Controlled Trials of CQI and Academic Detailing to Implement a Clinical Practice Guideline for Depression

Brown, Jonathan B.; Shye, Diana; McFarland, Bentson H.; Nichols, Gregory A.; Mullooly, John P.; Johnson, Richard E.

doi:10.1016/s1070-3241(00)26004-5

Cited by 50 publications

(35 citation statements)

References 32 publications

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“…Similar to pharmaceutical representatives, academic detailers bring food, present a cogent discussion on a particular topic, and leave attractive materials for physicians to review. [21][22][23][24][25] Initial meta-analyses of the data obtained from 18 educational outreach studies involving almost 1900 physicians suggested that educational outreach, especially when combined with other strategies, was a promising approach to changing provider behavior. 26 Despite the limitations of this technique, it has been endorsed by many experts as a primary modality to change physician behavior.…”

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confidence: 99%

Educational Outreach to Reduce Immunization Pain in Office Settings

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:Many strategies have been developed to address the pain and anxiety associated with immunizations, but these often are underutilized by pediatric providers. An educational outreach strategy known as "academic detailing" has been effective in changing health provider practices. WHAT THIS STUDY ADDS:In this study, an academic detailing strategy featuring a single teaching visit to the offices of pediatric practitioners in our community, focusing on reduction of injection pain, had demonstrable effects on practice behaviors up to 6 month after application.abstract OBJECTIVE: The goal was to examine the impact of a teaching module on immunization pain reduction practices in pediatric offices 1 and 6 months after the intervention. METHODS:Fourteen practices were selected randomly to receive a 1-hour teaching session on immunization pain reduction techniques, and 13 completed the study. Before the intervention, telephone interviews were conducted with parents concerning their children's recent immunization experiences. At 1 and 6 months after the intervention, parents of children who had recent immunizations were interviewed by using the same questionnaires. Clinicians also were surveyed at baseline and at 6 months. RESULTS:A total of 839 telephone interviews and 92 clinician surveys were included. Significant changes from baseline were identified at 1 and 6 months after the intervention. At 1 month, parents were more likely to report receiving information (P ϭ .04), using strategies to reduce pain (P Ͻ .01), learning something new (P Ͻ .01), using a ShotBlocker (P Ͻ .01), using sucrose (P Ͻ .01), and having higher levels of satisfaction (P ϭ .015). At 6 months, all rates remained significantly higher than baseline findings (all P Ͻ .01) except for satisfaction. Clinician surveys revealed significant increases in the use of longer needles, sucrose, pinwheels, focused breathing, and ShotBlockers at 6 months. CONCLUSIONS:A 1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention. This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors.

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confidence: 99%

Educational Outreach to Reduce Immunization Pain in Office Settings

et al. 2010

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“…1 Most primary care depression programs designed to improve acute depression management last 6 months or less. Because brief programs have little to no sustained effect 1 year after termination, [21][22][23][24] we tested a model that enhances primary care depression management on an ongoing basis. By supplementing acute management 25 with systematic monitoring for 24 months, this model incorporates chronic disease management principles 26,27 and results in clinically signifi cant improvements in both symptoms and functioning at 2 years.…”

