educational outreach

教育推广
  • 文章类型: Journal Article
    背景:科学和健康宣传活动旨在激发和激发未来学生在这些领域从事职业的兴趣;然而,支持这一假设的研究是有限的。
    目的:我们研究的目的是组织一个综合的解剖学和生理学外展活动,以检查大学前学生的学习经历(学习工具,活动,和促进者)以及从事医疗保健事业并收集有关他们对此类活动的态度和看法的证据的动机。
    方法:在新加坡的李光中华医学院开设了为期2天的心肺和胃肠解剖系统课程,使用其关键的教学方法,也就是说,多模式实践和基于团队的学习。来自新加坡21所大学预科院校的90名大学预科学生参加了这个为期2天的课程,他们的经验使用4点Likert量表和开放式调查问题进行了评估。使用归纳主题分析法对自由文本评论进行分析。
    结果:88名参与者中的81名(92%)完成了使用4点Likert量表的调查。大多数学生认为课程材料足够(平均3.57,SD0.57)并达到学习目标(平均3.73,SD0.52)。学生认为教师是明确的(平均3.73,SD0.52)和有效的(平均3.70,SD0.53)。他们喜欢外展会议的组织(平均3.64,SD0.48),并且非常积极地研究医学或联合/生物医学科学(平均3.69,SD0.54)。实践和基于团队的学习被认为是非常令人满意的(分别为平均3.63,SD0.53和平均3.58,SD0.54)。所有受访者都表示,他们会向同行推荐这门课程。主题分析表明,参与者对人体结构和功能有了新的认识,他们喜欢独特的学习环境,他们有动力去追求医疗保健事业,他们对会议感到满意,与主持人的互动增加了他们对人体解剖学和生理学的理解。
    结论:结构化的健康宣传活动为学生提供了独特的机会,可以在医学院体验临床前学习环境,加深对人体结构和功能的理解,并增加他们对科学的动机和兴趣。Further,外展计划可能为旨在追求健康专业教育的潜在学生奠定基础。
    BACKGROUND: Science and health outreach activities are aimed at motivating and sparking interest among prospective students to pursue careers in these fields; however, research studies supporting this hypothesis are limited.
    OBJECTIVE: The aim of our study was to organize an integrated Anatomy and Physiology outreach to examine preuniversity students\' learning experiences (learning tools, activities, and facilitators) and motivation to pursue a career in health care and to gather evidence on their attitudes and perceptions of such activities.
    METHODS: A 2-day course on cardiorespiratory and gastrointestinal anatomical systems was presented at the Lee Kong Chian School of Medicine in Singapore using its key pedagogies, that is, multimodal practical and team-based learning. Ninety preuniversity students from 21 preuniversity institutions in Singapore participated in this 2-day course, and their experiences were evaluated using a 4-point Likert scale and open-ended survey questions. Free-text comments were analyzed using inductive thematic analysis.
    RESULTS: The survey using the 4-point Likert scale was completed by 81 (92%) of the 88 participants. Most students felt that the course materials were adequate (mean 3.57, SD 0.57) and met the learning objectives (mean 3.73, SD 0.52). The students felt that the instructors were clear (mean 3.73, SD 0.52) and effective (mean 3.70, SD 0.53). They liked the organization of the outreach session (mean 3.64, SD 0.48) and were highly motivated to study medicine or allied/biomedical sciences (mean 3.69, SD 0.54). Practical and team-based learning were regarded as exceedingly satisfactory (mean 3.63, SD 0.53 and mean 3.58, SD 0.54, respectively). All the respondents said that they would recommend this course to peers. Thematic analysis revealed that the participants gained a new perspective of the human body structure and function, they liked the unique learning settings, they were motivated to pursue a career in health care, they were satisfied with the sessions, and interactions with the facilitators increased their understanding of the human anatomy and physiology.
