Supporting adherence and healthy lifestyles in leg ulcer patients: Systematic development of the Lively Legs program for dermatology outpatient clinics

Heinen, Maud; Bartholomew, L. Kay; Wensing, Michel; Kerkhof, Peter van de; Achterberg, Theo van

doi:10.1016/j.pec.2005.04.007

Cited by 61 publications

(44 citation statements)

References 31 publications

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“…The steps are summarised in Table 1. IM was originally used effectively in the health promotion domain to develop programs for smoking cessatation [19], stroke prevention [20], asthma management [21], HIV prevention [22], and leg ulcer management [23]. We modified the IM terminology in order to apply it to the quality improvement domain.…”

Section: Methodsmentioning

confidence: 99%

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Hesselink¹,

Zegers²,

Vernooij‐Dassen

et al. 2014

BMC Health Serv Res

131

120

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BackgroundThere is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.MethodsThe Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.ResultsIneffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.ConclusionsThis study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-389) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Hesselink¹,

Zegers²,

Vernooij‐Dassen

et al. 2014

BMC Health Serv Res

131

120

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“…The researchers used group-based methods for the development of the program. 22 In our experience, the type of implementation-specific interventions suggested by participants can be anticipated. They tend to mention what they know, such as continuing professional education and solutions based on information technology.…”

Section: Linking Interventions To These Barriersmentioning

confidence: 99%

Developing and selecting interventions for translating knowledge to action

Wensing¹,

Bosch²,

Grol³

2009

Canadian Medical Association Journal

170

132

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E85O nce knowledge has been adapted to local context and the barriers to and facilitators of use of knowledge have been identified, 1 we must select, tailor and implement interventions for the uptake of knowledge. 2This article provides an approach to selecting interventions for knowledge translation.How would we select interventions to translate the knowledge from practice guidelines and research into practice? For example, major variations in the treatment of chronic heart failure have been found repeatedly. In one survey, use of β-blockers in primary care ranged from 10% to 50% between countries, and use of angiotensin-converting enzyme (ACE) inhibitors ranged from 50% to 75%.3 Differences in the recommendations of national guidelines were not sufficient to explain this variation.4 Comorbidity explained some of the variation, but 14% of prescriptions were related to characteristics of patients that were not aligned with evidence.5 A study of barriers to adherence to guidelines related to heart failure showed that many family physicians found it difficult to change treatment initiated by a cardiologist. Titrating the dosage of ACE inhibitors and initiating ACE inhibitors in patients who were already using a diuretic or were stable on their current medication were perceived as barriers. 6Interventions to facilitate the uptake of research could include training for physicians (e.g., to learn about titrating the dosage of ACE inhibitors), the use of opinion leaders to influence patterns of prescribing by cardiologists, or the provision of financial incentives to physicians for each patient with heart failure who is treated according to guidelines. Alternatively, educators could better inform patients and their families about appropriate care in the hope that they will ask for such treatment in future consultations with clinicians. Ideally, the selection of an intervention for knowledge translation should be guided by research-based evidence of the effectiveness and efficiency of the various interventions. However, this evidence cannot explicitly guide our decisions in all situations and circumstances. Therefore, in addition to science, we will need some artistry to choose or design the intervention. A review of all of the evidence on developing and selecting interventions is beyond the scope of this paper; instead we will summarize available systematic reviews. 7,8 Many interventions for knowledge translation have not been well evaluated with rigorous studies. For interventions that have been evaluated, evidence suggests that their impact is variable and, on average, the effect size is moderate.Several conclusions can be drawn from the literature. Available research focuses mainly on professional interventions, such as educational programs, feedback and reminders. The methodological quality is variable but moderate overall. The overall absolute change in professional performance is usually not more than 10% on selected outcomes, but this finding can be clinically or economically relevant.Passive educational inter...

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“…Although patients report several problems that are related to lifestyle, studies show that the current care practice for this patient group does not address these topics sufficiently well [8-10]. In order to improve the adherence of patients with venous leg ulcers to a healthy lifestyle, the nurse-led counseling program Lively Legs was developed for outpatient dermatology clinics [11]. …”

Section: Introductionmentioning

confidence: 99%

Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

et al. 2012

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BackgroundImplementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care.MethodsA mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole.ResultsA total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation.ConclusionsThis study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer care is often fragmented, indicating that quality improvement is needed.

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Supporting adherence and healthy lifestyles in leg ulcer patients: Systematic development of the Lively Legs program for dermatology outpatient clinics

Cited by 61 publications

References 31 publications

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Developing and selecting interventions for translating knowledge to action

Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

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