18 results on '"van Achterberg, Theo"'
Search Results
2. A myriad of factors influencing the implementation of transitional care innovations: a scoping review
- Author
-
Fakha, Amal, Groenvynck, Lindsay, de Boer, Bram, van Achterberg, Theo, Hamers, Jan, and Verbeek, Hilde
- Published
- 2021
- Full Text
- View/download PDF
3. An inductive exploration of the implementation knowledge of research funders
- Author
-
Brantnell, Anders, Baraldi, Enrico, and van Achterberg, Theo
- Published
- 2019
- Full Text
- View/download PDF
4. Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals.
- Author
-
Van Grootven, Bastiaan, Irusta, Lucia Alvarez, Christiaens, Wendy, Mistiaen, Patriek, De Meester, Christophe, Cornelis, Justien, Dierckx de Casterlé, Bernadette, Van Durme, Thérèse, and van Achterberg, Theo
- Subjects
GENERAL practitioners ,MEDICAL quality control ,EVALUATION of medical care ,COVID-19 ,FOCUS groups ,HEALTH services accessibility ,RESEARCH methodology ,HEALTH status indicators ,INTERVIEWING ,HUMAN services programs ,EXPERIENCE ,PATIENT psychology ,QUALITATIVE research ,CONTINUUM of care ,PSYCHOSOCIAL factors ,DESCRIPTIVE statistics ,RESEARCH funding ,INTERPERSONAL relations ,DATA analysis software ,THEMATIC analysis ,CONTENT analysis ,TELEMEDICINE ,MEDICAL needs assessment - Abstract
Introduction: This study investigated how patients with COVID‐19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges. Design: A qualitative research approach was adopted, including focus group discussions and semi‐structured interviews. Methods: Four different groups of participants were interviewed, that is, patients (n = 17), TM teams (n = 27), GPs (n = 16), and primary care nurses (n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis. Results: All participants agreed that RPM‐reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow‐up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID‐19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM. Conclusion: Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low. Clinical relevance: Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID‐19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging logistics within projects, lack of data integration and communication, and a lack of an overarching guiding framework. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden
- Author
-
Brantnell, Anders, Woodford, Joanne, Baraldi, Enrico, van Achterberg, Theo, and von Essen, Louise
- Subjects
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,Male ,self-management ,Decision Making ,lcsh:Computer applications to medicine. Medical informatics ,primary care ,barriers and facilitators ,Surveys and Questionnaires ,Humans ,implementation ,Applied Psychology ,internet-administered CBT ,Sweden ,Original Paper ,Cognitive Behavioral Therapy ,Primary Health Care ,Depression ,lcsh:Public aspects of medicine ,lcsh:RA1-1270 ,Health Care Service and Management, Health Policy and Services and Health Economy ,decision-making ,Tillämpad psykologi ,Anxiety Disorders ,lcsh:R858-859.7 ,eHealth ,Female ,mental health ,Internet-Based Intervention - Abstract
BACKGROUND: Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. OBJECTIVE: The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers' (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). METHODS: An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. RESULTS: The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P
- Published
- 2020
6. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study
- Author
-
Geense Wytske W, van de Glind Irene M, Visscher Tommy LS, and van Achterberg Theo
- Subjects
Life styles ,Family practice ,Family nursing ,Implementation ,Qualitative study ,Attitude ,Medicine (General) ,R5-920 - Abstract
Abstract Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
- Published
- 2013
- Full Text
- View/download PDF
7. The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly
- Author
-
Ruikes Franca GH, Meys Antoinette RM, van de Wetering Gijs, Akkermans Reinier P, van Gaal Betsie GI, Zuidema Sytse U, Schers Henk J, van Achterberg Theo, and Koopmans Raymond TCM
- Subjects
Frail elderly ,Complex intervention ,Integrated care ,Functional status ,Cost-effectiveness ,Implementation ,Process evaluation ,Primary care ,Medicine (General) ,R5-920 - Abstract
Abstract Background With increasing age and longevity, the rising number of frail elders with complex and numerous health-related needs demands a coordinated health care delivery system integrating cure, care and welfare. Studies on the effectiveness of such comprehensive chronic care models targeting frail elders show inconclusive results. The CareWell-primary care program is a complex intervention targeting community-dwelling frail elderly people, that aims to prevent functional decline, improve quality of life, and reduce or postpone hospital and nursing home admissions of community dwelling frail elderly. Methods/design The CareWell-primary care study includes a (cost-) effectiveness study and a comprehensive process evaluation. In a one-year pragmatic, cluster controlled trial, six general practices are non-randomly recruited to adopt the CareWell-primary care program and six control practices will deliver ‘care as usual’. Each practice includes a random sample of fifty frail elders aged 70 years or above in the cost-effectiveness study. A sample