Changing Practice: Implementation strategies
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Changing Practice: Implementation strategies



Evidence based summary of strategies for changing clinical practice

Evidence based summary of strategies for changing clinical practice



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    Changing Practice: Implementation strategies Changing Practice: Implementation strategies Presentation Transcript

    • CHANGING PRACTICE Evidence Based Implementation José Francisco García Gutiérrez Escuela Andaluza de Salud Pública PAHO HQ HSS/HRH
    • The Path Continuous Improvement Design & Evaluation Need Redesign Design Management Audit Implementation
    • NO MAGIC BULLETS ! All strategies are effective sometimes, but none is effective in all circumstances
    • Summary points
      • Systematic reviews of rigorous studies provide the best evidence on the effectiveness of different strategies to promote the implementation of research findings
      • Passive dissemination of information is generally ineffective
      • It seems necessary to use specific strategies to encourage implementation of research based recommendations and to ensure changes in practice
      • Further research on the relative effectiveness and efficiency of different strategies is required
      • Interventions to promote behavioural change among health professionals
      • Bero, Grilli Grimshaw et al (1998). British Medical Journal.
      • Bero, Grilli, Grimshaw and Oxman (1998). Cochrane Library .
    • Consistently effective interventions
      • Reminders (manual or computerised)
      • Multifaceted interventions (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing)
      • Interactive educational meetings (participation of healthcare providers in workshops that include discussion or practice)
    • Interventions of variable effectiveness
      • Audit and feedback (or any summary of clinical performance)
      • The use of local opinion leaders (practitioners identified by their colleagues as influential)
      • Local consensus processes (inclusion of participating practitioners in discussions to ensure that they agree that the chosen clinical problem is important and the approach to managing the problem is appropriate)
      • Patient mediated interventions (any intervention aimed at changing the performance of healthcare providers for which specific information was sought from or given to patients)
    • Interventions that have little or no effect
      • Educational materials (distribution of recommendations for clinical care, including clinical practice guidelines, audiovisual materials, and electronic publications)
      • Didactic educational meetings (such as lectures)
    • TRADITIONAL MODEL OF DISEMINATION Publication of information Target audience Changes in clinical practice
      • Problem identification (Presentation)
      • Evaluation of barriers (Diagnosis)
      • Intervention design (Prescription)
      • Behavioural change/
      • Quality improvement (Cure)
        • Objectives
        • Key messages
        • Target audience
        • Responsible person
        • Situation analysis
        • Core improvement indicators
        • DAFO: Identification of barriers & “ad hoc” interventions
        • Proposal for improvement interventions
        • Priorization
        • Context adaptation
    • FROM THEORY TO ACTION Three key questions
      • Setting up GOALS
      • What are we trying to achieve
      • Establishing INDICATORS
      • How we do know that a change is an improvement
      • Developing CHANGES
      • What interventions might help to achieve improvements