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At least 1,333 records · Page 74Linked to original sources
PubMed2004

Beliefs about evidence-based practices in addiction treatment: a survey of Veterans Administration program leaders.

The purpose of this study was to determine Veterans Administration addiction treatment program leaders' familiarity with evidence-based practices, understanding of and attitudes toward existing VA treatment guidelines, the extent to which specific practices should be implemented, and perceived barriers to implementation. Two hundred and twenty surveys were mailed to program leaders between November 1999 and May 2000. One hundred and seventy-four (79%) were completed, representing 135 out of 162 (83%) facilities. Program leaders saw guidelines as educational tools that improved quality of care and could be implemented into existing programs. However, they also perceived staff resistance to implementation. The most strongly cited barriers to implementation were lack of administrative support, insufficient staff time, and lack of skills or knowledge. Several treatments were seen as strongly evidentiary, but were not widely implemented, suggesting possible foci for future translation studies.

Adult↗
PubMed2003

Challenges associated with implementing an education program in a residential aged care setting.

The link between independence and well-being of older people in residential care is well established. This paper reports some challenges encountered during implementation of an education program designed to assist nursing staff to adopt an independence-supporting model of residential care. The education program was part of a larger project aimed at developing an example of best practice in supported care which promotes independence, well-being and community linkages. Implementation of the program created many interesting challenges which were overcome by strategies and facilitating forces such as support from management and some staff and the collaborative nature of the project. Positive outcomes of the education program included increased awareness of and change in, practice; increased staff-resident interaction; and increased encouragement for residents to be independent and to engage with the wider community. Moreover, a facilitator manual - Promoting Independence: A Learning Resource for Aged Care Workers was subsequently developed so that the program can be implemented in aged care facilities elsewhere.

Activities of Daily Living↗
PubMed2000

Implementing the ASAM Criteria in community treatment centers in Illinois: opportunities and challenges. American Society of Addiction Medicine.

The incorporation of the ASAM Criteria into addiction treatment centers procedure has afforded us an enormous opportunity to add credibility to our treatment. Herein lies perhaps the strongest argument for these criteria. The ASAM Criteria encourage addiction treatment centers to establish themselves as healthcare providers in their own right. The task is now for Illinois addiction treatment providers; particularly community based providers, to prove our credibility through the legitimate use of the criteria. Since most, if not all, of our patients are without means and without knowledge on quality treatment, they become easy targets for substandard or at least unimaginative and uninspired treatment. It is not that community based treatment centers are, by nature, unprincipled treatment warehouses. But it certainly can be said that our centers are frequently the last to change our treatment practices. Certainly we have become "the last resort" for the courts, overburdened mental health centers and overpopulated homeless shelters with little emphasis on clinical quality of care. Overcoming such programmed ways of viewing treatment was difficult specifically for Triangle Center and generally for community treatment providers throughout Illinois. In fact, I dare say that this transition has not occurred in total as many still passively resist this opportunity. Yet others have viewed this change as the breath of fresh air that our profession has long sought. Such variance in opinion ultimately proves that implementation of the ASAM Criteria, in a community based system, is dependent on the clinician and administrators willingness to understand, recognize and apply the Criteria.

Ambulatory Care↗
PubMed2003

Randomized controlled trial of education and feedback for implementation of guidelines for acute low back pain.

