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PURPOSE We aimed to evaluate the effectiveness of a virtual community of practice (vCoP) in improving primary health care professionals' (HCPs') attitudes toward empowering patients with chronic disease. METHODS We conducted a cluster randomized controlled trial. Practices were units of randomization, and primary HCPs and patients were units of analysis. Sixty-three practices in Madrid, Catalonia, and the Canary Islands were randomly allocated to the intervention or control groups. Randominzation of practices was performed after HCP and patient recruitment. The patients and statistician were anonymized to group allocation; it was not possible to anonymize HCPs. The intervention was a 12-month multicomponent tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was Patient-Provider Orientation Scale (PPOS) score at baseline and at 12 months. The secondary outcome was the Patient Activation Measure (PAM) score. RESULTS A total of 321 HCPs and 1,921 patients were assessed. The intervention had a positive effect on PPOS total score (0.14 points higher in the vCoP arm; 95% CI, 0.03-0.25; P = .011) and the PPOS Sharing subscale (0.3 points higher in the vCoP arm; 95% CI, 0.150.44; P < .001). No effect was found for the PPOS Caring subscale, and no significant differences were found for PAM scores. CONCLUSIONS A vCoP led to a minor increase in the PPOS Sharing component and the total score but not in the Caring component. However, considerable uncertainty remains, given the observed attrition and other limitations of the study. Further research is needed on the effectiveness of the vCoP model and on how to improve HCP engagement. Key words: patient empowerment; chronic diseases; patient-centered care; virtual community of practice Ann Fam Med 2022;20:204-210. https://doi.org/10.1370/afm.2799, INTRODUCTION The high burden for health care systems that is associated with chronic care could be decreased by boosting patient empowerment. (1) Empowered patients take action to improve their quality [...]

A Core Measures Set (CMS) is an agreed standardized group of measures that should be assessed and reported in research for a specific condition or clinical area. This study undertook the development of a CMS for Patient Safety through a two-round, web-based Delphi consensus approach, in the context of the "Improving quality and patient SAFEty in surgical care through STandardisation and harmonization of perioperative care in Europe" (SAFEST) project—a collaborative, patient-centered and evidence-based European Union-funded project that aims to generate action-oriented evidence in perioperative care. We developed an Initial List of Measures via an umbrella review following the deployment of an e-Delphi method with an inclusive panel of experts to prioritize measures towards a consensualized Final List of Measures. All measures were rigorously assessed for both importance and feasibility. After the two rounds of the e-Delphi consensus method we observed 13 preoperative measures (40.6% of the initial number), 24 intraoperative measures (66.7%), 25 postoperative measures (20.3%) and 23 mixed period measures (41.1%) met consensus criteria for both importance and feasibility. Higher scores were detected in importance ratings compared to feasibility across all groups of measures. Importantly, numeric averages regarding pain-related measures differed in the assessment of patients when compared to that of Healthcare Professionals (HCPs). This work not only informs future SAFEST iterations but also sets a precedent for research into valid, patient-centered, and action-oriented perioperative safety measures. [ABSTRACT FROM AUTHOR]

Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings. [ABSTRACT FROM AUTHOR]

Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases are a leading cause of global morbidity and mortality. In response to this challenge, self-management interventions (SMIs) have emerged as an essential tool in improving patient outcomes. However, the diverse and complex nature of SMIs pose significant challenges in measuring their effectiveness. This work aims to investigate the comparative effectiveness of SMIs on Type 2 diabetes mellitus (T2DM) outcomes. Methods: A rigorous analytical framework was employed to assess the relative effectiveness of different SMIs, encompassing both pairwise and network meta-analysis (NMA), as well as component network meta-analysis (CNMA). Various outcomes were considered, including glycated hemoglobin (HbA1c) control, body mass index (BMI) reduction and low-density lipoprotein (LDL) cholesterol. Visualization tools were also utilized to enhance the interpretation of results. Results: SMIs were found promising in improving clinical outcomes and patient-reported measures. However, considerable heterogeneity and inconsistency across studies challenged the validity of NMA results. CNMA along with various visualization tools offered insights into the contributions of individual SMI components, highlighting the complexity of these interventions. Discussion/Conclusions: SMIs represent a valuable approach to managing chronic conditions, but their effectiveness is context-dependent. Further research is needed to elucidate the contextual factors influencing SMI outcomes. This work contributes to a comprehensive understanding of SMIs' role in T2DM management, aiming to aid decision-makers, clinicians, and patients in selecting tailored interventions. [ABSTRACT FROM AUTHOR]

