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B6 - Engaging Knowledge users in improving evidence-based prescribing - Colquhoun - Salon G

B6 - Engaging Knowledge users in improving evidence-based prescribing - Colquhoun - Salon G






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    B6 - Engaging Knowledge users in improving evidence-based prescribing - Colquhoun - Salon G B6 - Engaging Knowledge users in improving evidence-based prescribing - Colquhoun - Salon G Presentation Transcript

    • Engaging knowledgeusers in improvingevidence-basedprescribing2013 CADTH Symposium: Evidence in ContextHeather Colquhoun, CIHR and KT Canada Postdoctoral FellowClinical Epidemiology ProgramOttawa Hospital Research InstituteCentre for Practice Changing Research
    • Project TeamJeremy Grimshaw, Ottawa Hospital Research Institute (OHRI)Heather Colquhoun, OHRIEffie Helis, OHRIAl Mayhew, OHRIJulia Worswick, OHRIKatrina Sullivan, OHRIDenis Bélanger, CADTHSophie Hill, La Trobe, AustraliaDianne Lowe, La TrobeMichael Taylor, La Trobe4 knowledge users: Danielle Stowasser and Debra Kay (Australia),Judith Fisher (Nova Scotia), Anne Nguyen (British Columbia)Funder: Canadian Institutes of Health Research
    • Background Health systems globally are interested inpromoting and implementing the appropriateuse of medications Substantial collection of literature describingbest practices for prescribing The adoption of best practices typically requiressignificant effort
    • Background• Significant documented inadequacies in prescribingpractices and medication errors exist across mostcountries (Schoen et al., 2005; Schoen et al., 2008)• Suboptimal medication use by patients is also evident,with adherence to medicines typically around 50%(Haynes et al., 2008)• Room for improvement
    • Rx for Change Database(www.rxforchange.ca)• Collaboration: CADTH/EPOC/CC&CG• Aim: Improve the quality of prescribing, medication useand healthcare delivery• Rx for Change: an evidence-based resourcewarehousing continually updated evidence on theeffectiveness of strategies and interventions designed toimprove drug prescribing and use (Weir et al., 2010)• Online• High quality reviews• Intervention summaries• Targets groups who are concerned with interventionsfor improved consumer and provider behaviour as itrelates to prescribing of medicines
    • Rx for Change feedback• Web analytics• Increase in site visits and time spent on site• Over 5 months (Jan 2011-May 2011) there were40,000 page views• Anecdotal evidence• Positive feedback from healthcare providers,researchers and policy makers about its usability,applicability and quality• But,• Request for more training, overwhelming, uncertain ifgetting the most out of the database, use for evidenceinformed decision making and policy development,online module not enough
    • Objectives:Develop, pilot and evaluate a trainingprogram to encourage use andunderstanding of Rx for ChangeEngage knowledge users in the developmentof the trainingDevelop a sense of provider vs consumerneedsKnowledge to Action Project
    •  Four Knowledge User Groups Canada (provider) Drug Evaluation Alliance of Nova Scotia (DEANS), partof the NS Ministry of Health, Canada Drug Use Optimization, (DUO), division of the BCMinistry of Health, Canada Australia (consumer) Australian National Prescribing Service (NPS),Australia Asthma Australia, AustraliaInternational collaboration
    • Phase I• Development of trainingbased on Knowledge Users’feedbackPhase II• Training ImplementationPhase III• Evaluation (pre/post trainingsurveys, key informant interviews,web analytics)
    • Phase I – Knowledge User (KU)Engagement Process•Organizationcontext•Size and structure•Identification ofinterviewparticipantsContact KU(grant appointedindividual fromthe organization)Key InformantInterviewsFinalizeTraining2nd round offeedback on trainingfrom knowledgeusers, refinementsDevelopTrainingInterview Guide•Questions•Practical ‘use thedatabase’ exercise
    • • Organizational information (programs, structure, decision-making context)• Past/present use of Rx for Change• Current role and use of evidence in general• Barriers and facilitators to Rx for Change Use• Local training needs for Rx for Change• Structure of Training for Rx for ChangeKey Informant Interview Guide
    • Interviews• N=3• One hour interviews• Transcribed verbatim• Simple content analysis for themes as related to thetraining
    • What we have learned so far…and what itmeans for the training*The importance of understanding the organizationalcontextGather more organization information, focus training onproblems/issues specific to the organization*Divergent views on what the training should look likeConsider different choices of training
    • What we have learned so far…and what itmeans for the training*Database is not user friendly, hard for non-researchers tonavigate, hard to understand the terms*Knowledge users are expecting the database to functionlike a Pubmed search, leads to a lack of trust andconfidence in the searchingFocus on navigation, terms, clarity and accuracy inbenefits of the database, what the database cannot ordoes not do
    • What we have learned so far…and what itmeans for the training*The nature of using evidence: Evidence needs to beconcise and directive. In general evidence is viewed asuseful but is not collected systematicallyConsider evidence as a piece of the necessaryinformation. Training needs to focus on projects specificto the users and on solving those issues
    • Proposed training (preliminary)• Multiple formats to choose from – range from 2-3 hourworkshop to a web-based quick training• Centered exclusively on key issues relevant to the groupand the solutions to those issues• Information on the nature of evidence/terms/navigationembedded into the locally relevant projects• Encourage a routine Rx for Change step for all projects
    • Lessons learned/challenges• Maintaining momentum and organizational consistencyin a longer term research endeavor• Complexity of context• The value of knowledge user engagement• Benefit of face-to-face information gathering• Who’s role is it to gather the evidence?
    •  Future plan to develop prototypicaltraining for a broader population Understanding consumer vs providerneeds Improving the database itself Guide our efforts for databases ofevidence summaries in generalSignificance of the Project
    • Thank youhcolquhoun@ohri.caHeather Colquhoun