Development of a new management model for oral outpatient chemotherapy featured by concerted interventions by physicians and pharmacists
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ABSTRACT:
DISEASE(S): Colorectal Cancer Pancreatic Cancer Biliary Cancer
PROVIDER: 2642208 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:ObjectiveOutpatient no-shows have important implications for costs and the quality of care. Predictive models of no-shows could be used to target intervention delivery to reduce no-shows. We reviewed the effectiveness of predictive model-based interventions on outpatient no-shows, intervention costs, acceptability, and equity.Materials and methodsRapid systematic review of randomized controlled trials (RCTs) and non-RCTs. We searched Medline, Cochrane CENTRAL, Embase, IEEE Xplore, and Clinical Trial Registries on March 30, 2022 (updated on July 8, 2022). Two reviewers extracted outcome data and assessed the risk of bias using ROB 2, ROBINS-I, and confidence in the evidence using GRADE. We calculated risk ratios (RRs) for the relationship between the intervention and no-show rates (primary outcome), compared with usual appointment scheduling. Meta-analysis was not possible due to heterogeneity.ResultsWe included 7 RCTs and 1 non-RCT, in dermatology (n = 2), outpatient primary care (n = 2), endoscopy, oncology, mental health, pneumology, and an magnetic resonance imaging clinic. There was high certainty evidence that predictive model-based text message reminders reduced no-shows (1 RCT, median RR 0.91, interquartile range [IQR] 0.90, 0.92). There was moderate certainty evidence that predictive model-based phone call reminders (3 RCTs, median RR 0.61, IQR 0.49, 0.68) and patient navigators reduced no-shows (1 RCT, RR 0.55, 95% confidence interval 0.46, 0.67). The effect of predictive model-based overbooking was uncertain. Limited information was reported on cost-effectiveness, acceptability, and equity.Discussion and conclusionsPredictive modeling plus text message reminders, phone call reminders, and patient navigator calls are probably effective at reducing no-shows. Further research is needed on the comparative effectiveness of predictive model-based interventions addressed to patients at high risk of no-shows versus nontargeted interventions addressed to all patients.
| S-EPMC9933067 | biostudies-literature
Project description:IntroductionThere is a need for innovative workshops designed to teach students and residents the basics of clinical medical education. Resident physicians often spend a significant portion of their training teaching others and frequently have very little formal instruction on teaching techniques. Other teaching tools exist but are often either entirely lecture based or too extensive to easily incorporate into a residency teaching session. There is a need for the facilitated practice of teaching methods to improve the resident educational experience.MethodsThis 80-minute workshop blends interactive role-play case studies with quick lectures on the ARCH feedback model, the RIME model of medical information mastery, and the One-Minute Preceptor. This workshop includes three short PowerPoint lectures, four case studies, a handout, a pre-/posttest, and a session evaluation form.ResultsResident and student learners were engaged for the entirety of this session. Pre-/posttest results showed an improvement in understanding of basic teaching and feedback techniques, and survey results showed a higher likelihood of the learners wanting to incorporate teaching into their future practice.DiscussionThis workshop is quick and overall quite effective in teaching basic feedback and teaching techniques. It provides a much-needed opportunity for residents to practice teaching techniques immediately after they have learned the concepts. This training is ideal for a residency program looking to provide new senior residents with the teaching tools they need for success.
