All That Can Go Wrong In KT & What Can Be Done About It France Lgar BSc Arch, MD, MSc, PhD, CCFP, FCFP 1st National KT Conference in Rehabilitation Wednesday May 4th 2016 Knowledge application Synthesis
Adapt Knowledge to Local Context Kno wle dge Knowledge Inquiry Evaluate
Outcomes i ng I Assess Barriers to Knowledge Use KNOWLEDGE CREATION
Tai lor Select, Tailor, Implement Interventions Monitor Knowledge Use Products/
Tools Sustain Knowledge Use Identify Problem Identify, Review, Select Knowledge Graham and al. 2006
What can go wrong? Knowledge inquiry is incorrect
Knowledge synthesis is skipped Knowledge product is inadequate Knowledge product does not have a problem Context is artificial The wrong barriers are being addressed No clue about the implementation intervention No monitoring of meaningful impact Stopping short after some success Knowledge inquiry is incorrect Increasing value, reducing waste
1 MacLeod et al. Lancet. 2014 Research priorities identified by clinicians and patients Chalmers I, et al. Lancet. 2014 Development of a decision aid guide to support the frail elderly in decision making about location of care
Mirjam Garvelink1, Julie Emond2, Nathalie Brire2, Matthew Menear1, Dawn Stacey3, France Lgar1. CHU de Qubec Research Centre, Universit Laval, Qubec city 2 Centre de sant et de services sociaux de la Vieille-Capitale, Qubec city 3 Ottawa Hospital Research Unit and Faculty of Health Sciences, University of Ottawa, Ottawa 1 http://decision.chaire.fmed.ulaval.ca/ Knowledge product is inadequate
The lure of standardisation The modern city Le Corbusier Social disaster Pruitt-Igoe, St.Louis, Missouri Minoru Yamasaki 1954 1972
The Grey Zone of Decision Making 11.00% Beneficial 3.00% 7.00% Likely to be ineffective 50.00% 5.00%
Trade-offs Unlikely to be beneficial Likely to be beneficial Unknown effectiveness 24.00% About 3000 treatments BMJ Clinical Evidence 2016 Lomas & Lavis, Guidelines in the Mist, 1996
Decision Quality Best available evidence Patient values and preferences International Patient Decision Aids Standards 2006 & 2013
http://ipdas.ohri.ca/ Womens and Doctors Intention HRT %women 0.3 0.2 0.1 0.0 -2.0
-1.0 0.0 Intention 1.0 2.0 (n= 417)
%doctors 0.25 0.20 0.15 0.10 0.05 -3.0 -2.0
-1.0 0.0 Intention Lgar F, et al. Maturitas. 2000 Ringa V, et al. Menopause. 2004 1.0 2.0
(n= 467) 3.0 https://www.youtube.com/watch?v=DHDnqQ_mCBA&sns=tw Patient Decision Aids Context is artificial The Ecology of Care
100% 35% 6.4% 2.4% 0.3% Green LA, Fryer GE Jr, Yawn BP, Lanier D, Dovey SM. N Engl J Med. 2001 The ecology of medical care revisited. CIHR's funding decisions >2009 ALL RESEARCH 17 530 grants
$4,544,235,497 (100%) PRIMARY CARE 405 grants $73,019,344 (1.6%) Why is KT research in primary care essential? Primary care differs from other healthcare sectors in its founding principles in the range of possible presentations and illnesses they
are asked to address in the diversity of treatment options in the high incidence of collaboration with other healthcare professionals http://www.cfpc.ca/Principles/ Where does primary care KT research happen? In primary care Practice Based Research Networks (PBRNs): A group of ambulatory practices devoted principally to the primary care of patients, and affiliated in their
mission to investigate questions related to communitybased practice and to improve the quality of primary care Our primary care PBRN No clue about the implementation intervention: I2 PICO An effective I becomes a O
P= Residency programs in family medicine I= clear policy making C= no policy making O= uptake of training P= primary care
providers I= training C= no training O= use of decision aids P= patients with URTI I= decision aid C= usual care O= use of antibiotics
Stopping short At the minimum 10 years! Forms follow functions Intervention Descriptive studies Sca
Analytical methods Measurements Cap a Concepts and models ci t y
bui Knowledge syntheses l di n g Patient & Clinicians Powered Practice Based Research Network ling up
