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Addressing implementation challenges during guideline development - a case study of Swedish national guidelines for methods of preventing disease.

https://arctichealth.org/en/permalink/ahliterature277834
Source
BMC Health Serv Res. 2015 Jan 22;15:19
Publication Type
Article
Date
Jan-22-2015
Author
Linda Richter-Sundberg
Therese Kardakis
Lars Weinehall
Rickard Garvare
Monica E Nyström
Source
BMC Health Serv Res. 2015 Jan 22;15:19
Date
Jan-22-2015
Language
English
Publication Type
Article
Keywords
Adult
Consensus
Evidence-Based Practice - organization & administration - standards
Health promotion - organization & administration - standards
Humans
Practice Guidelines as Topic
Preventive Health Services - organization & administration - standards
Quality of Health Care
Risk Reduction Behavior
Sweden
Abstract
Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.
Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.
The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.
This case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.
Notes
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PubMed ID
25608684 View in PubMed
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American Indian perspectives on evidence-based practice implementation: results from a statewide Tribal Mental Health Gathering.

https://arctichealth.org/en/permalink/ahliterature277764
Source
Adm Policy Ment Health. 2015 Jan;42(1):29-39
Publication Type
Article
Date
Jan-2015
Author
Sarah Cusworth Walker
Ron Whitener
Eric W Trupin
Natalie Migliarini
Source
Adm Policy Ment Health. 2015 Jan;42(1):29-39
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Consumer Participation - methods
Cultural Competency
Evidence-Based Practice - organization & administration
Home Care Services - organization & administration
Humans
Indians, North American - psychology
Inuits - psychology
Mental Health Services - organization & administration
Program Evaluation
Washington
Abstract
Implementation of Evidence-Based Practices (EBP) within American Indian and Alaskan Natives communities is currently an area of debate and contention. There is considerable concern about expanding EBP policy mandates to AI/AN communities as these mandates, either through funding restrictions or other de facto policies, recall past histories of clinical colonization and exploitation by the state and federal government. As a response, work is being done to evaluate indigenous programs and examine strategies for culturally-sensitive implementation. While the literature reflects the perspectives of AI/AN populations on EBP generally, no one has yet reported the perspectives of AI/AN communities on how to feasibly achieve widespread EBP implementation. We report the findings of a statewide Tribal Gathering focused on behavioral health interventions for youth. The Gathering participants included AI/AN individuals as well as staff working with AI/AN populations in tribal communities. Participants identified strengths and weaknesses of the five legislatively fundable programs for youth delinquency in Washington State and discussed strategies likely to be effective in promoting increased uptake within tribes. Analysis of these discussions resulted in many useful insights in program-specific and community-driven strategies for implementation. In addition, two major themes emerged regarding widespread uptake: the importance of a multi-phase engagement strategy and adopting a consortium/learning community model for implementation. The findings from this Gathering offer important lessons that can inform current work regarding strategies to achieve a balance of program fidelity and cultural-alignment. Attending to engagement practices at the governance, community and individual level are likely to be key components of tribal-focused implementation. Further, efforts to embed implementation within a consortium or learning community hold considerable promise as a strategy for sustainability.
PubMed ID
24242820 View in PubMed
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Barriers in implementation of evidence-based practice: Supported employment in Swedish context.

