Traffic Lights Intervention Reduces Therapeutic Inertia: A Randomized Controlled Trial in Multiple Sclerosis Care
| Autor: | Saposnik, Gustavo, Mamdani, Muhammad, Montalban Gairín, Xavier, Terzaghi, Maria A, Silva, Berenice, Saladino, Maria Laura |
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| Přispěvatelé: | Institut Català de la Salut, [Saposnik G] Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, Canada. University of Toronto, Toronto, Canada. [Mamdani M] Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Toronto, Toronto, Canada. [Montalban X] Servei de Neurologia I Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Barcelona, Spain. Hospital Universitari Vall d'Hebron, Barcelona, Spain. [Terzaghi M] Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, Toronto, Canada. St. Michael's Hospital, Toronto, Canada. University of Toronto, Toronto, Canada. [Silva B, Saladino ML] Institute of Neuroscience Buenos Aires (INEBA), Buenos Aires, Argentina., Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus |
| Předmět: |
educación::educación profesional::educación continuada::educación médica continuada [ANTROPOLOGÍA
EDUCACIÓN SOCIOLOGÍA Y FENÓMENOS SOCIALES] Personal mèdic - Educació (Educació permanent) atención a la salud (salud pública)::prestación sanitaria::calidad de la atención sanitaria [SALUD PÚBLICA] Nervous System Diseases::Autoimmune Diseases of the Nervous System::Demyelinating Autoimmune Diseases CNS::Multiple Sclerosis [DISEASES] Other subheadings::/therapy [Other subheadings] características del estudio::estudio clínico::ensayo clínico::ensayo clínico controlado::ensayo clínico controlado aleatorizado [CARACTERÍSTICAS DE PUBLICACIONES] Health Care (Public Health)::Delivery of Health Care::Quality of Health Care [PUBLIC HEALTH] Study Characteristics::Clinical Study::Clinical Trial::Controlled Clinical Trial::Randomized Controlled Trial [PUBLICATION CHARACTERISTICS] Medicina - Pràctica professional enfermedades del sistema nervioso::enfermedades autoinmunitarias del sistema nervioso::enfermedades autoinmunes desmielinizantes del SNC::esclerosis múltiple [ENFERMEDADES] Esclerosi múltiple - Tractament Education::Education Professional::Education Continuing::Education Medical Continuing [ANTHROPOLOGY EDUCATION SOCIOLOGY AND SOCIAL PHENOMENA] Otros calificadores::/terapia [Otros calificadores] Assaigs clínics |
| Zdroj: | Scientia Recercat. Dipósit de la Recerca de Catalunya instname Recercat: Dipósit de la Recerca de Catalunya Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Popis: | Decision making; Disease-modifying therapy; Multiple sclerosis Toma de decisiones; Terapia modificadora de la enfermedad; Esclerosis múltiple Presa de decisions; Teràpia modificadora de la malaltia; Esclerosi múltiple Background: Therapeutic inertia (TI) is a common phenomenon among physicians who care for patients with chronic conditions. We evaluated the efficacy of the traffic light system (TLS) educational intervention to reduce TI among neurologists with MS expertise. Methods: In this randomised, controlled trial, 90 neurologists who provide care to MS patients were randomly assigned to the TLS intervention (n = 45) or to the control group (n = 45). The educational intervention employed the TLS, a behavioral strategy that facilitates therapeutic choices by facilitating reflective decisions. The TLS consisted in a short, structured, single session intervention of 5-7 min duration. Participants made therapeutic choices of 10 simulated case-scenarios. The primary outcome was a reduction in TI based on a published TI score (case-scenarios in which a participant showed TI divided by the total number of scenarios where TI was possible ranging from 0 to 8). Results: All participants completed the study and were included in the primary analysis. TI was lower in the TLS group (1.47, 95% CI 1.32-1.61) compared to controls (1.93; 95% CI 1.79-2.08). The TLS group had a lower prevalence of TI compared to controls (0.67, 95% CI 0.62-0.71 vs. 0.82, 95% CI 0.78-0.86; p = 0.001). The multivariate analysis, adjusted for age, specialty, years of practice, and risk preference showed a 70% reduction in TI for the TLS intervention compared to controls (OR 0.30; 95% CI 0.10-0.89). Conclusions: In this randomized trial, the TLS strategy decreases the incidence of TI in MS care irrespective of age, expertise, years for training, and risk preference of participants, which would lead to better patient outcomes. |
| Databáze: | OpenAIRE |
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