Post on 05-Dec-2014
description
Engaging knowledge
users in improving
evidence-based
prescribing
2013 CADTH Symposium: Evidence in Context
Heather Colquhoun, CIHR and KT Canada Postdoctoral FellowClinical Epidemiology Program
Ottawa Hospital Research Institute
Centre for Practice Changing Research
Project Team
Jeremy Grimshaw, Ottawa Hospital Research Institute (OHRI)
Heather Colquhoun, OHRI
Effie Helis, OHRI
Al Mayhew, OHRI
Julia Worswick, OHRI
Katrina Sullivan, OHRI
Denis Bélanger, CADTH
Sophie Hill, La Trobe, Australia
Dianne Lowe, La Trobe
Michael Taylor, La Trobe
4 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 in promoting and implementing the appropriate use of medications
Substantial collection of literature describing best practices for prescribing
The adoption of best practices typically requires significant effort
Background
• Significant documented inadequacies in prescribing
practices and medication errors exist across most
countries (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 use and healthcare delivery
• Rx for Change: an evidence-based resource warehousing continually updated evidence on the effectiveness of strategies and interventions designed to improve drug prescribing and use (Weir et al., 2010)
• Online
• High quality reviews
• Intervention summaries
• Targets groups who are concerned with interventions for improved consumer and provider behaviour as it relates 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 were
40,000 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 if
getting the most out of the database, use for evidence
informed decision making and policy development,
online module not enough
Objectives:Develop, pilot and evaluate a training program to encourage use and understanding of Rx for Change
Engage knowledge users in the development of the training
Develop a sense of provider vs consumer needs
Knowledge to Action Project
Four Knowledge User Groups
Canada (provider) Drug Evaluation Alliance of Nova Scotia (DEANS), part
of the NS Ministry of Health, Canada
Drug Use Optimization, (DUO), division of the BC Ministry of Health, Canada
Australia (consumer) Australian National Prescribing Service (NPS),
Australia
Asthma Australia, Australia
International collaboration
Phase I
• Development of training based on Knowledge Users’ feedback
Phase II• Training Implementation
Phase III
• Evaluation (pre/post training surveys, key informant interviews, web analytics)
Phase I – Knowledge User (KU)
Engagement Process
•Organization
context
•Size and structure
•Identification of
interview
participants
Contact KU
(grant appointed
individual from
the organization)
Key Informant
InterviewsFinalize
Training
2nd round of
feedback on training
from knowledge
users, refinements
Develop
Training
Interview Guide
•Questions
•Practical ‘use the
database’ 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 Change
Key Informant Interview Guide
Interviews
• N=3
• One hour interviews
• Transcribed verbatim
• Simple content analysis for themes as related to the
training
What we have learned so far…and what it
means for the training
*The importance of understanding the organizational
context
Gather more organization information, focus training on
problems/issues specific to the organization
*Divergent views on what the training should look like
Consider different choices of training
What we have learned so far…and what it
means for the training
*Database is not user friendly, hard for non-researchers to
navigate, hard to understand the terms
*Knowledge users are expecting the database to function
like a Pubmed search, leads to a lack of trust and
confidence in the searching
Focus on navigation, terms, clarity and accuracy in
benefits of the database, what the database cannot or
does not do
What we have learned so far…and what it
means for the training
*The nature of using evidence: Evidence needs to be
concise and directive. In general evidence is viewed as
useful but is not collected systematically
Consider evidence as a piece of the necessary
information. Training needs to focus on projects specific
to the users and on solving those issues
Proposed training (preliminary)
• Multiple formats to choose from – range from 2-3 hour
workshop to a web-based quick training
• Centered exclusively on key issues relevant to the group
and the solutions to those issues
• Information on the nature of evidence/terms/navigation
embedded into the locally relevant projects
• Encourage a routine Rx for Change step for all projects
Lessons learned/challenges
• Maintaining momentum and organizational consistency
in 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 prototypical training for a broader population
Understanding consumer vs provider needs
Improving the database itself
Guide our efforts for databases of evidence summaries in general
Significance of the Project