OBJECTIVE: The effect of clinical guidelines on resource utilization for complex conditions with substantial barriers to clinician behavior change has not been well studied. We report the impact of a multifaceted guideline implementation intervention on primary care clinician utilization of radiologic and specialty services for the care of acute low back pain. DESIGN: Physician groups were randomized to receive guideline education and individual feedback, supporting patient education materials, both, or neither. The impact on guideline adherence and resource utilization was evaluated during the 12-month period before and after implementation. PARTICIPANTS: Fourteen physician groups with 120 primary care physician and associate practitioners from 2 group model HMO practices. INTERVENTIONS: Guideline implementation utilized an education/audit/feedback model with local peer opinion leaders. The patient education component included written and videotaped materials on the care of low back pain. MAIN RESULTS: The clinician intervention was associated with an absolute increase in guideline-consistent behavior of 5.4% in the intervention group versus a decline of 2.7% in the control group (P =.04). The patient education intervention produced no significant change in guideline-consistent behavior, but was poorly adopted. Patient characteristics including duration of pain, prior history of low back pain, and number of visits during the illness episode were strong predictors of service utilization and guideline-consistent behavior. CONCLUSIONS: Implementation of an education and feedback-supported acute low back pain care guideline for primary care clinicians was associated with an increase in guideline-consistent behavior. Patient education materials did not enhance guideline effectiveness. Implementation barriers could limit the utility of this approach in usual care settings.

Acute Disease↗
PubMed1996

Implementing a continuous renal replacement therapies program.

Initiating and maintaining a continuous renal replacement therapy (CRRT) program presented more challenges than first anticipated; however, problems remained within the health care team's ability to solve. Here a multidisciplinary group reflects on what was done, should have been done, and remains to be done to offer effective CRRT at this university medical center. All participating members have come to realize that communication and collaboration are necessary to accomplish implementation of a complex program such as CRRT.

Academic Medical Centers↗
PubMed2006

Awareness and use of eye care services in Fiji.

PURPOSE: To determine the awareness, use, and barriers to use of eye services in Fiji's Central Province. METHODS: A cross-sectional survey study design with random clusters of households was used. Semi-structured interviews were conducted (152 females and 22 males). For 267 household members, presenting distance and near visual acuities were measured, and the perception of and satisfaction with their vision were recorded. RESULTS: Most (86%; 150/174) respondents were aware of at least one conventional eye care service. However, only 66% (121/183) of household members with previous eye problems had consulted one of these; the proportion was even lower for those in the older age groups (p < 0.01). Rural dwellers expressed satisfaction with their vision, despite being more likely to regard it as limiting their activities and being less likely to seek conventional care. A higher proportion of females were reported to have (or have had) eye problems (60:40) and were found to have bilateral visual impairment (60:40). Despite this, females and males attended the hospital eye clinic (47:53) or sought treatment from conventional services (51:49) nearly equally. The reasons given for not seeking conventional care were "fatalistic attitude" ("did not bother", "could manage", or accepted the condition: 57%), expense (12%), and fear (8%). CONCLUSION: Central Province Fijians, particularly the old, rural, and female, under-utilise conventional eye care services. As in developing countries elsewhere, fatalistic attitudes to visual impairment are a significant contributor to this. To improve eye health, planning and implementation of eye care services must overcome under-utilisation by addressing local barriers to uptake through community participation in education and affirmative action.

Adolescent↗
PubMed2006

The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals.

BACKGROUND AND OBJECTIVES: Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients' condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had implemented an outpatient preoperative evaluation clinic in 2004. Subsequently, current practice was compared with the results of a previous inventory (2000). It was also evaluated to what extent the guidelines of the Dutch Health Council and the Netherlands Society of Anaesthesiology were followed. METHODS: The study consisted of two phases. First, a literature research was performed and pilot interviews were constructed. The interviews were conducted face-to-face with anaesthesiologists in a sample of Dutch hospitals. Based on the results, written questionnaires were constructed. In the second phase these questionnaires were sent to all general and academic hospitals in the Netherlands. RESULTS: In 2004, 74% of the hospitals had an outpatient preoperative evaluation clinic, compared with 50% in 2000. The percentage of hospitals with an outpatient preoperative evaluation clinic available for all elective patients increased from 20% to 52%. CONCLUSIONS: The Dutch guidelines on preoperative evaluation seem to have influenced current practice. An increase in the number of outpatient preoperative evaluation clinics was seen after the guidelines were published. The implementation of an outpatient preoperative clinic seems to warrant that anaesthesiologists are carrying out the activities prescribed by the guidelines. Most hospitals without a clinic aim to implement one in the future.