    CONCLUSIONS: Structured health outreach activities provide students with unique opportunities to experience a preclinical learning environment in a medical school, deepen their understanding of human body structure and function, and increase their motivation and interest in science. Further, outreach programs may lay the foundations for potential students aiming to pursue health profession education.
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  • 文章类型: Journal Article
    在这项研究中,在帕尔默公园A池塘调查了摇蚊科的生物多样性,底特律的一个城市春季池塘,密歇根州,美国。这项研究是在帕尔默公园的底特律探索和自然中心进行的公共环境外展计划的一部分。使用分子和形态学方法,在该池塘的邻近河岸植被中发现了21种Chironomidae。三种BryophaenocladiuspalmerparacrumNamayandeh&Hudsonsp。11月。,LimnophyesstagnumNamayandeh,Guerra&Ramsp.11月。,和Rheocricotopus(s。s.)angustusNamayandeh&Hudsonsp.11月。对科学来说是新的。Bryophaenocladiuspalmerparaccumsp.11月。和L.stagnumsp.11月。是不寻常的正包围,与B.palmerparcumsp.11月。拥有一个刚毛,短,和宽肛点和L.stagnumsp.11月。两性均缺乏披针形刚毛。根据上伏拉的形状,R.angustussp.11月。,属于Effusus集团,DNA条形码分子分析也证实了这一点。在这项研究中,还发现了Nearctic的新动物记录以及密歇根州的四个新动物记录。短暂的水生栖息地,如春季池,经常被城市化活动忽视或破坏,控制媒介物种,创造整洁的领域,和/或住宅开发。因此,发现这些新物种证明了春季池塘作为重要栖息地的生物多样性价值,进一步激励我们保护它们。
    In this study, the biodiversity of Chironomidae was investigated in Palmer Park Pond A, an urban vernal pond in Detroit, Michigan, USA. This study is developed as part of our ongoing Public Environmental Outreach Program at the Detroit Exploration and Nature Center in Palmer Park. Twenty-one Chironomidae species were discovered in and on the adjacent riparian vegetation of this pond using molecular and morphological methods. Three species Bryophaenocladiuspalmerparcum Namayandeh & Hudson sp. nov., Limnophyesstagnum Namayandeh, Guerra & Ram sp. nov., and Rheocricotopus (s. s.) angustus Namayandeh & Hudson sp. nov. are new to science. Bryophaenocladiuspalmerparcum sp. nov. and L.stagnum sp. nov. are unusual Orthoclads, with B.palmerparcum sp. nov. possessing a setose, short, and wide anal point and L.stagnum sp. nov. lacking lanceolate setae on both sexes. Based on the shape of superior volsella, R.angustus sp. nov., belongs to the effusus group, which was also confirmed by DNA barcoding molecular analysis. In this study, a new faunistic record was also found for the Nearctic as well as four new faunistic records for the state of Michigan. Ephemeral aquatic habitats such as vernal pools are often overlooked or destroyed by urbanization activities, controlling vector species, creating groomed fields, and/or residential development. Therefore, finding these new species demonstrates the biodiversity value of vernal ponds as important habitats, further motivating us to preserve them.
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  • 文章类型: Journal Article
    背景:COVID-19大流行加速了向虚拟学术细节(AD)的转变。
    目的:我们旨在研究外部,上下文,以及医疗保健提供者(HCP)虚拟参与和AD交付中固有的特定于计划的因素。
    方法:联系了整个北美的AD组,以参加半结构化访谈。通过调整实施研究综合框架(CFIR),构建了采访指南。重点包括在实施虚拟广告计划时用于提供商参与的广告小组策略。独立编码人员使用框架方法进行了定性分析。
    结果:来自加拿大(n=3)和美国(n=12)的15个AD组参加。在向虚拟AD访问过渡期间,技术问题和培训详细人员以及HCP是挑战。大流行期间对亲自活动的限制造成了与HCP接触的困难和AD访问的减少。继续教育是激励参与的一种策略,但信用通常不被HCP要求。具有已建立网络和先前使用虚拟AD的经验的组利用连接来减轻中断并继续AD访问。其他促进者包括强调当代主题,包括基本指导方针之外的阿片类药物教育。虚拟AD具有扩展地理范围和与提供商的灵活安排的额外好处。
    结论:北美的AD组已经转向虚拟外展和交付策略。这种虚拟广告的趋势可能有助于推广到脆弱的农村社区,改善卫生公平。需要对虚拟AD的有效性及其未来影响进行更多研究。
    BACKGROUND: The shift toward virtual academic detailing (AD) was accelerated by the COVID-19 pandemic.
