Pub Date : 2024-02-20DOI: 10.1101/2024.02.16.24302927
Rachel Dewar-Haggart, Ingrid Muller, Felicity Bishop, Adam Geraghty, Beth Stuart, Tony Kendrick
Background Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples’ beliefs and attitudes towards long-term antidepressant use remain relatively unexplored. Objectives To determine the extent to which beliefs and attitudes towards antidepressant treatment predict intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation. Methods A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and predictors were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants’ intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months. Results 277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants’ medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. More favourable attitudes towards stopping, and normative beliefs about depression, were the strongest predictors of intentions to stop long-term antidepressant treatment. Conclusion Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.
{"title":"Predicting intentions towards long-term antidepressant use in the management of people with depression in primary care: A longitudinal survey study","authors":"Rachel Dewar-Haggart, Ingrid Muller, Felicity Bishop, Adam Geraghty, Beth Stuart, Tony Kendrick","doi":"10.1101/2024.02.16.24302927","DOIUrl":"https://doi.org/10.1101/2024.02.16.24302927","url":null,"abstract":"Background\u0000Over the last two decades, antidepressant prescribing in the UK has increased considerably, due to an increased number of people staying on antidepressants for longer. Even when treatment is no longer clinically indicated, qualitative research suggests many people continue due to a fear of depressive relapse or antidepressant withdrawal symptoms. The quantitative effects of peoples’ beliefs and attitudes towards long-term antidepressant use remain relatively unexplored.\u0000Objectives\u0000To determine the extent to which beliefs and attitudes towards antidepressant treatment predict intentions to stop or continue long-term use; and whether intentions translate into actual discontinuation.\u0000Methods\u0000A questionnaire survey formed the main component of an embedded mixed-methods study. Twenty general practices posted questionnaires to adults aged over 18 receiving continuous antidepressant prescriptions for over two years. Outcomes and predictors were determined using an extended model of the Theory of Planned Behaviour, conducting exploratory descriptive and regression analyses. The primary outcome was participants’ intentions to discontinue antidepressants. The secondary outcome of behaviour change was determined by any change in antidepressant dosage at six months.\u0000Results\u0000277 people were surveyed from 20 practices, with 10 years median antidepressant duration. Mean questionnaire scores for intention and subjective norms towards starting to come off antidepressants were low, and 85% of participants declared that continuing their antidepressant was necessary. Prescribing outcomes retrieved from 175 participants’ medical records six months after they completed the survey found 86% had not changed their antidepressant, 9% reduced the dose, only 1% discontinued their antidepressant, and 4% increased the dose. More favourable attitudes towards stopping, and normative beliefs about depression, were the strongest predictors of intentions to stop long-term antidepressant treatment.\u0000Conclusion\u0000Given few intentions to stop taking antidepressants, patients should be made more aware of the importance of ongoing antidepressant monitoring and review from their primary care practitioners. This would promote discussion to support an attitudinal change and initiation of antidepressant tapering where appropriate.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09DOI: 10.1101/2024.02.08.24302507
Lifang Li, Vanessa Chou, Oscar Hou In Chou, Sakshi Roy, Jeffrey Shi Kai Chan, Wing Tak Wong, Tong Liu, Gregory Y.H. Lip, Bernard M.Y. Cheung, Gary Tse, Jiandong Zhou
