Johanne Gagnon

Interventions for promoting information and communication technologies adoption in healthcare professionals

BACKGROUNDnInformation and communication technologies (ICT) are defined as digital and analogue technologies that facilitate the capturing, processing, storage and exchange of information via electronic communication. ICTs have the potential to improve information management, access to health services, quality of care, continuity of services, and cost containment. Knowledge is lacking on conditions for successful ICT integration into practice.nnnOBJECTIVESnTo carry out a systematic review of the effectiveness of interventions to promote the adoption of ICT by healthcare professionals.nnnSEARCH STRATEGYnSpecific strategies, defined with the help of an information specialist, were used to search the Cochrane Effective Practice and Organisation of Care Group (EPOC) register and additional relevant databases. We considered studies published from January 1990 until October 2007.nnnSELECTION CRITERIAnRandomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before/after studies (CBAs), and interrupted time series (ITS) that reported objectively measured outcomes concerning the effect of interventions to promote adoption of ICT in healthcare professionals practices.nnnDATA COLLECTION AND ANALYSISnTwo reviewers independently assessed each potentially relevant study for inclusion. We resolved discrepancies by discussion or a third reviewer. Two teams of two reviewers independently extracted data and assessed the quality of included studies. A meta-analysis of study outcomes was not possible, given the small number of included studies and the heterogeneity of intervention and outcomes measures. We conducted qualitative analyses, and have presented the results in a narrative format.nnnMAIN RESULTSnTen studies met the inclusion criteria. Nine of them were RCTs. All studies involved physicians as participants (including postgraduate trainees), and one study also included other participants. Only two studies measured patient outcomes. Searching skills and/or frequency of use of electronic databases, mainly MEDLINE, were targeted in eight studies. Use of Internet for audit and feedback, and email for provider-patient communication, were targeted in two studies. Four studies showed small to moderate positive effects of the intervention on ICT adoption. Four studies were unable to demonstrate significant positive effects, and the two others showed mixed effects. No studies looked at the long-term effect or sustainability of the intervention.nnnAUTHORS CONCLUSIONSnThere is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals. Small effects have been reported for interventions targeting the use of electronic databases and digital libraries. The effectiveness of interventions to promote ICT adoption in healthcare settings remains uncertain, and more well designed trials are needed.

Introducing patients' and the public's perspectives to health technology assessment: A systematic review of international experiences

OBJECTIVESnThe aim of this study was to review international experiences of patient or public involvement in the field of health technology assessment (HTA).nnnMETHODSnA systematic review of the scientific literature was conducted. A literature search was performed across nine databases. Other literature was identified through citation tracking, government websites (HTA agencies), and Internet search engines. Characteristics of the studies, description of the activities related to patient or public involvement, impact of these activities on the HTA process, and factors facilitating or limiting involvement were abstracted independently by two reviewers.nnnRESULTSnA total of 1,441 potentially relevant papers were identified by the main search strategy. Among these, seventeen papers met the inclusion criteria; other search strategies identified seven additional documents. The findings reveal that patient or public involvement in HTA activities was reported in two domains, research and HTA process. In the research domain, patients are consulted to gather evidence about their perspectives, experiences, or preferences about a health technology. These perspectives could add key dimensions to the evaluation of health technologies that might otherwise be overlooked. In the domain of the HTA process, patients or public representatives participate in different stages of this process: prioritization, evidence assessment, or dissemination of findings.nnnCONCLUSIONSnThere are few published examples of experiences involving patients and the public in HTA. These examples show that patients or the publics perspectives could add important dimensions to the evaluation of health technologies. However, there is a need to develop more systematic approaches to considering patients and the publics perspectives in HTA.

Using the Theory of Planned Behaviour to predict nurses’ intention to integrate research evidence into clinical decision-making

AIMSnUsing an extended theory of planned behaviour, this article is a report of a study to identify the factors that influence nurses intention to integrate research evidence into their clinical decision-making.nnnBACKGROUNDnHealth professionals are increasingly asked to adopt evidence-based practice. The integration of research evidence in nurses clinical decision-making would have an important impact on the quality of care provided for patients. Despite evidence supporting this practice and the availability of high quality research in the field of nursing, the gap between research and practice is still present.nnnDESIGNnA predictive correlational study.nnnMETHODSnA total of 336 nurses working in a university hospital participated in this research. Data were collected in February and March 2008 by means of a questionnaire based on an extension of the theory of planned behaviour. Descriptive statistics of the model variables, Pearson correlations between all the variables and multiple linear regression analysis were performed.nnnRESULTS/FINDINGSnNurses intention to integrate research findings into clinical decision-making can be predicted by moral norm, normative beliefs, perceived behavioural control and past behaviour. The moral norm is the most important predictor. Overall, the final model explains 70% of the variance in nurses intention.nnnCONCLUSIONnThe present study supports the use of an extended psychosocial theory for identifying the determinants of nurses intention to integrate research evidence into their clinical decision-making. Interventions that focus on increasing nurses perceptions that using research is their responsibility for ensuring good patient care and providing a supportive environment could promote an evidence-based nursing practice.