of patients and informal caregivers and all health care professionals participating in the CareWell-primary care program are included in the process evaluation. In the cost-effectiveness study, the primary outcome is the level of functional abilities as measured with the Katz-15 index. Hierarchical mixed-effects regression models / multilevel modeling approach will be used, since the study participants are nested within the general practices. Furthermore, incremental cost-effectiveness ratios will be calculated as costs per QALY gained and as costs weighed against functional abilities. In the process evaluation, mixed methods will be used to provide insight in the implementation degree of the program, patients’ and professionals’ approval of the program, and the barriers and facilitators to implementation. Discussion The CareWell-primary care study will provide new insights into the (cost-) effectiveness, feasibility, and barriers and facilitators for implementation of this complex intervention in primary care. Trial registration The CareWell-primary care study is registered in the ClinicalTrials.gov Protocol Registration System: NCT01499797
- Published
- 2012
- Full Text
- View/download PDF
8. Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study
- Author
-
van de Glind Irene M, Heinen Maud M, Evers Andrea W, Wensing Michel, and van Achterberg Theo
- Subjects
Lifestyle ,Varicose ulcer ,Venous leg ulcers ,Implementation ,Case study ,Medicine (General) ,R5-920 - Abstract
Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer care is often fragmented, indicating that quality improvement is needed.
- Published
- 2012
- Full Text
- View/download PDF
9. Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation
- Author
-
Robben Sarah HM, Perry Marieke, Huisjes Mirjam, van Nieuwenhuijzen Leontien, Schers Henk J, van Weel Chris, Rikkert Marcel GM Olde, van Achterberg Theo, Heinen Maud M, and Melis René JF
- Subjects
E-health ,Implementation ,Process evaluation ,Frail older people ,Primary care ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved. Methods Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12). Results 290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP. Conclusions This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.
- Published
- 2012
- Full Text
- View/download PDF
10. Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study
- Author
-
Janssen, Maaike AP, van Achterberg, Theo, Adriaansen, Marian JM, Kampshoff, Caroline S, Schalk, Donna MJ, and Mintjes-de Groot, Joke
- Subjects
clinical guideline ,emergency department ,nursing ,implementation strategies ,influencing factors ,implementation ,triage ,nurses - Abstract
AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline. BACKGROUND: Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline. METHODS: This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors. RESULTS: Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested. CONCLUSION: Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department. RELEVANCE TO CLINICAL PRACTICE: Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation. ispartof: Journal of Clinical Nursing vol:21 issue:3 pages:437-447 ispartof: location:England status: published
- Published
- 2012
11. Exploring the Range of Lifestyle Interventions Used in Dutch Health Care Practice.
- Author
-
van de Glind, Irene M., Heinen, Maud M., Geense, Wytske W., Mesters, Ilse, Wensing, Michel, and van Achterberg, Theo
- Subjects
BEHAVIOR modification ,CLINICS ,COUNSELING ,ALCOHOL drinking ,HEALTH behavior ,HEALTH promotion ,INTERVIEWING ,MEDICAL personnel ,MEDICAL referrals ,NUTRITION ,SMOKING cessation ,WEIGHT loss ,EVIDENCE-based medicine ,PHYSICAL activity - Abstract
Background. The application of evidence-based lifestyle interventions is suboptimal, but little is known what interventions are actually used. This study aimed to explore the range of lifestyle interventions used in Dutch ambulatory health care settings. Method. We conducted interviews (n = 67) in purposefully selected hospitals, general practices, and community care organizations. Interviews focused on identifying activities to help patients stop smoking, reduce alcohol consumption, increase physical activity, eat a healthy diet, and lose weight. We also asked who developed the interventions. All reported activities were registered and analyzed. Results. Four categories of health promotion activities emerged: giving advice, making referrals, offering counseling, and providing lifestyle interventions organized separately from the care process. In total, 102 lifestyle interventions were reported. Forty-five interventions were developed by researchers, of which 30 were developed by the Dutch Expert Center on Tobacco Control. Providers did not know the source of 31 interventions. Eighteen interventions were developed by the providers themselves, and eight were based on evidence-based guidelines. Conclusions. Health promotion activities seemed to be widely present in Dutch health care, in particular smoking cessation interventions. Although health care providers use many different interventions, replacing nontested for evidence-based interventions is required. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
12. Improvement of care for ICU patients with delirium by early screening and treatment: study protocol of iDECePTIvE study.