    OBJECTIVE: We aimed to examine the role of external, contextual, and intrinsic programme-specific factors in virtual engagement of healthcare providers (HCPs) and delivery of AD.
    METHODS: AD groups throughout North America were contacted to participate in semistructured interviews. An interview guide was constructed by adapting the Consolidated Framework for Implementation Research (CFIR). A point of emphasis included strategies AD groups employed for provider engagement while implementing virtual AD programmes. Independent coders conducted qualitative analysis using the framework method.
    RESULTS: Fifteen AD groups from Canada (n = 3) and the United States (n = 12) participated. Technological issues and training detailers and HCPs were challenges during the transition to virtual AD visits. Restrictions on in-person activities during the pandemic created difficulties engaging HCPs and fewer AD visits. Continuing education was one strategy to incentivize participation, but credits were often not claimed by HCPs. Groups with established networks and prior experience with virtual AD leveraged connections to mitigate disruptions and continue AD visits. Other facilitators included emphasizing contemporary topics, including opioid education beyond fundamental guidelines. Virtual AD had the additional benefit of expanding geographic reach and flexible scheduling with providers.
    CONCLUSIONS: AD groups across North America have shifted to virtual outreach and delivery strategies. This trend toward virtual AD may aid outreach to vulnerable rural communities, improving health equity. More research is needed on the effectiveness of virtual AD and its future implications.
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  • 文章类型: Journal Article
    背景:结合机器学习衍生内容的临床决策支持(CDS)工具有可能通过增强临床医生的专业知识来改变临床护理。为了实现这种潜力,这些工具必须设计成适合使用它们的临床医生的动态工作系统。我们建议使用学术细节-专家在特定的健康IT工具中对临床医生进行个人访问-作为一种方法,以确保对该工具及其证据基础的正确理解,并确定影响该工具实施的因素。
    目的:本研究旨在评估学术细节,作为一种方法,同时确保对基于急诊科的CDS工具的正确理解,以防止未来跌倒,并通过对所得定性数据的分析,确定影响临床医生使用该工具的因素。
    方法:以前,我们的团队设计了一个CDS工具来识别65岁及以上未来跌倒风险最高的患者,并向临床医生发出中断警报,建议将患者转诊到活动和跌倒诊所进行基于证据的预防性干预。我们进行了10分钟的学术详细访谈(n=16)与驻地急诊医师和高级实践提供者,他们在实践中遇到了我们的CDS工具。我们进行了归纳,基于团队的内容分析,以确定影响临床医生使用CDS工具的因素。
    结果:确定了影响临床医生使用CDS的以下几类因素:(1)CDS工具设计的方面(2)临床医生对CDS或转诊过程的理解(或误解),(3)急诊科环境的繁忙性质,(4)临床医生对患者及其相关跌倒风险的看法,和(5)转诊过程的不透明度。此外,进行了临床医生教育,以解决有关CDS工具或转诊过程的任何误解,例如,证明通过CDS进行转诊是多么简单,并明确转诊到哪个诊所.
    结论:我们的研究表明,使用学术细节来支持健康信息技术的实施,使我们能够确定影响临床医生使用CDS的因素,同时对临床医生进行教育,以确保对CDS工具和干预措施的正确理解。因此,学术细节可以为工具实施的实时调整提供信息,例如,用于介绍工具的语言的改进,并对CDS工具进行更大规模的重新设计,以更好地适应临床医生的动态工作环境。
    BACKGROUND: Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians\' expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing-personal visits to clinicians by an expert in a specific health IT tool-as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool\'s implementation.
