Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol
Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol
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DOI：
10.1016/j.sapharm.2019.06.006
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发表时间：
2020-03-01
影响因子：
3.9
通讯作者：
Williams, Marc S.
中科院分区：
文献类型：
--
作者：
Jones, Laney K.;Gidding, Samuel S.;Williams, Marc S.
背景资料：家族性高胆固醇血症（FH）影响超过一百万美国人，大多数人尚未被正式诊断患有这种疾病。FH患者从出生起血清低密度脂蛋白胆固醇（LDL-C）水平显著升高，这大大增加了早发性心血管（CV）事件的风险。指南推荐的治疗可降低FH和高胆固醇血症患者的LDL-C和CV事件风险。本研究旨在通过系统地开发一种有效的方法来增加指南推荐的FH治疗方法的采用，以解决FH患者护理中的一个重大差距。方法：本发展性研究将包括三个目标：1）确定FH治疗的障碍和促进因素; 2）制定一份潜在的实施策略清单，以促进采用指南推荐的FH个体治疗，以及3）在一个医疗系统中试行目标2中的一项实施策略，以评估该策略的实施效果。实用、稳健的实施和可持续性模式将指导该项目，包括制定访谈问题、实施战略和评价实施战略。实施结果包括：实施战略所针对的个人，有多少人受到影响（影响范围），衡量实施战略影响的知识，态度和行为的变化（有效性），在实施战略所针对的环境中，有多少人采用（采用），以及实施战略的忠诚度和成本（实施）。数据来源将包括电子健康记录，行政数据库，调查，和半结构化interviews.Discussion：纳入患者和组织利益相关者的经验是制定高效和有效的实施战略的一个至关重要的步骤。此外，从不同的地理区域和文化的角度来看，应该增加干预方法的可行性和保真度，以提高采用指南推荐的FH护理实践。
Background: Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia. This study seeks to address a significant gap in the care of individuals with FH by systematically developing an effective approach to increase the adoption of guideline-recommended treatments for FH.Methods: This developmental study will consist of three aims: 1) determine the barriers to and facilitators of treatment of FH; 2) develop a list of potential implementation strategies to promote the adoption of guideline-recommended treatment of individuals with FH, and 3) pilot one implementation strategy from Aim 2 in one health care system to evaluate implementation outcomes of the strategy. The Practical, Robust Implementation and Sustainability Model will guide this project, including the development of interview questions, implementation strategies, and evaluation of the implementation strategy. The implementation outcomes include: of individuals targeted by the implementation strategy, how many are impacted by it (reach), measure the change in knowledge, attitude, and behavior that is impacted by the implementation strategy (effectiveness), in settings targeted by the implementation strategy, how many adopt it (adoption), and fidelity and cost of the implementation strategy (implementation). Data sources will include electronic health records, administrative databases, surveys, and semi-structured interviews.Discussion: The inclusion of patient and organizational stakeholder experiences is a critically important step in developing efficient and effective implementation strategies. Additionally, perspectives from a variety of geographic areas and cultural perspectives should increase feasibility and fidelity of the interventional approach to improve adoption of guideline-recommended practices for FH care.