Abstract:
BACKGROUND:In 2014, nursing home administration and government officials were facing increasing public and media scrutiny around the variation of antipsychotic medication (APM) prescribing across Ontario nursing homes. In response, policy makers partnered to test an academic detailing (AD) intervention to address appropriate prescribing of APM in nursing homes in a cluster-randomized trial. This mixed-methods study aimed to explore how and why the AD intervention may have resulted in changes in the nursing home context. The objectives were to understand how the intervention was implemented, explore contextual factors associated with implementation, and examine impact of the intervention on prescribing. METHODS:Administrative data for the primary outcome of the full randomized trial will not be available for a minimum of 1 year. Therefore, this paper reports the findings of a planned, quantitative interim trial analysis assessed mean APM dose and prescribing prevalence at baseline and 3 and 6 months across 40 nursing homes (18 intervention, 22 control). Patient-level administrative data regarding prescribing were analyzed using generalized linear mixed effects regression. Semi-structured interviews were conducted with nursing home staff from the intervention group to explore opinions and experiences of the AD intervention. Interviews were analyzed using the framework method, with constructs from the Consolidated Framework for Implementation Research (CFIR) applied as pre-defined deductive codes. Open coding was applied when emerging themes did not align with CFIR constructs. Qualitative and quantitative findings were triangulated to examine points of divergence to understand how the intervention may work and to identify areas for future opportunities and areas for improvement. RESULTS:No significant differences were observed in prescribing outcomes. A total of 22 interviews were conducted, including four academic detailers and 18 nursing home staff. Constructs within the CFIR domains of Outer Setting, Inner Setting, and Characteristics of Individuals presented barriers to antipsychotic prescribing. Intervention Source, Evidence Strength and Quality, and Adaptability explained participant engagement in the AD intervention; nursing homes that exhibited a Tension for Change and Leadership Engagement reported positive changes in processes and communication. CONCLUSIONS:Participants described their experiences with the intervention against the backdrop of a range of factors that influence APM prescribing in nursing homes that exist at the system, facility, provider, and resident levels. In this context, the perceived credibility and flexibility of the intervention were critical features that explained engagement with and potential impact of the intervention. Development of a common language across the team to enable communication was reported as a proximal outcome that may eventually have an effect on APM prescribing rates. Process evaluations may be useful during early stages of evaluation to understand how the intervention is working and how it might work better. Qualitative results suggest the lack of early changes observed in prescribing may reflect the number of upstream factors that need to change for APM rates to decrease. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02604056.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Desveaux L,Saragosa M,Rogers J,Bevan L,Loshak H,Moser A,Feldman S,Regier L,Jeffs L,Ivers NMdoi
10.1186/s13012-017-0602-zsubject
Has Abstractpub_date
2017-05-26 00:00:00pages
71issue
1issn
1748-5908pii
10.1186/s13012-017-0602-zjournal_volume
12pub_type
杂志文章abstract:BACKGROUND:The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, mos...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-7-112
更新日期:2012-11-21 00:00:00
abstract:BACKGROUND:Hand hygiene prescriptions are the most important measure in the prevention of hospital-acquired infections. Yet, compliance rates are generally below 50% of all opportunities for hand hygiene. This study aims at evaluating the short- and long-term effects of two different strategies for promoting hand hygie...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-6-101
更新日期:2011-09-03 00:00:00
abstract:BACKGROUND:Measurement-based care is an evidence-based practice for depression that efficiently identifies treatment non-responders and those who might otherwise deteriorate [1]. However, measurement-based care is underutilized in community mental health with data suggesting fewer than 20 % of behavioral health provide...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13012-015-0313-2
更新日期:2015-09-07 00:00:00
abstract:BACKGROUND:Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0674-9
更新日期:2017-11-21 00:00:00
abstract:OBJECTIVE:To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes. METHODS:Participant-level meta-analysis including six practice-based randomized contr...
journal_title:Implementation science : IS
pub_type: 杂志文章,meta分析
doi:10.1186/1748-5908-9-26
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abstract:BACKGROUND:Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level ...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/1748-5908-8-22
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abstract:BACKGROUND:While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication amo...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0456-9
更新日期:2016-07-07 00:00:00
abstract:BACKGROUND:Experts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
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更新日期:2018-08-06 00:00:00
abstract:BACKGROUND:The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on general...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0757-2
更新日期:2018-05-09 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-015-0272-7
更新日期:2015-05-29 00:00:00
abstract:BACKGROUND:Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funder...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-015-0290-5
更新日期:2015-07-17 00:00:00
abstract:BACKGROUND:The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-017-0686-5
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abstract:BACKGROUND:Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective,...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01055-2
更新日期:2020-10-28 00:00:00
abstract:BACKGROUND:The adoption and diffusion of clinical information systems has become one of the critical benchmarks for achieving several healthcare organizational reform priorities, including home care, primary care, and integrated care networks. However, these systems are often strongly resisted by the same community tha...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-15
更新日期:2011-02-28 00:00:00
abstract:BACKGROUND:The Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing ...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-8-95
更新日期:2013-08-23 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-6-80
更新日期:2011-07-26 00:00:00
abstract:BACKGROUND:People in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels o...
journal_title:Implementation science : IS
pub_type: 杂志文章
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abstract:BACKGROUND:The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. METHODS:The study will compare the effectiveness of educational out...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-9-10
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
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journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2017-11-21 00:00:00
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journal_title:Implementation science : IS
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更新日期:2013-12-17 00:00:00
abstract:BACKGROUND:The World Health Organization recommends that nations implement evidence-based nutritional guidelines and policies in settings such as schools and childcare services to improve public health nutrition. Understanding the causal mechanism by which implementation strategies exert their effects could enhance gui...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2018-03-12 00:00:00
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,评审
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