Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER).
Dizziness
General practice
Implementation
Primary care
Vertigo
Vestibular rehabilitation
Vestibular symptoms
Journal
Implementation science communications
ISSN: 2662-2211
Titre abrégé: Implement Sci Commun
Pays: England
ID NLM: 101764360
Informations de publication
Date de publication:
22 Nov 2023
22 Nov 2023
Historique:
received:
29
08
2023
accepted:
01
11
2023
medline:
23
11
2023
pubmed:
23
11
2023
entrez:
23
11
2023
Statut:
epublish
Résumé
Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care. Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation. This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.
Sections du résumé
BACKGROUND
BACKGROUND
Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care.
METHODS
METHODS
Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation.
DISCUSSION
CONCLUSIONS
This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.
Identifiants
pubmed: 37993954
doi: 10.1186/s43058-023-00524-1
pii: 10.1186/s43058-023-00524-1
pmc: PMC10666423
doi:
Types de publication
Journal Article
Langues
eng
Pagination
147Subventions
Organisme : ZonMw
ID : 08391052110005
Pays : Netherlands
Informations de copyright
© 2023. The Author(s).
Références
Scand J Prim Health Care. 2017 Mar;35(1):19-26
pubmed: 28277043
Ann Intern Med. 2004 Oct 19;141(8):598-605
pubmed: 15492339
Am J Prev Med. 2012 Sep;43(3):337-50
pubmed: 22898128
Cochrane Database Syst Rev. 2023 Feb 23;2:CD015171
pubmed: 36827524
J Clin Pharm Ther. 2002 Aug;27(4):299-309
pubmed: 12174032
Handb Clin Neurol. 2016;137:67-82
pubmed: 27638063
F1000Res. 2018 Mar 5;7:276
pubmed: 29862019
Handb Clin Neurol. 2016;137:83-90
pubmed: 27638064
Arch Intern Med. 2008 Oct 27;168(19):2118-24
pubmed: 18955641
Br J Gen Pract. 2023 Aug 31;73(734):e710-e719
pubmed: 37487644
BMJ. 2015 Jun 09;350:h2750
pubmed: 26058820
Pharmacoepidemiol Drug Saf. 2009 Jan;18(1):84-91
pubmed: 19111012
Neurol Clin. 2015 Aug;33(3):541-50, vii
pubmed: 26231270
BMJ Open. 2016 Nov 9;6(11):e013166
pubmed: 28186945
Cochrane Database Syst Rev. 2016 Jun 21;(6):CD010696
pubmed: 27327415
Cancers (Basel). 2022 Oct 30;14(21):
pubmed: 36358772
BMC Ear Nose Throat Disord. 2008 Mar 27;8:2
pubmed: 18371190
Implement Sci. 2017 Jun 21;12(1):77
pubmed: 28637486
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
BMJ Open. 2015 Dec 23;5(12):e009993
pubmed: 26700290
BMJ. 2017 Mar 6;356:i6795
pubmed: 28264797
J Neurol. 2016 Apr;263 Suppl 1:S54-64
pubmed: 27083885
BMJ. 2019 Nov 5;367:l5922
pubmed: 31690561
Cochrane Database Syst Rev. 2015 Jan 13;1:CD005397
pubmed: 25581507
Health Econ Rev. 2019 Dec 27;9(1):37
pubmed: 31883042
Ann Fam Med. 2017 May;15(3):209-216
pubmed: 28483885
J Vestib Res. 2012;22(5-6):283-98
pubmed: 23302709
Prev Med Rep. 2017 Apr 04;6:322-328
pubmed: 28451518
Front Neurol. 2022 Dec 01;13:1016718
pubmed: 36530637
BMJ Glob Health. 2020 Oct;5(10):
pubmed: 33055094
Semin Neurol. 2009 Nov;29(5):473-81
pubmed: 19834858
Front Public Health. 2019 Mar 29;7:64
pubmed: 30984733
Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1245-1250
pubmed: 27450383
Implement Sci. 2018 Feb 08;13(1):25
pubmed: 29422076
J Clin Med. 2021 Dec 07;10(24):
pubmed: 34945023