Recommendation Adherence Research Articles

Access and adherence to the most recent recommendations regarding resumption of activities after a mild traumatic brain injury

ABSTRACT Objectives 1) To examine access and adherence to the Berlin (2016) recommendations for resuming physical and intellectual activities after mild traumatic brain injury (mTBI) (including an exploration of barriers and facilitators). 2) To assess post-mTBI symptoms in relation to recommendation adherence. Method 73 participants who sustained a mTBI completed an online survey with questions about access and adherence to recommendations and validated measures of symptoms. Results Almost all participants had received recommendations from a health professional after their mTBI. Two thirds of recommendations reported had at least moderate correspondence with the Berlin (2016) recommendations. The vast majority of participants reported weak or partial adherence to these recommendations and only 15.7% reported complete adherence. Overall, adherence to recommendations explained a significant portion of the variance in the severity and number of unresolved post-mTBI symptoms. The most common barriers were: being in a critical period for school or work, pressure to return to work or school, screen use, and presence of symptoms. Conclusions Sustained efforts are required to disseminate appropriate recommendations after mTBI. Clinicians should support patients in eliminating barriers to recommendation adherence, as greater adherence may facilitate recovery.

Automated Monitoring of Adherence to Evidenced-Based Clinical Guideline Recommendations: Design and Implementation Study.

Clinical practice guidelines are systematically developed statements intended to optimize patient care. However, a gapless implementation of guideline recommendations requires health care personnel not only to be aware of the recommendations and to support their content but also to recognize every situation in which they are applicable. To not miss situations in which recommendations should be applied, computerized clinical decision support can be provided through a system that allows an automated monitoring of adherence to clinical guideline recommendations in individual patients. This study aims to collect and analyze the requirements for a system that allows the monitoring of adherence to evidence-based clinical guideline recommendations in individual patients and, based on these requirements, to design and implement a software prototype that integrates guideline recommendations with individual patient data, and to demonstrate the prototype's utility in treatment recommendations. We performed a work process analysis with experienced intensive care clinicians to develop a conceptual model of how to support guideline adherence monitoring in clinical routine and identified which steps in the model could be supported electronically. We then identified the core requirements of a software system to support recommendation adherence monitoring in a consensus-based requirements analysis within the loosely structured focus group work of key stakeholders (clinicians, guideline developers, health data engineers, and software developers). On the basis of these requirements, we designed and implemented a modular system architecture. To demonstrate its utility, we applied the prototype to monitor adherence to a COVID-19 treatment recommendation using clinical data from a large European university hospital. We designed a system that integrates guideline recommendations with real-time clinical data to evaluate individual guideline recommendation adherence and developed a functional prototype. The needs analysis with clinical staff resulted in a flowchart describing the work process of how adherence to recommendations should be monitored. Four core requirements were identified: the ability to decide whether a recommendation is applicable and implemented for a specific patient, the ability to integrate clinical data from different data formats and data structures, the ability to display raw patient data, and the use of a Fast Healthcare Interoperability Resources-based format for the representation of clinical practice guidelines to provide an interoperable, standards-based guideline recommendation exchange format. Our system has advantages in terms of individual patient treatment and quality management in hospitals. However, further studies are needed to measure its impact on patient outcomes and evaluate its resource effectiveness in different clinical settings. We specified a modular software architecture that allows experts from different fields to work independently and focus on their area of expertise. We have released the source code of our system under an open-source license and invite for collaborative further development of the system.

Strength-training and balance activities in Canada: historical trends and current prevalence.

Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000-2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000-2014) in adherence to recommendations. Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000-2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression. Youth aged 12 to 17 years (56.6%, 95% CI: 52.4-60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1-56.8) had significantly greater adherence to the muscle/ bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9-44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014. Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation.

What guidelines?: Attitudes and behaviors for prescribing prophylactic hepatic encephalopathy medications.

What guidelines?: Attitudes and behaviors for prescribing prophylactic hepatic encephalopathy medications.

Explanation Seeking and Recommendation Adherence in Human-to-Human versus Human-to-Artificial Intelligence Interactions

Explanation Seeking and Recommendation Adherence in Human-to-Human versus Human-to-Artificial Intelligence Interactions

Adherence to Antibiotic Recommendations and Infection Among Patients With Open Long-Bone Fractures: An Examination of Antibiotic Prioritization in Fracture Management.

