Transcript kurc.tums.ac.ir

Jaleh Gholami Eshlaghi
MD. MPH. PhD Candidate in Epidemiology
‫اهداف آموزشی این بخش‬
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‫آشنایی با اصول کلی که در هنگام انتقال دانش باید در نظر گرفت‬
‫آشنایی با برخی از روش های انتقال دانش برای گروه های متفاوت‬
‫مخاطبین‬
‫آشنایی با روش های موثر انتقال دانش‬
‫توجه به اثربخشی روش های انتقال هنگام تدوین استراتژی انتقال‬
Review
Message (WHAT?)
Level of Evidence
Target Audience ( To WHOM?)
Messenger (BY WHOM?)
Barriers
Knowledge transfer process and support system (HOW?)
Evaluation (with what EFFECT should it be transferred?)
What should be considered?
 Consider the audience:
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the problems audiences face,
the message that is valuable to him/her
the level of detail they need,
the style of thinking they use
the messenger they can trust
the language they are comfortable with
‫‪Example‬‬
‫• مرور نظام مند و متاآنالیز كارازمايي هاي بالیني شاهد دار تصادفي‬
‫شده نشان مي دهد كه میزان خطر نسبي شكستگي ران براي‬
‫مصرف ويتامین ‪ D‬به تنهايي ‪( 1.1‬با حدود اطمینان ‪)1.36-0.89 %95‬‬
‫مي باشد در حالي خطر نسبي شكستگي ران در صورت مصرف‬
‫ويتامین ‪ D‬و مكمل كلسیم برابر با ‪( 0.82‬با حدود اطمینان ‪%95‬‬
‫‪ )0.71, 0.94‬مي باشد‪.‬‬
‫• ويتامین ‪ D‬در صورت مصرف مكمل كلسیم باعث كاهش خطر‬
‫شكستگي ران مي شود در صورتي كه مصرف ويتامین ‪ D‬به تنهايي‬
‫اين تاثیر را ندارد‪.‬‬
Evidence based medicine should be
complemented by evidence based
implementation.
Richard Grol
strategies focusing:
• Health care Professionals
• Patients
• Policy makers and managers
strategies focusing on professionals
– Printed Educational material (Clinical Practice
Guideline, audio-visual materials, and electronic
publications)
– Educational Meeting
• Didactic meeting (Lectures, Conferences)
• Interactive Educational Meeting (workshop)
– Educational Outreach (Prescribing behavior)
– Local opinion leaders (Educationally influential
providers)
– Audit and feedback (Any summary of Clinical
performance)
– Reminders (Patient or encounter specific information)
Clinical Practice Guideline
• Evidence-based clinical practice guidelines are
knowledge tools defined as systematically
developed statements that help clinicians and
patients make decisions about appropriate health
care for specific clinical circumstances.
How are clinical practice guidelines
developed?
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Establish multidisciplinary guideline team
Identify clinical question that explicitly defines the patients,
intervention/exposure, comparisons (if relevant), outcomes of interest
and setting
Conduct a systematic review of evidence
Appraise and interpret evidence and come to consensus on its meaning
Draft guideline recommendations that align with evidentiary base
Complete an external review of draft report among intended users and
key stakeholders
Revise the guidelines in response to external review
Read the final guideline report for distribution and dissemination
Prepare implementation strategy
Appraisal of Guidelines Research and Evaluation (AGREE)
Local opinion leaders
• Opinion leadership is the degree to which an
individual is able to influence other
individuals’ attitudes or overt behavior
informally in a desired way with relative
frequency.