| S-EPMC7394347 | biostudies-literature
Project description:BackgroundA growing body of research has examined adjunctive interventions supportive of engagement and retention in treatment among patients receiving buprenorphine for opioid use disorder (OUD). We conducted a systematic review of the literature addressing the effect on key outcomes of adjunctive interventions provided alongside standard medical management of buprenorphine in outpatient settings.MethodsWe included prospective studies examining adults receiving buprenorphine paired with an adjunctive intervention for the treatment of OUD in an outpatient setting. Data sources included Medline, Cochrane Central Register of Controlled Trials, CINAHL and PsycINFO from inception through January 2020. Two raters independently reviewed full-text articles, abstracted data and appraised risk of bias. Outcomes examined included abstinence, retention in treatment and non-addiction-related health outcomes.ResultsThe final review includes 20 manuscripts, 11 randomized control trials (RCTs), three secondary analyses of RCTs and six observational studies. Most studies examined psychosocial interventions (n = 14). Few examined complementary therapies (e.g., yoga; n = 2) or technological interventions (e.g., electronic pill dispensation; n = 3); one study examined an intervention addressing structural barriers to care (patient navigators; n = 1). Low risk of bias RCTs found no evidence that adding psychosocial interventions to buprenorphine treatment improves substance use outcomes.ConclusionsResearch is needed to identify adjunctive interventions with potential to support medication adherence and addiction-related outcomes for patients engaged in buprenorphine treatment. Data from clinical trials suggest that lack of ready access to psychosocial treatments should not discourage clinicians from prescribing buprenorphine.
| S-EPMC9063385 | biostudies-literature
Project description:BackgroundIn China, physicians aged 30-45 years who work in tertiary hospitals perform most of the clinical duties, especially outpatient services, and the high-intensity, high-pressure workplace may through long-term sedentary affect their health, particularly urinary health.MethodsThe study, conducted from October 2020 to October 2021, included male physicians in Xiangya Hospital, the Second Xiangya Hospital, and the Third Xiangya Hospital of Central South University (Hunan, China). They were divided into surgeon and non-surgeon groups. We collect the data on age, body mass index (BMI), duration of outpatient duties and the International Prostate Symptom Score-voiding (IPSS-V) and IPSS-storage (IPSS-S), and the IPSS-Total, and the IPSS-Quality of Life Index (IPSS-QOL), and the Athens insomnia scale (AIS), and the International Prostate Symptom Score (IIEF-5).ResultsThe duration of outpatient duties positively correlated with IPSS-Total (P<0.001), IPSS-S (P<0.001), and IPSS-QOL (P<0.001) and negatively correlated with IIEF-5 (p=0.032). Compared to non-surgeons, surgeons performed fewer outpatient duties. The IPSS-Total (P=0.016), IPSS-Storage (P=0.005), and QOL scores (P=0.046) of the non-surgeon group were higher and the IIEF-5 scores were lower (P=0.039). There were no significant differences between the groups regarding age, body mass index, IPSS-Voiding, and Athens insomnia scale scores. A positive correlation between outpatient visit duration and lower urinary tract symptoms (LUTS) in the IPSS-Storage subscale was observed and there was a weak negative correlation between duration of outpatient duties and the IIEF-5 score.ConclusionsCompared to surgeons, non-surgeons had more outpatient duties, and they experienced more severe LUTS and sexual dysfunction, which suggests that outpatient duties maybe should not be more than 4 days/week in Chinese tertiary medical centers.
| S-EPMC9547155 | biostudies-literature
Project description:Osteoarthritis of the knee is a common disease that causes significant disability. Most patients can be managed conservatively in the outpatient setting. A small minority require surgery. The cornerstones of treatment are weight loss, exercise and analgesia. Walking aids, medial patellar taping, acupuncture and transcutaneous electrical nerve stimulation are useful management adjuncts. Current evidence does not support routine prescription of glucosamine and chondroitin supplements. Early consultation with an orthopaedic surgeon should be made when conservative measures fail.
