Changing Practice: Implementation strategies

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Evidence based summary of strategies for changing clinical practice

Evidence based summary of strategies for changing clinical practice

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  • 1. CHANGING PRACTICE Evidence Based Implementation José Francisco García Gutiérrez Escuela Andaluza de Salud Pública PAHO HQ HSS/HRH
  • 2. The Path Continuous Improvement Design & Evaluation Need Redesign Design Management Audit Implementation
  • 3.  
  • 4. NO MAGIC BULLETS ! All strategies are effective sometimes, but none is effective in all circumstances
  • 5. 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
  • 6.
    • 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 .
  • 7. 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)
  • 8. 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)
  • 9. 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)
  • 10.  
  • 11. TRADITIONAL MODEL OF DISEMINATION Publication of information Target audience Changes in clinical practice
  • 12. DESIGN OF INTERVENTIONS
    • Problem identification (Presentation)
    • Evaluation of barriers (Diagnosis)
    • Intervention design (Prescription)
    • Behavioural change/
    • Quality improvement (Cure)
  • 13. IMPLEMENTATION PLAN
      • 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
  • 14. 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
  • 15.  
  • 16.