This study, as part of the COMPAR-EU project, utilized a mixed-methods approach involving 37 individual, semi-structured interviews and one focus group with 7 participants to investigate the factors influencing the implementation and use of self-management interventions (SMIs) decision tools in clinical practice. The interviews and focus group discussions were guided by a tailored interview and focus group guideline developed based on the Tailored Implementation for Chronic Diseases (TICD) framework. The data were analyzed using a directed qualitative content analysis, with a deductive coding system based on the TICD framework and an inductive coding process. A rapid analysis technique was employed to summarize and synthesize the findings. The study identified five main dimensions and facilitators for implementation: decision tool factors, individual health professional factors, interaction factors, organizational factors, and social, political, and legal factors. The findings highlight the importance of structured implementation through SMI decision support tools, emphasizing the need to understand their benefits, secure organizational resources, and gain political support for sustainable implementation. Overall, this study employed a systematic approach, combining qualitative methods and comprehensive analysis, to gain insights into the factors influencing the implementation of SMIs' decision-support tools in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: It is widely recognized that providing healthcare may produce harm to the patient. Different approaches have been developed to measure the burden of adverse events (AEs) to plan and measure the effects of interventions. One of the most widely used instruments is the Trigger Tool, which has previously been modified to be used on various settings and translated into many languages. Multimorbidity complicates care and may increase the number of AEs patients experience. Currently there is no instrument designed to measure AEs in multimorbid patients. In Estonia, there is currently no validated instrument to measure the burden of AEs. Aims: The aim of this study will be evaluating the characteristics and ocurrence of AEs in multimorbid patients in hospitalised internal medicine patients of Estonia, and describes the development of a trigger tool for this purpose. Methods and analysis: We will search for the evidence on measuring AEs in the population of multimorbid patients focusing on trigger tools, and synthesize the data. Data collection of the triggers from the literature will be followed by translating triggers from English to Estonian. An expert multidisciplinary panel will select the suitable triggers for this population. Trigger tool will be pre-tested to assess agreement among professionals and usability of the tool. Validation will be done using 90 medical records. A cross-sectional study in internal medicine departments of two Estonian tertiary care hospitals will be performed to identify the frequency and characteristics of AEs in 960 medical records. We will also provide preventability potential and influencing factors. Dissemination: Results will be disseminated to healthcare providers and stakeholders at national and international conferences, and as a doctoral medical thesis. [ABSTRACT FROM AUTHOR]

Context: The literature on self‐management interventions (SMIs) is growing exponentially, but it is characterized by heterogeneous reporting that limits comparability across studies and interventions. Building an SMI taxonomy is the first step towards creating a common language for stakeholders to drive research in this area and promote patient self‐management and empowerment. Objective: To develop and validate the content of a comprehensive taxonomy of SMIs for long‐term conditions that will help identify key characteristics and facilitate design, reporting and comparisons of SMIs. Methods: We employed a mixed‐methods approach incorporating a literature review, an iterative consultation process and mapping of key domains, concepts and elements to develop an initial SMI taxonomy that was subsequently reviewed in a two‐round online Delphi survey with a purposive sample of international experts. Results: The final SMI taxonomy has 132 components classified into four domains: intervention characteristics, expected patient/caregiver self‐management behaviours, outcomes for measuring SMIs and target population characteristics. The two‐round Delphi exercise involving 27 international experts demonstrated overall high agreement with the proposed items, with a mean score (on a scale of 1‐9) per component of 8.0 (range 6.1‐8.8) in round 1 and 8.1 (range 7.0‐8.9) in round 2. Conclusions: The SMI taxonomy contributes to building a common framework for the patient self‐management field and can help implement and improve patient empowerment and facilitate comparative effectiveness research of SMIs. Patient or public contribution. Patients' representatives contributed as experts in the Delphi process and as partners of the consortium. [ABSTRACT FROM AUTHOR]

Abstract Background Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain. Methods/Design A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development. Discussion Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere.

