Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial

J. Davis, R. Roberts, D. L. Davidson, A. Norman, S. Ogston, P. Davey, J. Grant, D. Ruta

    Research output: Contribution to journalArticle

    31 Citations (Scopus)

    Abstract

    Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings.

    Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1, 133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions.

    Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures.

    Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

    Original languageEnglish
    Pages (from-to)28-34
    Number of pages6
    JournalEpilepsia
    Volume45
    Issue number1
    DOIs
    Publication statusPublished - 2004

    Keywords

    • guidelines
    • implementation
    • epilepsy
    • primary care
    • quality of life
    • CLINICAL GUIDELINES
    • OUTCOME MEASURE
    • CLUSTER RANDOMIZATION
    • GENERAL-PRACTICE
    • SCALE

    Cite this

    Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial. / Davis, J.; Roberts, R.; Davidson, D. L.; Norman, A.; Ogston, S.; Davey, P.; Grant, J.; Ruta, D.

    In: Epilepsia, Vol. 45, No. 1, 2004, p. 28-34.

    Research output: Contribution to journalArticle

    Davis, J. ; Roberts, R. ; Davidson, D. L. ; Norman, A. ; Ogston, S. ; Davey, P. ; Grant, J. ; Ruta, D. / Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial. In: Epilepsia. 2004 ; Vol. 45, No. 1. pp. 28-34.
    @article{06c26bb28b8f4c9db0dc78c117b6ef56,
    title = "Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial",
    abstract = "Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings.Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1, 133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions.Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures.Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.",
    keywords = "guidelines, implementation, epilepsy, primary care, quality of life, CLINICAL GUIDELINES, OUTCOME MEASURE, CLUSTER RANDOMIZATION, GENERAL-PRACTICE, SCALE",
    author = "J. Davis and R. Roberts and Davidson, {D. L.} and A. Norman and S. Ogston and P. Davey and J. Grant and D. Ruta",
    year = "2004",
    doi = "10.1111/j.0013-9580.2004.24003.x",
    language = "English",
    volume = "45",
    pages = "28--34",
    journal = "Epilepsia",
    issn = "0013-9580",
    publisher = "Wiley-Blackwell",
    number = "1",

    }

    TY - JOUR

    T1 - Implementation strategies for a Scottish national epilepsy guideline in primary care: results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) trial

    AU - Davis, J.

    AU - Roberts, R.

    AU - Davidson, D. L.

    AU - Norman, A.

    AU - Ogston, S.

    AU - Davey, P.

    AU - Grant, J.

    AU - Ruta, D.

    PY - 2004

    Y1 - 2004

    N2 - Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings.Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1, 133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions.Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures.Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

    AB - Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings.Methods: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1, 133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions.Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures.Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

    KW - guidelines

    KW - implementation

    KW - epilepsy

    KW - primary care

    KW - quality of life

    KW - CLINICAL GUIDELINES

    KW - OUTCOME MEASURE

    KW - CLUSTER RANDOMIZATION

    KW - GENERAL-PRACTICE

    KW - SCALE

    U2 - 10.1111/j.0013-9580.2004.24003.x

    DO - 10.1111/j.0013-9580.2004.24003.x

    M3 - Article

    VL - 45

    SP - 28

    EP - 34

    JO - Epilepsia

    JF - Epilepsia

    SN - 0013-9580

    IS - 1

    ER -