactic therapy is heterogeneous across practices. A comprehensive treatment plan containing a prompt in the EMR can markedly increase appropriate utilization. We plan to add an EMR prompt and analytics-driven reminders across our network to improve utilization of all guideline-recommend, orally administered prophylactic medications. [Table: see text]

Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis

ObjectiveTo assess barriers and facilitators to de-implementation.DesignA qualitative evidence synthesis with a framework analysis.Data sourcesMedline, Embase, Cochrane Library and Rx for Change databases until September 2018 were searched.Eligibility criteriaWe included studies that primarily focused on identifying factors influencing de-implementation or the continuation of low-value care, and studies describing influencing factors related to the effect of a de-implementation strategy.Data extraction and synthesisThe factors were classified on five levels: individual provider, individual patient, social context, organisational context, economic/political context.ResultsWe identified 333 factors in 81 articles. Factors related to the individual provider (n=131; 74% barriers, 17% facilitators, 9% both barrier/facilitator) were associated with their attitude (n=72; 55%), knowledge/skills (n=43; 33%), behaviour (n=11; 8%) and provider characteristics (n=5; 4%). Individual patient factors (n=58; 72% barriers, 9% facilitators, 19% both barrier/facilitator) were mainly related to knowledge (n=33; 56%) and attitude (n=13; 22%). Factors related to the social context (n=46; 41% barriers, 48% facilitators, 11% both barrier/facilitator) included mainly professional teams (n=23; 50%) and professional development (n=12; 26%). Frequent factors in the organisational context (n=67; 67% barriers, 25% facilitators, 8% both barrier/facilitator) were available resources (n=28; 41%) and organisational structures and work routines (n=24; 36%). Under the category of economic and political context (n=31; 71% barriers, 13% facilitators, 16% both barrier/facilitator), financial incentives were most common (n=27; 87%).ConclusionsThis study provides in-depth insight into the factors within the different (sub)categories that are important in reducing low-value care. This can be used to identify barriers and facilitators in low-value care practices or to stimulate development of strategies that need further refinement. We conclude that multifaceted de-implementation strategies are often necessary for effective reduction of low-value care. Situation-specific knowledge of impeding or facilitating factors across all levels is important for designing tailored de-implementation strategies.

Providers Versus Platforms: Marketing Communications in the Sharing Economy

Peer-to-peer (P2P) business models have become increasingly prevalent in the marketplace. However, little is known about what factors influence consumer perceptions of purchases from firms using these models. The authors propose that features inherent to the P2P model lead consumers to perceive high provider–firm independence, where providers are viewed as relatively independent from the platform on which they offer goods/services. Across a series of studies, the authors show that when P2P brands use provider-focused (vs. platform-focused) marketing communications, consumers perceive a purchase as helping an individual provider to a greater extent, which increases consumers’ willingness to pay and their likelihood of both making a purchase and downloading the brand’s app. This is because provider-focused marketing communications in this context lead consumers to think about their purchase from the provider’s perspective, thus adopting an “empathy lens.” The authors further show that this effect does not extend to other business models. This work thus identifies provider- (vs. platform-) focused marketing communications as a way for marketing managers of P2P brands to drive important purchase-related outcomes.