Background: A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care. Methods: We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers' perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS. Results: From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness. Conclusion: The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients' preferences regarding COPD outcomes are more systematically included. [ABSTRACT FROM AUTHOR]

Background: In recent decades, many self‐report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person‐centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient‐Practitioner Orientation Scale (PPOS) using a sample of primary care health‐care professionals in Spain. Methods: Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item‐to‐scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2‐factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). Results: Low inter‐item correlations were observed, and the CFA 2‐factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10‐item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3‐factor structure. Participants showed a patient‐oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. Conclusion: Although the 2‐factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health‐care professionals overall show a patient‐oriented attitude, although less marked in issues such as patients' need for and management of medical information. [ABSTRACT FROM AUTHOR]

Introduction Population ageing and increasing chronic illness burden have sparked interest in innovative care models. While self-management interventions (SMIs) are drawing increasing attention, evidence of their efficacy is mostly based on pairwise meta-analysis, generally derived from randomised controlled trials comparing interventions versus a control or no intervention. As such, relevant efficacy data for comparisons among different SMIs that can be applied to specific chronic conditions are missing. Therefore, the relevance of the available evidence for decision-making at clinical, organisational and policy levels is limited. Aim To identify, compare and rank the most effective and cost-effective SMIs for adults with four high-priority chronic conditions: type 2 diabetes, obesity, chronic obstructive pulmonary disease, and heart failure. Methods and analysis All activities will be conducted as part of the cost-effectiveness of self-management interventions in four high-priority chronic conditions in Europe(COMPAR-EU, Comparing effectiveness of self-management interventions in 4 high priority chronic diseases inEurope) Project, an European Union (EU)-funded project designed to bridge the gap between current knowledge and practice on SMIs. In the first phase of the project, we will develop and validate a taxonomy, and a Core Outcome Set for each condition. These activities will inform a series of systematic review and network meta-analysis about the effectiveness of SMIs. We will also perform a cost-effectiveness analysis of the most effective SMIs and an evaluation of contextual factors. We will finally develop tailored decision-making tools for the different relevant stakeholders. Ethics and dissemination Ethical approval was obtained from the local ethics committee (University Institute for Primary Care Research - IDIAP Jordi Gol). All patients and other stakeholders will provide informed consent prior to participation. This project has been funded by the EU Horizon 2020 research and innovation programme (grant agreement no. 754936). Results will be of interest to relevant stakeholder groups (patients, professionals, managers, policymakers and industry), and will be disseminated in a tailored multi-pronged approach that will include deployment of an interactive platform. [ABSTRACT FROM AUTHOR]

