6 results on '"Sameh Mortazhejri"'
Search Results
2. Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework
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Amanda Hall, Andrea Pike, Andrea Patey, Sameh Mortazhejri, Samantha Inwood, Shannon Ruzycki, Kyle Kirkham, Krista Mahoney, and Jeremy Grimshaw
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Canada ,Automobile Driving ,Multidisciplinary ,Social Problems ,Newfoundland and Labrador ,Humans - Abstract
Introduction While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelines into clinical practice can be challenging and it is important to understand what is driving behaviour when developing interventions to change it. Aim Thus, we completed a theory-based investigation of the perceived barriers and enablers to reducing unnecessary preoperative tests for low-risk surgical procedures in Newfoundland, Canada. Method We used snowball sampling to recruit surgeons, anaesthesiologists, or preoperative clinic nurses. Interviews were conducted by two researchers using an interview guide with 31 questions based on the theoretical domains framework. Data was transcribed and coded into the 14 theoretical domains and then themes were identified for each domain. Results We interviewed 17 surgeons, anaesthesiologists, or preoperative clinic nurses with 1 to 34 years’ experience. Overall, while respondents agreed with the guidelines they described several factors, across seven relevant theoretical domains, that influence whether tests are ordered. The most common included uncertainty about who is responsible for test ordering, inability to access patient records or to consult/communicate with colleagues about ordering decisions and worry about surgery delays/cancellation if tests are not ordered. Other factors included workplace norms that conflicted with guidelines and concerns about missing something serious or litigation. In terms of enablers, respondents believed that clear institutional guidelines including who is responsible for test ordering and information about the risk of missing something serious, supported by improved communication between those involved in the ordering process and periodic evaluation will reduce any unnecessary preoperative testing. Conclusion These findings suggest that both health system and health provider factors need to be addressed in an intervention to reduce pre-operative testing.
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- 2022
3. Barriers to following imaging guidelines for the treatment and management of patients with low-back pain in primary care: a qualitative assessment guided by the Theoretical Domains Framework
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Andrea, Pike, Andrea, Patey, Rebecca, Lawrence, Kris, Aubrey-Bassler, Jeremy, Grimshaw, Sameh, Mortazhejri, Shawn, Dowling, Yamile, Jasaui, and Shannon, Ruzycki
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Diagnostic Imaging ,Male ,Primary Health Care ,Behavior Therapy ,Newfoundland and Labrador ,Humans ,Female ,Low Back Pain - Abstract
Background Low back pain (LBP) is a leading cause of disability and is among the top five reasons that patients visit their family doctors. Over-imaging for non-specific low back pain remains a problem in primary care. To inform a larger study to develop and evaluate a theory-based intervention to reduce inappropriate imaging, we completed an assessment of the barriers and facilitators to reducing unnecessary imaging for NSLBP among family doctors in Newfoundland and Labrador (NL). Methods This was an exploratory, qualitative study describing family doctors’ experiences and practices related to diagnostic imaging for non-specific LBP in NL, guided by the Theoretical Domains Framework (TDF). Data were collected using in-depth, semi-structured interviews. Transcripts were analyzed deductively (assigning text to one or more domains) and inductively (generating themes at each of the domains) before the results were examined to determine which domains should be targeted to reduce imaging. Results Nine family doctors (four males; five females) working in community (n = 4) and academic (n = 5) clinics in both rural (n = 6) and urban (n = 3) settings participated in this study. We found five barriers to reducing imaging for patients with NSLBP: 1) negative consequences, 2) patient demand 3) health system organization, 4) time, and 5) access to resources. These were related to the following domains: 1) beliefs about consequences, 2) beliefs about capabilities, 3) emotion, 4) reinforcement, 5) environmental context and resources, 6) social influences, and 7) behavioural regulation. Conclusions Family physicians a) fear that if they do not image they may miss something serious, b) face significant patient demand for imaging, c) are working in a system that encourages unnecessary imaging, d) don’t have enough time to counsel patients about why they don’t need imaging, and e) lack access to appropriate practitioners, community programs, and treatment modalities to prescribe to their patients. These barriers were related to seven TDF domains. Successfully reducing inappropriate imaging requires a comprehensive intervention that addresses these barriers using established behaviour change techniques. These techniques should be matched directly to relevant TDF domains. The results of our study represent the important first step of this process – identifying the contextual barriers and the domains to which they are related.