Background: Remnant cholesterol (RC) have been suggested as a significant mediator of atherosclerotic cardiovascular diseases. However, the relationship between RC with cause-specific mortality in long-term remained uncertain. This study aimed to investigate the association between time-weighted RC and cause-specific mortality outcomes. Methods: This retrospective population-based study enrolled patients attending family medicine clinics in Hong Kong between 1st January 2000, to 31st December 2003 with at least three RC testing results during follow-up. The time-weighted RC was calculated by the products of the sums of two consecutive measurements and the time interval divided by the total time. The primary outcomes were all-cause mortality and cause-specific mortality outcomes. Cox regression and marginal effective plots were applied to identify associations between time-weighted RC and mortality. Results: A cohort of 75,342 patients (39.69% males, mean age: 61.3 years old) with at least three valid RC test were included. During up to 19 years of follow-up, in the multivariate model adjusted for demographics, comorbidities, medications, and time-weighted laboratory results, time-weighted RC was associated with all-cause mortality (Hazard ratio [HR]: 1.41; 95% Confidence Interval [CI]: 1.35-1.48) but not RC (HR: 0.99; 95% CI: 0.89-1.10). Time-weighted RC was also associated with increased risks of cardiovascular-related mortality (HR: 1.40; 95% CI: 1.27-1.54), cancer-related mortality (HR: 1.59; 95% CI: 1.43-1.77), and respiratory-related mortality (HR: 1.33; 95% CI: 1.20-1.47). The exploratory analysis of the cause of death demonstrated that time-weighted RC was associated with Ischaemic heart disease, cerebrovascular-related and pneumonia. Conclusions: Time-weighted RC was independently associated with all-cause mortality and cause-specific mortality outcomes amongst the general population. Keywords: Cause-specific mortality, Low-density lipoprotein, Very-low-density lipoprotein, Intermediate-density lipoprotein, Remnant cholesterol, Atherosclerosis, Cardiovascular disease
{"title":"The association between time-weighted remnant cholesterol and cardiovascular and non-cardiovascular mortality: A population-based cohort study","authors":"Lifang Li, Vanessa Chou, Oscar Hou In Chou, Sakshi Roy, Jeffrey Shi Kai Chan, Wing Tak Wong, Tong Liu, Gregory Y.H. Lip, Bernard M.Y. Cheung, Gary Tse, Jiandong Zhou","doi":"10.1101/2024.02.08.24302507","DOIUrl":"https://doi.org/10.1101/2024.02.08.24302507","url":null,"abstract":"Background: Remnant cholesterol (RC) have been suggested as a significant mediator of atherosclerotic cardiovascular diseases. However, the relationship between RC with cause-specific mortality in long-term remained uncertain. This study aimed to investigate the association between time-weighted RC and cause-specific mortality outcomes. Methods: This retrospective population-based study enrolled patients attending family medicine clinics in Hong Kong between 1st January 2000, to 31st December 2003 with at least three RC testing results during follow-up. The time-weighted RC was calculated by the products of the sums of two consecutive measurements and the time interval divided by the total time. The primary outcomes were all-cause mortality and cause-specific mortality outcomes. Cox regression and marginal effective plots were applied to identify associations between time-weighted RC and mortality.\u0000Results: A cohort of 75,342 patients (39.69% males, mean age: 61.3 years old) with at least three valid RC test were included. During up to 19 years of follow-up, in the multivariate model adjusted for demographics, comorbidities, medications, and time-weighted laboratory results, time-weighted RC was associated with all-cause mortality (Hazard ratio [HR]: 1.41; 95% Confidence Interval [CI]: 1.35-1.48) but not RC (HR: 0.99; 95% CI: 0.89-1.10). Time-weighted RC was also associated with increased risks of cardiovascular-related mortality (HR: 1.40; 95% CI: 1.27-1.54), cancer-related mortality (HR: 1.59; 95% CI: 1.43-1.77), and respiratory-related mortality (HR: 1.33; 95% CI: 1.20-1.47). The exploratory analysis of the cause of death demonstrated that time-weighted RC was associated with Ischaemic heart disease, cerebrovascular-related and pneumonia. Conclusions: Time-weighted RC was independently associated with all-cause mortality and cause-specific mortality outcomes amongst the general population. Keywords: Cause-specific mortality, Low-density lipoprotein, Very-low-density lipoprotein, Intermediate-density lipoprotein, Remnant cholesterol, Atherosclerosis, Cardiovascular disease","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1101/2024.02.07.24302481
Kari A. Stephens, Constance van Eeghen, Zihan Zheng, Tracy Anastas, Kris Pui Kwan Ma, Maria G. Prado, Jessica Clifton, Gail Rose, Daniel Mullin, Kwun C. G. Chan, Rodger Kessler
Purpose A pragmatic, cluster-randomized controlled trial of a comprehensive practice-level, multi-staged practice transformation intervention aimed to increase behavioral health integration in primary care practices and improve patient outcomes. We examined association between the completion of intervention stages and patient outcomes across a heterogenous national sample of primary care practices.
