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Developing tools to enhance the use of systematic reviews for clinical care in health systems.
Morrow, Allison S; Whiteside, Stephen P; Sim, Leslie A; Brito, Juan P; Wang, Zhen; Murad, Mohammad H.
Afiliación
  • Morrow AS; Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
  • Whiteside SP; Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
  • Sim LA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
  • Brito JP; Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
  • Wang Z; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
  • Murad MH; Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Evid Based Med ; 23(6): 206-209, 2018 Dec.
Article en En | MEDLINE | ID: mdl-30194075
We aimed to develop tools that can facilitate uptake of evidence summarised in systematic reviews by clinical decision makers in health systems. After conducting a systematic review on the management of anxiety in children, we interviewed health system representatives, clinicians and patients to ask about additional information needed for decision-making. Using stakeholders' feedback and literature searches for contextual and implementation information, we developed two tools (decision aids (DAs)), one for the health system and the second for the clinical encounter. This information mapped to factors of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Evidence to Decision Framework. The health system DAs provided information on which patients are candidate for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates and prognosis. Health system stakeholders found the DA useful for clinical decision-making and generalisable to other conditions. The encounter DA was produced as cards containing information on issues that drive treatment decisions (effect on symptoms, effect on function, treatment burden, side effects and cost). Patients and parents prioritised the cards and chose the order in which these issues were discussed with clinician. The encounter DA was found to be helpful by patients, parents and clinicians. We conclude that the uptake of evidence summaries by health systems can be enhanced by developing tools that provide contextual and implementation information about clinical care. A dual approach addressing health system stakeholders as well as clinicians and patients is likely feasible and helpful.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Técnicas de Apoyo para la Decisión / Medicina Basada en la Evidencia / Toma de Decisiones Clínicas / Revisiones Sistemáticas como Asunto Tipo de estudio: Guideline / Prognostic_studies / Systematic_reviews Aspecto: Equity_inequality Límite: Child / Humans Idioma: En Revista: BMJ Evid Based Med Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Técnicas de Apoyo para la Decisión / Medicina Basada en la Evidencia / Toma de Decisiones Clínicas / Revisiones Sistemáticas como Asunto Tipo de estudio: Guideline / Prognostic_studies / Systematic_reviews Aspecto: Equity_inequality Límite: Child / Humans Idioma: En Revista: BMJ Evid Based Med Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido