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Getting evidence into practice in preventive health care settings Results of a systematic review

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Role of PHC providers in preventive care. Primary health care providers are ... studies tested strategies in specific preventive health settings. Results (2) ... – PowerPoint PPT presentation

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Title: Getting evidence into practice in preventive health care settings Results of a systematic review


1
Getting evidence into practice in preventive
health care settings Results of a systematic
review
PHAA/AFPHM/AHPA Conference, 21 October 2006
Making research matter Translating research
into health policy and practice
  • Belinda Lunnay
  • Petra Bywood
  • Ann Roche
  • National Centre for Education and Training on
    Addiction (NCETA)
  • Flinders University, Adelaide, South Australia

2
Overview
  • Background rationale
  • Aims approach
  • Preliminary results
  • Implications for practice

3
Role of PHC providers in preventive care
Primary health care providers are well-placed to
provide preventive health services
4
Research ? Practice
Research Innovations
Dissemination to research community
Dissemination to health care providers
Translation of research into practice guidelines
Adoption dissemination and implementation
strategies
Professional interventions
Skills knowledge support strategies
Organisational factors
Evidence-based Practice
Adapted from Roche et al 2002
5
The research-practice gap
  • Effective research innovations not translated to
    practice
  • Finite health resources used inefficiently
  • Potentially ineffective practices persist
  • …and preventable disease and infirmity is not
    prevented!

6
Dissemination Strategies
Effective Practice and Organisation of Care
(EPOC), 2002
7
Dissemination Strategies
Effective Practice and Organisation of Care
(EPOC), 2002
8
Project aims
  • To evaluate the effectiveness of dissemination
    strategies used to improve the work practices of
    health care providers
  • To identify key factors underlying the success of
    effective strategies

9
Project approach
  • Systematic literature review
  • Search 1966-March 2005 existing SRs
    updated search 1998-March 2005 new primary
    studies
  • Study inclusion criteria controlled collected
    baseline data min. 3-month study period
  • Study assessment 2 reviewers assessed studies
    for level (NHMRC, 2000) and quality of evidence
    (EPOC, 2002)

10
Systematic vs narrative reviews
11
Results (1)
  • 4,560 citations
  • (full SR all dissemination strategies)
  • Stratified by health settings
  • 3 existing systematic reviews 16 primary
    studies tested strategies in specific preventive
    health settings

12
Results (2)
  • Study quality findings variable - Poor
    reporting - Risk of bias - Underpowered
  • Conclusions based on higher level evidence,
    better quality evidence
  • Qualitative synthesis

13
Results (3) Preventive health settings
  • Levels of prevention

The continuum of care
Primary prevention promotion of wellbeing
Secondary prevention early intervention
Tertiary prevention disease management
Adapted from Preventing chronic disease A
strategic framework, National Public Health
Partnership, 2001
14
Primary prevention -
  • reduces the likelihood of disease occurring
  • Settings tested
  • Tobacco cessation support / services
  • Alcohol screening / counselling
  • Drug use prevention (among young people)
  • Immunisations / vaccinations
  • Stroke prevention
  • Falls prevention / reduction
  • HIV prevention

15
Which strategy to use for primary prevention…?
16
Secondary prevention -
  • early detection of disease before it becomes
    symptomatic
  • Settings tested
  • Screening for
  • Cancer (mammogram, pap smear, faecal occult blood
    test)
  • Diabetes (blood glucose tests)
  • Cholesterol
  • Tuberculosis
  • Anaemia (haemoglobin tests)
  • Lead (blood test)
  • Vitamin B12 deficiency
  • Hypertension (blood pressure measures)

17
Which strategy to use for secondary prevention…?
18
Tertiary prevention -
  • attempt to prevent or minimise the complications
    associated with established disease
  • Settings tested
  • Type II diabetes management

19
Which strategy to use for tertiary prevention…?
20
Implications for practice
  • Strategies exist to improve preventive health
    services
  • No single strategy is always effective
  • Each strategy is effective in some situations

21
Characteristics of success
  • Targeted change is simple/achievable
  • Strategy is tailored to context/setting of
    implementation
  • Organisational/systems approach

22
Where to from here?
  • Broader systematic review - ongoing
  • Cost effectiveness study
  • Tool for selecting strategies

23
Contact Details
Dissemination and Implementation Strategies
Project Team National Centre for Education and
Training on Addiction Flinders
University Adelaide SA http//www.nceta.flinders.
edu.au/ belinda.lunnay_at_flinders.edu.au
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