Dianne Lowe

The Rx for Change database: a first-in-class tool for optimal prescribing and medicines use

BackgroundGlobally, suboptimal prescribing practices and medication errors are common. Guidance to health professionals and consumers alone is not sufficient to optimise behaviours, therefore strategies to promote evidence-based decision making and practice, such as decision support tools or reminders, are important. The literature in this area is growing, but is of variable quality and dispersed across sources, which makes it difficult to identify, access, and assess. To overcome these problems, by synthesizing and evaluating the data from systematic reviews, we have developed Rx for Change to provide a comprehensive, online database of the evidence for strategies to improve drug prescribing and use.MethodsWe use reliable and valid methods to search and screen the literature, and to appraise and analyse the evidence from relevant systematic reviews. We then present the findings in an online format which allows users to easily access pertinent information related to prescribing and medicines use. The database is a result of the collaboration between the Canadian Agency for Drugs and Technologies in Health (CADTH) and two Cochrane review groups.ResultsTo capture the body of evidence on interventions to improve prescribing and medicines use, we conduct comprehensive and regular searches in multiple databases, and hand-searches of relevant journals. We screen articles to identify relevant systematic reviews, and include them if they are of moderate or high methodological quality. Two researchers screen, assess quality, and extract data on demographic details, intervention characteristics, and outcome data. We report the results of our analysis of each systematic review using a standardised quantitative and qualitative format. Rx for Change currently contains over 200 summarised reviews, structured in a multi-level format. The reviews included in the database are diverse, covering various settings, conditions, or diseases and targeting a range of professional and consumer behaviors.ConclusionsRx for Change is a novel database that synthesizes current research evidence about the effects of interventions to improve drug prescribing practices and medicines use.

A Systematic Review of Consumer-Providers’ Effects on Client Outcomes in Statutory Mental Health Services: The Evidence and the Path Beyond

Consumer-provider involvement in the delivery of mental health services has steadily increased in the past several decades; however, the effects on client and service outcomes have remained unclear. The objectives of this paper are to (a) summarize a Cochrane review of consumer-providers’ effects on client outcomes in statutory mental health services and (b) discuss several key issues that, if addressed, might strengthen evidence in this area. We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, and Current Contents until March 2012 to identify relevant studies. Studies were eligible for inclusion if they randomized adult clients to statutory mental health services delivered with and without consumer-provider involvement. Eleven studies met the eligibility criteria and were divided into 2 separate comparison groups: studies comparing consumer-providers with professionals employed in the same role within a mental health service (5 studies) and studies comparing mental health services with and without consumer-providers as an adjunct to the service (6 studies). The limited outcome data available from the studies indicated no difference in quality of life, function, social relations, mental health symptoms, client satisfaction, or attrition in those receiving services from consumer-providers compared with those who did not. None of the studies reported any adverse outcomes for clients. Addressing several key issues could strengthen the evidence such as: core outcome measures, appropriate study designs for evaluating complex interventions, minimal cross-contamination of treatment groups for community-based interventions, improved trial reporting, and the use of systematic reviews to inform future research.

Cross-sectional examination of musculoskeletal conditions and multimorbidity: influence of different thresholds and definitions on prevalence and association estimates

BackgroundMultimorbidity and musculoskeletal conditions create substantial burden for people and health systems. Quantifying the extent of co-occurring conditions is hampered by conceptual heterogeneity, imprecision and/or indecision about how multimorbidity is defined. The purpose of this study is to examine the influence of different ways of operationalising multimorbidity on multimorbidity prevalence rates with a focus on working-age adults with musculoskeletal conditions. Weighted population prevalence rates of multimorbidity among working-age Australians were estimated using data from the National Health Survey. Two nominal thresholds (2+ or 3+ co-occurring conditions) and three operational definitions of multimorbidity (survey-, policy- and research-based) were examined. Using logistic regression, we estimated the association between the prevalence of multimorbidity among persons with musculoskeletal conditions compared to persons with non-musculoskeletal conditions for each definition and threshold combination.ResultsAs few as 7.9% of working-age Australians have 2+ conditions using the research-based definition (95% CI 7.4–8.5%), compared to estimates of 15.3% (95% CI 14.3–16.2%) and 61.5% (95% CI 60.3–62.7%). with the policy- and survey-based definitions, respectively. Depending on definition, with the 3+ threshold multimorbidity prevalence ranged from 2.1% (research) to 41.9% (survey). Among the sub-sample with musculoskeletal conditions, multimorbidity with the 2+ threshold ranged from 20.2 to 92.2%; and with 3+ threshold from 5.9 to 75.4%, again lowest with the research-definition and highest with the survey-definition. When compared to any other condition (i.e. non-musculoskeletal conditions), all musculoskeletal conditions were positively associated with multimorbidity, regardless of definition or threshold.ConclusionsDepending on definition and threshold, multimorbidity is either rare or endemic in working-age Australians. Irrespective of definition, musculoskeletal conditions are a near-ubiquitous feature of multimorbidity.

Evidence on optimal prescribing and medicines use for decision makers: Scope and application of the 'Rx for change' database

Rx for Change, a freely available online database, summarises the evidence on the impact of interventions to improve the quality of prescribing and medicines use. The database serves as a resource for decision makers seeking to find and use the evidence from systematic reviews on interventions to improve prescribing and medicines use by targeting the behaviours of health professionals and consumers. We describe a panel discussion held in 2010 on the databases scope and application. Panellists explored the ways decision makers might use the database to access the evidence as an input to decision making; and presented examples of the range of interventions on which evidence is assembled within the Rx for Change database and through which professional and consumer behaviours might be targeted to improve prescribing and medicines use.