Anesthesia Department, Hospital↗
PubMed2000

Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal.

INTRODUCTION: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. METHODS: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. RESULTS: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. CONCLUSIONS AND RECOMMENDATIONS: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.

Abortion, Legal↗
PubMed2000

Thinking ahead--the importance of exit strategies to successful implementation of clinical effectiveness initiatives.

The Clinical Resource and Audit Group (CRAG) remains the focus for the development of clinical effectiveness with particular emphasis on strategic alignment and implementation. CRAG believes that early consideration and planning of exit strategies is essential to deliver successful dissemination and implementation of clinical effectiveness initiatives. Open sharing of results in encouraged, with due consideration of the challenges of presenting information fairly and clearly to avoid misinterpretation, particularly for the lay public. Valuable lessons from effectiveness initiatives should be shared widely and introduced quickly into normal clinical practice, releasing effectiveness resources for new challenges. CRAG will produce guidance to support the development of exit strategies later in the year; comments and contributions are welcome.

Clinical Competence↗
PubMed1998

In their own words: nursing assistants' perceptions of barriers to implementation of prompted voiding in long-term care.

Prompted voiding is an effective intervention for the improvement of continence in long-term care. This study investigated certified nursing assistants' (CNAs) perceptions of incontinence etiologies, as well as perceived barriers to prompted voiding implementation. A questionnaire was administered to CNAs in 23 long-term care facilities. Data analysis was conducted using descriptive statistics and correspondence analysis. CNAs perceived prompted voiding as helpful; however, inadequate staffing, workload, and turnover/absenteeism hindered implementation. CNA recommendations for long-term success included increased staff, staff support, improved communication, ongoing education, and alternative delivery models of care.

Aged↗
PubMed2003

Global elimination of tuberculosis: implementation, innovation, investigation.

The elimination of a public health menace such as tuberculosis is always an attractive proposition. Is it realistic to consider? Selecting elimination as a target engages commitment, identifies challenges and stimulates critical evaluation. Challenges are numerous, including the large pool of latent infection, the long incubation period, the inadequacy of present tools and strategies, poverty and its relation to tuberculosis, the dependence on declining health services, the negative impact of human immunodeficiency virus infection, and the long-term commitment required with present approaches. Although tuberculosis has a tragic impact in causing death and chronic illness, the target for elimination must remain preventing infection, and the aim to achieve a generation free of infection. Targeting decreased mortality or improved health will not be sufficient to guide the critical reflection required to eliminate the causative organism; this can only be achieved by focusing on preventing and eliminating infection. While we have an international consensus on the strategy for controlling tuberculosis, we must also keep in mind that it is not sufficient. We must improve the current strategy as well as develop new tools on which we can base a new strategy if we hope to achieve the objective of elimination of tuberculosis. Reaching the target will require commitment to implementing what we currently have, improving on it in every way possible and keeping our minds and imaginations open to new ways to approach the fight against tuberculosis.

Global Health↗
PubMed1994

The impact of a mobile dental system on a school community. Part III--Teachers and parents response to a mobile dental system at school.

According to the principles of the Primary Health Care Approach, planning and implementation of community health programmes should be carried out with the full participation of the community concerned (WHO, 1978). The introduction of the Mobile Dental System to the school environment is an example of a "Community health care/technology approach" where the programme was determined by the professionals for the community and not by the community for itself. Teachers play an important role in the implementation of oral health care programmes in the school, while parents provide the vital and appropriate context and continuity for the success of such programmes. This paper, therefore, deals with the responses of teachers and parents to an introduction of a mobile dental system at their school. A self-administered mostly open-ended questionnaire was distributed to all teachers in the four schools that participated in preventive programmes and were served by the Mobile Dental System. Based on the results it seems that both the teachers and the parents were apathetic in their commitment to the programme although they were quite willing to participate. Their participation was confined to compliance with instructions or suggestions given by the health professionals. It is clear that under these conditions the potential to sustain the momentum created by the introduction of the MDS is limited. It seems that only if the community is involved in the determination of their preferential needs, planning of the appropriate programme and playing an active role in its implementation, will the programme have a chance of long term success.