Local opinion leaders
This informal leadership is not a function of the individual’s
formal position or status in the system, it is earned and
maintained by the individual’s
– Technical competence,
– social accessibility, and
– conformity to the systems norms.
opinion leaders have more:
– external communication,
– higher social status,
– innovative
Local opinion leaders characteristics in Iran
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High level of knowledge
Communication skills
Taking into account stakeholders
Professional ethics
Gynaecologists’ social network
G085
G001
G005
G011
G004
G009
G095
G015
G013
G089
G086
G007
G115
G113
G087
G048
G098
G112
G140
G033
G074
G032
G150
G027
G147
G047
G141
G050
G100
G111
G099
G069
G065
G128
G062
G017
G053
G071
G049
G114
G064
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Effectiveness of professional behavior
change strategies
– Printed Educational material (Clinical Practice
Guideline, audio-visual materials, and electronic
publications)
– Educational Meeting
• Didactic meeting (Lectures, Conferences)
• Interactive Educational Meeting (workshop)
– Educational Outreach (Prescribing behavior)
– Local opinion leaders (Educationally influential
providers)
– Audit and feedback (Any summary of Clinical
performance)
– Reminders (Patient or encounter specific information)
strategies focusing on patients
• Patient decision aids
• Interactive Health Communication Applications
(Information packages for patients that combine
health information with at least one of social
support, decision support, or behavior change
support)
• Interventions to enhance medication adherence
(Instruction, telephone monitoring and counseling,
Reminders, special ‘reminder’ pill packaging, …)
What are patient decision aids?
Patient decision aids translate evidence into patient-friendly
tools to inform patients about their options, help them
clarify the value they place on benefits versus harms, and
guide them in the process of decision making.
Formats for decision aids are:
• paper-based booklets,
• video/DVDs,
• decision boards,
• and internet-based materials
Ottawa Hospital Research Institute (OHRI)
presentation of outcome probabilities
Ottawa PDA format
clarify patients’ values for outcomes
How do we determine the quality of
patient decision aids?
IPDAS Criteria
Effectiveness of knowledge translation
strategies focusing on patients
• Patient decision aids
• Interactive Health Communication Applications
(Information packages for patients that combine
health information with at least one of social
support, decision support, or behavior change
support)
• Interventions to enhance medication adherence
(Instruction, telephone monitoring and counseling,
Reminders, special ‘reminder’ pill packaging, …)
Do patient decision aids work?
PDAs improve:
• patients’ participation in decision making,
• knowledge of options,
• agreement between patients’ values and the subsequent
treatment or screening decisions.
• realistic expectations of the chances of benefits, harms, and
side effects
• More use of conservative options,
• without apparent adverse effects on health outcomes or
anxiety.
strategies focusing on professionals
Reader Friendly Writing (1:3:25)
Policy brief
“Reader Friendly Writing” Writing for health
policy makers, planners and managers
(Canadian Health Service Research Foundation)
1:3:25
1: Main message
3: Executive Summary
25: The Report
Main Messages
• This part is one page of main message bullets.
• They are the heart of your report, the lessons decision
makers can take from your research.
• Set aside your text and focus on expressing clear conclusions
based on what you've learned.
• Consider your audience - who are they, and what do they
most need to know about what you've learned?
• tell decision makers what implications your work has for
theirs.
• if you're really not ready to draw more conclusions, don't
just fall back on "more research is needed." Use your main
messages to define the questions that still need to be asked.
Executive Summary
• The three in 1:3:25 is the executive summary.
• An executive summary is not an academic abstract; it's
much more like a newspaper story, where the most
interesting stuff goes at the top, followed by the
background and context and less important information
further down.
• This is not the place for more than a line or two about your
approach, methods and other technical details.
The Report
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Context
Implications
Approach
Results
Additional Resources
Further Research
References and Bibliography
appendix
Policy Brief
Policy briefs are a relatively new
approach to packaging research
evidence for policymakers.
Possible outline of a policy brief
• Title
• Key messages
– What is the problem?
– What do we know (and not know) about viable options to
address the problem?
– What implementation considerations need to be borne in
mind?
• Report
– Introduction that describes the issue and the context in
which it will be addressed
– Definition of the problem
– Options for addressing the problem, with each one
assessed in a table (an example is shown below)
Effectiveness of knowledge translation strategies
focusing on policy makers and senior health service
managers
• In contrast to the substantial evidence base on
the effectiveness of knowledge translation
strategies targeting health care professionals and
patients, we are not aware of any experimental
studies evaluating the effects of knowledge
translation research that focused on policy
makers or senior health service managers.
Other strategies
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Mass media
Continuous medical education
Structural modification and support
Financial incentives
Changing rules and regulations
…
Thank you