BackgroundSystematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use.MethodsA three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs.ResultsTwo hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]).ConclusionsHCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0779-9) contains supplementary material, which is available to authorized users.

Despite its high prevalence, depression is often unrecognized and untreated in minority immigrants. Culture and environment influence perceptions of depression. The purpose of this study was to understand perceptions of depression (knowledge and coping mechanisms) in Korean American immigrants using focus group discussions. A convenience sample (n = 28) was recruited from Korean communities in the Puget Sound region of Washington State. Participants lacked an understanding of depression. Difficulties from immigration-related environmental changes were the main sources of stress. Immigration-related environmental changes resulted in changes in coping resources. Culture-friendly education and coping resources might benefit this minority group.

Objectives We aimed to identify, appraise, synthesize, and contextualize rapidly emerging reports on medication taking (‘adherence’) among patients with rheumatic diseases during the COVID‐19 pandemic. Methods We searched MEDLINE, EMBASE, and CINAHL for peer‐reviewed communications, letters, and manuscripts published during the COVID‐19 pandemic evaluating medication taking among individuals with rheumatic diseases. We appraised assessment and reporting of medication adherence according to established definitions of three distinct problems of medication taking (i.e., non‐initiation, poor implementation, and discontinuation) and pooled findings using random effects models. Results We included 31 peer‐reviewed studies in our synthesis from various jurisdictions, of which 25 described medication taking among rheumatology patients and 6 described medication prescribing among rheumatology providers. The pooled prevalence of overall medication non‐adherence was 14.8% (confidence interval [CI]: 12.3%, 17.2%) and that of medication discontinuation (i.e., stopping of prescriptions) and poor implementation (i.e., not taking medication at the dose/frequency prescribed) as 9.5% (CI: 5.1%, 14.0%) and 9.6% (CI: 6.2%, 13.0%), respectively. Non‐initiation (i.e., not starting/not filling new prescriptions) was not addressed. Conclusions Medication taking among individuals with rheumatic diseases during the COVID‐19 pandemic varies globally. Unclear reporting and extensive variation in research methods between studies creates barriers to research replication, comparison, and generalization to specific patient populations. Future research in this area should use consistent and transparent approaches to defining and measuring medication taking problems in order to ensure findings appropriately describe the epidemiology of medication adherence and have the potential to identify modifiable targets for improving patient care.

BackgroundPsychiatric syndromes are complicated by comorbidity and other factors that burden patients, making guideline-informed psychiatric care challenging, and negatively affecting outcome. A comprehensive intake tool could improve the quality of care. Existing tools to quantify these characteristics do not identify specific complications and may not be sensitive to phenomena that are common in psychiatric outpatients.ObjectiveTo develop a practical inventory to capture observations related to complex care in psychiatric outpatients and quantify the overall burden of complicating factors.DesignWe developed a checklist inventory through literature review and clinical experience. The inventory was tested and compared with related measures in a cross-sectional study of 410 consenting outpatients at the time of initial assessment.ResultsThe summed score of inventory checklist items was significantly correlated with patient-assessed measures of distress (K10, r=0.36) and function (WHODAS 2.0, r=0.31), and physician-assessed measures of function (GAF, r=−0.42), number of psychiatric diagnoses [F(df3)=33.6], and most complex diagnosis [F(df3)=37.4]. In 53 patients whose assessment was observed by two clinicians, inter-rater reliability was acceptable for both total inventory score (intraclass correlation, single measures = 0.74) and agreement on specific items (mean agreement score = 90%).ConclusionsThe Psychiatric C4 Inventory is a reliable instrument for psychiatrists that captures information that may be useful for quality improvement and resource planning. It demonstrates convergent validity with measures of patient distress, function, and complexity. Further tests of validity and replication in other settings are warranted.