Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

Implementation Science

Jose Ignacio Pijoan¹  Susana Gonzalez-Larragan²  Jon Argote³  Gaspar Lantaron⁴  Itxasne Lekue⁵  Rita Sainz de Rozas⁶  Susana Pablo⁷  Alvaro Sanchez⁷  Marta Mediavilla⁷  Pedro Maria Latorre⁷  Arturo García-Álvarez⁷  Gonzalo Grandes⁷  Christian D. Helfrich⁸ 

[1] Clinical Epidemiology Unit, Hospital Universitario de Cruces. BioCruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza;Department of Health Science Library, Cruces University Hospital-Osakidetza, Biocruces Bizkaia Health Research Institute;Healthcare Integration Directorate, Barakaldo-Sestao Integrated Health Organization–Osakidetza;Healthcare Integration Directorate, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization–Osakidetza;Primary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization–Osakidetza;Primary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization – Osakidetza;Primary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service;Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Health Care System;

关键词: Low-value care;    De-implementation;    Cardiovascular disease prevention;   

DOI  :  10.1186/s13012-020-0966-3

来源: DOAJ

【 摘 要 】

Abstract Background De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers, and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based, and theory-informed process involving the main stakeholders (clinicians, managers, patients, and researchers) for the design, deployment, and assessment of de-implementation strategies for reducing low-value pharmacological prescribing. Methods A phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies—specifically, the Behavior Change Wheel (BCW)—will be conducted to design and model de-implementation strategies to favor reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients, and researchers) in a collegiate way. Subsequently, a phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines (“what-not-to-do” recommendations). A mixed-methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians’ perspective, and patients’ experiences related to the clinical care received. Discussion The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policymakers, and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing. Trial registration Clinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019

【 授权许可】

Unknown