Browsing by Author "Gordon, Adelaide M"

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    ItemOpen Access
    Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods.
    (Systematic reviews, 2020-04-25) Lewinski, Allison A; Shapiro, Abigail; Gierisch, Jennifer M; Goldstein, Karen M; Blalock, Dan V; Luedke, Matthew W; Gordon, Adelaide M; Bosworth, Hayden B; Drake, Connor; Lewis, Jeffrey D; Sinha, Saurabh R; Husain, Aatif M; Tran, Tung T; Van Noord, Megan G; Williams, John W

    Background

    Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy.

    Methods

    We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers.

    Results

    The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system).

    Conclusion

    Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses.

    Systematic review registration

    PROSPERO registration number is CRD42018098604.
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    Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.
    (Journal of general internal medicine, 2020-07) Boggan, Joel C; Shoup, John Paul; Whited, John D; Van Voorhees, Elizabeth; Gordon, Adelaide M; Rushton, Sharron; Lewinski, Allison A; Tabriz, Amir A; Adam, Soheir; Fulton, Jessica; Kosinski, Andrzej S; Van Noord, Megan G; Williams, John W; Goldstein, Karen M; Gierisch, Jennifer M

    Background

    Technology-based systems can facilitate remote decision-making to triage patients to the appropriate level of care. Despite technologic advances, the effects of implementation of these systems on patient and utilization outcomes are unclear. We evaluated the effects of remote triage systems on healthcare utilization, case resolution, and patient safety outcomes.

    Methods

    English-language searches of MEDLINE (via PubMed), EMBASE, and CINAHL were performed from inception until July 2018. Randomized and nonrandomized comparative studies of remote triage services that reported healthcare utilization, case resolution, and patient safety outcomes were included. Two reviewers assessed study and intervention characteristics independently for study quality, strength of evidence, and risk of bias.

    Results

    The literature search identified 5026 articles, of which eight met eligibility criteria. Five randomized, two controlled before-and-after, and one interrupted time series study assessed 3 categories of remote triage services: mode of delivery, triage professional type, and system organizational level. No study evaluated any other delivery mode other than telephone and in-person. Meta-analyses were unable to be performed because of study design and outcome heterogeneity; therefore, we narratively synthesized data. Overall, most studies did not demonstrate a decrease in primary care (PC) or emergency department (ED) utilization, with some studies showing a significant increase. Evidence suggested local, practice-based triage systems have greater case resolution and refer fewer patients to PC or ED services than regional/national systems. No study identified statistically significant differences in safety outcomes.

    Conclusion

    Our review found limited evidence that remote triage reduces the burden of PC or ED utilization. However, remote triage by telephone can produce a high rate of call resolution and appears to be safe. Further study of other remote triage modalities is needed to realize the promise of remote triage services in optimizing healthcare outcomes.