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confidence: 99%

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis

Rost

Pyne

Dickinson

et al. 2005

The Annals of Family Medicine

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PURPOSE Although potentially costly, enhancing primary care depression management on an ongoing basis results in substantial long-term treatment effectiveness. The purpose of this article is to compare the cost-effectiveness of this approach with that of usual care. METHODSThe study was conducted in 12 community primary care practices randomized to enhanced or usual care after stratifi cation by baseline practice patterns. Practices assigned to enhanced care encouraged depressed patients to engage in active treatment, using practice nurses to provide regularly scheduled care management during the course of 24 months. We analyze outcomes for 211 adults (73.4% of potential eligible patients) beginning a new treatment episode for major depression determined by previsit screening. Outcomes included blinded estimates of days free of depression impairment as well as health care costs for 2 years.RESULTS Enhanced care signifi cantly increased the number of days free of depression impairment for 2 years when compared with usual care (647.6 days vs 588.2 days, P <.01). The incremental cost-effectiveness ratio for enhanced care ranged from $9,592 to $14,306 per quality-adjusted life-year (QALY). The number of incremental days free of depression impairment increased between the fi rst year and the second year (23.0 vs 36.4, respectively, P <.001) while incremental health plan costs decreased signifi cantly ($568 vs -$12, P <.001).CONCLUSIONS Enhancing primary care depression management on an ongoing basis should be considered for adoption by policy and health plan leaders. Most primary care depression programs designed to improve acute depression management last 6 months or less. Because brief programs have little to no sustained effect 1 year after termination, [21][22][23][24] we tested a model that enhances primary care depression management on an ongoing basis. By supplementing acute management 25 with systematic monitoring for 24 months, this model incorporates chronic disease management principles 26,27 and results in clinically signifi cant improvements in both symptoms and functioning at 2 years. 28 Given the clinical effectiveness at modest cost, we hypothesized that enhancing primary care depression management on an ongoing basis would be cost-effective when compared with usual care. Although it is premature to draw defi nitive conclusions when comparing the relative costs of brief and ongoing models of care, evidence of the cost-effectiveness of ongoing models provides important new information about the value of extending the brief programs currently being disseminated. METHODSExperimental Design and Sample Our methods, described in detail elsewhere, 25 are summarized here. After approval by the Human Research Advisory Committee of the University of Arkansas for Medical Sciences and the Colorado Multi-Institutional Review Board, the research team conducted the study in 12 community primary care practices across the United States, none of which employed onsite mental health professionals to treat depr...

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“…The CDC guidelines are widely and rapidly disseminated, 39,40 but awareness and dissemination of a guideline are not necessarily followed by adherence. [40][41][42] The CDC recommendations are based on the best available scientific evidence, but field trials are essential to differentiate between efficacy based on high not differ significantly between the 2 phases. These 3 studies [25][26][27] had the same design limitations as the studies in the previous systematic review, 21 including small sample sizes, single settings, and lack of control for potential biases and confounding.…”

Section: Compliance With Cdc Guidelinesmentioning

confidence: 99%

Isolation Precautions for Methicillin-Resistant Staphylococcus aureus: Electronic Surveillance to Monitor Adherence

Larson¹,

Cohen²,

Ross³

et al. 2009

American Journal of Critical Care

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The Centers for Disease Control and Prevention recently updated guidelines for isolation precautions and added specific recommendations for the management of multidrug-resistant organisms. However, the extent to which these recommendations are followed is unknown. Although the recommendations are based on studies with high internal validity, the effectiveness of these interventions in clinical practice also is unknown. Evidence of the effectiveness of isolation precautions for preventing transmission of infections caused by multidrug-resistant organisms in acute care settings, with methicillin-resistant Staphylococcus aureus as an example, was reviewed. Despite a lack of experimental data, numerous descriptive and correlational studies and a sound theoretical rationale strongly suggest that barrier precautions play an important role in the prevention of transmission of infections due to multidrugresistant organisms. Two major problems, however, still exist. First, staff members' adherence to national recommendations on isolation precautions, although insufficiently described, appears to be inadequate. Second, efficient, reproducible methods for ongoing surveillance of practices such as isolation precautions are not readily available. Automated surveillance systems that provide support for making decisions are promising for this purpose, are likely to result in cost savings, and therefore warrant more widespread development, testing, and implementation.

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Controlled Trials of CQI and Academic Detailing to Implement a Clinical Practice Guideline for Depression

Cited by 50 publications

References 32 publications

Educational Outreach to Reduce Immunization Pain in Office Settings

Educational Outreach to Reduce Immunization Pain in Office Settings

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis

Isolation Precautions for Methicillin-Resistant Staphylococcus aureus: Electronic Surveillance to Monitor Adherence

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