192 research outputs found
Methodologies for assessing telemedicine: A systematic review of reviews
No full textBackground and objectives: Previous reviews have expressed concerns about the quality of telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine research, discuss knowledge gaps and recommendations and suggest methodological approaches for further research. Methods: We conducted a review of systematic reviews of telemedicine according to a protocol listing explicit methods, selection criteria, data collection and quality assessment procedures. We included reviews where authors explicitly addressed and made recommendations for assessment methodologies. We did a qualitative analysis of the reviews included, sensitized by two broad methodological positions; positivist and naturalistic approaches. The analysis focused on methodologies used in the primary studies included in the reviews as reported by the review authors, and methodological recommendations made by the review authors. Results: We identified 1593 titles/abstracts. We included 50 reviews that explicitly addressed assessment methodologies. One group of reviews recommended larger and more rigorously designed controlled studies to assess the impacts of telemedicine; a second group proposed standardisation of populations, and/or interventions and outcome measures to reduce heterogeneity and facilitate meta-analysis; a third group recommended combining quantitative and qualitative research methods; and others applying different naturalistic approaches including methodologies addressing mutual adaptations of services and users; politically driven action research and formative research aimed at collaboration to ensure capacity for improvement of services in natural settings. Conclusions: Larger and more rigorous studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine services for pre defined outcome measures. Summative methodologies acknowledging telemedicine as complex innovations and outcomes as partly contingent on values, meanings and contexts are also important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing collaborative achievements and engage with stakeholders, including patients to produce and conceptualise new and effective telemedicine innovations
Effectiveness of telemedicine: A systematic review of reviews
No full textObjectives: To conduct a review of reviews on the impacts and costs of telemedicine services. Methods: A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review. Results: In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes. Conclusions: The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest
Implementation science: A reappraisal of our journal mission and scope
No full textThe implementation of research findings into healthcare practice has become increasingly recognised as a major priority for researchers, service providers, research funders and policymakers over the past decade. Nine years after its establishment, Implementation Science, an international online open access journal, currently publishes over 150 articles each year. This is fewer than 30% of those submitted for publication. The majority of manuscript rejections occur at the point of initial editorial screening, frequently because we judge them to fall outside of journal scope. There are a number of common reasons as to why manuscripts are rejected on grounds of scope. Furthermore, as the field of implementation research has evolved and our journal submissions have risen, we have, out of necessity, had to become more selective in what we publish. We have also expanded our scope, particularly around patient-mediated and population health interventions, and will monitor the impact of such changes. We hope this editorial on our evolving priorities and common reasons for rejection without peer review will help authors to better judge the relevance of their papers to Implementation Science
Use of Evidence to Decision frameworks for evidence-informed decision-making in healthcare
No full textObjectius:
La tesi té tres objectius principals: 1) analitzar les experiències dels usuaris de la plataforma interactiva dels marcs Evidence to Decision (iEtD); 2) identificar i descriure els processos i marcs EtD suggerits als manuals metodològics per al desenvolupament de guies en salut; i 3) avaluar la relació entre l'ús dels marcs EtD i la qualitat de les guies i les seves recomanacions.
Mètodes:
La tesi es presenta com un compendi de tres articles publicats en revistes científiques. El primer estudi és una anàlisi qualitativa de les experiències d'usuaris de l'iEtD, utilitzant entrevistes semiestructurades i anàlisi de contingut. El segon estudi és una revisió sistemàtica dels marcs i processos proposats als manuals metodològics per al desenvolupament de guies en salut, identificant els criteris utilitzats en la formulació de recomanacions. El tercer estudi avalua la relació entre l'ús d'un marc EtD i la qualitat de les guies i recomanacions en una mostra de guies publicades.
Resultats:
Primer Estudi:
Es va entrevistar 8 de 20 persones que van utilitzar l'iEtD en escenaris de presa de decisions, principalment en el desenvolupament de guies. Els participants van informar experiències positives, utilitzant la majoria dels criteris del marc GRADE-EtD. Tot i això, es van observar esforços d'adaptació, com l'eliminació de criteris i l'edició de títols. Alguns van optar per exportar els marcs a Word per facilitar-ne l'ús fora de línia.
Segon Estudi:
Es van revisar 68 manuals metodològics, i la majoria de les organitzacions tenien un procés per graduar la força de les recomanacions. El 66% va proposar un marc EtD, amb el marc GRADE-EtD sent el més comú. L'ús d'un marc EtD es va associar amb la inclusió de més criteris rellevants, especialment en àrees com valors i preferències, equitat, i acceptabilitat.
