Telemedicine in the NHS for the millennium and beyond.
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This article defines telemedicine, discusses evidence of its effectiveness, looks at its advantages and disadvantages (and barriers to implementation), and considers its role in the NHS for the millennium and beyond. (+info)
Nationwide implementation of guided supermarket tours in The Netherlands: a dissemination study.
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The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department. (+info)
Diffusion of new drugs in Danish general practice.
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OBJECTIVES: There is a large variation in implementing research findings in clinical practice. We examined whether the concept of early or late adopters is universal for the diffusion of all new drugs, and whether it is associated with non-scientific factors in general practice. METHODS: We identified all prescriptions for five new drugs from the population-based prescription database in North Jutland County, Denmark (490000 inhabitants) from 1993 to 1996, and calculated the period from release of the drugs to the issuing of the first prescription by each GP. Logistic regression was performed to predict early or late prescribing from physician characteristics, practice activity and the number of prescriptions, adjusted for age and sex. RESULTS: The distributions of the diffusion time of the drugs by 95 solo practitioners were asymmetrical, with a long upper tail representing the late prescribers. The shape and slope of the diffusion curve were highly drug dependent. There was poor agreement of the three adopter categories (early, intermediate and late prescribers) between the five drugs (kappa < 0.35), but being a late prescriber was the most consistent condition. Late prescribing of tramadol, compared with intermediate prescribing, was associated with female physicians (odds ratio (OR) 5.7; 95% CI 1.5-21.3), smaller list size (OR 0.1; 95% CI 0.0-0.8), a strong general restrictive attitude to pharmacotherapy (OR 0.07; 95% CI 0.01-0.68) and a tendency to lower diagnostic activity per patient (OR 0.4; 95% CI 0.1-1.9). CONCLUSIONS: The slope and shape of the diffusion curve are both dependent on physician and drug characteristics, but late prescribers share some common characteristics. (+info)
Information technology outside health care: what does it matter to us?
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Non-health-care uses of information technology (IT) provide important lessons for health care informatics that are often overlooked because of the focus on the ways in which health care is different from other domains. Eight examples of IT use outside health care provide a context in which to examine the content and potential relevance of these lessons. Drawn from personal experience, five books, and two interviews, the examples deal with the role of leadership, academia, the private sector, the government, and individuals working in large organizations. The interviews focus on the need to manage technologic change. The lessons shed light on how to manage complexity, create and deploy standards, empower individuals, and overcome the occasional "wrongness" of conventional wisdom. One conclusion is that any health care informatics self-examination should be outward-looking and focus on the role of health care IT in the larger context of the evolving uses of IT in all domains. (+info)
Diffusion of a quality improvement programme among allied health professionals.
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OBJECTIVE: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands. DESIGN: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%. SETTINGS AND PARTICIPANTS: All subsectors in health care were covered, including primary care and institutional care. The participants were either salaried or self-employed in private practice. INTERVENTION: The governing boards of the professional associations developed a QI policy. This study reports the evaluation of the diffusion of this policy. MAIN OUTCOME MEASURE: Respondents' knowledge of the QI programme and their opinions with respect to the relevance of 15 QI activities. Respondents were asked whether they were currently taking part in QI activities and, if not, whether they intended to participate in them in the near future. In addition, the advantages of the QI programme and the barriers to further implementation which respondents perceived were assessed. RESULTS: Most of the health professionals were familiar with the QI programme. The relevance of the QI activities for the profession was rated. Continuing education was ranked highest in priority. The respondents perceived the advantages of many of the QI activities. At the time of the study, less than one-third of the respondents were taking part in peer review, or complying with national guidelines. Respondents listed a number of barriers to further implementation. CONCLUSIONS: The perceived advantages and barriers related to implementation appear to differ per QI activity. Consequently, implementation strategies should differ per QI activity and be tailored to the specific advantages and barriers of each one. (+info)
Health promotion research and the diffusion and institutionalization of interventions.
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To examine the extent to which health promotion research is providing an empirical basis for the diffusion and institutionalization of effective interventions, we conducted a systematic audit of all articles in 12 public health and health promotion journals for the 1994 calendar year. We identified empirical/non-empirical and health promotion/non-health promotion articles. For each study, the health behaviours or outcomes studied, the target group, gender and setting were categorized. Each study was also categorized as belonging to one of four stages: basic research and development, innovation development, diffusion research, and research into institutionalization or policy implementation. Of all articles coded (n = 1210), 33.9% were identified as non-research, 39.5% were health promotion research and 26.6% were non-health promotion research. The vast majority of studies fell within the basic research and development stage (89.6%), with less than 1% categorized as diffusion research and only 5% as institutionalization or policy implementation research. The published studies reviewed provide a limited empirical basis for diffusion and institutionalization of health promotion programs. These findings suggest a need to more systematically monitor research input (funding) and research output (publications), and to develop a more explicit focus on the relevance of the stages of research innovation and development, the issues and/or behaviours addressed, the target population, and the research setting. (+info)
Diffusion of laparoscopic cholecystectomy in the Veterans Affairs health care system, 1991-1995.
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CONTEXT: Laparoscopic cholecystectomy has become the most widely used treatment for gallbladder disease. In HMO, Medicare, and fee-for-service settings, cholecystectomy rates increased 28% to 59% after introduction of laparoscopic cholecystectomy. OBJECTIVE: To investigate the impact of the introduction of laparoscopic cholecystectomy on cholecystectomy rates and the operative mortality rate in Veterans Affairs (VA) hospitals. DESIGN: Sequential cross-sectional study. PATIENTS: All patients who underwent cholecystectomy from 1991 (before introduction of laparoscopic cholecystectomy) to 1995. SETTING: 133 VA hospitals. OUTCOME MEASURES: Cholecystectomy rates, use of laparoscopic or open cholecystectomy, and operative mortality rate. RESULTS: The annual number of cholecystectomies in the VA system increased by 10% from 1991 to 1995; the laparoscopic procedure accounted for 25% of the caseload in 1992 and 52% in 1995. Compared with patients having laparoscopic cholecystectomy, those having open cholecystectomy were more likely to be older, be male, and have acute cholecystitis or comorbid illnesses (P < 0.001). The operative mortality rate of open cholecystectomy increased by 46% during this 4-year period (from 2.4% to 3.4%) and was constant for laparoscopic cholecystectomy (about 0.5%). Given the increasing use of the laparoscopic procedure, however, the overall mortality rate of cholecystectomy during surgery decreased by 22% (from 2.4% to 1.8%). Despite increased use of the surgery, the absolute number of deaths decreased by 9%. CONCLUSIONS: The introduction of laparoscopic cholecystectomy in the VA system was not accompanied by a large increase in cholecystectomy rates, as it was in fee-for-service, Medicare, and HMO systems. Because the rate of operations has changed only slightly, the total number of cholecystectomy-related deaths has decreased. (+info)
Some limits to evidence-based medicine: a case study from elective orthopaedics.
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There has been growing interest in recent years in the application of the principles of evidence-based medicine (EBM), although implementation is complex. Scientific, organisational, and behavioural factors all combine to shape clinical behaviour change. Case study based qualitative data are presented which illuminate such processes within one clinical setting (elective orthopaedics), drawn from a larger study. It is suggested that (1) there are alternative models of what constitutes "evidence" in use; (2) scientific knowledge is in part socially constructed; and (3) clinical professionals retain a monopoly of technical knowledge. The implication is that there may be severe obstacles to the rapid or broad implementation of EBM. (+info)