Login
Communauté Vinci
Extérieur
Si votre nom d'utilisateur ne se termine pas par @vinci.be ou @student.vinci.be, utilisez le formulaire ci-dessous pour accéder à votre compte de lecteur.
Titre : | Factors Influencing the Implementation of Guideline-Recommended Practices for Postconcussive Sleep Disturbance and Headache in the Veterans Health Administration: A Mixed Methods Study (2022) |
Auteurs : | Adam R. Kinney ; Nazanin Bahraini ; Jeri E. Forster ; Lisa A. Brenner |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 103, n° 11, 2022) |
Article en page(s) : | p. 2153-2163 |
Note générale : | https://doi.org/10.1016/j.apmr.2022.01.164 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Adhésion aux directives ; Anciens combattants ; Céphalées ; Lésions traumatiques de l'encéphale ; Réadaptation ; Sommeil |
Résumé : |
Objective
Understand barriers and facilitators of implementing recommended practices for postconcussive sleep disturbance and headache, as outlined in the Veterans Administration/Department of Defense 2016 Clinical Practice Guideline (CPG) for mild traumatic brain injury (mTBI). Design Convergent parallel mixed methods. Setting Ten national Veterans Health Administration (VHA) facilities. Participants Twenty VHA stakeholders (14 clinicians; 4 researchers; 2 policymakers), 55% of whom were affiliated with a VHA polytrauma rehabilitation center (N=20). Interventions None. Main Outcome Measures Stakeholders rated the quality of recommendations for sleep disturbance and headache using the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence instrument. A descriptive analysis of item scores was performed to understand the following features of the recommendations: (1) clinical credibility (eg, evidence quality), (2) alignment with stakeholder values, and (3) implementability. We conducted semistructured interviews with stakeholders and used descriptive and interpretive analyses to reveal emergent themes. After analyzing the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence and qualitative interview data, we synthesized the results into coherent conclusions (ie, meta-inferences) by comparing and contrasting respective findings. Results Stakeholders highlighted that the mTBI CPG includes features that reflect clinical priorities (eg, alignment with veteran preferences), making it an appropriate standard of care and facilitating its implementation. However, stakeholders also identified that the design of the mTBI CPG, along with provider-level (eg, knowledge) and facility-level (eg, resources) factors, may create barriers for implementation. In addition to these potential barriers, stakeholders noted a lack of comprehensive and systematic efforts designed to promote the uptake of these recommendations. Findings also revealed stakeholder recommendations for addressing potential barriers (eg, decision support). Conclusions With the recent release of the 2021 mTBI CPG, decision makers are encouraged to incorporate information gathered from previous implementation efforts to promote adherence to updated recommendations. Study findings, including recommended changes suggested by stakeholders, offer information that can be leveraged to design such efforts and promote care quality and associated outcomes for veterans with mTBI. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999322002386 |