Peer-to-Peer Webinar Series: Success Stories in EIDM / Webinar #3
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There are many examples of evidence-informed decision making (EIDM) among public health professionals and organizations in Canada. However, there are limited mechanisms in place to facilitate the sharing of these stories within the public health community. The National Collaborating Centre for Methods and Tools (NCCMT) seeks to address this gap with an interactive, peer-led webinar series featuring a collection of EIDM success stories in public health. These success stories will illustrate what EIDM in public health practice, programs and policy looks like across the country. Join us to engage with public health practitioners across Canada as they share their success stories of using or implementing EIDM in the real world. Learn about the strategies and tools used by presenters to improve the use of evidence. Each webinar will feature two presentations. This series will feature authors from the NCCMT’s EIDM Casebook as well as other presenters. Effective Psychological and Psychosocial Interventions to Prevent Perinatal Depression and Anxiety Disorders: A Rapid Review and Applicability Assessment Becky Blair, Louise Azzara, John Barbaro, and Amy Faulkner, Simcoe-Muskoka District Health Unit A higher-than-provincial-average rate of mental health concerns during pregnancy in the SMDHU catchment area prompted a review of the evidence for interventions to prevent perinatal mood disorders. Learn more about how this team synthesized available evidence and shared it with decision makers. Building a Best Practice Tool to Address the Needs of Clients with Hepatitis C Mary Guyton and Heidi Parker, Sherbourne Health Centre Site Following Hepatitis C care integration within primary care settings, there was a lack of resources tailored to primary care nurses caring for Hep C patients. Learn more about how a best practice resource tool was developed to fill a resource gap.
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Peer-to-Peer Webinar Series: Success Stories in EIDM / Webinar #3
- 1. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.. Peer-to-Peer Webinar: Success Stories in EIDM Webinar 3 - Featuring: Effective Psychological and Psychosocial Interventions to Prevent Perinatal Depression and Anxiety Disorders: A Rapid Review and Applicability Assessment Becky Blair, John Barbaro, and Amy Faulkner Simcoe Muskoka District Health Unit Building a Best Practice Tool to Address the Needs of Clients with Hepatitis C Mary Guyton and Heidi Parker, Sherbourne Health Centre Site November 15, 2017 1:00 – 2:30 PM ET
- 2. Follow us @nccmt Suivez-nous @ccnmo 2 Housekeeping Use Chat to post comments and/or questions during the webinar • ‘Send’ questions to All (not privately to ‘Host’) Connection issues • Recommend using a wired Internet connection (vs. wireless), • WebEx 24/7 help line • 1-866-229-3239 Participant Side Panel in WebEx Chat
- 3. Follow us @nccmt Suivez-nous @ccnmo 3 After Today Presentation slides (in English and French) and a video recording (in English) will be posted. These resources will be available at: http://www.nccmt.ca/previous-webinars Surveys will be conducted immediately following webinar and in 2-3 months.