Introduction: Virtual Communities of Practice (VCoP) have become a strategic approach for fostering learning and transferring knowledge among people with similar interests/common problems. VCoP allow informal and continuous training, especially valuable for people with a chronic disease. Main benefits may include information exchange, social support, improving skills to cope with the disease and manage stress. Moreover, social interaction itself boots a better mood and optimism, decreasing the sense of isolation. As a result, such integrated and tailored approach empowers people to co-manage their disease, developing self-care skills for daily life. Aims and Method: We aim to describe the implementation process of a co-designed VCoP to empower people with ischemic heart disease (IHD). This intervention is part of a randomized controlled trial performed in Catalonia, Madrid and Canary Islands, Spain. One hundred seventytwo patients with a recent diagnosis of IHD were actively recruited to participate in the intervention or control (usual care) group. In a previous co-designed phase, a Patient Journey Map created by people with a long IHD background showed experiences and empowerment needs, and the empodera2 VCoP content framework was created. Based on this background, a tailored educational intervention was designed on a gamified 2.0 platform following three stages: 1) on-boarding, 2) deep empowerment, 3) maintenance and consolidation of skills and behaviours. A workflow for contents' building was created regarding empowerment dimensions such as health literacy, shared decision making, self-management, social and family support. Key findings: Between June 2021 and December 2021, ninety-three participants were gradually included in the empodera2 VCoP. Fifty-four contents were added twice a week following the framework, user's knowledge gaps, needs and expectations detected on 452 users' comments. Seventy per cent of participants accessed the VCoP. Main topics focused on healthy eating, sports, stopping smoking, managing stress and negative emotions, facing habit's change, and getting back to a "normal" life. The moderator motivated participation and answered questions as appeared, backed up by a multidisciplinary team. Highlights: At the first stage, people seemed to interact more with contents than with other peers. To meet interest on interaction expressed by some participants, a series of virtual meetings were set up monthly during second stage. An average of 12 people attended the three meetings organized during 2021. Topics focused on experiences with IHD, difficulties regarding healthy diet, managing feelings and stress are interests to further work on the VCoP. Conclusion: An ongoing tailored educational intervention (VCoP) may better approach people needs and priorities regarding IHD. The combination of previous co-produced content, partnership with professionals, and the ongoing co-creation of the intervention seem to be a key element in engaging and maintaining an active learning context and improving the community experience for different types of users (readers vs active participants). Implications for applicability, sustainability, and limitations: A minimum digital literacy requirement is needed to participate in VCoPs, followed by an updated platform that facilitates interactions among participants. Intervention is still taking place, so further research will be done considering VCoP progress, users' satisfaction, clinical and psychological impact and values. [ABSTRACT FROM AUTHOR]

Background: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases.Methods: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice.Discussion: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases.Trial Registration: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016. [ABSTRACT FROM AUTHOR]

Introduction In past years, the urgency of putting people in the centre of health care research has clearly been established in the public discourse. However, the depth of patient inclusion is still limited. In our COMPAR-EU project (Horizon 2020) we aim to move forward by investigating effectiveness of self-management interventions (SMIs) through the lens of the patients themselves. We do so developing of core outcome sets (COS) for SMIs for adults living with type 2 diabetes, obesity, heart failure or COPD. We now go one step further by reviewing if and how the RCTs on SMIs are reporting on those outcomes, with a focus on which patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) are being used. Methods After developing our COS we searched Pubmed, Embase, Cinahl, PsycINFO and Cochrane for RCTs on SMIs for people of 18 years and older living with TYPE 2 DIABETES, COPD, HEART FAILURE and Obesity. Articles and abstracts were screened by two independent reviewers and information extracted for, among other, outcomes (guided by the four COSs) and the PREM and PROM instruments used. We analysed whether all outcomes included in our COS were measured in the literature and the variability and concentration in the use of specific PREMs and PROMs for each outcome and disease. Results PREMs and PROMs where both highlighted by patients as being important. For type 2 diabetes we reviewed 697 RCTs on SMIs, which used PROMs for 17 of the 23 outcomes in our COS (some were not susceptible to be measured by PROM/PREM or they were not reported in the literature). For obesity, we reviewed 517 RCTs on SMIs, which used PROMs for the 10 of the 15 outcomes included in our COS. For heart failure we reviewed 288 RCTs on SMIs, which used PROMs for the 19 outcomes in our COS. For COPD we reviewed 252 RCTs on SMIs, which used PROMs for the 10 outcomes in our COS. PREMs were less used in the literature. Discussions Our research confirms that the use of PROMs, is extensive, but some outcomes relevant to patients are still not regularly included in effectiveness research, specially those related to experiences of care (PREMs). Conclusions There are significant advances in the use of PROMs, the use of PREMs is still more limited in selfmanagement research. Lessons learned The way in which research measures effectiveness often is mismatched with patient preferences. Our COMPAR-EU COS for type 2 diabetes, obesity, heart failure and COPD, and literature review can help align research with patient preferences. Limitations As any literature review, ours could face limitations in search and extraction and our participatory process due to the small sample of patient and other stakeholders. Several mitigation strategies have been applied. Suggestions for future research We suggest expanding the measure of the relevant outcomes to patients in effectiveness research, and the specific PREM and PROM instruments to do so, therefore facilitating comparability. [ABSTRACT FROM AUTHOR]