Open fractures are at high risk of infection because of exposure of bone and tissue to the environment. Initiation of intravenous antibiotics is recommended within 1 hour of hospital arrival, although the presence of other severe injuries may lead to delays in fracture management. This retrospective study of adult patients with open long-bone fractures admitted to six level 1 trauma centers between January 1, 2018, and December 31, 2019, aimed to examine adherence to antibiotic recommendations. Associations between receiving recommendation-adherent antibiotics and patient and injury characteristics were investigated univariately and in adjusted regression analyses. The most common fracture locations among the 404 patients included were the tibia (43%) and fibula (26%). Fifty-eight percent of patients received recommendation-adherent antibiotics. After adjustment, patient demographics, comorbidities, cause of injury, and overall injury severity did not show significant associations with adherence to recommendations. Concomitant serious abdominal (adjusted odds ratio [AOR]=0.44) and spinal injuries (AOR=0.23) were associated with lower odds of receiving recommendation-adherent antibiotics. Additionally, fractures of certain locations were associated with increased odds of adherence (humerus: AOR=2.78; fibula: AOR=1.64), as were type 3 fractures (AOR=1.55). The overall infection rate was 4%, and adherence to antibiotic recommendations was not associated with infection (3% vs 5% for nonadherent, P=.34). Results suggest that although full recommendation adherence was somewhat low among this patient population, certain injury characteristics were predictive of adherence rates. Current antibiotic recommendations may benefit from consideration of how antibiotic initiation may fit into the prioritization of injury management, especially in patients with polytrauma with other severe injuries. [Orthopedics. 2023;46(1):54-58.].

Implementation of genetic carrier screening in the OB population: guideline recommendation adherence

Implementation of genetic carrier screening in the OB population: guideline recommendation adherence

Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia.

Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.

Adherence to Canadian 24-Hour Movement Guidelines among infants and associations with development: a longitudinal study

BackgroundTo examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) associations between adherence to the guidelines over time and development.MethodsParticipants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a sub-sample (n = 93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥ 30 min/day of tummy time, 2) no screen time, some reading time, no restrained bouts > 1 h (time-use diary only), and 3) 14–17 h (2 months) or 12–16 h (4 and 6 months) of sleep per 24-h period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics.ResultsFew infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8–8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5–11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months.ConclusionsGuideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.

674 FOCUSING ON ADHERENCE TO INFECTION PREVENTION AND CONTROL RECOMMENDATIONS: FACILITATORS AND BARRIERS. AN EXPLORATORY STUDY OF THE ROLE OF HEALTHCARE PROVIDERS IN CARDIOLOGY SETTINGS

Abstract Introduction Cardiovascular devices and their associated placement, management and maintenance require adequate adherence to infection prevention and control (IPC) programs, which are paramount to patient and healthcare provider safety. The lack of control of adverse events and complications due to non-compliance with guidelines and recommendations is clearly a potential risk that needs to be known and avoided. Therefore, it is crucial to identify and describe the potential enabling factors and existing barriers to the use of and adherence to infection control guidelines and recommendations by healthcare providers in the cardiovascular setting. Methods An observational study was conducted involving 53 healthcare providers from cardiovascular settings. An online survey was used to explore sociodemographic information, attitudes towards evidence-based practice and its application (IPC-COQ), factors influencing adherence to standard precautions (FIASP Adapted), and potential barriers and facilitators. Results The sample was mostly composed by female providers (66%) with a mean age of 41 years. The Attitude domain score (IPC-COQ) was 3.87 (+-0.44), while the Utilization domain score was 3.20 (+- 0.61). The overall FIASP score was 2.84 (+-0.44). The main barriers to adherence reported were: poor relationship between health providers and patients, heavy workload, limited availability of PPE; of the facilitators of adherence, the most frequently cited were: interest in infection control in my department, personal motivation to adhere to EPB, peer involvement. A significant relationship was found between the domains IPC-COQ, FIASP and facilitators and barriers. Discussion The identification of potential barriers and facilitators to adherence to IPC recommendations in cardiology could serve as a starting point for the development and implementation of guideline and recommendation adherence strategies by healthcare providers. This will naturally support decision-making processes from which to infer which of these factors need to be removed and which need to be strengthened in order to improve the efficiency and utility of IPC programs in cardiology settings.