- 4. Follow us @nccmt Suivez-nous @ccnmo 4 How many people are watching today’s session with you? Poll Question #1 a. Just me b. 1-3 c. 4-5 d. 6-10 e. >10
- 5. Follow us @nccmt Suivez-nous @ccnmo 5
- 6. NCC Infectious Diseases Winnipeg, MB NCC Methods and Tools Hamilton, ON NCC Healthy Public Policy Montreal, QC NCC Determinants of Health Antigonish, NS NCC Aboriginal Health Prince George, BC NCC Environmental Health Vancouver, BC 6
- 7. Registry of Methods and Tools Online Learning Opportunities WorkshopsVideo Series Public Health+ Networking and Outreach NCCMT Products and Services 7
- 8. Follow us @nccmt Suivez-nous @ccnmo The EIDM Casebook • Collection of success stories in public health • Available at www.nccmt.ca/impact/ eidm-casebook 8
- 9. Follow us @nccmt Suivez-nous @ccnmo 9 Presenters Becky Blair, RD, MSc Simcoe Muskoka District Health Unit John Barbaro, MSc Simcoe Muskoka District Health Unit Amy Faulkner, MISt Simcoe Muskoka District Health Unit
- 10. Simcoe Muskoka District Health Unit’s EIDM Team Health Evidence Case Book Series November 15th, 2017 EFFECTIVE PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS TO PREVENT PERINATAL DEPRESSION AND ANXIETY DISORDERS
- 11. OUTLINE • Research Question Selection Process • PICO & Search Strategy • Study Selection & Quality Assessment Process Description of Studies Included and Excluded • Results Characteristics of Included Systematic Reviews Characteristics of Included Guidelines Key Findings • Applicability & Transferability
- 12. RESEARCH QUESTION • Potential research questions were submitted by each health unit department. • Each question was scored (0-2) and ranked using pre- established criteria and group consensus • Top 3 choices were presented to Executive Committee for endorsement. • The top ranked question was the one selected for the Rapid Review.
- 13. PICO P (population) - pregnant or postpartum women at no known risk or at risk of developing perinatal depression or an anxiety disorder. I (intervention) - any psychological or psychosocial intervention C (comparison) - standard or usual care O (outcome) - proportion of women diagnosed with perinatal depression or an anxiety disorder Lesson learned: The definitions document developed by the EIDM team for the PICO was very helpful when screening studies for inclusion / exclusion.
- 14. SEARCH STRATEGY • The following databases were searched between January 20, 2016 - January 26, 2016: Ovid MEDLINE(R) 1946 to January Week 1 2016 PsycINFO 2002 to January Week 2 2016 EMBASE 1996 to 2016 Week 3- limited to exclude Medline journals CINAHL Plus with Full Text Medline in process searched on January 25, 2016 Lesson learned: Ensure time to discuss iterations of the search with key members of the team, save search strategies, document decision- making process
- 15. STUDY SELECTION & QUALITY ASSESSMENT • At least two team members screened the initial list of titles and abstracts and then reviewed full text articles for inclusion/exclusion as required– disagreements were brought to the entire group for consensus. • Full text articles went on to the quality assessment stage. • Only systematic reviews and guidelines were considered for quality assessment and inclusion in the rapid review results. • All systematic reviews and meta-analyses were assessed using the AMSTAR quality assessment tool. The two guidelines were appraised using the AGREE II tool. Lesson learned: Make sure everyone is clear in how the outcome of interest is defined and measured.
- 16. EVIDENCE SEARCH AND SCREENING FLOW DIAGRAM
- 17. CHARACTERISTICS OF INCLUDED REVIEWS Citation (AMSTAR quality assessment rating) # studies with outcome (total # studies in SR) Study designs included in systematic review Total sample size of studies with outcome Characteristics of sample Intervention Type (vs. comparison/co ntrol) Outcome Measure Outcome Dennis and Dowswell9 (11) 5 (28) RCTs 458/481 Pregnant women and new mothers, both with and with- out known risk. psychological and psychosocial (vs. TAU) As variously defined and measured by study authors. Diagnosis of depression, RR=0.50(0.32 to 0.78) Pilkington et al.27 (2) 1/13 Matthey (2004)28: 3 x3 RCT Matthey n=268 Couples expecting first baby. Australian sample. Psycho- education vs. (non-specific control) or