Implementation Strategies for a Scottish National Epilepsy Guideline in Primary Care: Results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) Trial

Davis, Junior; Roberts, Richard C.; Davidson, Diane W.; Norman, Angela; Ogston, Simon; Grimshaw, Jeremy; Davey, Peter; Grant, James D.; Ruta, Danny

doi:10.1111/j.0013-9580.2004.24003.x

Cited by 33 publications

(41 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although CPGs have been found in a variety of clinical settings, to improve the quality of care in a variety of clinical settings, 23 improvements can occur only if CPGs are implemented in clinical practice. Practical implementation of CPGs remains a challenge, especially in epilepsy, 14,15,17 and lack of applicability of CPGs has been cited as a reason for limited adoption of CPGs in clinical practice. 24 Other cited reasons for not Figure 2.…”

Section: Discussionmentioning

confidence: 99%

“…12 For example, a cardiac care study found that when CPG recommendations were followed, patients had lower rates of heart failure, recurrence of atrial fibrillation, and hospitalizations. 13 Unfortunately, this has not necessarily been the experience in epilepsy, 14,15 most likely because of the poor adoption of CPG recommendations into routine clinical practice. [14][15][16][17] Although CPGs can be useful for health professionals and have widespread application beyond the clinical setting, they are not without limitations.…”

mentioning

confidence: 99%

“…13 Unfortunately, this has not necessarily been the experience in epilepsy, 14,15 most likely because of the poor adoption of CPG recommendations into routine clinical practice. [14][15][16][17] Although CPGs can be useful for health professionals and have widespread application beyond the clinical setting, they are not without limitations. As with the general medical literature, the number of CPGs is rising exponentially, making it difficult to determine which CPG should be consulted.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The current state of epilepsy guidelines: A systematic review

et al. 2015

View full text Add to dashboard Cite

SUMMARYObjective: The International League Against Epilepsy (ILAE) Epilepsy Guidelines Task Force, composed of 14 international members, was established in 2011 to identify, using systematic review methodology, international epilepsy clinical care guidelines, assess their quality, and determine gaps in areas of need of development. Methods: A systematic review of the literature was performed in six electronic databases (e.g. Medline, Embase) using a broad search strategy without initial limits to language or study design. Six gray literature databases (e.g., American Academy of Neurology [AAN], ILAE) were also searched to minimize publication bias. Two independent reviewers screened abstracts, reviewed full text articles, and performed data abstraction. Descriptive statistics and a meta-analysis were generated. Results: The search identified 10,926 abstracts. Of the 410 articles selected for full text review, 63 met our eligibility criteria for a guideline. Of those included, 54 were in English and 9 were in other languages (French, Spanish, and Italian). Of all guidelines, 29% did not specify the target age groups, 27% were focused on adults, 22% included only children, and 6% specifically addressed issues related to women with epilepsy. Guidelines included in the review were most often aimed at guiding clinical practice for status epilepticus (n = 7), first seizure (n = 6), drug-resistant epilepsy (n = 5), and febrile seizures (n = 4), among others. Most of the guidelines were therapeutic (n = 35) or diagnostic (n = 16) in nature. The quality of the guidelines using a 1-7 point scale (7 = highest) varied and was moderate overall (mean = 4.99 AE 1.05 [SD]). Significance: We identified substantial gaps in topics (e.g., epilepsy in the elderly) and there was considerable heterogeneity in methodologic quality. The findings should offer a valuable resource for health professionals caring for people with epilepsy, since

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The current state of epilepsy guidelines: A systematic review

et al. 2015

View full text Add to dashboard Cite

show abstract

“…14,20,29 Clinical decision support tools, such as the one examined in this study, are a potential means of closing this gap and improving quality of care delivered. [30][31][32][33][34] They tend to Figure Examples of the tool before and after knowledge translation activities conducted throughout this study…”

Section: Discussionmentioning

confidence: 99%

Knowledge translation of an online tool to determine candidacy for epilepsy surgery evaluation

et al. 2016

View full text Add to dashboard Cite

Background: Guidelines recommend that surgery be considered in patients with drug-resistant epilepsy, yet delays to epilepsy surgery still exist. A Webbased, evidence-informed clinical decision tool (www.toolsforepilepsy.com) was developed to help physicians determine which patients are appropriate for an epilepsy surgery evaluation. We evaluated the usability and feasibility of the tool with the intended end users in order to improve implementation into practice. Methods: Usability testing was conducted with relevant end users. After the tool was modified based on usability results, another group of end users trialed the tool in their clinical practice. This latter group of end users then participated in focus groups and semi-structured interviews to address barriers and facilitators to tool implementation. Finally, a stakeholder meeting was held with domain experts and end users to discuss further changes to the tool and implementation strategies. Results: Six overall themes were identified through usability testing, and an additional 11 themes were identified through the focus groups and interviews. The tool was modified based on these findings, which were then presented at the stakeholder meeting of experts and end users for further refinement. The findings were also used to guide discussions of potential implementation strategies at the meeting. Conclusion: This study provides guidance on how to improve the usability of clinical decision tools by engaging end users, experts, and other key stakeholders. The modifications to the tool should facilitate its implementation in clinical practice and ultimately enhance the quality of care persons with epilepsy receive. Neurol Clin Pract 2016;6:304-314 Editorial, page 291 E pilepsy is a chronic neurologic condition that can be very disabling and associated with premature mortality.1,2 The condition consequently contributes substantially to the global burden of disease 3,4 and high health care utilization. 5,6 It is commonly managed by family medicine and general neurology specialists. 7The diagnosis and management of epilepsy can be challenging for physicians because of its diverse presentations, resulting in evidence-care gaps. [8][9][10][11] One such gap is the delayed referral of persons with epilepsy for a surgical evaluation. It has been estimated that the length of time for an appropriately selected person with epilepsy to be referred to an epilepsy center for a surgical evaluation is around 20 years.12-15 This is despite recommendations, based on the highest level of evidence, suggesting that persons with epilepsy with disabling seizures who have failed adequate trials of antiseizure medications should be referred for an epilepsy surgery evaluation. 16 The referral patterns for these patients remain unchanged over time, 14 highlighting poor implementation of guidelines through passive dissemination alone. In an effort to address this particular gap, a Web-based, evidence-informed clinical decision tool was developed by a group of national experts u...

show abstract

“…Do they improve the lives of patients? To investigate this, Julian Davis and his colleagues (13) attempted to assess the impact of SIGN guideline number 21 on outcomes in primary care.…”

mentioning

confidence: 99%