Printed educational materials (PEMs) are commonly used simple interventions that can be used alone or with other interventions to disseminate clinical evidence. They have been shown to have a small effect on health professional behaviour. However, we do not know whether they are effective in primary care. We investigated whether PEMs improve primary care physician (PCP) knowledge, behaviour, and patient outcomes. We conducted a systematic review of PEMs developed for PCPs. Electronic databases were searched for randomized controlled trials, quasi randomized controlled trials, controlled before and after studies, and interrupted time series. We combined studies using meta-analyses when possible. Statistical heterogeneity was examined, and meta-analysis was performed using a random effects model when significant statistical heterogeneity was present and a fixed effects model otherwise. The template for intervention description and replication (TIDieR) checklist was used to assess the quality of intervention description. Our search identified 12,439 studies and 40 studies met our inclusion criteria. We combined outcomes from 26 studies in eight meta-analyses. No significant effect was found on clinically important patient outcomes, physician behaviour, or physician cognition when PEMs were compared to usual care. In the 14 studies that could not be included in the meta-analyses, 14 of 71 outcomes were significantly improved following receipt of PEMs compared to usual care. Most studies lacked details needed to replicate the intervention. PEMs were not effective at improving patient outcomes, knowledge, or behaviour of PCPs. Further trials should explore ways to optimize the intervention and provide detailed information on the design of the materials. PROSPERO, CRD42013004356
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.
Primary care is the foundation of health care systems around the world. Physician autonomy means that governments rely on a limited selection of levers to implement reforms in primary care delivery, and these policies may impact the practice choices, intentions, and patterns of primary care physicians. Using a systematic search strategy to capture publicly available policy documents, we conducted a scan of such policies from 1998 to 2018 in three Canadian provinces: British Columbia, Nova Scotia, and Ontario. We reviewed 388 documents and extracted 170 policies from their texts, followed by analysis of the policies' instruments, actors, and topic areas. Policy reforms across the three provinces were primarily focused on physician payment, with governments relying on both targeted incentives and reformed payment models. Policies also employed various instruments to target priority areas of practice: 24/7 access to care, team-based primary care, unattached patients, eHealth, and rural/Northern recruitment of physicians. Across the three provinces and the 20-year timespan, reform priorities and instruments were largely uniform, with Ontario's policies tending to be the most diverse. Physicians helped shape reforms through the agreements negotiated between provincial governments and medical associations, influencing the topics and timing of reforms. Future research should evaluate impacts on the delivery of primary care and explore opportunities for policy innovation.
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.
Introduction: Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability. This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts.Theory/Methods: The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data.Results: The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts.Discussion: The quantitative content analysis of participant interviews suggests that the social and psychological context for integrating care should not be neglected in research and practice. Five of the nine organizational capabilities deemed most important to integrating care are from the "People and Values" domain of the framework. An understanding of the subjective context, and associated organizational capabilities such as leadership approach, clinician engagement, organizational culture, and readiness for change, may be of equal, if not greater, importance to study as the objective contextual factors such as physical features, resources, and organizational/network design. Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities.Conclusions: We developed a consolidated research- and practice-informed framework to guide the implementation of integrated care interventions and to help focus measurement of organizational context and capabilities. We also prioritized the most important organizational capabilities and explored their inter-relationships via interviews with key informants.Lessons Learned: Participants' views and experiences did not always align with the initial framework's structure and wording. Based on the results, we made modifications to terminology. Participants also identified complex, often non-linear relationships among capabilities that require additional study in future research.Limitations: The validation results presented are based on a sample of 29 participants in one Canadian province. Although participants came from diverse organizations and differed in approaches to integrating care, the limited scope of the sample indicates that the results may not be widely generalizable.Suggestions for Future Research: Additional research is needed to empirically test the proposed framework, with a focus on the hypothesized relationships. Research needs to move beyond general statements about variations in the performance of integrated care interventions being due, for example, to "culture" or "leadership", to more specific assessments of these capabilities.
Background It is difficult to communicate new and complex clinical evidence to physicians already experiencing information overload. Proper use of design principles may increase uptake of guidelines and other printed educational materials (PEM) and improve practice. Objectives We aimed to determine whether physician-oriented PEMs are created in accordance with design principles. Methods We analysed PEMs identified in a 2012 Cochrane review of their effect on professional and patient outcomes and developed a checklist of design principles based on a literature review of clinical guideline implementability. Two analysts independently evaluated each PEM to determine how design principles were applied. Results Though the sample consisted of PEMs designed and developed to influence care, no single PEM scored well across all categories. Some PEMs failed to differentiate major recommendations and did not present them in a stepwise fashion. Most used clear and easy to read text, but highlighting was often inappropriate. Some algorithms lacked logic and consistency. Images were poorly designed and used, which may distract and confuse the reader. Discussion Design principles are not consistently applied in the development of PEMs and improvements are needed to images, presentation of recommendations, and usability of algorithms. Improvements to the design of PEMs may influence their uptake by combating information overload and increasing their perceived ease of use and perceived usefulness. Implications for Guideline Developers/Users Those who create guidelines and other PEMs consider some design principles, but do not implement them consistently. Our checklist can assist guideline developers in employing a range of design principles.
People with serious mental illnesses (e.g., schizophrenia, bipolar disorder) have inequitable access to primary care, which is associated with avoidable morbidity and mortality. Assertive Community Treatment (ACT) is an evidence-based model that provides intensive mental and social health support. ACT’s engagement with primary care (both in providing primary care services or collaborating with external primary care providers) is not well understood.
Objective:
To discover ACT team members’ mental models (i.e., psychological representations) of the provision of primary care (within the team and through collaboration with external primary care providers), and the perceived impact of COVID-19 on these mental models.
Study Design and Analysis:
An exploratory multiple qualitative case study using semi-structured interviews and thematic analysis. Shared Mental Model theory framed analysis.
Setting or Dataset:
Ontario, Canada.
Population Studied:
Interdisciplinary ACT team members.
Results:
Twenty-seven participants from 5 ACT teams in one region were interviewed, including administrators, social workers, psychiatrists, mental health workers/counsellors, occupational therapists, nurses, and a recreational therapist. ACT team members perceived that primary care was important for their clients. Some teams offered a limited set of medical primary care services to meet clients’ needs. Most participants did not think that ACT team mandates should expand to include primary care. They should instead support collaboration with clients’ external primary care providers, as this enables client integration into the wider community. To liaise with external providers, ACT team members reported that they must navigate barriers at multiple levels (i.e., client, provider, and system levels). Most participants believed the COVID-19 pandemic delayed client access to primary care, demanded more time and risk exposure from ACT to support care, and shifted to virtual care without considering all clients’ needs. Some teams reported an increase in internal primary care provision during the pandemic. This was associated with burnout and reinforced the importance of external primary care provision.
Conclusions:
Findings provide insight into the different ways primary care can be delivered to ACT clients, which could provide important lessons for ACT teams in North America.