Tercer Estudi:
Es van analitzar 66 guies de 17 països. El 45% d'aquestes guies va utilitzar un marc EtD per formular recomanacions. Les guies que van utilitzar un marc EtD van obtenir puntuacions més altes en qualitat metodològica i recomanacions en comparació amb les que no el van utilitzar. No hi va haver diferències significatives entre les guies que van utilitzar el marc GRADE-EtD i altres marcs.
Conclusions:
L'ús de l'iEtD ha estat limitat, encara que les experiències reportades són majoritàriament positives. Es van identificar àrees de millora per a l'eina, que podrien aplicar-se a altres marcs EtD. L'ús de marcs EtD s'associa amb la inclusió de criteris rellevants i amb una millor qualitat metodològica de les guies i recomanacions. L'adopció d'aquests marcs per part de les organitzacions podria millorar la qualitat de les guies clíniques.Objetivos:
La tesis tiene tres objetivos principales: 1) analizar las experiencias de los usuarios de la plataforma interactiva de los marcos Evidence to Decision (iEtD); 2) identificar y describir los procesos y marcos EtD sugeridos en los manuales metodológicos para el desarrollo de guías en salud; y 3) evaluar la relación entre el uso de los marcos EtD y la calidad de las guías y sus recomendaciones.
Métodos:
La tesis se presenta como un compendio de tres artículos publicados en revistas científicas. El primer estudio es un análisis cualitativo de las experiencias de usuarios del iEtD, usando entrevistas semiestructuradas y análisis de contenido. El segundo estudio es una revisión sistemática de los marcos y procesos propuestos en los manuales metodológicos para el desarrollo de guías en salud, identificando los criterios usados en la formulación de recomendaciones. El tercer estudio evalúa la relación entre el uso de un marco EtD y la calidad de las guías y recomendaciones en una muestra de guías publicadas.
Resultados:
Primer Estudio:
Se entrevistó a 8 de 20 personas que usaron el iEtD en escenarios de toma de decisiones, mayormente en el desarrollo de guías. Los participantes informaron experiencias positivas, usando la mayoría de los criterios del marco GRADE-EtD. Sin embargo, hubo esfuerzos de adaptación, como la eliminación de criterios y la edición de títulos. Algunos optaron por exportar los marcos a Word para mayor facilidad de uso offline.
Segundo Estudio:
Se revisaron 68 manuales metodológicos, y la mayoría de las organizaciones tenía un proceso para graduar la fuerza de las recomendaciones. El 66 % propuso un marco EtD, con el marco GRADE-EtD siendo el más común. El uso de un marco EtD se asoció con la inclusión de más criterios relevantes, especialmente en áreas como valores y preferencias, equidad, y aceptabilidad.
Tercer Estudio:
Se analizaron 66 guías de 17 países. El 45 % de estas guías utilizó un marco EtD para formular recomendaciones. Las guías que utilizaron un marco EtD obtuvieron puntuaciones más altas en calidad metodológica y recomendaciones en comparación con las que no lo usaron. No hubo diferencias significativas entre las guías que usaron el marco GRADE-EtD y otros marcos.
Conclusiones:
El uso del iEtD ha sido limitado, aunque las experiencias reportadas son mayormente positivas. Se identificaron áreas de mejora para la herramienta, que podrían aplicarse a otros marcos EtD. El uso de marcos EtD se asocia con la inclusión de criterios relevantes y con una mejor calidad metodológica de las guías y recomendaciones. La adopción de estos marcos por parte de las organizaciones podría mejorar la calidad de las guías clínicas.**Summary of the Doctoral Thesis**
**Objectives:**
The thesis has three main objectives: 1) to analyze the experiences of users of the interactive platform for Evidence to Decision (iEtD) frameworks; 2) to identify and describe the processes and EtD frameworks suggested in methodological manuals for the development of health guidelines; and 3) to evaluate the association between the use of EtD frameworks and the quality of both the guidelines and their individual recommendations.
**Methods:**
The thesis is presented as a compendium of three articles published in peer-reviewed scientific journals. The first study is a qualitative analysis of iEtD user experiences, using semi-structured interviews and content analysis. The second study is a systematic review of the frameworks and processes proposed in methodological manuals for health guideline development, identifying the criteria used in the formulation of recommendations. The third study evaluates the relationship between the use of an EtD framework and the quality of guidelines and recommendations in a sample of published guidelines.
**Results:**
1. **First Study:**
Eight out of twenty people who used the iEtD in decision-making scenarios were interviewed, mainly in the development of guidelines. Participants reported positive experiences, using most of the criteria from the GRADE-EtD framework. However, there were adaptation efforts, such as the removal of certain criteria and the editing of titles. Some participants chose to export the frameworks to Word for easier offline use.