Development of training for medicines-oriented policymakers to apply evidence

BackgroundHealth systems globally promote appropriate prescribing by healthcare providers and safe and effective medicine use by consumers. Rx for Change, a publicly available database, provides access to systematic reviews regarding best practices for prescribing and using medicines. Despite the value of the database for improving prescribing and medicine use, its use remains suboptimal. This study aimed to develop a training program for five medicine-focused organisations in Canada and Australia to facilitate the use and understanding of the Rx for Change database.MethodsFour steps were undertaken: 1) key informant interviews were completed across all organisations to understand the knowledge user perspective; 2) a directed content analysis was completed of the interview transcripts and proposed training was developed; 3) a second round of feedback on the proposed training by knowledge users was gathered; and 4) feedback was integrated to develop the final training.ResultsSixteen key informant interviews with knowledge users were conducted. Themes for training content included the scope of, navigation and strategies for using Rx for Change (generic content) and practical examples on incorporating evidence within their workplace context (tailored content). The final training consisted of an informational video, a 60-minute face-to-face workshop and two post-training reminders.ConclusionsA method of engaging knowledge users in the development of a training program to improve the use of an on-line database of systematic reviews was established and used to design training. Next steps include the delivery and evaluation of the training.

Communication Vulnerabilities in Working-age Australians with Musculoskeletal Conditions: A Cross-sectional Analysis

Objective. To estimate the prevalence of communication vulnerability (CV) and its association with various health measures among working-age Australians with musculoskeletal conditions (MSK). The various vulnerability characteristics may lead to inadequate communication between consumers and healthcare professionals. Methods. Prevalence of CV among 18–64 year olds, with or without MSK, was analyzed using the Australian Bureau of Statistics’ National Health Survey 2007–08 data. Associations between CV and measures of health complexity (accumulating multimorbidity and risk factors) and health burden (poorer self-rated health, psychological distress, and pain restricting work) in the MSK population were estimated using logistic regression. Further analyses were conducted for each vulnerability characteristic to determine the degree of association (crude and adjusted) with measures of interest. Results. CV were more prevalent in working-age Australians with MSK (65%) than those without (51%). Adjusted for age and sex among working-age Australians with at least 1 MSK, those with 1 or more CV were more likely to have multimorbidity [adjusted OR (aOR) = 1.8, 95% CI 1.5–2.2], lifestyle risk factors (aOR = 2.1, 95% CI 1.5–2.8), poorer self-rated health (aOR = 3.4, 95% CI 2.7–4.2), greater psychological distress (aOR = 2.9, 95% CI 2.3–3.7), and pain restricting employment (aOR = 1.7, 95% CI 1.4–2.1) compared with those without CV. Conclusion. For working-age people, there is an association between MSK and CV. For those with MSK, CV were associated with increased likelihood of health complexity and burden. These findings have policy and clinical relevance. Research is needed to determine whether interventions that address these specific CV characteristics reduce the burden of disease within these populations.

Notification and support for people exposed to the risk of Creutzfeldt-Jakob disease (CJD) through medical treatment (iatrogenically)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the eDects of interventions to notify and support consumers (patients and their carers or families) in situations where exposure to the risk of CJD or vCJD has occurred as a result of medical treatment (iatrogenically), on consumer, carer, healthcare provider and healthcare system outcomes. Notification and support for people exposed to the risk of Creutzfeldt-Jakob disease (CJD) through medical treatment (iatrogenically) (Protocol) Copyright

Research priorities in health communication and participation: international survey of consumers and other stakeholders

Objective To identify research priorities of consumers and other stakeholders to inform Cochrane Reviews in ‘health communication and participation’ (including such concepts as patient experience, shared decision-making and health literacy). Setting International. Participants We included anyone with an interest in health communication and participation. Up to 151 participants (18–80 years; 117 female) across 12 countries took part, including 48 consumers (patients, carers, consumer representatives) and 75 professionals (health professionals, policymakers, researchers) (plus 25 people who identified as both). Design Survey. Methods We invited people to submit their research ideas via an online survey open for 4 weeks. Using inductive thematic analysis, we generated priority research topics, then classified these into broader themes. Results Participants submitted 200 research ideas, which we grouped into 21 priority topics. Key research priorities included: insufficient consumer involvement in research (19 responses), ‘official’ health information is contradictory and hard to understand (18 responses), communication/coordination breakdowns in health services (15 responses), health information provision a low priority for health professionals (15 responses), insufficient eliciting of patient preferences (14 responses), health services poorly understand/implement patient-centred care (14 responses), lack of holistic care impacting healthcare quality and safety (13 responses) and inadequate consumer involvement in service design (11 responses). These priorities encompassed acute and community health settings, with implications for policy and research. Priority populations of interest included people from diverse cultural and linguistic backgrounds, carers, and people with low educational attainment, or mental illness. Most frequently suggested interventions focused on training and cultural change activities for health services and health professionals. Conclusions Consumers and other stakeholders want research addressing structural and cultural challenges in health services (eg, lack of holistic, patient-centred, culturally safe care) and building health professionals’ communication skills. Solutions should be devised in partnership with consumers, and focus on the needs of vulnerable groups.