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Background: Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist). Methods: We performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers. Results: We screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist. Conclusions: Based on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects. ; publishedVersion

Accepted manuscript version, licensed CC BY-NC-ND 4.0. Published version available in Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, 2017, 123-124, p. 75-80. ; Norway has traditionally high standards regarding civil rights particularly emphasizing equal access to societal resources including health care. This background and the health care system's centralized national organization make it perfectly suited for implementation of shared decision making (SDM). In recent years, great efforts have been made by policy- makers, regional health authorities and not least the patients to facilitate a process of change in health communication culture. SDM is currently even given highest priority in health care strategies on all system levels. SDM has been structurally implemented, e.g. by including corresponding guidance in the standard patient pathways. Moreover, SDM is established as an element of service on the national health portal hosting a constantly increasing number of decision aids. Essentially the Norwegian Knowledge Center for Health Services contributes by searching and providing information for use in decision aids. Implementation is now being rolled out unit by unit for a list of medical problems as a series production of SDM using decision aids and health professional training. Importantly, production of SDM begins and succeeds as a soundly structured communication with both clinical environments and patients. However, as communication training has not been implemented before now, there are no data demonstrating sufficient realization of SDM in current health care. Beyond making reasonable use of scientific achievements, the Norwegian movement's secret of success is the simultaneous commitment of all actors of the health system to a common idea. ; Die norwegischen Bürgerrechte legen traditionell viel Gewicht auf gleichberechtigten Zugang zu sozialen und insbesondere Gesundheitsleistungen. Im Zusammenspiel mit der zentralisierten Organisation des norwegischen Gesundheitswesens bietet dies perfekte Voraussetzungen für die Implementierung einer Kultur der Patientenbeteiligung an den eigenen Entscheidungen (PEF). In den vergangenen Jahren wurden seitens der Politik, der regionalen Gesundheitsbehörden und nicht zuletzt der Patienten große Anstrengungen zur Veränderung der gesundheitsbezogenen Kommunikation unternommen. Auf allen Systemniveaus rangiert PEF unter den wichtigsten Strategiezielen. Strukturell ist PEF bereits explizit und fest implementiert, z.B. in den klinischen Standardpatientenpfaden oder als ständig wachsendes Angebot von Entscheidungshilfen auf der nationalen Gesundheitsplattform. Das Norwegische Institut für Evidenz im Gesundheitswesen trägt mit systematischer Informationsbeschaffung essentiell zur Produktion von Entscheidungshilfen bei. Unter Anwendung von Entscheidungshilfen und Trainings von Gesundheitsberufen wird die Implementierung entlang einer Liste mit medizinischen Problemstellungen nun im Sinne einer Serienproduktion Einheit für Einheit ausgeweitet. Der Erfolg der Produktion von PEF steht und fällt dabei mit der Einbeziehung der medizinischen Milieus und der Patienten. Da allerdings die Trainings erst jetzt systematisch eingeführt werden, wäre es falsch zu behaupten, dass PEF schon richtig in der klinischen Praxis angekommen ist. Eine Stärke des norwegischen Vorgehens ist die konsequente Orientierung an der wissenschaftlichen Evidenz. Darüber hinaus stellt das gleichzeitige Engagement aller Akteure im Gesundheitswesen für die gemeinsame Idee das Erfolgsgeheimnis der Norwegischen Bewegung dar.

Introduction Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA. Methods Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated. Results In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic. Conclusions The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.