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- 2022
4. Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design
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Kelly Mrklas, Amanda Hall, Justin Presseau, Andrea M Patey, Andrea Pike, Rebecca Lawrence, Krista Mahoney, Samantha Inwood, Sameh Mortazhejri, Jeremy Grimshaw, Kyle Kirkham, Shawn Dowling, Sacha Bhatia, Todd Sikorski, Patrick Parfrey, and Yamile Jasaui
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Risk ,medicine.medical_specialty ,protocols & guidelines ,Newfoundland and Labrador ,media_common.quotation_subject ,Health Status ,education ,MEDLINE ,lcsh:Medicine ,Unnecessary Procedures ,quality in health care ,03 medical and health sciences ,Presentation ,0302 clinical medicine ,Clinical Protocols ,030202 anesthesiology ,Perioperative Nursing ,Health care ,Preoperative Care ,Medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,media_common ,Protocol (science) ,Surgeons ,Research ethics ,business.industry ,Diagnostic Tests, Routine ,lcsh:R ,change management ,Change management ,General Medicine ,Surgical procedures ,Models, Theoretical ,Anesthesiologists ,Evidence Based Practice ,Family medicine ,Surgical Procedures, Operative ,Guideline Adherence ,business ,Test ordering - Abstract
IntroductionCurrent evidence suggests that preoperative tests such as chest X-rays, electrocardiograms and baseline laboratory studies may not be useful for healthy patients undergoing low-risk surgical procedures. Routine preoperative testing for healthy patients having low-risk surgery is not a scientifically sound practice. In this study, we will interview healthcare providers working at medical facilities where low-risk surgical procedures are carried out. This will allow us to gain insight into the determinants of preoperative testing behaviours for healthy patients undergoing low-risk surgeries and their barriers and enablers to guideline adherence.Methods and analysisWe will use semistructured interviews with anaesthesiologists, surgeons and preadmission clinic nurses to assess the determinants of preoperative testing behaviours. The interview guide was designed around the Theoretical Domains Framework (TDF), developed specifically to determine the barriers and enablers to implementing evidence-based guidelines. Interviews will be audio-recorded, transcribed verbatim and coded according to the TDF. Key themes will be generated for each of the identified domains.Ethics and disseminationWe have received ethics approval from the Health Research Ethics Board in Newfoundland and Labrador (HREB #2018.190) for this study. The results of this work will be disseminated through a peer-reviewed publication, presentation at a healthcare forum and plain-language infographic summaries. Additionally, deidentified data collected and analysed for this study will be available for review from the corresponding author on reasonable request.
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- 2020
5. Systematic review of patient-oriented interventions to reduce unnecessary use of antibiotics for upper respiratory tract infections
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Sameh Mortazhejri, R. Sacha Bhatia, Jeremy M. Grimshaw, Brian Y. Hong, Ashley M. Yu, Patrick Jiho Hong, and Dawn Stacey
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Upper respiratory tract infections ,medicine.medical_specialty ,Psychological intervention ,MEDLINE ,lcsh:Medicine ,Medicine (miscellaneous) ,Subgroup analysis ,CINAHL ,030204 cardiovascular system & hematology ,law.invention ,Patient-oriented intervention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Intensive care medicine ,Respiratory Tract Infections ,Respiratory tract infections ,business.industry ,Research ,lcsh:R ,Antibiotic ,Drug Resistance, Microbial ,Anti-Bacterial Agents ,Delayed prescription ,Meta-analysis ,Research Design ,Systematic review ,business - Abstract
BackgroundAntibiotics are prescribed frequently for upper respiratory tract infections (URTIs) even though most URTIs do not require antibiotics. This over-prescription contributes to antibiotic resistance which is a major health problem globally. As physicians’ prescribing behaviour is influenced by patients’ expectations, there may be some opportunities to reduce antibiotic prescribing using patient-oriented interventions. We aimed to identify these interventions and to understand which ones are more effective in reducing unnecessary use of antibiotics for URTIs.MethodsWe conducted a systematic review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), CINAHL, and the Web of Science. We included English language randomized controlled trials (RCTs), quasi-RCTs, controlled before and after studies, and interrupted time series (ITS) studies. Two authors screened the abstract/titles and full texts, extracted data, and assessed study risk of bias. Where pooling was appropriate, a meta-analysis was performed by using a random-effects model. Where pooling of the data was not possible, a narrative synthesis of results was conducted.ResultsWe included 13 studies (one ITS, one cluster RCTs, and eleven RCTs). All interventions could be classified into two major categories: delayed prescriptions (seven studies) and patient/public information and education interventions (six studies). Our meta-analysis of delayed prescription studies observed significant reductions in the use of antibiotics for URTIs (OR = 0.09, CI 0.03 to 0.23; six studies). A subgroup analysis showed that prescriptions that were given at a later time and prescriptions that were given at the index consultation had similar effects. The studies in the patient/public information and education group varied according to their methods of delivery. Since only one or two studies were included for each method, we could not make a definite conclusion on their effectiveness. In general, booklets or pamphlets demonstrated promising effects on antibiotic prescription, if discussed by a practitioner.ConclusionsPatient-oriented interventions (especially delayed prescriptions) may be effective in reducing antibiotic prescription for URTIs. Further research is needed to investigate the costs and feasibility of implementing these interventions as part of routine clinical practice.Systematic review registrationPROSPEROCRD42016048007.
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- 2020
6. Understanding determinants of patients' decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study
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Jeremy M. Grimshaw, Sameh Mortazhejri, R. Sacha Bhatia, Alykhan Abdulla, Andrea M. Patey, and Dawn Stacey
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Semi-structured interview ,Adult ,Male ,medicine.medical_specialty ,Canada ,medicine.drug_class ,Attitude of Health Personnel ,Antibiotics ,Psychological intervention ,Coping strategy ,Medical Overuse ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Illness representation ,Respiratory Tract Infections ,Qualitative Research ,lcsh:R5-920 ,0303 health sciences ,Physician-Patient Relations ,Respiratory tract infections ,Primary Health Care ,030306 microbiology ,business.industry ,Qualitative descriptive ,Attendance ,Physicians, Family ,Upper respiratory tract infection ,Patient Preference ,medicine.disease ,Anti-Bacterial Agents ,Social Perception ,Family medicine ,Self regulation model ,Female ,Thematic analysis ,lcsh:Medicine (General) ,Family Practice ,business ,Attitude to Health ,Research Article - Abstract
Background Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients’ expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients’ views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics). Methods Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied. Results Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms. Conclusion Our participants reported good understanding regarding the likely lack of benefit from antibiotics for URTIs. Developing interventions that specifically help patients discuss their concerns with their physicians, instead of providing more education to public may help in reducing the use of unnecessary antibiotics.
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- 2019
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