RESUMO

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

Assuntos

RESUMO

Physicians are frequently faced with questions related to their patients' care that they cannot answer. A vast number of randomised trials have tested a wide variety of behaviour-changing strategies designed to improve practitioners' evidence utilisation, but systematic reviews have concluded that the effects are generally small and inconsistent. We conducted a randomised controlled trial to determine whether a question identification and solving system, using structured evidence summaries with recommendations, would change physician's behavior related to the care of their hospitalised patients. The trial was conducted at the secondary level, internal medicine ward. Relevant clinical questions were the units of randomisation; 14 clinicians participated in the study. The question identification and answering system was carried out using evidence summaries with recommendations based on the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach stressing influence on clinician behaviour (decision/recommendation concordance). During 131 morning reports, 553 questions were identified (4.2 questions per meeting). 398 were excluded because they were not about diagnostic or therapeutic interventions or because their answers could not have impact on clinician behaviour, and 31 were excluded because of lack of time to answer them, leaving 124 included questions. The proportion of clinical decisions concordant with the proposed recommendations was 79%in the intervention arm and 44% in the control arm: relative risk 1.8 (95% CI 1.3 to 2.4), number of evidence summaries needed to change a care decision for one question raised was 3 (95% CI 2 to 6). A question identification and answering system was feasible, effectively performed and significantly influenced clinician behaviour related to the care of hospitalised patients, which suggests that interventions facilitating accessibility and interpretability of the best available evidence at the point of care have the potential to significantly impact on the quality of healthcare.

Assuntos

RESUMO

The PLATO study evaluated the efficacy of adding ticagrelor, instead of clopidogrel, to aspirin in patients with acute coronary syndrome, which showed surprisingly positive results making the drug acceptable to regulatory agencies and specialty societies worldwide. Notwithstanding the aforementioned success, contradictory information supplied by critical analysis was submitted by the sponsor. The controversial findings revealed several aspects that are difficult to explain, threatening the veracity of the study's conclusions. Mortality rate pattern, excessive benefit not comparable to prior studies, unexplained loss of follow-up development and inconsistency in findings in accordance with the country, the type of events arbitrator and monitoring committee are some of the most questionable issues. Dubious reaction to this trial is based on the fact that the information could not be found in published articles. This complex situation poses a challenge to the critical analysis of the text and raises questions as to how far the conflicts of financial interest influenced the development of the study, the communication of its results and probably, acceptance of the drug for commercial use.

Assuntos

RESUMO

The PLATO study evaluated the efficacy of adding ticagrelor, instead of clopidogrel, to aspirin in patients with acute coronary syndrome, which showed surprisingly positive results making the drug acceptable to regulatory agencies and specialty societies worldwide. Notwithstanding the aforementioned success, contradictory information supplied by critical analysis was submitted by the sponsor. The controversial findings revealed several aspects that are difficult to explain, threatening the veracity of the study’s conclusions. Mortality rate pattern, excessive benefit not comparable to prior studies, unexplained loss of follow-up development and inconsistency in findings in accordance with the country, the type of events arbitrator and monitoring committee are some of the most questionable issues. Dubious reaction to this trial is based on the fact that the information could not be found in published articles. This complex situation poses a challenge to the critical analysis of the text and raises questions as to how far the conflicts of financial interest influenced the development of the study, the communication of its results and probably, acceptance of the drug for commercial use.

Assuntos

RESUMO

The PLATO study evaluated the efficacy of adding ticagrelor, instead of clopidogrel, to aspirin in patients with acute coronary syndrome, which showed surprisingly positive results making the drug acceptable to regulatory agencies and specialty societies worldwide. Notwithstanding the aforementioned success, contradictory information supplied by critical analysis was submitted by the sponsor. The controversial findings revealed several aspects that are difficult to explain, threatening the veracity of the studys conclusions. Mortality rate pattern, excessive benefit not comparable to prior studies, unexplained loss of follow-up development and inconsistency in findings in accordance with the country, the type of events arbitrator and monitoring committee are some of the most questionable issues. Dubious reaction to this trial is based on the fact that the information could not be found in published articles. This complex situation poses a challenge to the critical analysis of the text and raises questions as to how far the conflicts of financial interest influenced the development of the study, the communication of its results and probably, acceptance of the drug for commercial use.