| S-EPMC5651502 | biostudies-literature
Project description:BackgroundDespite international guidelines providing evidence-based recommendations on appropriate management of infants with bronchiolitis, wide variation in practice occurs. This results in infants receiving care of no benefit, with associated cost and is potentially harmful. Theoretical frameworks are increasingly used to develop interventions, utilising behaviour change techniques specifically chosen to target factors contributing to practice variation, with de-implementation often viewed as harder than implementing. This paper describes the stepped process using the Theoretical Domains Framework (TDF) to develop targeted, theory-informed interventions which subsequently successfully improved management of infants with bronchiolitis by de-implementing ineffective therapies. Explicit description of the process and rationale used in developing de-implementation interventions is critical to dissemination of these practices into real world clinical practice.MethodsA stepped approach was used: (1) Identify evidence-based recommendations and practice variation as targets for change, (2) Identify factors influencing practice change (barriers and enablers) to be addressed, and (3) Identification and development of interventions (behaviour change techniques and methods of delivery) addressing influencing factors, considering evidence of effectiveness, feasibility, local relevance and acceptability. The mode of delivery for the intervention components was informed by evidence from implementation science systematic reviews, and setting specific feasibility and practicality.ResultsFive robust evidence-based management recommendations, targeting the main variation in bronchiolitis management were identified: namely, no use of chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline. Interventions developed to target recommendations addressed seven TDF domains (identified following qualitative clinician interviews (n = 20)) with 23 behaviour change techniques chosen to address these domains. Final interventions included: (1) Local stakeholder meetings, (2) Identification of medical and nursing clinical leads, (3) Train-the-trainer workshop for all clinical leads, (4) Local educational materials for delivery by clinical leads, (5) Provision of tools and materials targeting influencing factors, and prompting recommended behaviours, and (6) Audit and feedback.ConclusionA stepped approach based on theory, evidence and issues of feasibility, local relevance and acceptability, was successfully used to develop interventions to improve management of infants with bronchiolitis. The rationale and content of interventions has been explicitly described allowing others to de-implement unnecessary bronchiolitis management, thereby improving care.
| S-EPMC8335893 | biostudies-literature
Project description:Background:Hymenoptera venom allergy (HVA) is an underestimated condition representing an important cause of morbidity and mortality worldwide. Preventing future allergic reactions in patients who have already developed a systemic reaction is based on the correct management of the acute phase of the reaction followed by a correct diagnosis and, where indicated, prescription of adrenaline autoinjectors and VIT. A possible strategy to optimize care processes and to improve outcomes is the implementation of a Diagnostic and Therapeutic Care Pathways, also known as Integrated Care Pathways or Clinical Pathways (CPWs). The aim of the care pathway is to enhance the quality of care by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. To our knowledge, currently in Italy as well as in Europe, there is no CPWs codified for the management of HVA patients. This paper describes the development of the clinical content of a care pathway for the management of HVA. Methods:The methodology applied is based on the eight step method to build the clinical content of an evidence-based care pathway suggested by Lodewijckx et al. Results:Three hundred and seventeen different clinical activities were extracted from the selected literature. The expert panel was involved in their evaluation, expressing a judgment of relevance through the Delphi study. As a result, 126 clinical activities were appraised to be valid and feasible. The final recommendations (126) were translated into 123 key interventions. Six indicators were produced by the clinical activities. Conclusion:A set of 123 key interventions and of six process indicators were found to be appropriate for the development and standardization of the clinical content of the Hymenoptera venom allergy care pathway.
| S-EPMC7055031 | biostudies-literature
Project description:Interventions: ACN:Nil;Control group:Nil
Primary outcome(s): incidence of advanced colorectal neoplasia;SEN, SPE, ACC, AUC of ROC
Study Design: Factorial
| 2693089 | ecrin-mdr-crc
Project description:BackgroundThe health care innovation "MamBo - people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management" aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physicians' personal values, which influence the individual perception of the project's advantages and thus possibly the acceptance and sustainable implementation of new care structures.MethodsTwo Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context.ResultTwo central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent.ConclusionsThe results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision.Trial registrationThe study has been registered in the German Clinical Trials Register ( DRKS00014047 ).
| S-EPMC8495962 | biostudies-literature
Project description:Sample tissue: peripheral blood Disease: diabetes Samples for gene expression analysis were obtained before the meal and 1.5 hours after the event. Event: listening to a Japanese comic story or a monotonous academic lecture without humor. Keywords: equivalent probe
2004-10-21 | GSE1322 | GEO