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

Thank you

hcolquhoun@ohri.ca

Heather Colquhoun