    OBJECTIVE: This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department-based CDS tool to prevent future falls and identifying factors impacting clinicians\' use of the tool through an analysis of the resultant qualitative data.
    METHODS: Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians\' use of the CDS tool.
    RESULTS: The following categories of factors that impacted clinicians\' use of the CDS were identified: (1) aspects of the CDS tool\'s design (2) clinicians\' understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians\' perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to.
    CONCLUSIONS: Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians\' use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool\'s implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians.
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  • 文章类型: Journal Article
    外展活动涉及指导学生,大学合作,和程序创建,以使学术界和法医从业人员之间的角色多样化。Mixer练习促进学生与法医科学家的互动。重点是提高对法医学的认识,特别是在南部非洲等地区,媒体的描述经常扭曲人们的看法。外展计划旨在纠正这些误解,促进循证法医学教育,并通过法医实验室和大学之间的合作来解决研究短缺问题。提议在南部非洲区域法证科学论坛内设立一个常设委员会,以促进合作与协调。通过促进合作和鼓励参与会议和研究出版物,该倡议旨在满足该地区法医科学家的需求。
    Outreach initiatives involves mentoring students, university collaboration, and program creation to diversify roles between academia and forensic practitioners. Mixer exercises foster student-forensic scientist interaction. Emphasis is placed on improving understanding of forensic science, particularly in regions like Southern Africa, where media portrayals often distort perceptions. The outreach initiative aims to correct these misconceptions, promote evidence-based forensic education, and address research shortages through collaboration between forensic laboratories and universities. A permanent committee within the Southern Africa Regional Forensic Science Forum is proposed to facilitate cooperation and coordination. By fostering collaboration and encouraging participation in conferences and research publication, the initiative aims to meet the region\'s forensic scientist needs.
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  • 文章类型: Journal Article
    法医学教育计划与实际法医实验室需求之间经常存在技能和知识差距。成立了一个教育外展项目,涉及三个专上学术机构和一个大型多学科法证实验室,为学生提供讲座,为法医科学家提供指导,并在法医实验室内提供互动体验。导师混合器练习鼓励学生和科学家之间有意义的互动,为就业要求的实际讨论创造机会,基于学生的兴趣和法医学要求的最佳班级选择,以及更好地了解操作法医科学家的日常任务和职责。来自学生的反馈,教授们,和法医导师已经改进了计划,这将为未来的教育推广计划提供信息,包括更广泛的社区宣传。
    Skills and knowledge gaps frequently exist between forensic educational programs and practical forensic laboratory needs. An educational outreach project involving three post-secondary academic institutions and a large multidisciplinary forensic laboratory was created to provide lectures to students, enable mentorship with forensic scientists, and provide an interactive experience within the forensic laboratory. Mentorship mixer exercises encouraged meaningful interactions between students and scientists, creating opportunities for practical discussion on employment requirements, optimal class selections based on students\' interests and forensic science requirements, and better understanding of the daily tasks and duties of operational forensic scientists. Feedback from students, professors, and forensic mentors have resulted in program improvements which will inform the educational outreach initiative going forward, including broader community outreach.