2. **Second Study:**
Sixty-eight methodological manuals were reviewed, and most organizations had a process for grading the strength of recommendations. 66% proposed an EtD framework, with the GRADE-EtD framework being the most common. The use of an EtD framework was associated with the inclusion of more relevant criteria, especially in areas such as values and preferences, equity, and acceptability.
3. **Third Study:**
Sixty-six guidelines from 17 different countries were analyzed. Forty-five percent of these guidelines used an EtD framework to formulate recommendations. The guidelines that used an EtD framework scored higher in methodological quality and recommendations compared to those that did not. No significant differences were observed between the guidelines that used the GRADE-EtD framework and those that used other EtD frameworks.
**Conclusions:**
The use of the iEtD has been limited, although user experiences have been generally positive. Areas for improvement of the tool were identified, which could also apply to other EtD frameworks. The use of EtD frameworks is associated with the inclusion of relevant criteria and with better methodological quality of guidelines and recommendations. The adoption of these frameworks by guideline-developing organizations could enhance the quality of clinical guidelines.Universitat Autònoma de Barcelona. Programa de Doctorat en Metodologia de la Recerca Biomèdica i Salut Públic
Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods
No full textAbstract Background Theories of behaviour change indicate that an analysis of factors that facilitate or impede change is helpful when trying to influence professional practice. The aim of this study was to identify barriers to implementing evidence-based guidelines for urinary tract infection and sore throat in general practice in Norway, and to tailor interventions to address these barriers. Methods We used a checklist to identify barriers and possible interventions to address these in an iterative process that included a review of the literature, brainstorming, focus groups, a pilot study, small group discussions and interviews. Results We identified at least one barrier for each category. Both guidelines recommended increased use of telephone consultations and reduced use of laboratory tests, and the barriers and the interventions were similar for the two guidelines. The complexity of changing routines involving patients, general practitioners and general practitioner assistants, loss of income with telephone consultations, fear of overlooking serious disease, perceived patient expectations and lack of knowledge about the evidence for the guidelines were the most prominent barriers. The interventions that were tailored to address these barriers included support for change processes in the practices, increasing the fee for telephone consultations, patient information leaflets and computer-based decision support and reminders. Conclusion A systematic approach using qualitative methods helped identify barriers and generate ideas for tailoring interventions to support the implementation of guidelines for the management of urinary tract infections and sore throat. Lack of resources limited our ability to address all of the barriers adequately.</p
Case definitions for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) - A systematic review
No full textObjective To identify case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and explore how the validity of case definitions can be evaluated in the absence of a reference standard. Design Systematic review. Setting International. Participants A literature search, updated as of November 2013, led to the identification of 20 case definitions and inclusion of 38 validation studies. Primary and secondary outcome measure Validation studies were assessed for risk of bias and categorised according to three validation models: (1) independent application of several case definitions on the same population, (2) sequential application of different case definitions on patients diagnosed with CFS/ME with one set of diagnostic criteria or (3) comparison of prevalence estimates from different case definitions applied on different populations. Results A total of 38 studies contributed data of sufficient quality and consistency for evaluation of validity, with CDC-1994/Fukuda as the most frequently applied case definition. No study rigorously assessed the reproducibility or feasibility of case definitions. Validation studies were small with methodological weaknesses and inconsistent results. No empirical data indicated that any case definition specifically identified patients with a neuroimmunological condition. Conclusions Classification of patients according to severity and symptom patterns, aiming to predict prognosis or effectiveness of therapy, seems useful. Development of further case definitions of CFS/ME should be given a low priority. Consistency in research can be achieved by applying diagnostic criteria that have been subjected to systematic evaluation
Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change
No full textAbstract Background We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions. Methods We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention. Results A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention. Conclusions A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.</p
Case stories in general practice: a focus group study
No full textObjectives: To explore the interactive process of sharing case stories in small-group activity in general practice. Design: Qualitative focus group study. Setting: Peer-group meetings of doctors attending specialist training or continuous medical education in general practice. Participants: Twenty female and 30 male doctors working in general practice in Norway. Results: The storyline of case presentations included detailed stories with emotional engagement, coauthored by other group members. The stories initiated discussions and reflections concerning patients’ and doctors’ perspectives, medical ethics as well as clinical problems. The safe atmosphere allowed testing out boundaries of socially shared knowledge. Conclusions: Sharing case stories in small groups in general practice initiated interaction that facilitated meaning-making, reflection and peer support
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