Introducing patient perspective in health technology assessment at the local level

BackgroundRecognizing the importance of increased patient participation in healthcare decisions leads decision makers to consider effective ways to incorporate patient perspectives in Health Technology Assessment (HTA) processes. The implementation of local health HTA units in university hospitals in Quebec provides a unique opportunity to foster an increased participation of patients in decisions regarding health technologies and clinical interventions. This project explores strategies that could be effective in involving patients in HTA activities at the local level. To do so, three objectives are pursued: 1) To synthesise international knowledge and experiences on patient and public involvement in HTA activities; 2) To explore the perceptions of stakeholders (administrators, clinical managers, healthcare professionals, HTA producers, and patients) regarding strategies for involving patients in various HTA activities; and 3) To produce a consensual strategic framework that could guide interventions for involving patients in HTA activities at the local level.MethodsA systematic review of the literature will be conducted to synthesise international knowledge and experiments regarding the implication of patients and public in HTA. Then, focus groups will be carried out with representatives of various stakeholder groups in order to explore their perceptions regarding patient participation in HTA. Based on findings from the systematic review and the focus groups, a framework to support patient participation in HTA activities will be proposed. It will then be validated during a deliberative meeting with the research team, composed of scientists and decision makers, and representatives from different groups involved in HTA in Quebec. This deliberative meeting will aim at identifying the type and the degree of participation as well as the adequate timing for involving patients in local HTA activities.DiscussionGiven the actual state of evidence, integrating patient perspective in HTA activities has the potential to improve the quality of healthcare services. This study provides an opportunity to bridge the gap between HTA producers and its ultimate end-user: the patient. It will provide guidance to support local HTA units in Quebec and elsewhere in their decisions regarding patient participation. The framework developed could be applied to design and implement strategies for involving patients in HTA activities.

The impact of blended teaching on knowledge, satisfaction, and self-directed learning in nursing undergraduates: a randomized, controlled trial.

AIM This study aimed to assess the effectiveness of a blended‐teaching intervention using Internet‐based tutorials coupled with traditional lectures in an introduction to research undergraduate nursing course. Effects of the intervention were compared with conventional, face‐to‐face classroom teaching on three outcomes: knowledge, satisfaction, and self‐learning readiness. METHOD A two‐group, randomized, controlled design was used, involving 112 participants. Descriptive statistics and analysis of covariance (ANCOVA) were performed. RESULTS The teaching method was found to have no direct impact on knowledge acquisition, satisfaction, and self‐learning readiness. However, motivation and teaching method had an interaction effect on knowledge acquisition by students. Among less motivated students, those in the intervention group performed better than those who received traditional training. CONCLUSION These findings suggest that this blended‐teaching method could better suit some students, depending on their degree of motivation and level of self‐directed learning readiness.

Introducing the patient's perspective in hospital health technology assessment (HTA): the views of HTA producers, hospital managers and patients

The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patients perspective is taken into consideration when such decisions are made.

A systematic review of interventions promoting clinical information retrieval technology (CIRT) adoption by healthcare professionals

PURPOSEnThis paper presents the evidence on the effectiveness of interventions promoting the use of clinical information retrieval technologies (CIRTs) by healthcare professionals.nnnMETHODSnWe electronically searched articles published between January 1990 and March 2008 using following inclusion criteria: (1) participants were healthcare professionals; (2) specific intervention promoted CIRT adoption; (3) studies were randomised controlled trials, controlled clinical trials, controlled before and after studies or interrupted time series analyses; and (4) they objectively reporting measured outcomes on CIRT use.nnnRESULTSnWe found nine studies focusing on CIRT use. Main outcomes measured were searching skills and/or frequency of use of electronic databases by healthcare professionals. Three studies reported a positive effect of the intervention on CIRT use, one showed a positive impact post-intervention, and four studies failed to demonstrate significant intervention effect. The ninth study examined financial disincentives, and found a significant negative effect of introducing user fees for searching MEDLINE in clinical settings. A meta-analysis showed that educational meetings were the only type of interventions reporting consistent positive effects on CIRT adoption.nnnCONCLUSIONnCIRT is an information and communication technology commonly used in healthcare settings. Interventions promoting CIRT adoption by healthcare professionals have shown some success in improving searching skills and use of electronic databases. However, the effectiveness of these interventions remains uncertain and more rigorous studies are needed.