Background: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providersand policy-makers in improving hospital discharge. Methods: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance. Results: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, wellcoordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change. Conclusions: This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines (CGs) are popular for healthcare decision making but their acceptability and use by healthcare providers is influenced by numerous factors. Some of these factors are professional-related, such as knowledge and perceptions of and attitudes toward CGs in general. The aim of our study was to evaluate attitudes and perceptions of Spanish physicians towards CGs. Methods: We coordinated six discussion groups with a total of 46 physicians. The participants were drawn from 12 medical specialties from both specialized and primary care. We recorded the sessions and transcribed the content verbatim. We analyzed the data using an approach based on the grounded theory. Results: We identified two main constructs that defined the physicians' perceptions towards guidelines: knowledge and usefulness. “Knowledge” defined the theoretical meanings of guidelines, while “Usefulness” referred to the pragmatic approach to guidelines. These constructs were interrelated through a series of categories such as confidence, usability, accessibility, dissemination and formats. Conclusions: In our study, the constructs that impacted most on physician's attitudes to clinical guidelines were knowledge and usefulness. The tension between the theoretical and the pragmatic constructs determined the attitudes and how physicians use guidelines. Groups developing guidelines should ask relevant clinical questions and develop implementable and context specific recommendations. Developers should be explicit and consistent in the development and presentation of recommendations. [ABSTRACT FROM AUTHOR]

Background: Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. Objective: To explore handover practices at discharge and to focus on the patients' role in handovers and on the potential additional risks for vulnerable patients. Methods: We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. Results: We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. Conclusions: Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain. Methods/Design: A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development. Discussion: Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere. [ABSTRACT FROM AUTHOR]

Background: Person-centred care can have a big impact on the quality of care. Reviews of research about this topic found that offering care in a more person-centred way usually improves outcomes. Some of the most common ways that have shown to improve person-centred care include helping people learn more about their conditions, prompting people to be more engaged in health consultations and training professionals to facilitate care that empowers people to take part. REDISSEC, the Spanish Research Network on Health Services Research, is shedding light on how to incorporate the perspective of the patient in the different phases of the development of interventions to enhance the empowerment of patients with chronic disease, and how to develop a proof of concept of personalized interventions that includes the coordination of different levels of care and the feasibility of its integration into routine clinical practice. Aims and Objectives: The workshop will cover three objectives: 1- Exemplifying, with a number of case studies, the importance of patients' engagement to improve chronic care and patients' outcomes. 2- Discussing facilitators and barriers when engaging people in screening and treatment decisions. 3- Raising the current and future challenges when involving patients to develop personalised interventions and for generating meaningful evidence from their perspective. Methodology: This workshop will be composed of four presentations: "Engaging women in breast cancer screening decisions: a proof of concept of personalized screening in a shared decision-making context" The study objective is to develop a proof of concept of personalized screening that includes the coordination of the levels of care and the population-screening program, as well as the feasibility of its integration into routine clinical practice. We will present the study protocol and the results of a pilot study. "Health-related Preferences of Older Patients with Multimorbidity: An Evidence Map How do elderly multimorbid patients prioritize diseases and treatment options?" Exploring the existing body of evidence to identify clusters and gaps. "Enabling professionals to empower patients. Results from a c-RCT of: virtual community of practice on patient empowerment for professionals in primary care" One of the key barriers to the expansion of patient empowerment practices is the professionals' training and attitudes. The e-MPODERA project aims to address this barrier through a virtual community of practice on patient empowerment for professionals in primary care. We will present the quantitative and qualitative results of the e-MPODERA study (cluster randomised control trial), and we will share the advances of the scaling-up of the intervention. "Generating meaningful evidence for patients and measuring what matters to people: Focus on patients priorities". The aim is to present how to incorporate the perspective of the patient in the different phases of the development of interventions, to enhance the empowerment of patients with chronic diseases (i.e., development of decision aids for shared decision-making), in order to identify the outcome measures and aspects that are most important for patients (offering some examples with our previous experiences in processes of co-creation/co-design of interventions). [ABSTRACT FROM AUTHOR]

