Evidence map›Paper›PMID 31969175›Full record

ArticleImplementation science : IS2020

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study.

Alvaro Sanchez, Jose Ignacio Pijoan, Susana Pablo, Marta Mediavilla, Rita Sainz de Rozas, Itxasne Lekue, Susana Gonzalez-Larragan, Gaspar Lantaron, Jon Argote, Arturo García-Álvarez and 3 more

Registry-linked trialOpen access · goldFull text readClinical Trial Protocol
In one paragraph

Article in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04022850 (De-implementation of Low-value Pharmacological Prescriptions), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.1field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04022850 nacompletednot on this mapstarted 2022, after this paper: background citation

De-implementation of Low-value Pharmacological Prescriptions

TypeinterventionalSponsorBasque Health ServiceRan2022 to 2024Enrolled348ConditionsInappropriate Prescribing, Implementation Science, Behavioral SciencesArmsA non-reflective decision assistance strategy, A both reflective and non-reflective decision information strategy, A reflective decision structure strategy
3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 8 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 2 countries.

Alvaro SanchezPrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain. Alvaro.sanchezperez@osakidetza.eus.ORCID 0000-0001-8600-2119
Jose Ignacio PijoanClinical Epidemiology Unit, Hospital Universitario de Cruces. BioCruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Susana PabloPrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Marta MediavillaPrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Rita Sainz de RozasPrimary Care Pharmacy Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization - Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Itxasne LekuePrimary Care Pharmacy Unit, Barakaldo-Sestao Integrated Health Organization-Osakidetza, Antonio Miranda Etorbidea, E-48902, Barakaldo, Spain.
Susana Gonzalez-LarraganDepartment of Health Science Library, Cruces University Hospital-Osakidetza, Biocruces Bizkaia Health Research Institute, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Gaspar LantaronHealthcare Integration Directorate, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization-Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Jon ArgoteHealthcare Integration Directorate, Barakaldo-Sestao Integrated Health Organization-Osakidetza, Antonio Miranda Etorbidea, E-48902, Barakaldo, Spain.
Arturo García-ÁlvarezPrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Pedro Maria LatorrePrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
Christian D HelfrichSeattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Health Care System, Seattle, USA.
Gonzalo GrandesPrimary Care Research Unit, BioCruces Bizkaia Health Research Institute, Basque Healthcare Service, Osakidetza, Plaza Cruces s/n, E-48903, Barakaldo, Spain.
BioCruces Health research Institute · ESOsasun Sistemen Ikerketa Institutua · ESUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDe-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers, and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based, and theory-informed process involving the main stakeholders (clinicians, managers, patients, and researchers) for the design, deployment, and assessment of de-implementation strategies for reducing low-value pharmacological prescribing.

methodsA phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies-specifically, the Behavior Change Wheel (BCW)-will be conducted to design and model de-implementation strategies to favor reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients, and researchers) in a collegiate way. Subsequently, a phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines ("what-not-to-do" recommendations). A mixed-methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians' perspective, and patients' experiences related to the clinical care received. DISCUSSION: The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policymakers, and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing.

trial registrationClinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019.

Indexed as

AdultAgedCardiovascular DiseasesDrug UtilizationFeasibility StudiesFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypercholesterolemiaImplementation ScienceInappropriate PrescribingInterviews as TopicMaleMiddle AgedObservational Studies as TopicPrimary PreventionHydroxymethylglutaryl-CoA Reductase InhibitorsCardiovascular disease preventionDe-implementationLow-value care

Identifiers

PMID31969175
PMCPMC6977270
OpenAlexW3005263025

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.