    Protocol registration

    This study was registered and followed a published protocol (PROSPERO: CRD42019112262).
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    Effectiveness of Synchronous Postdischarge Contacts on Health Care Use and Patient Satisfaction : A Systematic Review and Meta-analysis.
    (Ann Intern Med, 2025-01-14) Boggan, Joel C; Sankineni, Spoorthi; Dennis, Paul A; Chen, Dazhe; Sledge, Tina Wong; Halpern, David; Rushton, Sharron; Williams, John W; Der, Tatyana; Tabriz, Amir Alishahi; Gordon, Adelaide M; Jacobs, Morgan; Boucher, Nathan A; Colandrea, Maria; Alexopoulos, Anastasia-Stefania; Roman Jones, Joanne; Leflore-Lloyd, Nina; Cantrell, Sarah; Goldstein, Karen M; Gierisch, Jennifer M
    BACKGROUND: Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear. PURPOSE: To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction. DATA SOURCES: MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023. STUDY SELECTION: Randomized and nonrandomized trials of PDC within 7 days. DATA EXTRACTION: Two investigators independently screened articles and assessed risk of bias (ROB). Single reviewers extracted data, with verification by second investigators. Random-effects meta-analyses were done on outcomes shared by at least 3 studies, and the certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. DATA SYNTHESIS: Of 13 included studies (11 randomized trials [RTs]), 12 delivered PDCs via telephone. Three of 11 RTs were rated as having low ROB, with 1 rated high. Most PDC interventions (n = 10) consisted of single telephone contacts, often within 3 days. Eight studies focused on patients identified as higher-risk by the authors. There were no differences in 30-day ED use (5 RTs; 3054 patients; risk difference, 0.00 [95% CI, -0.02 to 0.03]; moderate certainty) or 30-day hospital readmissions (7 RTs; 7075 patients; risk difference, 0.00 [CI, -0.02 to 0.02]; moderate certainty) with PDC. LIMITATION: Adherence and fidelity to PDC interventions were poorly described, and only 1 study investigated nontelephone PDC. CONCLUSION: Postdischarge contacts within 7 days of discharge were not associated with reductions in 30-day ED use or readmissions compared with usual care. Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge. PRIMARY FUNDING SOURCE: Department of Veterans Affairs. (PROSPERO: CRD42023465675).
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    Self-management of Epilepsy: A Systematic Review.
    (Annals of internal medicine, 2019-07) Luedke, Matthew W; Blalock, Dan V; Goldstein, Karen M; Kosinski, Andrzej S; Sinha, Saurabh R; Drake, Connor; Lewis, Jeffrey D; Husain, Aatif M; Lewinski, Allison A; Shapiro, Abigail; Gierisch, Jennifer M; Tran, Tung T; Gordon, Adelaide M; Van Noord, Megan G; Bosworth, Hayden B; Williams, John W
    Background:Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose:To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons. Data Sources:English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection:Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction:An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis:13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation:High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion:There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit. Primary Funding Source:U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604).
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    Telehealth Interventions Designed for Women: an Evidence Map.
    (Journal of general internal medicine, 2018-12) Goldstein, Karen M; Zullig, Leah L; Dedert, Eric A; Alishahi Tabriz, Amir; Brearly, Timothy W; Raitz, Giselle; Sata, Suchita Shah; Whited, John D; Bosworth, Hayden B; Gordon, Adelaide M; Nagi, Avishek; Williams, John W; Gierisch, Jennifer M

    Background

    Telehealth employs technology to connect patients to the right healthcare resources at the right time. Women are high utilizers of healthcare with gender-specific health issues that may benefit from the convenience and personalization of telehealth. Thus, we produced an evidence map describing the quantity, distribution, and characteristics of evidence assessing the effectiveness of telehealth services designed for women.

    Methods

    We searched MEDLINE® (via PubMed®) and Embase® from inception through March 20, 2018. We screened systematic reviews (SRs), randomized trials, and quasi-experimental studies using predetermined eligibility criteria. Articles meeting inclusion criteria were identified for data abstraction. To assess emerging trends, we also conducted a targeted search of ClinicalTrials.gov .

    Results

    Two hundred thirty-four primary studies and three SRs were eligible for abstraction. We grouped studies into focused areas of research: maternal health (n = 96), prevention (n = 46), disease management (n = 63), family planning (n = 9), high-risk breast cancer assessment (n = 10), intimate partner violence (n = 7), and mental health (n = 3). Most interventions focused on phone as the primary telehealth modality and featured healthcare team-to-patient communication and were limited in duration (e.g., < 12 weeks). Few interventions were conducted with older women (≥ 60 years) or in racially/ethnically diverse populations. There are few SRs in this area and limited evidence regarding newer telehealth modalities such as mobile-based applications or short message service/texting. Targeted search of clinical.trials.gov yielded 73 ongoing studies that show a shift in the use of non-telephone modalities.

    Discussion

    Our systematic evidence map highlights gaps in the existing literature, such as a lack of studies in key women's health areas (intimate partner violence, mental health), and a dearth of relevant SRs. With few existing SRs in this literature, there is an opportunity for examining effects, efficiency, and acceptability across studies to inform efforts at implementing telehealth for women.