{"title":"Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial","authors":"Kari A. Stephens, Constance van Eeghen, Zihan Zheng, Tracy Anastas, Kris Pui Kwan Ma, Maria G. Prado, Jessica Clifton, Gail Rose, Daniel Mullin, Kwun C. G. Chan, Rodger Kessler","doi":"10.1101/2024.02.07.24302481","DOIUrl":"https://doi.org/10.1101/2024.02.07.24302481","url":null,"abstract":"<strong>Purpose</strong> A pragmatic, cluster-randomized controlled trial of a comprehensive practice-level, multi-staged practice transformation intervention aimed to increase behavioral health integration in primary care practices and improve patient outcomes. We examined association between the completion of intervention stages and patient outcomes across a heterogenous national sample of primary care practices.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1101/2024.02.08.24302493
Kethaki Prathivadi Bhayankaram, Jonathan Mant, James Brimicombe, Andrew Dymond, Kate Williams, Peter H. Charlton, SAFER authorship group
Background and Aims Self-recorded, single-lead ECGs are increasingly used to diagnose arrhythmias. However, they can be of variable quality, which can affect the reliability of interpretation. In this analysis of ECGs collected in atrial fibrillation screening studies, our aims were to: (i) determine the quality of ECGs when recorded unsupervised (at home); and (ii) investigate whether telephone training improved ECG quality.
{"title":"Telephone training to improve ECG quality in remote screening for atrial fibrillation","authors":"Kethaki Prathivadi Bhayankaram, Jonathan Mant, James Brimicombe, Andrew Dymond, Kate Williams, Peter H. Charlton, SAFER authorship group","doi":"10.1101/2024.02.08.24302493","DOIUrl":"https://doi.org/10.1101/2024.02.08.24302493","url":null,"abstract":"<strong>Background and Aims</strong> Self-recorded, single-lead ECGs are increasingly used to diagnose arrhythmias. However, they can be of variable quality, which can affect the reliability of interpretation. In this analysis of ECGs collected in atrial fibrillation screening studies, our aims were to: (i) determine the quality of ECGs when recorded unsupervised (at home); and (ii) investigate whether telephone training improved ECG quality.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-07DOI: 10.1101/2024.02.05.24302368
Lucas Gomes Souza, Patrick Archambault, Dalil Asmaou Bouba, Suélène Georgina Dofara, Sabrina Guay-Bélanger, Sergio Cortez Ghio, Souleymane Gadio, LeAnn Michaels, Jean-Sébastien Paquette, Shigeko (Seiko) Izumi, Annette M. Totten, France Légaré, The Meta-LARC ACP Cluster Randomized Trial team
Background Cluster Randomized Trials (cRTs) conducted in real-world settings face complex challenges due to diverse practices and populations. Process evaluations alongside cRTs can help explain their results by exploring possible causal mechanisms as the trial proceeds.
