Implementing cardiovascular disease prevention guidelines to translate evidence-based medicine and shared decision making into general practice: theory-based intervention development, qualitative piloting and quantitative feasibility

Background: The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid. Methods: Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on "think aloud" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98). Results: Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment. Conclusions: Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research

Complete LibTech 2013 Print Program

PDF of the complete print program from the 2013 Library Technology Conferenc

Promoting the Readiness of Minors in Supplemental Security Income (PROMISE) [CFDA 84.418P]

Over the past two decades, New York State (NYS) has been actively and collaboratively engaged in systems change across three primary domains: 1) to develop a comprehensive employment system to reduce barriers to work and improve employment outcomes of individuals with disabilities; 2) to enhance the post-school adult outcomes of youth with disabilities, by collaboratively advancing evidence-based secondary transition practices at the regional, school district and individual student levels; and, 3) to support the return-to-work efforts of individuals with disabilities who receive Social Security Administration (SSA) disability benefits under the Supplemental Security Income (SSI) program and Social Security Disability Insurance (SSDI). These domains have been supported by numerous federal and state initiatives including: the US Department of Education’s Office of Special Education and Rehabilitation Services (OSERS)-sponsored Transition Systems Change grant; the SSA-sponsored State Partnership Initiative (NYWORKS); two Youth Transition Demonstrations (YTD); the Benefits Offset National Demonstration (BOND); and, three cycles of funding for the National Work Incentives Support Center (WISC); the US Department of Labor (DOL)-sponsored Work Incentive Grant, Disability Program Navigator Initiative, and Disability Employment Initiative; three rounds of funding from the Center for Medicaid and Medicare Services (CMS) for Medicaid Infrastructure Grants (MIG, NY Makes Work Pay); the NYS Education Department (NYSED) sponsored Model Transition Program (MTP); and three multi-year cycles of the statewide Transition Coordination Site network. Most recently, NYS has sponsored the Statewide Transition Services Professional Development Support Center (PDSC); the NYS Developmental Disability Planning Council (DDPC)-sponsored Transition Technical Assistance Support Program (T-TASP), NYS Work Incentives Support Center (NYS WISC), and NYS Partners in Policy Making (PIP); the NYS Office of Mental Health (OMH)-sponsored Career Development Initiative; and others. The growing statewide and gubernatorial emphasis on employment for New Yorkers with disabilities developed over the past two decades stemming from these initiatives, supported by service innovations and shared vision across state agencies and employment stakeholders, establishes a strong foundation for implementing and sustaining a research demonstration to “Promote the Readiness of Minors in Supplemental Security Income” (PROMISE). The NYS PROMISE will build upon NYS’ past successes and significantly support NYS in removing systems, policy and practice barriers for transition-age youth who receive SSI and their families. The NYS OMH through the Research Foundation for Mental Hygiene (RFMH), with their management partners the New York Employment Support System (NYESS) Statewide Coordinating Council (SCC) and Cornell University Employment and Disability Institute, along with the proposed research demonstration site community, join the NYS Governor’s Office in designing and implementing a series of statewide strategic service interventions to support the transition and employment preparation of youth ages 14-16 who receive SSI

Participatory, Visible and Sustainable. Designing a Community Website for a Minority Group

This paper tackles three aspects of community-based technological initiatives aimed to support minority groups’ public expression and communication: participation, visibility and sustainability. Participation requires\ud the active involvement of the community members in various project phases (from design to evaluation), sharing decisional power with project leaders. Visibility\ud refers to the capacity of community messages to reach a relevant audience outside the boundaries of the community itself. Sustainability indicates the capacity of a project to continue, under the control and management of the local community, beyond its “supported” lifetime. The mutual influence of these three dimensions is examined in general and also in the light of a specific case study: an initiative involving a Romani community in rural Romania, having as main outcome the development of a community website (www.romanivoices.com/podoleni)