- Author
-
Ista, Erwin, Trogrlic, Zoran, Bakker, Jan, Osse, Robert Jan, van Achterberg, Theo, and van der Jagt, Mathieu
- Subjects
INTENSIVE care patients ,CRITICALLY ill ,DELIRIUM ,HEALTH outcome assessment ,MEDICAL screening ,DISEASE management ,THERAPEUTICS ,MEDICAL care - Abstract
Background Delirium in critically ill patients has a strong adverse impact on prognosis. In spite of its recognized importance, however, delirium screening and treatment procedures are often not in accordance with current guidelines. This implementation study is designed to assess barriers and facilitators for guideline adherence and next to develop a multifaceted tailored implementation strategy. Effects of this strategy on guideline adherence as well as important clinical outcomes will be described. Methods Current practices and guideline deviations will be assessed in a prospective baseline measurement. Barriers and facilitators will be identified from a survey among intensive care health care professionals (intensivists and nurses) and focus group interviews with selected health care professionals (n = 60). Findings will serve as a foundation for a tailored guideline implementation strategy. Adherence to the guideline and effects of the implementation strategies on relevant clinical outcomes will be piloted in a before-after study in six intensive care units (ICUs) in the southwest Netherlands. The primary outcomes are adherence to screening and treatment in line with the Dutch ICU delirium guideline. Secondary outcomes are process measures (e.g. attendance to training and knowledge) and clinical outcomes (e.g. incidence of delirium, hospital-mortality changes, and length of stay). Primary and secondary outcome data will be collected at four time points including at least 460 patients. Furthermore, a process evaluation will be done, including an economical evaluation. Discussion Little is known on effective implementation of delirium management in the critically ill. The proposed multifaceted implementation strategy is expected to improve process measures such as screening adherence in line with the guideline and may improve clinical outcomes, such as mortality and length of stay. This ICU Delirium in Clinical Practice Implementation Evaluation study (iDECePTIvE-study) will generate important knowledge for ICU health care providers on how to improve their clinical practice to establish optimum care for delirious patients. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
13. Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial.
- Author
-
Huis, Anita, Holleman, Gerda, van Achterberg, Theo, Grol, Richard, Schoonhoven, Lisette, and Hulscher, Marlies
- Subjects
HAND care & hygiene ,HEALTH promotion ,NURSES ,HEALTH education ,HOSPITAL personnel ,SOCIAL influence ,LEADERSHIP - Abstract
Background: There is only limited understanding of why hand hygiene improvement strategies are successful or fail. It is therefore important to look inside the 'black box' of such strategies, to ascertain which components of a strategy work well or less well. This study examined which components of two hand hygiene improvement strategies were associated with increased nurses' hand hygiene compliance. Methods: A process evaluation of a cluster randomised controlled trial was conducted in which part of the nursing wards of three hospitals in the Netherlands received a state-of-the-art strategy, including education, reminders, feedback, and optimising materials and facilities; another part received a team and leaders-directed strategy that included all elements of the state-of-the-art strategy, supplemented with activities aimed at the social and enhancing leadership. This process evaluation used four sets of measures: effects on nurses' hand hygiene compliance, adherence to the improvement strategies, contextual factors, and nurses' experiences with strategy components. Analyses of variance and multiple regression analyses were used to explore changes in nurses' hand hygiene compliance and thereby better understand trial effects. Results: Both strategies were performed with good adherence to protocol. Two contextual factors were associated with changes in hand hygiene compliance: a hospital effect in long term (p < 0.05), and high hand hygiene baseline scores were associated with smaller effects (p < 0.01). In short term, changes in nurses' hand hygiene compliance were positively correlated with experienced feedback about their hand hygiene performance (p < 0.05). In the long run, several items of the components 'social influence' (i.e., addressing each other on undesirable hand hygiene behaviour p < 0.01), and 'leadership' (i.e., ward manager holds team members accountable for hand hygiene performance p < 0.01) correlated positively with changes in nurses' hand hygiene compliance. Conclusion: This study illustrates the use of a process evaluation to uncover mechanisms underlying change in hand hygiene improvement strategies. Our study results demonstrate the added value of specific aspects of social influence and leadership in hand hygiene improvement strategies, thus offering an interpretation of the trial effects. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
14. Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation.