https://arctichealth.org/en/permalink/ahliterature132127
Source
J Health Organ Manag. 2011;25(3):332-45
Publication Type
Article
Date
2011
Author
Henna Hasson
Mats Andersson
Ulrika Bejerholm
Author Affiliation
Department of Business Administration, Lund University School of Economics and Management, Lund, Sweden. henna.hasson@fek.lu.se
Source
J Health Organ Manag. 2011;25(3):332-45
Date
2011
Language
English
Publication Type
Article
Keywords
Employment, Supported - standards - trends
Evidence-Based Practice - organization & administration - standards
Health Plan Implementation - standards - utilization
Humans
Mentally Ill Persons
Models, organizational
Rehabilitation, Vocational - standards - utilization
Social Security - standards
Sweden
Abstract
The aim of this paper is to identify initial barriers influencing implementation of supported employment (SE). SE, according to the individual placement and support (IPS) approach, has been recognised as an evidence-based method to help people with severe mental illness to find regular employment.
A systematic implementation evaluation of the first randomised controlled SE (IPS) trial in Sweden was conducted in August 2008 and August 2009. Data were collected on a regular basis from SE employment specialists, process heads, clients and representatives from mental health care units and vocational services (social insurance and public employment offices) using interviews, non-participant observations and document analysis.
SE employment specialists reported that existing regulations for social insurance and employment regulations presented major obstacles to implementation. Difficulties were reported in cooperation with handling officers at the vocational services. Scepticism towards persons with mental illness was common and employers expected to receive subsidies if they hired a person with mental illness. SE participants expressed fear of losing their social benefits.
The results illuminate a collision between an innovative evidence-based practice and the existing systems for social benefits and work rehabilitation.
PubMed ID
21845986 View in PubMed
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Building the evidence base for chronic disease self-management support interventions across Canada.

https://arctichealth.org/en/permalink/ahliterature114421
Source
Can J Public Health. 2012 Nov-Dec;103(6):e462-7
Publication Type
Article
Author
Sharon Johnston
Clare Liddy
Karina Mill
Hannah Irving
Author Affiliation
Department of Family medicine, University of Ottawa, ON. SJohnston@bruyere.org
Source
Can J Public Health. 2012 Nov-Dec;103(6):e462-7
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - therapy
Evidence-Based Practice - organization & administration
Humans
Internet
Program Evaluation
Qualitative Research
Self Care
Social Support
Abstract
The objective of this project was to determine how to improve evaluation of self-management support (SMS) in Canada to generate high-quality evidence to guide policy-makers, implementers, providers and participants.
This project used a multi-method approach, including a scoping and a focused literature review, an internet scan, interviews with key stakeholders, a review of existing theoretical evaluation frameworks and a consensus meeting with experts.
Four themes were identified through the collection and analysis of data: 1) diverse SMS interventions are identifiable; 2) emerging evaluation activity in Canada is limited to mostly disease-specific, clinic-based programs; 3) there is little evaluation capacity among program implementers in Canada; and 4) there is a gap between the evidence and expectations.
Policy-makers, community organizations and health care teams, regional health authorities and, most importantly, people living with chronic conditions, need better evidence about how to support self-management in their communities. Measuring outcomes must be an explicit part of program implementation and development and requires coordinated support. A common evaluation framework may provide researchers, practitioners and decision- or policy-makers with a systems approach to understanding the possible structural and process factors that can affect self-management outcomes, and could support capacity building in evaluation.
PubMed ID
23618029 View in PubMed
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The clinical nurse specialist role in Canada: forecasting the future through research.

https://arctichealth.org/en/permalink/ahliterature142343
Source
Can J Nurs Res. 2010 Jun;42(2):19-25; discussion 26-8
Publication Type
Article
Date
Jun-2010

Creating Clinical Cohorts: Challenges Encountered in Two Canadian Provinces.

https://arctichealth.org/en/permalink/ahliterature308575
Source
Healthc Policy. 2019 08; 15(1):10-18
Publication Type
Journal Article
Date
08-2019
Author
Esther S Shoemaker
Marissa L Becker
Clare E Liddy
Leigh M McClarty
Shabnam Asghari
Jillian Hurd
Sean B Rourke
Souradet Y Shaw
Christine Bibeau
Ron Rosenes
Philip Lundrigan
Lois Crowe
Laurie Ireland
Carla Loeppky
Claire E Kendall
Author Affiliation
Bruyère Research Institute, University of Ottawa, Ottawa Hospital Research Institute, Institute of Clinical and Evaluative Sciences, Ottawa, ON.
Source
Healthc Policy. 2019 08; 15(1):10-18
Date
08-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Data Collection - methods
Evidence-Based Practice - organization & administration
Female
HIV Infections - epidemiology
Health Policy
Health Services Research - organization & administration
Humans
Male
Manitoba - epidemiology
Middle Aged
Newfoundland and Labrador - epidemiology
Patient Selection
Research Design
Young Adult
Abstract
In 2013, the Living with HIV (LHIV) Innovation team established clinical cohorts of people living with HIV in Manitoba and Newfoundland and Labrador, and they linked the data to provincial health administrative databases. Access to these data enabled researchers to conduct studies across provincial borders; contribute to a national dialogue on HIV health system performance; and give recommendations for evidence-based healthcare, health policy and public health. However, research funding is episodic; maintaining cohorts requires stable funding. We support the establishment of a cross-jurisdictional approach to facilitate streamlined data collection and linkage without interruption and to allow for meaningful analysis in order to inform national policies.
PubMed ID
31629452 View in PubMed
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Effective population management practices in diabetes care - an observational study.