{"title":"Impact of a team-based versus individual clinician-focused training approach on primary healthcare professionals’ intention to have serious illness conversations with patients: a theory informed process evaluation of a cluster randomized trial","authors":"Lucas Gomes Souza, Patrick Archambault, Dalil Asmaou Bouba, Suélène Georgina Dofara, Sabrina Guay-Bélanger, Sergio Cortez Ghio, Souleymane Gadio, LeAnn Michaels, Jean-Sébastien Paquette, Shigeko (Seiko) Izumi, Annette M. Totten, France Légaré, The Meta-LARC ACP Cluster Randomized Trial team","doi":"10.1101/2024.02.05.24302368","DOIUrl":"https://doi.org/10.1101/2024.02.05.24302368","url":null,"abstract":"<strong>Background</strong> Cluster Randomized Trials (cRTs) conducted in real-world settings face complex challenges due to diverse practices and populations. Process evaluations alongside cRTs can help explain their results by exploring possible causal mechanisms as the trial proceeds.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.1101/2024.01.30.24302041
Afisulahi Abiodun Maiyegun, Mark D Akangoziri, Bukar A Grema, Yahkub B Mutalub, Farida B Ibrahim, AbdulRauf S Ibraheem
Background: Herbal medicine use remains an important part of primary care and the World Health Organization has mandated member countries to conduct research into this and other forms of traditional medicine. However, research into traditional medicine remains scanty, even in the developing where it is often a major health option. Objective: to determine the prevalence, types and sources of herbal medicine used among the study population. Methods Three hundred and forty-one questionnaires were administered to adult patients attending the general outpatient clinic of a tertiary hospital in Northern Nigeria. The data was collected and analysed using EPI INFO version 7.2.5.0 software. Results The prevalence of herbal medicine use was 85.34%; the commonest herbs were moringa (59.8%), black seed (36.8%), and olive oil (34.4%); and the commonest source of the herbs were herbal practitioners and herbal medicine vendors (79.04%). Herbal medicine use was associated with religion (P= 0.0005) and residential area (P= 0.01). Only 18.12 % of participants ever discussed herbal medicine use with their doctors. Conclusion: herbal medicine use remains high even among patients attending outpatient clinics in tertiary hospitals in Nigeria. However, health workers are often not the source of herbal medicine and patients rarely disclose its use to them.
背景：草药的使用仍然是初级保健的重要组成部分，世界卫生组织已授权成员国对草药和其他形式的传统医药进行研究。然而，对传统医学的研究仍然很少，即使是在传统医学通常是主要保健选择的发展中国家也是如此。方法：对尼日利亚北部一家三级医院普通门诊的成年患者发放了 341 份调查问卷。使用 EPI INFO 7.2.5.0 版软件收集和分析数据。结果草药使用率为 85.34%；最常见的草药是辣木（59.8%）、黑种子（36.8%）和橄榄油（34.4%）；最常见的草药来源是草药医师和草药商贩（79.04%）。草药的使用与宗教信仰（P= 0.0005）和居住地区（P= 0.01）有关。结论：即使在尼日利亚三级医院门诊就诊的患者中，草药的使用率仍然很高。然而，医护人员往往不是草药的来源，患者也很少向他们透露草药的使用情况。
{"title":"Patterns of Herbal Medicine Use in a General Outpatient Clinic in Nigeria- A Cross-sectional Study","authors":"Afisulahi Abiodun Maiyegun, Mark D Akangoziri, Bukar A Grema, Yahkub B Mutalub, Farida B Ibrahim, AbdulRauf S Ibraheem","doi":"10.1101/2024.01.30.24302041","DOIUrl":"https://doi.org/10.1101/2024.01.30.24302041","url":null,"abstract":"Background: Herbal medicine use remains an important part of primary care and the World Health Organization has mandated member countries to conduct research into this and other forms of traditional medicine. However, research into traditional medicine remains scanty, even in the developing where it is often a major health option. Objective: to determine the prevalence, types and sources of herbal medicine used among the study population.\u0000Methods\u0000Three hundred and forty-one questionnaires were administered to adult patients attending the general outpatient clinic of a tertiary hospital in Northern Nigeria. The data was collected and analysed using EPI INFO version 7.2.5.0 software. Results\u0000The prevalence of herbal medicine use was 85.34%; the commonest herbs were moringa (59.8%), black seed (36.8%), and olive oil (34.4%); and the commonest source of the herbs were herbal practitioners and herbal medicine vendors (79.04%). Herbal medicine use was associated with religion (P= 0.0005) and residential area (P= 0.01). Only 18.12 % of participants ever discussed herbal medicine use with their doctors.\u0000Conclusion: herbal medicine use remains high even among patients attending outpatient clinics in tertiary hospitals in Nigeria. However, health workers are often not the source of herbal medicine and patients rarely disclose its use to them.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139656589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-17DOI: 10.1101/2024.01.16.24301360
Lauren Lapointe-Shaw, Christine Salahub, Peter C. Austin, Li Bai, Sundeep Banwatt, Simon Berthelot, R. Sacha Bhatia, Cherryl Bird, Laura Desveaux, Tara Kiran, Aisha Lofters, Malcolm Maclure, Danielle Martin, Kerry A. McBrien, Rita K. McCracken, J. Michael Paterson, Bahram Rahman, Jennifer Shuldiner, Mina Tadrous, Braeden A. Terpou, Niels Thakkar, Ruoxi Wang, Noah M. Ivers
Objective We aimed to describe family physicians who primarily practice in a walk-in clinic setting and compare them to family physicians who provide longitudinal care.
