A pragmatic guide to implementation science for clinicians and clinical researchers
Implementation science can be defined as the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice. The necessary use of theory to inform implementation programs is recognized, but clinicians and researchers are often unfamiliar with these theories and behavioral change. Although they are interested in such approaches, clinicians and researchers find it difficult to navigate the expanding number of theories, frameworks, and models. In addition, they are often unfamiliar with the language as well as the inconsistencies in nomenclature.
The debate article by Lynch et al discusses the implementation of evidence-based practice in health care and can be used as a pragmatic guide to help clinicians and clinical researchers understand implementation theories, models and frameworks; what are they, how can they be used, and what prompts to consider when selecting a theoretical approach.
Health systems are pressured to deliver efficient, effective, and affordable care. Patient-related factors such as malnutrition, anemia, and delirium affect efficiency and affordability of health care by increasing the length of stay and cost per patient. Another symptom common in patients with complex medical conditions is difficulty in swallowing, also known as oropharyngeal dysphagia. Although dysphagia is a symptom of a range of critical head and neck conditions, it is often reported as a secondary measure, and as a result the associated resource utilization costs to treat this condition are inconsistently reported
overall expenditure measured via monetary cost increased by 40.36% in patients with oropharyngeal dysphagia
The systematic review by Attrill et al investigated studies reporting on costs data and length of stay data related to oropharyngeal dysphagia. They report that dysphagia increases length of stay by nearly 3 days, and increases the health care costs per patient by more than 40%, suggesting that oropharyngeal dysphagia should be recognized as an important contributor to pressure on health care systems.
Cost benefit of rehabilitating tortured refugees
Following the recent surge of asylum seekers entering the European Union, questions have been raised about the ability of member states to integrate the newcomers into their societies and economy. This is particularly the case for individuals that have been subjected to torture. For torture is not only a socio-political phenomenon with severe psychological ramifications, it is also financially costly to society, in terms of both treatment and reduced productivity of the victim. In their study, Bager et al investigate if rehabilitation of traumatized refugees is economically beneficial in long term economic and social perspectives.
The study describes a cost evaluation comprised of cost-utility analysis and partial cost-benefit analysis described for refugees treated at the Rehabilitation and Research Centre for Torture Victims. The results suggest that productivity gains by family members lead to positive net social benefit after as little as 3 years, and these gains persisted over the study period. The authors suggest that multidisciplinary intervention to treat refugees provides “value-for-money” and is economically sustainable.
Service user and carer involvement in mental health care safety
They can make life very difficult, refuse to help you, and most likely change your diagnosis to personality disorder so that no one will want to treat you.
Patient and carer involvement is a crucial tool to facilitate patient safety improvements. Despite serious failures in service provision, limited research has been carried out to identify these issues in the service provision of mental health care in the UK. Berzins et al address these issues in their study, wherein they discuss mental health service users’ and carers’ experiences of raising concerns about safety in mental health care services, and their views on the potential for service user and carer involvement in future safety interventions.
The study suggests that mental health service users and carers experience great difficulties in raising concerns about the safety of these services. Reasons for not providing feedback on the services include unresponsiveness to complaints and fear of repercussions. The authors suggest that not collecting the user and carer feedback is a missed opportunity for learning and improvement of mental health services.
Implementation strategy for health care interventions
Implementation of new interventions into complex health care environments can prove to be a problematic and complicated matter. Factors that may affect implementation include interoperability, cost, fit with existing systems, disruptions to interactions between medical personnel and service users, and poor implementation planning. Despite the complexity of the process of implementation, there is limited evidence on how to successfully implement new interventions into health care environments. The paper by Ross et al provides an example of a successfully implemented digital health intervention.
The intervention described in this study is the HeLP-Diabetes digital self-management program for people with type 2 diabetes. To provide a learning opportunity, the authors describe strategies planned and employed as well as barriers encountered. The article may be of particular interest to people in the process of planning and executing implementation activities in health care services.