Examining the Performance of the MMPI-2-RF in a Sample of Pretransplant Military Veterans

The present study aimed to describe the personality and psychopathology dimensions reported by veterans seeking organ transplantation, as well as to identify those dimensions associated with subsequent presurgical recommendations and transplant outcomes. Data were collected from 245 veterans undergoing a pretransplant psychological evaluation that included the MMPI-2-RF. Three treatment recommendations resulting from these evaluations, three recommendation adherence variables, and two transplant outcomes were extracted from electronic medical records. The sample’s MMPI-2-RF scale scores were compared to the normative sample and two other presurgical samples and contrasted across subgroups defined by organ transplanted. Point-biserial correlations and logistic regression analyses examined associations between MMPI-2-RF scale scores and the eight measured outcomes. Results indicated that over-reporting, internalizing tendencies, negative emotionality, and a lack of positive emotions were uniquely predictive of mental health treatment recommendation, whereas somatic over-reporting, externalizing tendencies, and disinhibition were predictive of substance use treatment recommendation. Veterans who reported higher levels of activation were less likely to initiate mental health treatment. Finally, veterans with greater somatic preoccupation were less likely to be listed for organ transplant. More suspicious and mistrustful veterans were less likely to receive the transplant. These findings offer support for the role of the MMPI-2-RF in veteran pretransplant evaluations.

The Effect of Auditory and Visual Recommendations on Choice

We explore the effect of recommendation modality on recommendation adherence. Results from five experiments run on various online platforms (N = 6,103 adults from TurkPrime and Prolific) show that people are more likely to adhere to recommendations that they hear (auditory) than recommendations that they read (visual). This effect persists regardless of whether the auditory recommendation is spoken by a human voice or an automated voice and holds for hypothetical and consequential choices. We show that the effect is in part driven by the relative need for closure—manifested in a sense of urgency—that is evoked by the ephemerality of auditory messages. This work suggests that differences in the physical properties of auditory and visual modalities can lead to meaningful psychological and behavioral consequences.

Provider Perspectives on Patient- and Provider-Facing High Blood Pressure Clinical Decision Support.

Hypertension, persistent high blood pressures (HBP) leading to chronic physiologic changes, is a common condition that is a major predictor of heart attacks, strokes, and other conditions. Despite strong evidence, care teams and patients are inconsistently adherent to HBP guideline recommendations. Patient-facing clinical decision support (CDS) could help improve recommendation adherence but must also be acceptable to clinicians and patients. This study aimed to partly address the challenge of developing a patient-facing CDS application, we sought to understand provider variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools. We engaged hypertension experts and primary care respondents to iteratively develop and implement a pilot survey and a final survey which presented five clinical cases that queried clinicians' attitudes related to actions; variations; prioritization; patient input; importance; and barriers for HBP diagnosis, monitoring, and treatment. Analysis of Likert's scale scores was descriptive with content analysis for free-text answers. Fifteen hypertension experts and 14 providers took the pilot and final version of the surveys, respectively. The majority (>80%) of providers felt the recommendations were important, yet found them difficult to follow-up to 90% of the time. Perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22 to 100%. Stated reasons for variation included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Providers were generally positive toward patient use of electronic CDS applications but worried about access to health care, nuance of recommendations, and patient understanding of the tools. At baseline, provider management of HBP is heterogeneous. Providers were accepting of patient-facing CDS but reported preferences for that CDS to capture the complexity and nuance of guideline recommendations.

Associations between meeting the Canadian 24-hour movement guidelines and physical, cognitive, social-emotional, and overall development in early childhood

