Tailored Implementation for Chronic Diseases (TICD): a protocol for process evaluation in cluster randomized controlled trials in five European countries

Jäger, Cornelia; Freund, Tobias; Steinhäuser, Jost; Aakhus, Eivind; Flottorp, Signe; Godycki-Cwirko, Maciek; Lieshout, Jan van; Krause, Jane E.; Szécsényi, Joachim; Wensing, Michel

doi:10.1186/1745-6215-15-87

Cited by 16 publications

(17 citation statements)

References 17 publications

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“…Yet there is evidence that tablet computers can be efficiently used in the treatment of patients suffering from an early-stage dementia and studies exploring further uses of this technology in patient care have been requested [ 34 ]. The assessment of the usability and influence of the tablet computers on patient behavior will be part of the process evaluation of the main study [ 35 ]. If this technology proves to be useful for the target group of elderly patients, more advanced interactive training tools following the serious gaming approach could be developed [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Design and Delivery of a Tailored Intervention to Implement Recommendations for Multimorbid Patients Receiving Polypharmacy into Primary Care Practices

Jäger

Szécsényi

Steinhäuser

2015

BioMed Research International

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Introduction. Managing polypharmacy is particularly demanding for general practitioners as coordinators of care. Recently, a German guideline for polypharmacy in primary care has been published. This paper describes the content and delivery of a tailored intervention, which aims at improving the implementation of guideline recommendations for polypharmacy into practice, considering individual barriers. Materials and Methods. Firstly, barriers for implementation and the corresponding strategies to address them have been identified. On this basis, an intervention consisting of a workshop for health care professionals and educational materials for patients has been developed. The workshop focused on knowledge, awareness, and skills. The educational materials included a tablet computer. Practice teams will elaborate individual concepts of how to implement the recommendations into their practice. The workshop has been evaluated by the participants by means of a questionnaire. Results. During the workshop 41 possible sources of medication errors and 41 strategies to improve medication management have been identified. Participants evaluated the workshop overall positively, certifying its relevancy to practice. Discussion. The concept of the workshop seemed appropriate to impart knowledge about medication management to the participants. It will have to be evaluated, if the intervention finally resulted in an improved implementation of the guideline recommendations.

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Section: Discussionmentioning

confidence: 99%

Design and Delivery of a Tailored Intervention to Implement Recommendations for Multimorbid Patients Receiving Polypharmacy into Primary Care Practices

Jäger

Szécsényi

Steinhäuser

2015

BioMed Research International

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“…The findings of the interviews informed these assessments only to a limited extent. We will assess the degree to which we have identified the most important determinants by conducting a process evaluation alongside a cluster randomized trial of a tailored intervention that addresses the determinants that we prioritized [ 8 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Determinants of adherence to recommendations for depressed elderly patients in primary care: A multi-methods study

Aakhus

Oxman

Flottorp

2014

Scandinavian Journal of Primary Health Care

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Objective. It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression. Design and setting. Group and individual interviews and a survey were conducted in Norway. Method. Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants. Participants. Physicians and nurses from primary and specialist care, psychologists, researchers, and patients. Main outcome measures. Determinants of adherence to recommendations for depressed elderly patients in primary care. Results. A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners’ time constraints, the low prioritization of elderly patients with depression, and the patients’ or relatives’ wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions. Implications. The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.

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“…We are evaluating the effectiveness of the tailored interventions that we have developed in a randomised trial [ 4 ]. We will assess whether we identified the most important determinants and selected appropriate interventions to address those in a process evaluation [ 18 ].…”

Section: Implications For Research and Practicementioning

confidence: 99%

“…The aim of this article is to describe how we developed implementation interventions based on these determinants of practice. We will evaluate the effectiveness of these interventions in a randomised trial [ 4 ], and conduct a process evaluation to examine the validity of the tailoring methods that were used [ 18 ]. Partners in the TICD project are conducting parallel studies addressing the implementation of guidelines for different chronic conditions in four other European countries.…”

Section: Introductionmentioning

confidence: 99%

Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study

Aakhus

Granlund

Oxman

et al. 2015

Int J Ment Health Syst

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BackgroundTo improve adherence to evidence-based recommendations, it is logical to identify determinants of practice and tailor interventions to address these. We have previously prioritised six recommendations to improve treatment of elderly patients with depression, and identified determinants of adherence to these recommendations. The aim of this article is to describe how we tailored interventions to address the determinants for the implementation of the recommendations.MethodsWe drafted an intervention plan, based on the determinants we had identified in a previous study. We conducted six group interviews with representatives of health professionals (GPs and nurses), implementation researchers, quality improvement officers, professional and voluntary organisations and relatives of elderly patients with depression. We informed about the gap between evidence and practice for elderly patients with depression and presented the prioritised determinants that applied to each recommendation. Participants brainstormed individually and then in groups, suggesting interventions to address the determinants. We then presented evidence on the effectiveness of strategies for implementing depression guidelines. We asked the groups to prioritise the suggested interventions considering the perceived impact of determinants and of interventions, the research evidence underlying the interventions, feasibility and cost. We audiotaped and transcribed the interviews and applied a five step framework for our analysis. We created a logic model with links between the determinants, the interventions, and the targeted improvements in adherence.ResultsSix groups with 29 individuals provided 379 suggestions for interventions. Most suggestions could be fit within the drafted plan, but the groups provided important amendments or additions. We sorted the interventions into six categories: resources for municipalities to develop a collaborative care plan, resources for health professionals, resources for patients and their relatives, outreach visits, educational and web-based tools. Some interventions addressed one determinant, while other interventions addressed several determinants.ConclusionsIt was feasible and helpful to use group interviews and combine open and structured approaches to identify interventions that addressed prioritised determinants to adherence to the recommendations. This approach generated a large number of suggested interventions. We had to prioritise to tailor the interventions strategies.

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Tailored Implementation for Chronic Diseases (TICD): a protocol for process evaluation in cluster randomized controlled trials in five European countries

Cited by 16 publications

References 17 publications

Design and Delivery of a Tailored Intervention to Implement Recommendations for Multimorbid Patients Receiving Polypharmacy into Primary Care Practices

Design and Delivery of a Tailored Intervention to Implement Recommendations for Multimorbid Patients Receiving Polypharmacy into Primary Care Practices

Determinants of adherence to recommendations for depressed elderly patients in primary care: A multi-methods study

Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study

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