TAU Structured diagnostic interview schedule- DSM-IV No effect on rates of depression or depression-anxiety across conditions. Sockol29 (5) 12 (40) RCTs and quasi-RCTs 3,149 Studies from developed and developing nations, both antenatal and postnatal. CBT (vs. TAU, active control, or enhanced TAU) Met criteria for depressive episode. No outcome definition for prevention studies provided. OR= 0.71 (0.59-0.87) Sockol30 (5) 23 (28) RCTs and quasi-RCTs 4,485 Studies from developed and developing nations, both antenatal and postnatal. Biological and psychosocial intervention. Various scales and diagnostic criteria as defined by primary study authors, including EDPS Psychosocial interventions: OR = 0.61 (0.50, 0.84)
- 18. CHARACTERISTICS OF INCLUDED GUIDELINES Citation (AGREE II quality assessment rating) Evidence Description Recommendations National Institute for Health and Care Excellence (NICE)1 (7/7) Social support vs TAU - preventing depression diagnosis (at risk women) – intention-to-treat (ITT) analysis 1 study: ->RR 0.85 (0.65 to 1.1) 117 participants, VERY LOW QUALITY CBT/IPT informed psychoeducation vs. TAU - preventing depression diagnosis (at risk women) – ITT analysis 3 studies: ->RR 0.69 (0.45 to 1.05) 360 participants. LOW QUALITY. Depression diagnosis intermediate follow (up) (17-24 weeks post) ITT analysis. 1 study: ->RR 0.77 (0.33 to 1.75) 45 participants, LOW QUALITY. Mother-infant relationship interventions vs TAU - preventing depression diagnosis post-treatment (at risk women) – intention-to- treat (ITT) analysis 1 study: ->RR 1 (0.76 to 1.31) 449 participants, LOW QUALIT. No studies were found that assessed change in diagnosis of depression in populations without risk. There are no recommendations specific to preventative interventions for depression or anxiety disorders in the antenatal or postnatal period. BC Reproductive Mental Health & Perinatal Services BC.10 (4/7) Regarding prenatal depression, the guideline cites a guideline from Scotland31. It identified that current evidence does not support specific interventions for the prevention of depression in pregnancy in those without identified risk factors. Regarding post-partum depression, the guideline describes promising practices for all postpartum related outcomes (not just prevalence of diagnosed postpartum depression) from Dennis and There are no recommendations specific to preventative interventions for depression or anxiety disorders in the antenatal or postnatal period.
- 19. Available case analysis from Table 1.3 of Dennis- Dowswell Cochrane Review
- 20. Intention-to-treat (ITT) analysis from Table 1.3 of Dennis- Dowswell Cochrane Review
- 21. KEY FINDINGS • Small evidence base for PICO question and majority of studies are of low quality. Differing definitions and outcome measurements make comparing results across studies difficult. • Guidelines did not recommend the implementation of psychological or psychosocial interventions for the prevention of perinatal mood disorders. • The NICE guideline found no strong evidence that psychosocial and/or psychological interventions are effective to prevent the diagnosis of perinatal mood disorders in women. • The Dennis Cochrane Review found a large (RR=0.5) beneficial effect of combined psychosocial and psychological interventions to prevent the diagnosis of postpartum depression compared to standard or routine care. However, this finding was based on 5 studies, most of low quality. Lesson learned: It is easy to accept the conclusions of a systematic review authored by an expert in the field. However, critical appraisal is still important. Always look at the data presented.
- 22. APPLICABILITY AND TRANSFERABILITY • Group discussion with Program Managers, Executive representatives, EIDM Team members facilitated by Donna. • Applied the A&T tool in a 2 hour meeting – group consensus that the Rapid Review scored low on the tool (i.e. little impact). • Actionable message: “No evidence to support a change in practice with respect to public health’s role in preventing the diagnosis of perinatal mood disorders”. • Next steps: Include the A&T activity as an appendix in the final report Identify all target audiences and craft key messages. Explore additional research questions that were not addressed by this review.