Background: The ever increasing complexity of health care paired with the increasing proportion of chronic patients and other factors are clearly exacerbating the need for an all round well coordinated health (and social) system. This need for better integration of services has long sparked the interest for health system research and in the last 15 years this area has expanded and it now includes the increasingly active role of the patients, the field of patient empowerment. Although it has been strongly developed for over a decade now, it is still far from being consistent in terms of conceptualisations, categorisations and analysis. The results from the EMPATHiE project, by conducting a through review of systematic reviews analysing patient empowerment interventions targeting chronic conditions, aims to provide an overview of the field and advance in our common understanding of the role the patients as active players can have in the future developments of an integrated health (and social) systems. Objectives: To identify the effective empowerment interventions targeting chronic patients (chronic respiratory diseases (COPD or Asthma); chronic cardiovascular diseases; diabetes mellitus (type 1 and 2); severe mental illness (schizophrenia or chronic depression); complex patients (multi-morbidity) or health or social professionals working with the described chronic patients). Also we aimed to describe main contextual factors that help or hinder their implementation. Methods: Overview of systematic reviews (SR) of empowerment interventions for patients with chronic conditions from 2000 to 2013 was conducted for EMPATHIE (EU Project on Patient empowerment). Selected articles were extracted collecting intervention characteristics, outcome measures and scientific quality (AMSTAR). The effectiveness of the interventions was measured in terms of patient empowerment related measures, clinical outcomes, quality of life measures and use of health services. The success and failure factors were identified with a mixed methodology: results from meta-analysis and subgroup analysis and qualitative review of the conclusions of the SR's authors. The interventions and identified factors are categorized by type of intervention, targeted condition, and level of evidence. Results: The search identified 101 SRs of interest (corresponding to more than 2300 individual studies) A descriptive analysis detected that most of the interventions reported in the studies were addressed to patients at micro or meso level. A predominance of interventions targeted diabetic patients (28.7% of SRs), followed at a distance by interventions targeting chronic respiratory conditions (25.7%), cardiovascular (12.9%), mental health conditions (10.9%) and just 1% specifically targeting complex patients. Within a general positive tendency (when compared to usual clinical centred care) some specific interventions emerge as the most effective: self-management support interventions across all conditions and different formats of patient education for diabetic patients. Recent innovative practices (such as virtual interactive platforms and tele-monitoring through smartphones) present a positive tendency, mainly in diabetes and cardiovascular conditions. Finally, systemic changes regarding the model of care (such as the chronic care model), seem to yield positive results. Similar interventions report different levels of effectiveness, which can be partially explained by multiple factors such as targeted condition, specific components of the intervention, patient and provider characteristics, contextual factors and outcome measures used. The study of the effect appears to indicate that, to a significant degree, success and failure factors are related to the targeted behaviour, which in turn is mediated, by the type of condition in which it is applied. Conclusion: Interventions targeting patient empowerment tend to present positive results in several types of outcomes. Self-management support interventions and some type of patient education formats presented the most conclusive evidence in their effectiveness. Recent innovative practices (as IT based platforms) present a positive tendency but still need further research particularly regarding the ideal combination between more traditional care and these innovative practices. Practical implications for policy and clinical organization will be discussed during the presentation. Stronger evaluative work on effectiveness of meso and macro level initiatives of patient empowerment is needed. Overall patient empowerment has opened a promising avenue towards healthcare (and social) integration. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain.Methods/design: A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development.Discussion: Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere. [ABSTRACT FROM AUTHOR]

Introduction: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported., Aim: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events., Methods: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices., Discussion: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Valli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions., Methods and Analysis: People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community., Ethics and Dissemination: The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences., Trial Registration Number: NCT06046326., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)