- Author
-
M. Robben, Sarah H., Perry, Marieke, Huisjes, Mirjam, van Nieuwenhuijzen, Leontien, Schers, Henk J., van Weel, Chris, M. Olde Rikkert, Marcel G., van Achterberg, Theo, Heinen, Maud M., and F. Melis, René J.
- Subjects
CAREGIVERS ,MEDICAL care ,PRIMARY care ,ELDER care ,CONTINUUM of care - Abstract
Background: Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved. Methods: Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12). Results: 290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people's exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP. Conclusions: This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
15. Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review.
- Author
-
Ista, Erwin, van Dijk, Monique, and van Achterberg, Theo
- Subjects
- *
RESEARCH methodology evaluation , *CINAHL database , *LEGAL compliance , *HOSPITAL patients , *HOSPITALS , *INFORMATION storage & retrieval systems , *MEDICAL databases , *MEDICAL information storage & retrieval systems , *MEDLINE , *ONLINE information services , *PROFESSIONS , *RESEARCH funding , *SYSTEMATIC reviews , *PAIN measurement , *DESCRIPTIVE statistics - Abstract
Objectives: Pain assessment and reassessment is an essential part of the treatment of hospitalised patients and must be integrated in pain management protocols. Yet nurses' adherence to pain assessment recommendations is problematic. We sought to review the comparative evidence for implementation strategies aiming to improve nurses' adherence to pain assessment recommendations in hospitalised patients. Design: Systematic review using the narrative method. Data sources: PubMed (MEDLINE), CINAHL, Cochrane library and hand searching. Review methods: Studies published since 1990, reporting implementation strategies that aimed to improve nurses' adherence to pain assessment recommendations in hospitalised patients were included. According to the Cochrane Effective Practice and Organization of Care group (EPOC) classification system, strategies were categorized as directed at: health professionals, organizations, financing, or regulations. Given the heterogeneity in strategies, samples, outcomes and settings, evidence from the studies was synthesized using a narrative approach. Results: From 743 initial citations, 23 studies were included. They reported a variety of implementation strategies, but only directed at health professionals and/or organizations. In seven studies, a single strategy was applied (e.g. education or feedback). The remaining 16 studies used multifaceted approaches. The effectiveness of the implementation strategies varied. In all studies but one, adherence rates had improved after implementation compared to the before measurement, by 9% up to 49%. These effects were measured at different time points after completion of the implementation, ranging from 2 weeks to 6 months. Half of the reviewed studies reported an adherence rate of 80% or higher after implementation activities; other reported rates ranging from 24 to 80%. In two controlled studies the adherence to pain assessment recommendations increased significantly when feedback was provided compared to no feedback. Sustained effects were reported in three studies. Conclusions: Based on this systematic review we conclude that implementation strategies to improve nurses' adherence to pain assessment recommendations vary but generally address professionals and organizational aspects. Educational and feedback strategies are often used and seem largely effective. Due to the heterogeneity of the implementation strategies it is not possible to recommend one preferred strategy. The level of evidence for strategies to improve pain assessment recommendations is limited however, as well-conducted studies are lacking. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
16. Cost-effectiveness of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: A cluster randomised trial.
- Author
-
Huis, Anita, Hulscher, Marlies, Adang, Eddy, Grol, Richard, van Achterberg, Theo, and Schoonhoven, Lisette
- Subjects
- *
CROSS infection prevention , *PREVENTION of communicable diseases , *LEGAL compliance , *CONFIDENCE intervals , *COST effectiveness , *DISINFECTION & disinfectants , *HAND washing , *HOSPITAL wards , *SCIENTIFIC observation , *PROFESSIONS , *RESEARCH funding , *TIME , *RANDOMIZED controlled trials , *DESCRIPTIVE statistics , *HOSPITAL nursing staff - Abstract
Background: Many strategies have been designed and evaluated to address poor hand hygiene compliance. Unfortunately, well-designed economic evaluations of hand hygiene improvement strategies are lacking. Objective: To compare the cost-effectiveness of two successful implementation strategies for improving nurses' hand hygiene compliance and reducing hospital acquired infections (HAI's). Design and setting: A cost-effectiveness analysis alongside a cluster randomised controlled trial was conducted in 67 nursing wards of three hospitals in the Netherlands. The evaluation used a hospital perspective. Participants: All affiliated nurses of the nursing wards. Wards were randomly assigned to either the control group (n = 30) or the experimental group (n = 37). Methods: The control group received a state-of-the-art strategy including education, reminders feedback and optimising materials and facilities. The