Uptake Of Best Practices Research Articles

Mental Health and Emergency Medicine: A Research Agenda

The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.

Dementia risk reduction in primary care: Barriers & enablers

nBackground:nThe implementation of intervention strategies by primary care practitioners aimed at modifying risky lifestyle behaviors in patients has the potential to prevent or delay the onset of dementia. The main aim of this review was to identify and summarize the research evidence regarding barriers and enablers to dementia risk reduction in primary care. A secondary objective was to use this evidence to make recommendations to inform the Australian national dementia prevention strategy around the translation of evidence-based care into practice. This project was carried out as part of the work of the Dementia Collaborative Research Centres.nMethods:nA comprehensive search of the literature for English language publications up to October 2007 was undertaken using the electronic databases: MEDLINE, PubMed, PsycINFO, Health Source, CINAHL, Pre-CINAHL and the Cochrane library. Search terms included combinations of the keywords: dementia, chronic disease, mental disorders, neurology or geriatric, primary prevention, lifestyle modification/intervention, evidence based; one-to-one intervention, guideline and implementation strategies, prevention, preventive interventions, control of risk, guideline, practice, change in behaviour, behavioural change, dissemination and implementation strategies. Systematic reviews, meta-analyses and large scaled pooled analyses were retrieved in the first instance.nResults:nOf a total of 950 titles initially identified, 16 studies were included in this review, of which 12 were systematic reviews. Only one study examined the uptake of best practice in dementia care at the primary care level and only limited research has been undertaken to identify factors that impede the uptake of evidence based recommendations or guidelines by primary health care practitioners, generally. Identified barriers include factors that influence a physician's knowledge of, and attitudes towards guidelines as well as factors intrinsic to the guidelines themselves. Additional barriers also arise at the level of the patient or the health-care system or are specific to certain population groups and barriers to implementation vary across place and time. Case studies from Australia indicate the most problematic barriers for GPs include inadequate remuneration for complex clinical activities and time constraints.nConclusions:nConsiderable gaps in the knowledge base remain regarding factors that impede and facilitate the uptake of evidence based medicine. Of particular relevance for dementia are studies that examine the uptake of activities designed to prevent vascular disease in primary care. The limited evidence available indicates that, for a dementia risk reduction or screening activity to be effective, it should be quick and easy to administer, have a sound rationale and be readily incorporated into existing work processes.

Use of communities of practice in business and health care sectors: A systematic review

BackgroundSince being identified as a concept for understanding knowledge sharing, management, and creation, communities of practice (CoPs) have become increasingly popular within the health sector. The CoP concept has been used in the business sector for over 20 years, but the use of CoPs in the health sector has been limited in comparison.ObjectivesFirst, we examined how CoPs were defined and used in these two sectors. Second, we evaluated the evidence of effectiveness on the health sector CoPs for improving the uptake of best practices and mentoring new practitioners.MethodsWe conducted a search of electronic databases in the business, health, and education sectors, and a hand search of key journals for primary studies on CoP groups. Our research synthesis for the first objective focused on three areas: the authors' interpretations of the CoP concept, the key characteristics of CoP groups, and the common elements of CoP groups. To examine the evidence on the effectiveness of CoPs in the health sector, we identified articles that evaluated CoPs for improving health professional performance, health care organizational performance, professional mentoring, and/or patient outcome; and used experimental, quasi-experimental, or observational designs.ResultsThe structure of CoP groups varied greatly, ranging from voluntary informal networks to work-supported formal education sessions, and from apprentice training to multidisciplinary, multi-site project teams. Four characteristics were identified from CoP groups: social interaction among members, knowledge sharing, knowledge creation, and identity building; however, these were not consistently present in all CoPs. There was also a lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group. We did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis, and so the effectiveness of CoP in this sector remained unclear.ConclusionThere is no dominant trend in how the CoP concept is operationalized in the business and health sectors; hence, it is challenging to define the parameters of CoP groups. This may be one of the reasons for the lack of studies on the effectiveness of CoPs in the health sector. In order to improve the usefulness of the CoP concept in the development of groups and teams, further research will be needed to clarify the extent to which the four characteristics of CoPs are present in the mature and emergent groups, the expectations of facilitators and other participants, and the power relationship within CoPs.

Do European hospitals have quality and safety governance systems and structures in place?

Internal systems for quality and safety were assessed in 89 hospitals in six European states, by external teams using standardised criteria and procedures, as part of the Methods of Assessing...

Changing clinicians' habits: Is this the hidden challenge to increasing best practices?

Purpose. The purpose of this article is to reflect on the concept of habit as an under-explored, but critically important factor that might help explain the lack of uptake of new, scientifically sound practices by rehabilitation clinicians.Method. The complexity relating to being a scholarly practitioner is first presented. The transtheoretical model of behaviour change, developed to better understand behaviour change such as stopping a ‘bad’ habit or implementing a ‘good’ one for health improvement purposes, is used to foster reflection on factors involved in uptake of best practices in rehabilitation. To illustrate simply the different scenarios relating to uptake of best practices, such as the use of a standardised tool over a home-grown one, two well known approaches to assessment (use of thermometer versus hand on forehead) that could be used to assess the same construct (body temperature) are contrasted.Results. As rehabilitation clinicians, we are potentially blocked in our uptake of best practices by our habits. Although habits are often comfortable, and change is less so, we need to move away from our comfort zone if we are to adopt best practices.Conclusions. Given the extensive literature suggesting that there are major gaps between best practice and actual practices, it behoves us to explore the impact of habits to a greater extent.