Adolescent↗
PubMed2006

Changing practice: implementing validated paediatric pain assessment tools.

This study attempted to address a lack of evidence-based pain management by implementing validated pain assessment tools across a children's hospital. The method used was action research. The first part of this study where nurses' views of pain tools was elicited has already been reported (Simons and Macdonald, 2004). An action research cycle of negotiation, assessment, diagnosing, planning, action, evaluation and withdrawal was utilized. Data collection occurred at two points in time. Three age-appropriate tools were implemented hospital-wide supported by education and clinical input. A survey of nurses was carried out six months and 12 months post implementation of the tools. At the same time evaluation of the use of the tool was performed. Six months after education and implementation 23 percent of children on 10 wards had a pain tool in use. This had increased to 40 percent six months later. There were many inconsistencies between the replies the nurses gave in relation to their reported use of the tools and the actual use of the tools.

Child↗
PubMedDate not supplied

Creating a cultural shift. A gerontological enrichment program for acute care.

As the number of older adults in acute care rises, acute care specialty nurses must gain gerontological knowledge in their nursing practice with older patients. A blend of two bodies of knowledge and competencies is required to care effectively for older adults in the hospital. To this end, a gerontological enrichment program was developed to improve care to hospitalized older patients by augmenting acute care nurses competencies with gerontological skill, knowledge, and abilities. This article will explain the implementation details, the anticipated outcomes for nurses and older acutely ill patients, the evaluation process, and the strategies that are in place to maintain the gains.

Acute Disease↗
PubMedDate not supplied

Making nurse-led discharge work to improve patient care.

This article discusses nurse-led discharge and provides guidance. Robust implementation of nurse-led discharge requires a thorough understanding of the 'discharge planning' process, and also requires educational support, training and achievement of discharge competencies. Without these, nurse-led discharges are at risk of becoming yet another quick-fix remedy for freeing up hospital beds.

Health Plan Implementation↗
PubMed2001

[Interdisciplinary quality management in the treatment of severely injured patients. Validation of a QM system for the diagnostic and therapeutic process in early clinical management].

A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients was validated in a trauma center in Germany. In the presented prospective study a QMS developed at another trauma center was implemented at the department of trauma surgery of the University of Essen for the presented study. The essential elements of the QMS were the establishment of (1) an adequate protocol for documentation, (2) 20 criteria for the assessment of treatment quality, (3) regular statistical analysis of treatment quality and (4) a quality circle comprising all medical specialties for data discussion. From 5/98-9/99 a cohort of 447 patients with an average injury severity score (ISS) of 22 +/- 17 was treated in the emergency department. The impact of the QMS was assessed in 4 periods (1: 5/1998-8/1998; 2: 9-12/1998; 3: 1-4/1999; 4: 5-8/1999). The quality circle met 8 times. For the improvement of the process 16 long-term changes were introduced. In 60% (n = 12) of the 20 assessment criteria significant improvements were detected. In diagnostics there were significant reductions of the time needed for basic radiological and sonographic check-up (from 24 +/- 12 min in the first to 14 +/- 8 min in the last period) and of the duration until performance of a cranial computed tomography in severe traumatic brain injury (sTBI; from 45 +/- 22 to 28 +/- 8 min). The rate of delayed diagnoses remained low (4% in the first, 5% in the last period). Further positive changes were the time savings in transfusion (from 35 +/- 20 to 20 +/- 4 min) and emergency operations (from 67 +/- 20 to 48 +/- 4 min) in hemorrhagic shock as well as for craniotomies (77 +/- 41 to 54 +/- 19 min) in sTBI. Apart from the significant time reductions other improvements were found. Overall mortality was diminished from 17% in the first to 10% in the last observation period. In conclusion the study revealed that the quality of the early therapy of severely injured patients was significantly improved by implementation of a multidisciplinary quality management system especially with respect to treatment efficiency.

Adolescent↗