Development of a shared theory in palliative care to enhance nursing competence

AIMnThis discussion article focuses on the theoretical development of a shared theory in the field of palliative care nursing through a process of comparison between Banduras social cognitive theory and Orems conceptual model.nnnBACKGROUNDnIn many countries, nurses are little prepared to provide care to patients with life-limiting illness. Banduras theory provides an appropriate framework for evaluating the impact of training programmes aimed at improving nursing competence in palliative care. However, this borrowed psychological theory is not specific to nursing contexts. Orems self-care deficit theory seems to be an appropriate nursing model to guide the use of Banduras theory in palliative care nursing situations.nnnDATA SOURCESnA review of the literature published between 1987 and 2011 was conducted to evaluate how Banduras social cognitive theory and Orems conceptual model have been linked at a theoretical level in the past.nnnDISCUSSIONnBanduras theory has been linked with Orems model essentially at the patient level. A new shared theory that combines Banduras social cognitive theory and Orems conceptual model at the nursing level is thus proposed. Palliative care nursing self-competence is hypothesized to influence the quality of nursing interventions in palliative care situations.nnnCONCLUSIONnTo further demonstrate the relevance of this proposed shared theory in palliative care nursing contexts, empirical studies are recommended. This shared theory has the potential to provide a solid theoretical framework for evaluating nursing training programmes and, eventually, to improve quality of care and quality of life for patients with life-limiting illness.

FRAMEWORK FOR USER INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT AT THE LOCAL LEVEL: VIEWS OF HEALTH MANAGERS, USER REPRESENTATIVES, AND CLINICIANS.

OBJECTIVESnThe aim of this study was to explore stakeholders points of views regarding the applicability and relevance of a framework for user involvement in health technology assessment (HTA) at the local level. We tested this framework in the context of the assessment of alternative measures to restraint and seclusion among hospitalized adults and those living in long-term-care facilities.nnnMETHODSnTwenty stakeholders (health managers, user representatives, and clinicians) from seven regions of Quebec participated in a semi-structured interview. A thematic analysis of the transcribed interviews was performed.nnnRESULTSnThe findings highlighted the relevance and applicability of the framework to this specific HTA. According to interviewees, direct participation of users in the HTA process allows them to be part of the decision-making process. User consultation makes it possible to consider the views of a wide variety of people, such as marginalized and vulnerable groups, who do not necessarily meet the requirements for participating in HTA committees. However, some user representatives emphasized that user consultation should be integrated into a more holistic and participatory perspective. The most frequent barrier associated with user involvement in HTA was the top-down health system, which takes little account of the users perspective.nnnCONCLUSIONSnThe proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.

Involving patients in HTA activities at local level: a study protocol based on the collaboration between researchers and knowledge users

BackgroundThe literature recognizes a need for greater patient involvement in health technology assessment (HTA), but few studies have been reported, especially at the local level. Following the decentralisation of HTA in Quebec, Canada, the last few years have seen the creation of HTA units in many Quebec university hospital centres. These units represent a unique opportunity for increased patient involvement in HTA at the local level. Our project will engage patients in an assessment being carried out by a local HTA team to assess alternatives to isolation and restraint for hospitalized or institutionalized adults. Our objectives are to: 1) validate a reference framework for exploring the relevance and applicability of various models of patient involvement in HTA, 2) implement strategies that involve patients (including close relatives and representatives) at different stages of the HTA process, 3) evaluate intervention processes, and 4) explore the impact of these interventions on a) the applicability and acceptability of recommendations arising from the assessment, b) patient satisfaction, and c) the sustainability of this approach in HTA.MethodsFor Objective 1, we will conduct individual interviews with various stakeholders affected by the use of alternatives to isolation and restraint for hospitalized or institutionalized adults. For Objective 2, we will implement three specific strategies for patient involvement in HTA: a) direct participation in the HTA process, b) consultation of patients or their close relatives through data collection, and c) patient involvement in the dissemination of HTA results. For Objectives 3 and 4, we will evaluate the intervention processes and the impact of patient involvement strategies on the recommendations arising from the HTA and the understanding of the ethical and social implications of the HTA.DiscussionThis project is likely to influence future HTA practices because it directly targets knowledge users need for strategies that increase patient involvement in HTA. By documenting the processes and outcomes of these involvement strategies, the project will contribute to the knowledge base related to patient involvement in HTA.