{"title":"Characteristics of Walk-In Clinic Physicians and Patients in Ontario, Canada: A Cross-Sectional Study","authors":"Lauren Lapointe-Shaw, Christine Salahub, Peter C. Austin, Li Bai, Sundeep Banwatt, Simon Berthelot, R. Sacha Bhatia, Cherryl Bird, Laura Desveaux, Tara Kiran, Aisha Lofters, Malcolm Maclure, Danielle Martin, Kerry A. McBrien, Rita K. McCracken, J. Michael Paterson, Bahram Rahman, Jennifer Shuldiner, Mina Tadrous, Braeden A. Terpou, Niels Thakkar, Ruoxi Wang, Noah M. Ivers","doi":"10.1101/2024.01.16.24301360","DOIUrl":"https://doi.org/10.1101/2024.01.16.24301360","url":null,"abstract":"<strong>Objective</strong> We aimed to describe family physicians who primarily practice in a walk-in clinic setting and compare them to family physicians who provide longitudinal care.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-21DOI: 10.1101/2023.12.19.23300235
Annie LeBlanc, Megan E Branda, Jason Egginton, Jonathan Inselman, Sara Dick, Janet Schuerman, Jill Kemper, Nilay Shah, Victor Montori
BACKGROUND: While decision aids have been proven effective to facilitate patient-centered discussion about evidence-based health information in practice and enable shared decision making (SDM), a chasm remains between the promise and the use of these SDM tools in practice. AIMS: To promote evidence-based patient-centered care in primary care by using encounter SDM tools for medication management of chronic conditions. METHODS: We conducted a mixed methods study centered around a practice-based, multi-centered pragmatic randomized trial comparing active implementation (active) to passive dissemination (passive) of a web-based toolkit, ShareEBM, to facilitate the uptake in primary care of four SDM tools designed for use during clinical encounters. These tools supported collaborative decisions about medications for chronic conditions. ShareEBM included activities and tactics to increase the likelihood that encounter SDM tools will be routinized in practice. Study team members worked closely with practices in the active arm to actively integrate and promote the use of SDM tools; passive arm practices received no support from the study team. The embedded qualitative evaluation included clinician phone interviews (n=10) and site observations (n=5) for active practices, and exit focus groups for all practices (n=11). RESULTS: Eleven practices and 62 clinicians participated in the study. Clinicians in the active arm used SDM tools in 621 encounters (Mean [SD]: 21 [25] encounters per clinician, range: 0-93) compared to 680 in the passive arm (Mean [SD]: 20 [40] encounters per clinician, range: 0-156, p=0.4). Six of 29 (21%) clinicians in the active arm and 14 of 33 (42%) in the passive arm did not use any tools (p=0.1). Clinicians' views covered four major themes: general views of using encounter SDM tools, perceived impact on patients, strategies used, and how encounter SDM tools are incorporated into practice flow. CONCLUSION: Neither active nor passive implementation of a toolkit improved the uptake and use of encounter SDM tools in primary care. Overcoming clinician reluctance to consider using encounter SDM tools, their seamless integration into the electronic and practice workflows, and ongoing feedback about the quality of their use during encounters appear necessary to implement their use in primary care practices.