BackgroundThe importance of all movement behaviours (i.e., sleep, sedentary behaviour, and physical activity) for children's health has led to the creation of national and international 24-h movement behaviour guidelines for children. Few studies have examined the associations between guideline adherence and a broad array of health indicators in early childhood, and no study has done so with composite development scores for overall development. The objective of the present study was to examine associations for 24-h movement guideline adherence with physical, cognitive, social-emotional, and overall development indicators in a sample of 3–5-year-olds.MethodsChildren (n = 95) were recruited for this cross-sectional study in Edmonton, Canada. Sleep, light-intensity physical activity, and moderate- to vigorous-intensity physical activity were measured with ActiGraph wGT3X-BT accelerometers. Screen time was measured via parental-report. Guideline recommendation adherence was categorized using the Canadian 24-h Movement Guidelines. Composite z-scores were created for physical (i.e., adiposity, growth, motor skills), cognitive (i.e., vocabulary, executive functions), social-emotional (i.e., self-regulation, social-emotional behaviours), and overall development. Linear regression models were conducted to examine associations between meeting different recommendation combinations (e.g., physical activity alone, combination of physical activity and sleep), and number of recommendations met (e.g., meeting only one of any of the recommendations) with each composite development outcome variable adjusted for relevant covariates.ResultsMost children were 3–4 years old (77%) and males (69%). The physical activity guideline recommendation was the most frequently met single recommendation (94%), while the physical activity and sleep recommendations (80%) were the most frequently met combination of two recommendations. Further, 43% of children met all three recommendations. Meeting the sleep recommendation was positively associated with overall development (B: 0.29; 95% CI: 0.08–0.50), while meeting both the sleep and physical activity recommendations was positively associated with overall (B: 0.28; 95% CI: 0.10–0.46) and physical (B: 0.27; 95% CI: 0.03–0.51) development.ConclusionsMeeting sleep recommendations alone, as well as the combination of sleep and physical activity recommendations were associated with better physical and overall development in this sample. Future research should continue to examine a broad array of development outcomes using longitudinal study designs across early childhood.

Does combining traditional and information and communications technology–based extension methods improve agricultural outcomes? Evidence from field experiments in Mali

AbstractAdequate flow of appropriate information to farmers is vital for accelerating the uptake of modern agricultural technologies and improving access to markets, all of which are important for the transformation of African economies. Yet there is limited evidence regarding how information should be disseminated to farmers to achieve the needed impact. Should ICT‐based approaches be used together with traditional methods, or should they be used alone? We used cluster quasi‐random and randomized experiments involving 140 villages in southern Mali to study three chains of causality: does farmer training increase knowledge? Does knowledge lead to change in behavior? Do the different actions generate varying economic outcomes? We show that the role of farmer training in the uptake of extension advice may be overstated in some settings; that procrastination and inattention are more binding constraints to recommendation adherence than information per se; and that such constraints could be mitigated by timely voice SMS reminders. Although timely reminders nudged farmers to take‐up recommendations, leading to meaningful improvements in some intermediate outcomes, these impacts were not large enough to generate improvements in output, prices and profits in the short term. These findings must be interpreted within the context of imperfect compliance with experimental protocols, which pose threats to both the internal and external validity of some of the impact estimates.

Screening recommendation adherence among first-degree relatives of individuals with colorectal cancer.

A first-degree relative (FDR) with colorectal cancer (CRC) is one of the most important risk factors for the disease. Adherence to CRC screening recommendations can help mitigate this risk; however, adherence has historically been low. This study aimed to determine the factors associated with CRC screening. The study used data from the 2015 National Health Interview Survey. CRC screening rates were compared between FDRs and their peers without a family history of CRC. Participants were considered to be adherent if they had undergone any of the following: fecal immunochemical test within the prior 1 year, sigmoidscopy or computed tomography colongraphy within 5 years, or colonoscopy within 10 years. The analysis included 11,381 participants age 50-75 at time of survey. Overall, 62% of participants were adherent to screening recommendations. Seventy-six percent of FDRs of individuals with CRC were adherent to guidelines; they were 86% more likely to be adherent than their peers. Race, ethnicity, and socioeconomic variables were all associated with adherence. Models were largely similar between FDRs of individuals with CRC and the general public. Nearly one-quarter of FDRs of individuals with CRC are not adherent to screening recommendations. Further outreach is needed for members of minority races and the Hispanic community and additional efforts are needed to increase the accessibility of CRC screening for those with more limited finances and the uninsured.