- 23. Follow us @nccmt Suivez-nous @ccnmo 23 Your Comments/Questions • Use Chat to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Chat Participant Side Panel in WebEx
- 24. Follow us @nccmt Suivez-nous @ccnmo 24 Presenters Mary Guyton, RN, MEd Sherbourne Health Centre Site Heidi Parker, RN, MT Sherbourne Health Centre Site
- 25. National Collaborating Centre for Methods and Tools Peer-to-Peer Webinar 3 Mary Guyton, RN, BScN, Med Heidi Parker, RN, BScN, MT Quality Improvement Project to Build Best Practice Tool to Address the Needs of Clients with Hepatitis C
- 35. References European Association for the Study of the Liver (EASL). (2016). EASL Recommendations onTreatment of HepatitisC. Journal of Hepatology http://dx.doi.org/10.1016/j.jhep.2016.09.001 ASHM. (2016). PrimaryCare Providers and HepatitisC. The Australian Government, Department of Health Von Aesch, Z., Steele, L.S. & Shah, H. (2016). Primary care flow sheet for hepatitisC virus: tool for improved monitoring. Canadian Family Physician 62, p.384-92 Meyers, R.P., Shah, H., Burak, K.W.,Cooper, C. & Feld, J.J. (2015).An update on the management of chronic hepatitisC: 2015 Consensus guidelines from theCanadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 29(1). Pinette,G.D.,Cox, J.J., Heathcote, J., Moore, L., Adamowski, K. & Riehl G. (2009). PrimaryCare Management of Chronic Hepatitis C: A professional desk reference 2009. Public Health Agency of Canada (PHAC). Plan-Do-Study-Act (PDSA)Worksheet (IHI tool). Institute for Healthcare Improvement. (November 10, 2016) Ha, S.,Totten,S., Pogany, L.,Wu, J. & Gale-Rowe, M. (2016). HepatitisC in Canada and the importance of risk-based screening. Can Comm Dis Rep 42, p57-62 GastroenterologicalSociety of Australia (GESA). (2016). Clinical Guidance for treating hepatitisC virus infection: a summary. Retrieved from: http://membes.gesa.org.au/membes/files/GP%20algorithm%20v3.pdf
- 36. Follow us @nccmt Suivez-nous @ccnmo 36 Your Comments/Questions • Use Chat to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Chat Participant Side Panel in WebEx
- 37. Follow us @nccmt Suivez-nous @ccnmo Share your story! • Are you using EIDM in your practice? We want to hear about it! • Email us: nccmt@mcmaster.ca • Need support for EIDM? Contact us for help! • Email us: nccmt@mcmaster.ca • We typically respond within 24 business hours 37
- 38. Follow us @nccmt Suivez-nous @ccnmo 38 Your Feedback is Important Please take a few minutes to share your thoughts on today’s webinar. Your comments and suggestions help to improve the resources we offer and plan future webinars. The short survey is available at: https://nccmt.co1.qualtrics.com/jfe/form/SV_ehTzigwDigXV KFn
- 39. Follow us @nccmt Suivez-nous @ccnmo EIDM Casebook Issue #2: Call for Abstracts • We are looking for success stories in EIDM • Submissions accepted until Friday, January 12, 2018 • For more information and abstract template, please visit http://www.nccmt.ca/impact/user- story/evidence-informed-decision-making- casebook-project 39
- 40. Follow us @nccmt Suivez-nous @ccnmo Webinar Series from NCCMT www.nccmt.ca/webinar-series • Spotlight on Methods and Tools • Topic-Specific Methods and Tools • Online Journal Club • Peer-to-peer Webinars 40
- 41. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.. For more information about the National Collaborating Centre for Methods and Tools: NCCMT website www.nccmt.ca Contact: nccmt@mcmaster.ca
Notas do Editor
- the NCCPH program is dispersed across the country with 6 National Collaborating Centres the National Collaborating Centre for Methods and Tools is located at McMaster University, in Hamilton 4 of the other NCC’s support the use of research evidence in specific public health content areas NCCMT and NCC Healthy Public Policy work across content areas the focus of NCCMT improving access to, and use of, methods and tools that support moving research evidence into decisions related to public health practice, programs, and policy in Canada.