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  • 文章类型: Journal Article
    研究学术详细干预对全科医生使用2型糖尿病药物的影响。
    我们根据修订后的全国糖尿病治疗指南和现有的最佳证据,开展了一项学术详细宣传活动。由训练有素的学术细节专家为全科医生提供了20分钟的一对一访问。
    共有371名全科医生接受了访问,并代表干预组。对照组由1282名未接受访问的全科医生组成。
    从干预前12个月到干预后12个月的处方变化。主要终点是二甲双胍的变化。次要终点是其他2型糖尿病药物和这些药物的变化。
    二甲双胍处方在干预组中增加了7.4%,在对照组中增加了5.2%(p=.043)。钠-葡萄糖协同转运蛋白-2抑制剂在干预组中增加了27.6%,在对照组中增加了33.8%(p=.019)。对于磺酰脲类药物,干预组的下降幅度为3.6%。对照组为8.9%(p=0.026)。干预组2型糖尿病处方药的总量增加了9.1%,对照组增加了7.3%(p=.08)。
    学术细节引发了二甲双胍处方的小幅增加,但具有统计学意义。对于像2型糖尿病这样的复杂受试者,我们建议在访问中保留更多的时间,而不是我们活动的目标20分钟。
    学术细节是一种经过验证的方法,用于促进处方变更,通过与训练有素的学术细节专家的一对一互动会议。接受20分钟2型糖尿病治疗的全科医生开了更多的二甲双胍,与对照组相比。对于像现在这样复杂的干预措施,我们建议留出20分钟以上,确保有足够的时间进行讨论和思考。学术细节会影响处方,甚至对于像治疗2型糖尿病这样的复杂主题。
    UNASSIGNED: To investigate the effect of an academic detailing intervention on the utilisation of type 2 diabetes medication among general practitioners.
    UNASSIGNED: We developed an academic detailing campaign based on the revised national treatment guideline for diabetes and the best available evidence. General practitioners were offered a 20-minute one-to-one visit by a trained academic detailer.
    UNASSIGNED: A total of 371 general practitioners received a visit and represented the intervention group. The control group consisted of 1282 general practitioners not receiving a visit.
    UNASSIGNED: Changes in prescribing from 12 months before to 12 months after the intervention. The primary endpoint was a change in metformin. Secondary endpoints were changes in other groups of Type 2 diabetes medication and of these drugs in total.
    UNASSIGNED: Prescribing of metformin increased by 7.4% in the intervention group and 5.2% in the control group (p = .043). Sodium-glucose cotransporter-2 inhibitors increased by 27.6% in the intervention group and 33.8% in the control group (p = .019). For sulfonylureas there was a decrease of 3.6% in the intervention group vs. 8.9% in the control group (p = .026). The total amount of prescribed medications for type 2 diabetes increased by 9.1% in the intervention group and 7.3% in the control group (p = .08).
    UNASSIGNED: Academic detailing initiated a small but statistically significant increase in the prescription of metformin. For a complex subject like type 2 diabetes, we recommend reserving more time in the visit than the 20 min our campaign aimed for.
    Academic detailing is a validated method for facilitating changes in prescribing, via interactive one-to-one meetings with a trained academic detailer.General practitioners who received a 20-minute visit on the treatment of type 2 diabetes prescribed more metformin, compared to the control group.For a complex interventions like the present, we recommend setting aside more than 20 minutes, to ensure sufficient time for discussion and reflection.Academic detailing can impact prescribing, even for a complex subject like the treatment of Type 2 Diabetes.
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  • 文章类型: Journal Article
    学术细节,促进循证实践以提高患者护理质量的教育推广,主要是通过一对一的面对面互动来交付的。2018年,美国退伍军人事务部(VA)药房福利管理实施了一项试点虚拟学术详细计划,以增加面临阿片类药物过量或死亡风险的退伍军人的纳洛酮处方。此评估的目的是比较VA中纳洛酮处方率的虚拟和亲自学术细节。
    使用回顾性准实验前测-后测非等效组设计,比较了提供者在2018年1月1日至2020年5月31日期间在三个VA区域网络中接受纳洛酮特定遭遇之前和之后12个月的纳洛酮处方率的虚拟学术细节和亲自学术细节。对农村提供者进行亚组分析。构建了广义估计方程模型,以比较纳洛酮处方率在接受虚拟或面对面的学术细节控制提供者水平特征之前和之后的差异。
    接受虚拟(N=67)或当面(N=186)学术细节的提供者在纳洛酮处方上有显著增加,但两组之间的纳洛酮比率差异无统计学意义(纳洛酮比率变化差异=+0.63;95%CI:-2.23,3.48).农村提供者也有类似的发现。
    接受与纳洛酮相关的面对面或虚拟学术细节的提供者增加了纳洛酮处方率;然而,两种模式之间没有差异.虚拟学术细节是提供学术细节的可行替代方案,并允许学术细节提供者将其覆盖范围扩展到农村提供者。
    Academic detailing, an educational outreach that promotes evidence-based practices to improve the quality of care for patients, has primarily been delivered using one-on-one in-person interactions. In 2018, the U.S. Department of Veterans Affairs (VA) Pharmacy Benefits Management implemented a pilot virtual academic detailing program to increase naloxone prescribing among veterans at risk for opioid overdose or death. The aim of this evaluation was to compare virtual and in-person academic detailing on naloxone prescribing rates at VA.
