Rationale: The benefits of clinical practice guideline (CPG) adoption for the management of patients with back pain are well documented. However, the gap between knowledge creation and implementation remains wide with few studies documenting the iterative process of comprehensive implementation in clinical settings. The objective of this study was to improve adherent physical therapy care according to CPG's for low back pain and describe the knowledge to action (K2A) process used in a rural healthcare organization.
Methods: A prospective case control cohort design was used to evaluate physical therapy provider practice changes during an 18 month intervention. Four clinical sites were selected, two of which received multifaceted educational and process interventions tailored to feedback from ongoing K2A cycle outcomes. Overall program assessment included monthly charge code reports for adherence and a pre-post survey of confidence for guideline use. Pragmatic Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) criteria were used to complete the process evaluation.
Results: A significant difference (p < 0.001, mean difference 13.5, CI [8.5,18.5]) for charge code adherence favoured education site-1 over control site-2 after implementation. Adherence scores remained above target at both education sites 18 months after implementation. Survey differences were significant for confidence scores at education sites in use of the cognitive behavioural category, overall treatment category use and guideline communication. Process evaluation supported multifaceted interventions tailored to education sites with average cost measured by staff education time of 15.5 h per therapist trained.
Conclusion: This study extends the literature of guideline implementation by describing the unique cycles required for promoting provider behaviour change within a rural healthcare system. Adherence and confidence results suggest increased provider CPG use which was supported by the process evaluation. This study demonstrates the importance of multiple site comparisons, long-term reporting and standardized frameworks for assessment of real-world CPG implementation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/jep.13633 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Implementation of Alcohol Use Disorder Training Curriculum Improves Perceived Confidence in Treating Alcohol-Related Liver Disorder Amongst Gastroenterology Fellows.
Dig Dis Sci
January 2025
Department of Internal Medicine and Center for Recovery Medicine, Allegheny General Hospital, 1307 Federal St Suite B300, Pittsburgh, PA, 15212, USA.
Background: Alcohol use disorder and alcohol-associated liver disease is increasing in the US, with subsequent and expected increases in morbidity and mortality due to these conditions.
Aims: To determine the impact of an educational intervention regarding alcohol use disorder on gastroenterology fellows.
Methods: A before-after survey study was carried out.
Measurement of Blood Pressure in Children and Adolescents Outside the Office for the Diagnosis of Hypertension.
Curr Cardiol Rep
January 2025
Section of Pediatric Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, USA.
Purpose Of Review: To review the benefits of ambulatory blood pressure monitoring and home blood pressure monitoring in children and to discuss implementation of guideline-recommended ambulatory blood pressure monitoring.
Recent Findings: Compared with office blood pressure, ambulatory blood pressure monitoring and home blood pressure monitoring provide superior accuracy, reproducibility, and stronger associations with target organ damage although future work is needed to determine the utility of home blood pressure monitoring to predict hypertension status on ambulatory blood pressure monitoring. Due to the benefits of out-of-office blood pressure measurement, ambulatory blood pressure monitoring has been recommended to confirm the diagnosis of hypertension in children and adolescents since publication of the 2017 American Academy of Pediatrics clinical practice guidelines on hypertension.
An Interprofessional Collaboration Between a Community-Based Doula Organization and Clinical Partners: The Champion Dyad Initiative.
J Midwifery Womens Health
January 2025
Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, California.
As access to doula services expands through state Medicaid coverage and specific initiatives aimed at improving maternal health equity, there is a need to build and improve upon relationships between the doula community, hospital leaders, and clinical staff. Previous research and reports suggest rapport-building, provider education, and forming partnerships between community-based organizations and hospitals can improve such relationships. However, few interventions or programs incorporating such approaches are described in the literature.
View Article and Find Full Text PDFA 2024 Update on US FDA Implementation of Partial Area Under the Curve Into Bioavailability and Bioequivalence Assessments.
Clin Pharmacol Ther
January 2025
Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
Comparisons of maximum drug concentration (C) and total area under the concentration vs. time curve (AUC) may be inadequate for bioavailability (BA)/bioequivalence (BE) assessments in cases where the shape of the pharmacokinetic (PK) profile of a drug impacts the clinical performance. In such cases, partial area under the concentration vs.
View Article and Find Full Text PDFAn observational study of socioeconomic disparities in psychiatry consultation uptake in Australia, using routinely collected national data from 2015 to 2022.
Int J Soc Psychiatry
January 2025
Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.
Background: The COVID-19 pandemic was associated with increased psychological distress and psychiatric service usage in Australia. Previous research into the first few months of the pandemic found severe inequality in telehealth psychiatry but no change in inequality for psychiatry service usage overall. However, it is unknown how inequality evolved over the remainder of the pandemic, as extended lockdowns continued in major Australian cities.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!