Comparing the Efficacy of Staff Versus Housestaff Instruction in an Intervention to Improve Hypertension Management

Denton, Gerald D.; Smith, Jordan; Faust, Joanne; Holmboe, Eric S.

doi:10.1097/00001888-200112000-00022

Cited by 26 publications

(14 citation statements)

References 5 publications

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“…It is likely that this finding indicates a general distrust of change and practices that are perceived as different from usual care where leadership is suboptimal. These findings suggest that having a positively perceived local opinion leader to introduce and guide change in practice may facilitate receptivity to change in providers' behavior (59). Consistent with the above findings, transactional leadership was positively associated with scores on both the openness subscale and the total EBPAS scale.…”

Section: Discussionsupporting

confidence: 78%

Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice

Aarons¹

2006

Psychiatric Services

261

253

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Objective-Leadership in organizations is important in shaping workers' perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices. Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. Studies have shown that in youth and family service organizations, mental health providers' attitudes toward adopting an evidence-based practice are associated with organizational context and individual provider differences. The purpose of this study was to expand these findings by examining the association between leadership and mental health providers' attitudes toward adopting evidence-based practice.Methods-Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers' characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors' leadership behaviors. Zero-order correlations and multilevel regression analyses were conducted that controlled for effects of service providers' characteristics.Results-Both transformational and transactional leadership were positively associated with providers' having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers' perception of difference between the providers' current practice and evidence-based practice.Conclusions-Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices.There is growing momentum and pressure to move evidence-based mental health interventions into real-world practice settings (1-5). Most of these practice settings involve a relationship between a clinical or case management supervisor and practitioners who provide services. Often in community settings the clinical supervisor also supervises work activities, including conducting performance appraisals and other human resource functions. Leadership is important in these activities. Recent work has also demonstrated that mental health service providers' attitudes toward adopting evidence-based practice are associated with organizational context (for example, structure and policies) and individual provider differences (for example, education and experience) (6,7). Yet, although leadership is held to influence the adoption of innovations, such as evidence-based practices (8), there has been little research on the association between leadership of the mental health supervisor and staff attitudes toward adopting evidence-based practice. However, some more general leadership studies have been conducted.Leadership research is pervasive in the organizational literature, and studies in mental health services suggest that leadership is important for both for the organizational proces...

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Section: Discussionsupporting

confidence: 78%

Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice

Aarons¹

2006

Psychiatric Services

261

253

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“…The perceived time barrier in early resident development (years 1–2), may be related to a focus on hospital based medicine, with less time spent in the out patient clinic. The more experienced third year residents reported that a lack of specific guideline instruction and staff role modeling were the most important CPG compliance barriers [2,17]. Positive pre-intervention attitudes toward the guidelines were demonstrated in this study [Figure 2] and in previous studies [2,11].…”

Section: Discussionsupporting

confidence: 65%

Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes

2004

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“…6,[14][15][16][17][18] One randomized controlled trial using chart audit of 10-12 patients per resident, report cards assessing 78 audit items, and a 10-to 15-minute feedback session did not demonstrate improved patient management. 19 Possible reasons for the lack of benefit with this approach include the limited number of patients assessed per resident; diffuse nature of the feedback; and the single, brief feedback session.…”

Section: Discussionmentioning

confidence: 95%

Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial

Thomas

Stroebel

et al. 2007

J GEN INTERN MED

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BACKGROUND: Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes. OBJECTIVE:To assess the effects of a registrygenerated audit, feedback, and patient reminder intervention on diabetes care. PARTICIPANTS: Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n=39) received instruction on diabetes registry use; quarterly performance audit, feedback, and written reports identifying patients needing care; and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n=39) received usual clinic education.MEASUREMENTS: Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c <7.0%, LDL cholesterol <100 mg/dL, and blood pressure <130/85 mmHg) were assessed. RESULTS:Patients cared for by residents in the intervention group had higher adherence to guideline recommendations for hemoglobin A1c testing (61.5% vs 48.1%, p = .01) and LDL testing (75.8% vs 64.1%, p=.02). Intermediate clinical outcomes were not different between groups.CONCLUSIONS: Use of a registry-generated audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.

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Comparing the Efficacy of Staff Versus Housestaff Instruction in an Intervention to Improve Hypertension Management

Abstract: This intervention was effective in improving providers' compliance with a hypertension practice guideline, but only when led by a faculty opinion leader. A resident instructor using the same format was unable to change the providers' behaviors.

Cited by 26 publications

References 5 publications

Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice

Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice

Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes

Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial

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