experimental group received a team and leaders-directed strategy which included all elements of the state-ofthe- art strategy supplemented with interventions aimed at the social context of teams and enhancing leadership. The most efficient implementation strategy was determined by the incremental costeffectiveness ratio per extra percentage of hand hygiene compliance gained and the incremental cost-effectiveness ratio per additional percentage reduction in the HAI rate. Bootstrap methods were used to determine confidence intervals for these incremental cost-effectiveness ratio's. Two scenarios of 15 and 30% were used to express the association between increased hand hygiene compliance and the reduction in HAIs. Results: The team and leaders-directed strategy was significantly more effective in improving hand hygiene compliance. The mean difference effect was 8.91% (95% CI, 0.75-17.06). This extra increase was achieved at an average cost of €5497 per ward. The incremental cost per extra percentage of hand hygiene gained on ward level was €622. The incremental cost per additional percentage reduction in the HAI rate on ward level was €2074 (30% scenario) and €4125 (15% scenario). Within the 30% scenario, there is a probability of 90% that the team and leaders-directed strategy is cost-effective and within the 15% scenario, there is a probability of 70% that the team and leaders-directed strategy is cost-effective. Conclusions: Optimising hand hygiene compliance through a team and leaders-directed strategy is cost-effective as compared to a state-of-the-art strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
17. The SAFE or SORRY? programme. Part II: Effect on preventive care
- Author
-
van Gaal, Betsie G.I., Schoonhoven, Lisette, Mintjes, Joke A.J., Borm, George F., Koopmans, Raymond T.C.M., and van Achterberg, Theo
- Subjects
- *
BEDSORES prevention , *ACCIDENTAL fall prevention , *PREVENTION of medical errors , *URINARY tract infection prevention , *URINARY tract infections , *RISK factors of falling down , *ANALYSIS of variance , *CLINICAL trials , *CONFIDENCE intervals , *HOSPITAL wards , *MEDICAL protocols , *MEDICAL records , *NURSING care facilities , *PATIENT safety , *PREVENTIVE health services , *RESEARCH , *RESEARCH funding , *CHANGE management , *DISEASE risk factors ,BEDSORE risk factors - Abstract
Abstract: Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given. Design: Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008. Settings: Ten hospital wards and ten nursing home wards. Participants: We monitored nursing care given to adult patients with an expected length of stay of at least five days. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed. Results: The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate=6%, CI: −7–19) and nursing homes (estimate=4%, CI: −5–13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate=19%, CI: 17–21). For falls in hospitals and nursing homes, no more patients at risk received preventive care. Conclusion: Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators. [Copyright &y& Elsevier]
- Published
- 2011
- Full Text
- View/download PDF
18. Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. Part I: Primary outcome of a cluster randomised trial
- Author
-
van Gaal, Betsie G.I., Schoonhoven, Lisette, Mintjes, Joke A.J., Borm, George F., Hulscher, Marlies E.J.L., Defloor, Tom, Habets, Herbert, Voss, Andreas, Vloet, Lilian C.M., Koopmans, Raymond T.C.M., and van Achterberg, Theo
- Subjects
- *
BEDSORES prevention , *ACCIDENTAL fall prevention , *PREVENTION of medical errors , *URINARY tract infection prevention , *ANALYSIS of variance , *PRESSURE ulcers , *CLINICAL medicine , *CLINICAL trials , *CONFIDENCE intervals , *ACCIDENTAL falls , *HOSPITALS , *LONG-term health care , *LONGITUDINAL method , *MEDICAL errors , *MEDICAL protocols , *MEDICAL records , *NURSING care facilities , *PATIENT education , *PATIENT safety , *PERSONNEL management , *POISSON distribution , *RESEARCH funding , *STATISTICAL sampling , *URINARY tract infections , *EFFECT sizes (Statistics) , *KEY performance indicators (Management) - Abstract
Abstract: Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events. Design: A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period. Settings: Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group. Participants: During baseline and follow-up, patients (≥18 years) with an expected length of stay of at least five days, were asked to participate. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up. Results: At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses showed a rate ratio for the development of an adverse event in favour of the intervention group of 0.57 (95% CI: 0.34–0.95) and 0.67 (95% CI: 0.48–0.99) for hospital patients and nursing home patients respectively. Conclusion: This study showed that implementing multiple guidelines simultaneously is possible, which is promising. Patients in the intervention groups developed 43% and 33% fewer adverse events compared to the usual care groups in hospitals and nursing homes respectively. Even so, more research is necessary to underline these results. Trial registration: clinicaltrials.gov, number NCT00365430. [Copyright &y& Elsevier]
- Published
- 2011
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.