    A retrospective quasi-experimental pretest-posttest non-equivalent groups design was used to compare virtual academic detailing and in-person academic detailing on naloxone prescribing rates 12 months before and after providers received a naloxone-specific encounter at three VA regional networks between January 1, 2018 to May 31, 2020. Subgroup analysis was performed on rural providers. Generalized estimating equation models were constructed to compare the difference in naloxone prescribing rates before and after receiving virtual or in-person academic detailing controlling for provider-level characteristics.
    Providers who received virtual (N = 67) or in-person (N = 186) academic detailing had significant increases in naloxone prescribing, but the differences in the naloxone rates between the groups were not statistically significant (difference in changes in naloxone rates=+0.63; 95% CI: -2.23, 3.48). Similar findings were reported for rural providers.
    Providers who received naloxone-related in-person or virtual academic detailing had increased naloxone prescribing rates; however, there were no differences between the two types of modalities. Virtual academic detailing is a viable alternative for delivering academic detailing and allows academic detailers to expand their reach to rural providers.
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  • 文章类型: Journal Article
    在英国初级保健中,实施基于证据的建议具有挑战性,特别是考虑到系统压力和多个指南建议争夺注意力。可以调整并因此适用于针对多个准则建议的实施包可以为具有共同障碍的建议提供效率。我们开发并评估了一套基于证据的干预措施(审计和反馈,教育外展和提醒)纳入行为改变技术,以针对常见障碍,在两项针对四个“高影响”指标的务实试验中:危险处方;糖尿病控制;血压控制;和房颤的抗凝治疗。我们观察到一个重要的,风险处方的成本效益降低,但对其他结局的影响证据不足。我们探讨了实施包对社会过程(规范化过程理论;NPT)和假设的行为决定因素(理论域框架;TDF)的影响。
    我们进行了前瞻性多方法过程评估。观察,8个初级保健实践的行政和访谈数据收集和分析由NPT和TDF指导。来自试验和过程评估实践的调查数据探讨了保真度。
    我们观察到实践如何响应实施包的三种主要变化模式。首先,在整合和成就中,当它被认为是独特和可行的时候,这个包“工作”。针对特定行为的及时反馈可以实现连续的目标设定,行动和审查,这加强了动机和集体行动。第二,对基于团队的决定因素的影响有限,特别是当临床行动的复杂性阻碍进展时。第三,有交货延误和意想不到的后果。安排外展活动的延误进一步减少了所有权和改进时间。没有反映努力的反复停滞或下降的反馈破坏了参与。
    实践例程和护理组织中的变量集成,对行为决定因素的变量影响,延迟交付和意外后果有助于解释适应方案在初级保健中的部分成功。
    Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations competing for attention. Implementation packages that can be adapted and hence applied to target multiple guideline recommendations could offer efficiencies for recommendations with common barriers to achievement. We developed and evaluated a package of evidence-based interventions (audit and feedback, educational outreach and reminders) incorporating behaviour change techniques to target common barriers, in two pragmatic trials for four \"high impact\" indicators: risky prescribing; diabetes control; blood pressure control; and anticoagulation in atrial fibrillation. We observed a significant, cost-effective reduction in risky prescribing but there was insufficient evidence of effect on the other outcomes. We explored the impact of the implementation package on both social processes (Normalisation Process Theory; NPT) and hypothesised determinants of behaviour (Theoretical Domains Framework; TDF).
