dc.contributor | Vall d'Hebron Barcelona Hospital Campus |
dc.contributor.author | Saposnik, Gustavo |
dc.contributor.author | Mamdani, Muhammad |
dc.contributor.author | Montalban Gairín, Xavier |
dc.contributor.author | Terzaghi, Maria A |
dc.contributor.author | Silva, Berenice |
dc.contributor.author | Saladino, Maria Laura |
dc.date.accessioned | 2019-07-19T08:33:00Z |
dc.date.available | 2019-07-19T08:33:00Z |
dc.date.issued | 2019-06-21 |
dc.identifier.citation | Saposnik G, Mamdani M, Montalban X, Terzaghi M, Silva B, Saladino ML, et al. Traffic Lights Intervention Reduces Therapeutic Inertia: A Randomized Controlled Trial in Multiple Sclerosis Care. MDM Policy Pract. 2019;4(1):238146831985564. |
dc.identifier.issn | 2381-4683 |
dc.identifier.uri | https://hdl.handle.net/11351/4193 |
dc.description | Decision making; Disease-modifying therapy; Multiple sclerosis |
dc.description | Toma de decisiones; Terapia modificadora de la enfermedad; Esclerosis múltiple |
dc.description.abstract | Background: Therapeutic inertia (TI) is a common phenomenon among physicians who care for patients with chronic conditions. We evaluated the efficacy of the traffic light system (TLS) educational intervention to reduce TI among neurologists with MS expertise. Methods: In this randomised, controlled trial, 90 neurologists who provide care to MS patients were randomly assigned to the TLS intervention (n = 45) or to the control group (n = 45). The educational intervention employed the TLS, a behavioral strategy that facilitates therapeutic choices by facilitating reflective decisions. The TLS consisted in a short, structured, single session intervention of 5-7 min duration. Participants made therapeutic choices of 10 simulated case-scenarios. The primary outcome was a reduction in TI based on a published TI score (case-scenarios in which a participant showed TI divided by the total number of scenarios where TI was possible ranging from 0 to 8). Results: All participants completed the study and were included in the primary analysis. TI was lower in the TLS group (1.47, 95% CI 1.32-1.61) compared to controls (1.93; 95% CI 1.79-2.08). The TLS group had a lower prevalence of TI compared to controls (0.67, 95% CI 0.62-0.71 vs. 0.82, 95% CI 0.78-0.86; p = 0.001). The multivariate analysis, adjusted for age, specialty, years of practice, and risk preference showed a 70% reduction in TI for the TLS intervention compared to controls (OR 0.30; 95% CI 0.10-0.89). Conclusions: In this randomized trial, the TLS strategy decreases the incidence of TI in MS care irrespective of age, expertise, years for training, and risk preference of participants, which would lead to better patient outcomes. |
dc.language.iso | eng |
dc.publisher | SAGE Publications |
dc.relation.ispartofseries | MDM Policy and Practice;4(1) |
dc.rights | Attribution-NonCommercial 4.0 International |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/ |
dc.source | Scientia |
dc.subject | Esclerosi múltiple - Tractament |
dc.subject | Personal mèdic - Educació (Educació permanent) |
dc.subject | Medicina - Pràctica professional |
dc.subject | Assaigs clínics |
dc.subject.mesh | Multiple Sclerosis |
dc.subject.mesh | /therapy |
dc.subject.mesh | Quality of Health Care |
dc.subject.mesh | Education, Medical, Continuing |
dc.subject.mesh | Randomized Controlled Trial |
dc.title | Traffic Lights Intervention Reduces Therapeutic Inertia: A Randomized Controlled Trial in Multiple Sclerosis Care |
dc.type | info:eu-repo/semantics/article |
dc.identifier.doi | 10.1177/2381468319855642 |
dc.subject.decs | esclerosis múltiple |
dc.subject.decs | /terapia |
dc.subject.decs | calidad de la atención sanitaria |
dc.subject.decs | educación médica continuada |
dc.subject.decs | ensayo clínico controlado aleatorizado |
dc.relation.publishversion | https://journals.sagepub.com/doi/10.1177/2381468319855642 |
dc.type.version | info:eu-repo/semantics/publishedVersion |
dc.audience | Professionals |
dc.contributor.organismes | Institut Català de la Salut |
dc.contributor.authoraffiliation | [Saposnik G] Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, Canada. University of Toronto, Toronto, Canada. [Mamdani M] Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Toronto, Toronto, Canada. [Montalban X] Servei de Neurologia I Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Barcelona, Spain. Hospital Universitari Vall d'Hebron, Barcelona, Spain. [Terzaghi M] Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, Toronto, Canada. St. Michael's Hospital, Toronto, Canada. University of Toronto, Toronto, Canada. [Silva B, Saladino ML] Institute of Neuroscience Buenos Aires (INEBA), Buenos Aires, Argentina. |
dc.identifier.pmid | 31259250 |
dc.rights.accessrights | info:eu-repo/semantics/openAccess |