- NCCMT offers a products and services to help apply research evidence in decision making This presentation today is going to provide an overview of the Online Learning Opportunities that NCCMT offers.
- Becky
- Becky
- Becky Information is needed to make a major decision Service area/program is able to provide consultation to EIDM team Timely – decision is required ~6-8 months Amount of evidence is adequate Not broad topic, amenable to completion in ~6 months
- Amy
- Amy The initial Medline search strategy was peer reviewed by two librarians. The search strategies for the electronic databases contained select MeSH and free-text terms Limited to search for randomized controlled trials, systematic reviews, meta-analyses or guidelines. Results were limited to articles published between 2013 and 2016 and were limited to English language Authors of Cochrane reviews located in our initial search were contacted.
- Amy This process was cumbersome and time consuming even with six team members breaking the work down into manageable numbers. Sometimes the Title and abstract would not have enough information to tell us what type of study it was or if the contact was relevant to the PICO so you would have to pull up full text. Make sure that the Intervention and the population of interest is clearly defined prior to search. (developed world vs developing world) (Scale of depression measured) for applicability. Utilizing the tools helped to exclude reviews that would have been utilized as good research when it was not.
- Amy
- John
- John Guidelines had been based on low quality evidence. Recommendations within the guidelines were not provided for interventions that would prevent PPD. Evidence available for preventing depression within high risk populations but not for our specific PICO.
- John
- John
- Becky
- Becky
- MARY- Read title I’m Mary Guyton, a Hepatitis C treatment nurse at Sherbourne Health Center in East Toronto. I have a background in primary care and have now part of a Hepatitis C treatment team
- Mary – read out
- MARY – I’d like to first give you a brief background of our Hepatitis C Program. My work is through one of three sites for the Toronto Community Hepatitis C Program, a model that houses care within Community Health Centers and Family health teams. Our program started in approximately 2007. Our clients were facing barriers to hepatitis C care through specialists because of their alcohol and substance use- we didn’t feel this was right. Within a harm reduction framework and wrap around care including RNs, MDs, counseling and support staff our care is anchored in a group model. Heidi joined our team in fall of 2016 as a student for a 168 hours community health practicum through the University of Toronto RN program and was placed with Mary, the Hepatitis C Program Nurse. . Motivated by the changing landscape in Hepatitis C toward more effective and better tolerated treatments and increased integration into primary care (Meyer, 2015) we were approached to provide RN specific primary care education to the nurses within Sherbourne Health to facilitative more comprehensive client care. Heidi In developing this support , Heidi identified a gap. While best practice resources exist for family physicians, there is a gap in resources tailored to RNs providing care to clients receiving Hepatitis C treatment.
- Heidi I started working on the project when Mary asked me to put together a brief overview of care for patients with Hepatitis C for the nurses working at Sherbourne. While it began as a small project, we expanded the goals of the project to include: Exploring the education needs of the nurses in primary care caring for clients with Hepatitis C throughout their illness and post cure care To develop a best practice resource tool as reference for nurses To disseminate this resource to the primary care nursing community FROM mary’s slides: We sought to provide basic information with links/references to more thorough resources for clinical care primary care RNs will encounter (i.e. initial screening, treatment overview and post cure care/follow up). We considered several formats (i.e. paper reference vs. online tool, links to existing resources vs. creating our own We developed and continue to develop this tool in consultation with members of the hepatitis C medical team, primary care nurses, community support workers and people with lived experience as well as the entire team of the Toronto Community Hep C program.