    We conducted a prospective multi-method process evaluation. Observational, administrative and interview data collection and analyses in eight primary care practices were guided by NPT and TDF. Survey data from trial and process evaluation practices explored fidelity.
    We observed three main patterns of variation in how practices responded to the implementation package. First, in integration and achievement, the package \"worked\" when it was considered distinctive and feasible. Timely feedback directed at specific behaviours enabled continuous goal setting, action and review, which reinforced motivation and collective action. Second, impacts on team-based determinants were limited, particularly when the complexity of clinical actions impeded progress. Third, there were delivery delays and unintended consequences. Delays in scheduling outreach further reduced ownership and time for improvement. Repeated stagnant or declining feedback that did not reflect effort undermined engagement.
    Variable integration within practice routines and organisation of care, variable impacts on behavioural determinants, and delays in delivery and unintended consequences help explain the partial success of an adaptable package in primary care.
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  • 文章类型: Journal Article
    背景:学术细节(AD)是量身定制的,交互式教育外展干预可以改善患者的治疗效果。深入了解AD干预措施的设计及其有效程度,有助于为未来的AD计划提供信息。这项范围审查的目的是描述阿片类药物集中的AD干预措施并描述他们的发现。
    方法:在PubMed,EMBASE和CINAHL数据库至2021年7月1日。如果用英语编写,研究有资格纳入,包括以阿片类药物为重点的交互式教育干预措施,要么亲自进行,实际上或通过电话。四名独立审稿人审查了标题和摘要。使用标准化表格从全文出版物中提取数据。
    结果:在最初确定的6086篇文章中,22篇文章符合纳入标准,确定了20种独特的干预措施。AD干预要么是一对一(n=16),要么是小的,交互式组设置(n=4)。AD干预措施的设计各不相同。根据阿片类药物和纳洛酮处方率评估有效性,提供者知识差距,提供者遵守准则,干预的可行性。16项(80%)干预措施导致一个或多个结果的统计学显着改善。
    结论:一般来说,阿片类药物相关的AD是有效的,方案主要是在药剂师和初级保健提供者之间一对一进行16-30分钟。使用各种指标和结果来评估AD干预的成功/有效性。这是未来研究中的一个重要考虑因素,因为没有一个单一的指标能反映出基于教育外展的疼痛管理干预措施的有效性.
    BACKGROUND: Academic detailing (AD) is a tailored, interactive educational outreach intervention that may improve patient outcomes. Insight into the design of AD interventions and the extent to which they are effective can help inform future AD-based programmes. The objective of this scoping review was to characterize opioid-focused AD interventions and describe their findings.
    METHODS: A scoping review focused on AD interventions for opioids was conducted in PubMed, EMBASE and CINAHL databases through July 1, 2021. Studies were eligible for inclusion if written in English, included interactive opioid-focused educational interventions, and were conducted either in person, virtually or via telephone. Four independent reviewers reviewed titles and abstracts. Data extraction from full-text publications was completed using a standardized form.
    RESULTS: Of 6086 articles initially identified, 22 articles met the inclusion criteria and 20 unique interventions were identified. The AD intervention was either delivered one-on-one (n=16) or in a small, interactive group setting (n=4). AD interventions varied in design. Effectiveness was evaluated in terms of opioid and naloxone prescribing rates, provider knowledge gaps, provider adherence to guidelines, and intervention feasibility. Sixteen (80%) interventions resulted in statistically significant improvement in one or more outcomes.
    CONCLUSIONS: Generally, opioid-related AD was effective and programmes were primarily conducted one-on-one between pharmacists and primary care providers for 16-30 minutes. A variety of metrics and outcomes were used to assess the success/effectiveness of AD interventions, which is an important consideration in future studies as no single metric captures the effectiveness of an educational outreach-based intervention for pain management.
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