Leg-ulcer care in the community, before and after implementation of an evidence-based service

Harrison, Margaret B.; Graham, Ian D.; Lorimer, Karen; Friedberg, Elaine; Pierscianowski, Tadeusz A.; Brandys, Tim

doi:10.1503/cmaj.1041441

Cited by 75 publications

(67 citation statements)

References 21 publications

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“…10,13 Regional managers of home care were concerned about costs of supplies, amount of nursing time, and frequency of visiting for clients with ulcers of the leg. A regional task force was developed to review existing practice guidelines to help guide the care plan.…”

Section: Why Adapt Guidelines For Local Use?mentioning

confidence: 99%

“…For example, to streamline the process of assessment and facilitate application of evidence-based care, documentation forms were created to collect information about the cause of the ulcer, with venous symptoms and history on one side of the page and arterial symptoms on the other. With the exception of a few studies such as this collaboration for care of ulcers of the leg, 10,13,17 no validated process for the adaptation of guidelines has been documented. Recently, the Canadian work 16 in this area was integrated with an international initiative known as the ADAPTE collaboration (www.adapte.org).…”

mentioning

confidence: 99%

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Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

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308

322

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Key points• Clinical practice guidelines can be adapted to local circumstances and settings to avoid duplication of efforts and optimize use of resources.• The ADAPTE process is an approach to adapting guidelines to local contexts through the explicit participation of relevant decision-makers.• Assessing barriers to and facilitators of the use of knowledge is closely linked to the adaptation and uptake of the evidence. Review CMAJ • FEBRUARY 9, 2010 • 182(2) E79evidence-based practice guidelines have become mandatory for the care of patients with cancer in France. 14 For many regions and territorial jurisdictions, de novo development of guidelines is not feasible because of lack of time, expertise and resources, and thus taking advantage of existing highquality guidelines is sensible. [15][16][17] Adaptation of existing high-quality guidelines for local use is an approach with the potential to reduce duplication of effort and enhance applicability. National guidelines often lack details on applicability and description of the changes in the organization of care required to apply the recommendations. 18 Adaptation of evidence may promote local uptake of evidence through a sense of ownership by the end-users who are engaged in this process. However, customizing a guideline to local conditions could weaken the integrity of the evidence base. We outline a systematic, participatory approach for evaluating and adapting available guidelines to a local context of use while maintaining the quality and validity of the guideline. Whether evidence is provided in the format of syntheses of knowledge, patient decision aids or clinical practice guidelines, end-users must consider if or how it could be adapted to the local context and the same principles can be applied to ensure these factors are considered before implementation of the evidence.To illustrate how to adapt guidelines, we will use a recent study that was performed to improve community care of individuals living with venous ulcers of the leg. 10,13 Regional managers of home care were concerned about costs of supplies, amount of nursing time, and frequency of visiting for clients with ulcers of the leg. A regional task force was developed to review existing practice guidelines to help guide the care plan. The task force identified that many of these guidelines were from international bodies and would require adaptation to the local context. How are guidelines adapted for local use?Existing guidelines can be evaluated and customized to fit local circumstances through an active, systematic and participatory process. This process must preserve the integrity of the evidence-based recommendations when differences in organizational, regional or cultural circumstances may legitimately require important variations in recommendations. 8,9,[14][15][16]19 In adapting a guideline, consideration is given to local evidence, such as specific health questions relevant to a local context of use; to specific needs, priorities, legislation, policies and resources; to scopes of practic...

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Section: Why Adapt Guidelines For Local Use?mentioning

confidence: 99%

mentioning

confidence: 99%

Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

Self Cite

308

322

View full text Add to dashboard Cite

show abstract

“…11 Besides occupation, another factor to be considered in Harrison points out that there is evidence that low socioeconomic status negatively influences healthy behavior in the home environment, access to health services, health care and access to material resources. 13 Household income is an important aspect in the planning of actions, as it determines the living conditions of this population, often making it difficult to implement actions, prolonging treatment and chronicity of lesions. 6 With regard to health characteristics, several studies have reported that healthy lifestyle habits, such as not smoking, sleeping at least six hours, having a balanced diet, do not drink alcohol and take control of underlying diseases and risk factors, contribute positively to the healing of venous ulcers.…”

mentioning

confidence: 99%

“…6 With regard to health characteristics, several studies have reported that healthy lifestyle habits, such as not smoking, sleeping at least six hours, having a balanced diet, do not drink alcohol and take control of underlying diseases and risk factors, contribute positively to the healing of venous ulcers. [10][11][13][14] Corroborating this study, research conducted in a referral hospital for treatment to people with VU identified risk factors such as family history of venous disease; history (proven or suspected) of DVT; prior venous surgery or other sources; activities for long periods of standing or sitting; pregnancy; diabetes; heart disease; chronic venous insufficiency; hypertension and stroke. 15 Margolis identified chronic diseases such as hypertension (38,9%), lung disease (16,7%) and diabetes mellitus (11,1%).…”

mentioning

confidence: 99%

“…9 Lucas and Costa also report that the edges are usually flat, attached to the rocker and irregular; but, due to the presence of edema, may appear thick. 13 A study reports the clinical characteristics of VU, such as: shallow and painful wound, with tissue of granulating and fibrin, varicosites presence, and edema and dermatitis. 16 França features VU as irregular wounds, painful in varying intensities, with welldefined edges, rockers where, hardly, presents necrotic tissue and feature commonly yellowish exudate.…”

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confidence: 99%

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Sociodemographic, clinic and health characterization of people with venous ulcers attended at the family health strategy

Torres¹,

Monteiro²,

Salvetti³

et al. 2014

R. pesq. cuid. fundam. online

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Objetivo: caracterizar os aspectos sociodemográficos, de saúde e assistenciais das pessoas com úlceras venosas atendidas pela Estratégia Saúde da Família (ESF) em Maceió-Alagoas. Método: pesquisa transversal, com abordagem quantitativa, realizada em 36 unidades da ESF com 59 pessoas com úlceras venosas por meio de formulário estruturado. Resultados: as pessoas com úlceras venosas estavam em tratamento > 1 ano (69,5%), eram do sexo feminino (71,2%) e ≥ 60 anos (67,8%). A maioria era não tabagista e não alcoolista, e 100,00% tinham dois ou mais fatores de risco e antecedentes pessoais patológicos, cada. Possuía tempo de lesão > 6 meses (64,4%), dor na úlcera/membro (86,4%) e leito com ≤ 30% de granulação/epitelização (78,0%). Conclusões: as pessoas com úlcera venosa apresentavam: baixo nível socioeconômico, doenças crônicas e características da lesão desfavoráveis contribuindo para cronicidade das lesões.

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Adapting knowledge to local context

Harrison

Graham

Fervers

et al. 2013

Knowledge Translation in Health Care

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Leg-ulcer care in the community, before and after implementation of an evidence-based service

Cited by 75 publications

References 21 publications

Adapting clinical practice guidelines to local context and assessing barriers to their use

Adapting clinical practice guidelines to local context and assessing barriers to their use

Sociodemographic, clinic and health characterization of people with venous ulcers attended at the family health strategy

Adapting knowledge to local context

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