Category: Primary care

Doing research with busy doctors – an open space world

Family doctors are notoriously busy. Lack of their time is the number #1 barrier of doing anything outside their patient workload, including research. And yet, some enthusiasts get involved in the research endeavour, believing it can enhance primary care.

Knowing this, I looked for ways to do research with busy family physicians for my INVEST fellowship in Portland, OR. I needed to get them in one room and ask the group a couple of questions about their recent resident training initiative, SBIRT Oregon. The only time when my doctors were all in the clinic was right after another meeting. One of them suggested doing an open meeting technology. The phrase vaguely rang a bell with me.

‘Open space’ describes the process by which a wide range of individuals, in any organisation, can facilitate creative meetings around a complex theme of importance to all stakeholders 1. While a theme may be important to all stakeholders, they may have differing perspectives and responses, so this approach permits all voices to be heard and facilitates a process where stakeholders move from conflicting views to consensus. The approach has been widely used in commerce, religious communities, (non-)governmental agencies and war zones 2.

How did this work for us?

Our field ‘experiment’ lasted for about 90 minutes with two meetings in one room, right after each other. The meetings were unrelated, but 3/4 of the participants from the first meeting were scheduled for the second meeting too. I and my co-facilitator arrived well ahead of the first meeting. As doctors started to show up for the 2nd meeting – the 1st meeting was still in progress – some people were confused; others patiently listened to people talking at the 1st meeting. I found it very useful to sit on the 1st meeting and the transition to the 2nd meeting was much easier – all were in their seats already.

All in all, this set up had many advantages for multiple meetings with extra busy attendees. It can help solve problems and it works best with many people attending your meeting, but maybe it’s not ideal for research focus groups. A tip for a freshman facilitator: it’s amazing how much powerful an incentive for research can food be, especially pizza.

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1http://www.michaelherman.com/cgi/wiki.cgi
2http://www.openspaceworld.com/papers.htm

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

In our new new paper, we outline plans for doing a study which should tell us whether doctors and agonist patients accept psychological interventions as means of curbing alcohol in primary care; it should also tell us whether we can do more research on this topic in Ireland. Access the full protocol here  http://www.researchprotocols.org/2013/2/e26/

For some people, publishing research protocols is not fun because of two reasons:

  1. everybody knows what you’re doing
  2. you have to do what you said – everybody knows now.

However tough for researchers, these two reasons make publicly available research protocols the best way to achieve transparency in research. Transparent research is in line with ethical principles of research conduct and makes an honorable contribution to the scientific knowledge – to the honor pot. Together with accountability, it should be the core pillar of scientific discovery.

If these safeguards fail, we may see more instances of academic fraud and data falsification, such as Diederik Stapels’. The social psychology community has been embarassed by the revelation that Diederik Stapels made up the data for his papers.  The NY Times link provides a detailed analysis of the Stapels and his academic fraud.

Helping agonist patients with alcohol problems: A NEW guide for primary care staff

What should doctors do differently when screening for alcohol use and delivering brief interventions for agonist patients in primary care? General principles remain the same like for other people, but:
  1. the screening and treatment processes should be more systematic and proactive in all problem drug users, especially in those with concurrent chronic illnesses or psychiatric co-morbidity,
  2. lower thresholds should be applied for both identification and intervention of problem alcohol use and referral to specialist services,
  3. special skills and specialist supervision is required if managing persistent/dependent alcohol use in primary care.

What agonist patients think about alcohol #SBIRT? A new paper out now

What do patients attending family physicians for methadone treatment think of screening and brief interventions for alcohol problems? Except for being screened at the intake, few recalled routine screening or treatment, and felt that primary care staff should be more proactive when addressing excessive drinking.
Check out our new qualitative study (www.biomedcentral.com/1471-2296/14/98/abstract)

Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

UL researchers have been awarded €300,000 by Ireland’s Health Research Board to develop and evaluate psychosocial interventions for drug and alcohol users in primary care. Psychosocial interventions are described as aimed at reducing consumption behaviour or alcohol-related problems by using psychological approaches

UL Researchers Undertake Study to Evaluate Impact of Psychology Based Treatments for Drugs Users

Principal Investigator and Professor of General Practice at UL, Walter Cullen, explains: “The focus of this study is to evaluate the impact of psychology based treatments as opposed to the approach of medicating patients dealing with drug and alcohol addiction. There is a significant knowledge gap in this area internationally and we hope this study will help practitioners in Ireland assist their patients to deal with this issue.”
 
Led by Dr Jan Klimas Post-doctoral Researcher at the Centre for Interventions in Inflammation, Infection & Immunity (4i) (http://www.4i.ie) hosted by University of Limerick’s Graduate Entry Medical School, the study involves collaborators from a wide range of disciplines and agencies as well as international experts from the UK, USA and Australia.
 
The study, entitled ‘‘Are Psychosocial Interventions Effective for Problem Alcohol Use among Problem Drug Users’ (the PINTA study) will involve over 20 practices in the Midwest and Eastern regions.
 
The Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, UL brings together a multidisciplinary team of researchers focused on developing studies that impact health outcomes.
 
Director of the Centre, Professor Colum Dunne, complimented the team that successfully competed for this funding, adding “this study builds on previous work, also funded by the HRB, that qualitatively explored patients’ and practitioners’ experiences of problem drug and alcohol use. In a recent Cochrane review we identified gaps in the currently available scientific evidence relating to effectiveness treatments for problem alcohol use. This new study will add considerably to that field of practice.”
Read more here …