Background—There is currently a political enthusiasm for the development and use of clinical guidelines despite, paradoxically, there being relatively few healthcare issues that have a sound research evidence base. As decisions have to be made even where there is an undetermined evidence base and that limiting recommendations to where evidence exists may reduce the scope of guidelines, thus limiting their value to practitioners, guideline developers have to rely on various different sources of evidence and adapt their methods accordingly. This paper outlines a method for guideline development which incorporates a consensus process devised to tackle the challenges of a variable research evidence base for the development of a national clinical guideline on risk assessment and prevention of pressure ulcers.
Background Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. Methods A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. Results Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. Conclusions This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and "doses" of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi:10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors. Trial registration Current Controlled Trials ISRCTN11598502. Date 4/2/10. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646.
The StaRI initiative and workshop was funded by contributions from the Asthma UK Centre for Applied Research (AC-2012-01); Chief Scientist Office, Scottish Government Health and Social Care Directorates (PCRCA_08_01); the Centre for Primary Care and Public Health, Queen Mary University of London; and with contributions in kind from the PRISMS team (NIHR HS&DR Grant ref: 11/1014/04). SJCT was (in part) supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust. AS is supported by the Farr Institute
Complex interventions are commonly used in the health and social care services, public health practice, and other areas of social and economic policy that have consequences for health. Such interventions are delivered and evaluated at different levels, from individual to societal. Examples include a new surgical procedure, the redesign of a health care programme, and a change in welfare policy. The UK Medical Research Council (MRC) published a framework for researchers and research funders on developing and evaluating complex interventions in 2000 and revised guidance in 2006.[1] Although these documents continue to be widely used and are now accompanied by a range of more detailed guidance on specific aspects of the research process,[2–5] there have been important conceptual, methodological and theoretical developments since 2006. These developments have been addressed in a new framework commissioned by the National Institute of Health Research (NIHR) and the MRC.[6] The framework aims to help researchers work with other stakeholders to identify the key questions about complex interventions, and to design and conduct research with a diversity of perspectives and appropriate choice of methods. ; The work was funded by the NIHR (Department of Health and Social Care 73514) and Medical Research Council (MRC). Additional time on the study was funded by grants from the MRC for Kathryn Skivington (MC_UU_12017/11, MC_UU_00022/3), Lynsay Matthews, Sharon Anne Simpson, Laurence Moore (MC_UU_12017/14, MC_UU_00022/1), Peter Craig (MC_UU_12017/15, MC_UU_00022/2), Martin White (MC_UU_12015/6 and MC_UU_00006/7). Additional time on the study was also funded by grants from the Chief Scientist Office of the Scottish Government Health Directorates for Kathryn Skivington (SPHSU11 and SPHSU18), Lynsay Matthews, Sharon Anne Simpson and Laurence Moore (SPHSU14 and SPHSU16), and Peter Craig (SPHSU13 and SPHSU15). Kathryn Skivington and Sharon Anne Simpson were also supported by an MRC Strategic Award (MC_PC_13027). JBl received ...