Evaluating the Adherence of Popular Diet and Nutrition Apps to Evidence-Based Guidelines for Adult Weight Management

ObjectivesTo assess the adherence of popular, commercially available diet and nutrition apps to the Academy of Nutrition and Dietetics’ Adult Weight Management (AWM) guideline recommendations and to discern associations between the guideline adherence and indicators of the perceived popularity of an app among consumers. MethodsA preliminary search for apps was conducted in Apple App Store and Google Play Store using keywords “diet” and “weight loss” in October 2020. Selection criteria screened to only include calorie-tracking apps with greater than 10 million installations, focused on weight management as a primary outcome. Apps addressing other health outcomes, disease management, or specific dietary approaches were excluded. Selected apps were assessed with iPads using a prescribed 7-day dietary intake and collected data were recorded. ResultsThere were no significant correlations between any of the individual recommendation categories and app metadata attributes (app ratings, installations, subscription cost). Greatest recommendation adherence was observed in those corresponding to nutrition intervention (n = 9 recommendations; 65.9%) and monitoring and evaluation categories (n = 2 recommendations; 75%). ConclusionsPopular, commercially available diet and nutrition apps offer limited adherence to expert guideline recommendations for adult weight management. Funding SourcesThe authors of this article disclose no funding source in support of this work.

Evaluation of Guideline Adherence and Subsequent Follow-Up Outcomes for Incidental Thyroid Nodules Detected in Hybrid Academic-Community Practice.

Incidental thyroid nodules (ITNs) are common, and variability regarding follow-up and recommendation practices exist. The study purpose was to determine adherence to the American College of Radiology (ACR) ITN criteria and analyze recommendation outcomes. ITNs listed in the impression section on computed tomography, magnetic resonance imaging, and positron emission tomography studies over a 6-month period were included. Report recommendations were compared with ACR white paper criteria for adherence (concordant recommendation) or nonadherence (discordant recommendation). Reader characteristics, further ITN workup, and pathology were recorded. A P value less than 0.05 was used for significance. Three hundred fifty patients (mean age, 64.6 years) were included with a median ITN size of 18-mm. Most nodules (289/350) were reported on computed tomography and were identified for follow-up due to size (235/350). Only 39 of 350 reports (11.1%) did not follow ACR recommendations. Patient age was significantly related to recommendation adherence ( P < 0.05) as opposed to radiologist practice type (ie, community-based or academic) which was not. Nonadherence most often involved recommending ultrasound follow-up for nonactionable small ITNs. The rate of fine-needle aspiration biopsy from concordant ITNs was significantly higher than discordant ITNs ( P < 0.05). Six patients, all with concordant recommendations, had malignant final pathology results. Recommendation adherence to the ACR ITN criteria was high, approaching 90%. Nonadherence was mostly due to recommending thyroid ultrasound when not indicated and was correlated with a younger patient age. The rate of fine-needle aspiration biopsy stemming from nonindicated ultrasounds was significantly lower and did not result in the diagnosis of any malignancies.

Impact of an Additional Immunizing Pharmacist at an Interprofessional Student-led Clinic for the Underserved

Background: To streamline workflow during peak influenza season in our weekly student-led free Interprofessional Community Clinic (ICC), an additional pharmacist shift solely responsible for providing immunization services was implemented from October 2018 to February 2019. The objective of this study was to determine the impact of adding an immunizing pharmacist, in addition to a clinical pharmacist, on adherence to Centers for Disease Control and Prevention (CDC) vaccine recommendations and overall immunization rates at ICC.&#x0D; Methods: A retrospective chart review of patient visits from October 2017 to February 2019 was conducted. Vaccination rates and CDC recommendation adherence were compared to a historical control when an immunizing pharmacist was not scheduled. Chi-square analysis was performed on categorical data; Fisher’s exact test was used to assess impact of an immunizing pharmacist on vaccination rates and adherence to CDC recommendations. A p-value of &lt;0.05 was considered statistically significant. &#x0D; Results: A total of 78 patient visits and 58 unique patients were included. There was a significant increase in the adherence to CDC recommendations for pneumococcal vaccine when an immunizing pharmacist was present (p=0.02). There was no significant difference in the adherence to CDC recommendations for all other vaccines and overall vaccine rate between the two groups (p&gt;0.05). &#x0D; Conclusion: Implementation of an immunizing pharmacist in an interprofessional clinic significantly impacts the adherence to CDC recommendations for pneumococcal vaccine without significantly impacting the overall vaccine rate. Benefit of an additional pharmacist dedicated to vaccinations should be weighed for workflow improvement versus impact on vaccine adherence and rate.

Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery

BackgroundDespite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention.MethodsCoordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention.DiscussionThe proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities.Trial registrationClinicaltrials.gov, NCT04758338. Registered 17 February 2021 – Retrospectively registered, http://www.clinicaltrials.gov/