- Heidi To begin the project, I started with a literature review searching for documents for Primary Care Registered Nurses in Canada regarding care for Hepatitis C. I used both Google and PubMed databases and found many resources however they did not relate to primary care nurses in Canada. I then compiled a number of resources for primary care physicians in Canada and Australia as well as some resources for nurses in Australia. These resources include:... After that, I consulted with Mary to discuss what sort of information would be important to include, I created the tool with relevant information for nurses in the Canadian Context and then we presented it to the nurses at Sherbourne to gain some valuable feedback. (including using links to keep information relevant). In terms of evaluation we plan to use IHI’s Plan-Do-Study-Act tool. As of now we are finishing the “plan” phase as we finalize the tool and gain insight from key stakeholders as to what should be included. Moving forward as we share the tool with the nurses at Sherbourne and see if it improves their confidence in caring for clients with hepatitis C we will complete the do and study phases. Finally, after finalizing the tool, ensuring all improvements have been made, we will complete the “act” phase to disseminate the tool to other Primary Care RN’s. How evidence was used to inform decisions How did we seek feedback from primary care RNs Sent out the draft tool via email Presented it in weekly nursing rounds and received verbal feedback Requested further email feedback (none yet received) What did they tell us Not too much information on the document - include links to the references so you can see basics and easily get to more in depth Less interested in details not related to nursing??
- How it looked for us to go through this process; PLAN: reviewed our objections, our predictions were that the primary health care RNs would be interested in a document/educational support around HCV, supported by Mary previously working as a primary care RN and feeling this was a need at the time; Plan was also supported by the gap in literature/educational documents Heidi uncovered during her lit search; Plan for data collection? DO/STUDY: met with RNs to understand what they would like, developed a document, sent document around for feedback? What feedback was received?- did we combine the do and study in this project? I kind of think we are a little in the study phase still with getting more feedback from key stakeholders and that the doing was the initial creation of the tool and initial feedback ACT: currently stuck in the act phase- go over more details of this in the limitations section
- MARY- Our next steps are to solicit feedback by circulating the resource through our interprofessional team. We intend to review with our team pharmacist, MDs and infectious disease specialist, at a meeting of Hepaitis C treatment nurses and with our Patient Advisory Board to get rounded and comprehensive feedback. We will then update our document and create a plan for knowledge transfer From Mary’s slides Acknowledge that next steps have stalled and lead into the lessons learned
- Mary – I’d like to share the preceptor perspective. This was my first time working with a student on a Quality Improvement project and overall it was a very good experience. I think it is an important part of clinical practice placements if students are interested to encourage them to take on projects that have the potential for presentations and publications. I feel this is an important part of nursing education. To consider when embarking on this type of project especially if it involves stakeholder consolations is that it is likely beyond the scope of an 8-12 week semester and might be more appropriate for a consolidation project. At the very least it is an important consideration when planning a project like this that we did not plan for--This is why this QI project is yet to be completed. From Mary’s slides: It can be challenging to continue with the project's momentum when student and preceptor no longer have the time and ongoing contact facilitated by a clinical placement. Heidi- student perspective From a student perspective, it can be intimidating to work on a “best practice” tool for experienced nurses. I think that the positive environment created by the nurses enabled me to feel confident to present what I had found in the research. As well, having this project to work on throughout the placement was beneficial as it ensured I had work to do during the down times of the program and gave me a sense of ownership and commitment to the program even after the placement was done. From Mary’s Slides It was beneficial for the have a project to work on throughout the placement to feel accountable and responsible for one aspect of the program. + key messages
- Mary – Here is a screen shot of the working version of our tool. We will believe after stakeholder consultations we will have more concreate changes to make, but some things we are considering are: Do we create an online or paper resource? We are leaning to an online tool for several reasons We could like to resources that were routinely updated (i.e. information about medication) and make the document more of a living document and not something that is quickly outdate It would give us the capability to have other types of resources (i.e. hyperlink to a map of areas where Hep C is endemic for screening considerations) Heidi- Screening, transmission information, understand complexities of hep c testing, assessment and future care, patient education about healthy lifestyle Mary- drawing on my background as primary care RN, wanting to include information about immunization, routine screening, social impact of stigmatized illness and treatment
- Heidi- Presumably these are nurses are there things they would like to see Mary -Also what do they see as best way to disseminate information? Questions?