{"title":"Implementation of Evidence-Based Medicine in Primary Care Through the Use of Encounter Shared Decision Making Tools: The ShareEBM Pragmatic Trial","authors":"Annie LeBlanc, Megan E Branda, Jason Egginton, Jonathan Inselman, Sara Dick, Janet Schuerman, Jill Kemper, Nilay Shah, Victor Montori","doi":"10.1101/2023.12.19.23300235","DOIUrl":"https://doi.org/10.1101/2023.12.19.23300235","url":null,"abstract":"BACKGROUND: While decision aids have been proven effective to facilitate patient-centered discussion about evidence-based health information in practice and enable shared decision making (SDM), a chasm remains between the promise and the use of these SDM tools in practice. AIMS: To promote evidence-based patient-centered care in primary care by using encounter SDM tools for medication management of chronic conditions. METHODS: We conducted a mixed methods study centered around a practice-based, multi-centered pragmatic randomized trial comparing active implementation (active) to passive dissemination (passive) of a web-based toolkit, ShareEBM, to facilitate the uptake in primary care of four SDM tools designed for use during clinical encounters. These tools supported collaborative decisions about medications for chronic conditions. ShareEBM included activities and tactics to increase the likelihood that encounter SDM tools will be routinized in practice. Study team members worked closely with practices in the active arm to actively integrate and promote the use of SDM tools; passive arm practices received no support from the study team. The embedded qualitative evaluation included clinician phone interviews (n=10) and site observations (n=5) for active practices, and exit focus groups for all practices (n=11). RESULTS: Eleven practices and 62 clinicians participated in the study. Clinicians in the active arm used SDM tools in 621 encounters (Mean [SD]: 21 [25] encounters per clinician, range: 0-93) compared to 680 in the passive arm (Mean [SD]: 20 [40] encounters per clinician, range: 0-156, p=0.4). Six of 29 (21%) clinicians in the active arm and 14 of 33 (42%) in the passive arm did not use any tools (p=0.1). Clinicians' views covered four major themes: general views of using encounter SDM tools, perceived impact on patients, strategies used, and how encounter SDM tools are incorporated into practice flow. CONCLUSION: Neither active nor passive implementation of a toolkit improved the uptake and use of encounter SDM tools in primary care. Overcoming clinician reluctance to consider using encounter SDM tools, their seamless integration into the electronic and practice workflows, and ongoing feedback about the quality of their use during encounters appear necessary to implement their use in primary care practices.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138823705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-17DOI: 10.1101/2023.12.16.23300074
Tejal Patel, Christoph Laeer, Hamed Darabi, Maxime Lachance, Michelle Anawati, Marie-Hélène Chomienne
Background Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations resulting in medication non-adherence. While automated medication dispensing technologies may offer a solution for medication self-management among older adults, these technologies must demonstrate usability before effectiveness can be investigated and products made available for widespread use.
{"title":"Assessing the usability of the new automated medication dispensation device for patients and the adherence dashboard for real-time medication monitoring for healthcare providers: a study protocol","authors":"Tejal Patel, Christoph Laeer, Hamed Darabi, Maxime Lachance, Michelle Anawati, Marie-Hélène Chomienne","doi":"10.1101/2023.12.16.23300074","DOIUrl":"https://doi.org/10.1101/2023.12.16.23300074","url":null,"abstract":"<strong>Background</strong> Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations resulting in medication non-adherence. While automated medication dispensing technologies may offer a solution for medication self-management among older adults, these technologies must demonstrate usability before effectiveness can be investigated and products made available for widespread use.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138823584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-14DOI: 10.1101/2023.12.12.23299871
Gadaffi Mostapha, Noor Azah Abd Aziz, Mohd Fairuz Ali
Background Primary-care long-term stroke care service offers comprehensive management at the community level. A clinical audit was carried out to assess the services of this clinic as compared to the established standardized criteria for longer-term stroke care.
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