Symptom relief in patients with pneumonia and dementia: implementation of a practice guideline

Tessa van der Maaden, Jenny T. van der Steen, Raymond T.C.M. Koopmans, Sarah M.M.M. Doncker, Johannes R. Anema, Cees M.P.M. Hertogh, Henrica C.W. de Vet

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: This study aimed to assess the degree of implementation and barriers encountered in the use of a practice guideline for optimal symptom relief for patients with dementia and pneumonia in Dutch nursing homes. Methods: A process evaluation included assessment of reach, fidelity, and dose delivered using researcher's observations, and dose received was addressed in a question “use of the practice guideline,” which the physicians completed for each patient included in the study. Perceived barriers were assessed with a structured questionnaire (response 69%) and semi-structured interviews (n = 14), which were subject to qualitative content analysis. Results: Of the 55 physicians involved in the intervention phase, 87% attended an implementation meeting; 20 physicians joined the study later (reach). The intervention was implemented as planned, and all intervention components were delivered by the researchers (fidelity and dose delivered). Thirty-six physicians included 109 patients. For 81% of the patients, the treating physician stated to have used the guideline (dose received). The guideline was perceived as providing a good overview of current practice, but some physicians had expected a more directive protocol or algorithm. Further, recommended regular observations of symptoms were rarely performed. Physician's often felt that “this is not different from what we usually do,” and with the acute illness, there was not always enough time to (re)familiarize with the contents. Conclusions: The physicians used the practice guideline frequently despite important barriers. Future implementation may involve strategies such as multiple interactive meetings. Further, the greatest potential to alter usual practice should be emphasized, such as using observational instruments.

Original languageEnglish
Pages (from-to)829-839
Number of pages11
JournalInternational Journal of Geriatric Psychiatry
Volume32
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

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title = "Symptom relief in patients with pneumonia and dementia: implementation of a practice guideline",
abstract = "Objective: This study aimed to assess the degree of implementation and barriers encountered in the use of a practice guideline for optimal symptom relief for patients with dementia and pneumonia in Dutch nursing homes. Methods: A process evaluation included assessment of reach, fidelity, and dose delivered using researcher's observations, and dose received was addressed in a question “use of the practice guideline,” which the physicians completed for each patient included in the study. Perceived barriers were assessed with a structured questionnaire (response 69{\%}) and semi-structured interviews (n = 14), which were subject to qualitative content analysis. Results: Of the 55 physicians involved in the intervention phase, 87{\%} attended an implementation meeting; 20 physicians joined the study later (reach). The intervention was implemented as planned, and all intervention components were delivered by the researchers (fidelity and dose delivered). Thirty-six physicians included 109 patients. For 81{\%} of the patients, the treating physician stated to have used the guideline (dose received). The guideline was perceived as providing a good overview of current practice, but some physicians had expected a more directive protocol or algorithm. Further, recommended regular observations of symptoms were rarely performed. Physician's often felt that “this is not different from what we usually do,” and with the acute illness, there was not always enough time to (re)familiarize with the contents. Conclusions: The physicians used the practice guideline frequently despite important barriers. Future implementation may involve strategies such as multiple interactive meetings. Further, the greatest potential to alter usual practice should be emphasized, such as using observational instruments.",
keywords = "dementia, discomfort, nursing homes, pneumonia, process evaluation",
author = "{van der Maaden}, Tessa and {van der Steen}, {Jenny T.} and Koopmans, {Raymond T.C.M.} and Doncker, {Sarah M.M.M.} and Anema, {Johannes R.} and Hertogh, {Cees M.P.M.} and {de Vet}, {Henrica C.W.}",
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Symptom relief in patients with pneumonia and dementia : implementation of a practice guideline. / van der Maaden, Tessa; van der Steen, Jenny T.; Koopmans, Raymond T.C.M.; Doncker, Sarah M.M.M.; Anema, Johannes R.; Hertogh, Cees M.P.M.; de Vet, Henrica C.W.

In: International Journal of Geriatric Psychiatry, Vol. 32, No. 8, 01.08.2017, p. 829-839.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Symptom relief in patients with pneumonia and dementia

T2 - implementation of a practice guideline

AU - van der Maaden, Tessa

AU - van der Steen, Jenny T.

AU - Koopmans, Raymond T.C.M.

AU - Doncker, Sarah M.M.M.

AU - Anema, Johannes R.

AU - Hertogh, Cees M.P.M.

AU - de Vet, Henrica C.W.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objective: This study aimed to assess the degree of implementation and barriers encountered in the use of a practice guideline for optimal symptom relief for patients with dementia and pneumonia in Dutch nursing homes. Methods: A process evaluation included assessment of reach, fidelity, and dose delivered using researcher's observations, and dose received was addressed in a question “use of the practice guideline,” which the physicians completed for each patient included in the study. Perceived barriers were assessed with a structured questionnaire (response 69%) and semi-structured interviews (n = 14), which were subject to qualitative content analysis. Results: Of the 55 physicians involved in the intervention phase, 87% attended an implementation meeting; 20 physicians joined the study later (reach). The intervention was implemented as planned, and all intervention components were delivered by the researchers (fidelity and dose delivered). Thirty-six physicians included 109 patients. For 81% of the patients, the treating physician stated to have used the guideline (dose received). The guideline was perceived as providing a good overview of current practice, but some physicians had expected a more directive protocol or algorithm. Further, recommended regular observations of symptoms were rarely performed. Physician's often felt that “this is not different from what we usually do,” and with the acute illness, there was not always enough time to (re)familiarize with the contents. Conclusions: The physicians used the practice guideline frequently despite important barriers. Future implementation may involve strategies such as multiple interactive meetings. Further, the greatest potential to alter usual practice should be emphasized, such as using observational instruments.

AB - Objective: This study aimed to assess the degree of implementation and barriers encountered in the use of a practice guideline for optimal symptom relief for patients with dementia and pneumonia in Dutch nursing homes. Methods: A process evaluation included assessment of reach, fidelity, and dose delivered using researcher's observations, and dose received was addressed in a question “use of the practice guideline,” which the physicians completed for each patient included in the study. Perceived barriers were assessed with a structured questionnaire (response 69%) and semi-structured interviews (n = 14), which were subject to qualitative content analysis. Results: Of the 55 physicians involved in the intervention phase, 87% attended an implementation meeting; 20 physicians joined the study later (reach). The intervention was implemented as planned, and all intervention components were delivered by the researchers (fidelity and dose delivered). Thirty-six physicians included 109 patients. For 81% of the patients, the treating physician stated to have used the guideline (dose received). The guideline was perceived as providing a good overview of current practice, but some physicians had expected a more directive protocol or algorithm. Further, recommended regular observations of symptoms were rarely performed. Physician's often felt that “this is not different from what we usually do,” and with the acute illness, there was not always enough time to (re)familiarize with the contents. Conclusions: The physicians used the practice guideline frequently despite important barriers. Future implementation may involve strategies such as multiple interactive meetings. Further, the greatest potential to alter usual practice should be emphasized, such as using observational instruments.

KW - dementia

KW - discomfort

KW - nursing homes

KW - pneumonia

KW - process evaluation

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DO - 10.1002/gps.4533

M3 - Article

VL - 32

SP - 829

EP - 839

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

SN - 0885-6230

IS - 8

ER -