https://arctichealth.org/en/permalink/ahliterature140619
Source
BMC Health Serv Res. 2010;10:277
Publication Type
Article
Date
2010
Author
Anne Frølich
Jim Bellows
Bo Friis Nielsen
Per Bruun Brockhoff
Martin Hefford
Author Affiliation
Department of Integrated Healthcare, Bispebjerg Hospital, Copenhagen, Denmark. anne.frolich@dadlnet.dk
Source
BMC Health Serv Res. 2010;10:277
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care Facilities
Blood Glucose - analysis
Cross-Sectional Studies
Denmark
Diabetes mellitus, type 2 - therapy
Evidence-Based Practice - organization & administration
Female
Humans
Logistic Models
Male
Middle Aged
Observation
Odds Ratio
Patient Care
Physician's Practice Patterns
Practice Management, Medical
Primary Health Care - organization & administration
Quality of Health Care
Abstract
Ensuring that evidence based medicine reaches patients with diabetes in the US and internationally is challenging. The chronic care model includes evidence based management practices which support evidence based care. However, despite numerous studies, it is unclear which practices are most effective. Few studies assess the effect of simultaneous practices implemented to varying degrees. The present study evaluates the effect of fifteen practices applied concurrently and takes variation in implementation levels into account while assessing the impact of diabetes care management practices on glycemic and lipid monitoring.
Fifteen management practices were identified. Implementation levels of the practices in 41 medical centres caring for 553,556 adults with diabetes were assessed from structured interviews with key informants. Stepwise logistic regression models with management practices as explanatory variables and glycemic and lipid monitoring as outcome variables were used to identify the diabetes care practices most associated with high performance.
Of the 15 practices studied, only provider alerts were significantly associated with higher glycemic and lipid monitoring rates. The odds ratio for glycemic monitoring was 4.07 (p
Notes
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PubMed ID
20858247 View in PubMed
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Evidence-based practice supports among Canadian occupational therapists.

https://arctichealth.org/en/permalink/ahliterature104131
Source
Can J Occup Ther. 2014 Apr;81(2):79-92
Publication Type
Article
Date
Apr-2014
Author
Aliki Thomas
Mary C Law
Source
Can J Occup Ther. 2014 Apr;81(2):79-92
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Canada
Child
Child, Preschool
Clinical Nursing Research
Cross-Sectional Studies
Evidence-Based Practice - organization & administration
Female
Humans
Male
Middle Aged
Occupational Therapy - organization & administration
Physical Therapists - psychology
Young Adult
Abstract
Supports for evidence-based practice (EBP) and research utilization are needed for moving evidence into practice.
The purpose of this study was to identify the presence of individual and organizational EBP supports (based on a previous scoping review) and the attitudes toward the supports in a convenience sample of Canadian occupational therapists.
A cross-sectional survey was used to collect data from members of the Canadian Association of Occupational Therapists.
Data from 368 clinicians (21%) indicated that although factors that have been shown to support EBP, such as student supervision and participation in research and mentoring, were not common practice, attitudes toward these EBP supports were positive.
EBP supports, although viewed favourably by clinicians, have yet to be integrated fully into clinical practice. These findings provide researchers with an opportunity to design studies to support clinicians who view EBP in a positive light in integrating evidence into their practice.
PubMed ID
25004584 View in PubMed
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21 records – page 1 of 3.