Show simple item record

 
dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorSaposnik, Gustavo
dc.contributor.authorMamdani, Muhammad
dc.contributor.authorMontalban Gairín, Xavier
dc.contributor.authorTerzaghi, Maria A
dc.contributor.authorSilva, Berenice
dc.contributor.authorSaladino, Maria Laura
dc.date.accessioned2019-07-19T08:33:00Z
dc.date.available2019-07-19T08:33:00Z
dc.date.issued2019-06-21
dc.identifier.citationSaposnik 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.issn2381-4683
dc.identifier.urihttp://hdl.handle.net/11351/4193
dc.descriptionDecision making; Disease-modifying therapy; Multiple sclerosis
dc.descriptionToma de decisiones; Terapia modificadora de la enfermedad; Esclerosis múltiple
dc.description.abstractBackground: 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.isoeng
dc.publisherSAGE Publications
dc.relation.ispartofseriesMDM Policy and Practice;4(1)
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.sourceScientia
dc.subjectEsclerosi múltiple - Tractament
dc.subjectPersonal mèdic - Educació (Educació permanent)
dc.subjectMedicina - Pràctica professional
dc.subjectAssaigs clínics
dc.subject.meshMultiple Sclerosis
dc.subject.mesh/therapy
dc.subject.meshQuality of Health Care
dc.subject.meshEducation, Medical, Continuing
dc.subject.meshRandomized Controlled Trial
dc.titleTraffic Lights Intervention Reduces Therapeutic Inertia: A Randomized Controlled Trial in Multiple Sclerosis Care
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.1177/2381468319855642
dc.subject.decsesclerosis múltiple
dc.subject.decs/terapia
dc.subject.decscalidad de la atención sanitaria
dc.subject.decseducación médica continuada
dc.subject.decsensayo clínico controlado aleatorizado
dc.relation.publishversionhttps://journals.sagepub.com/doi/10.1177/2381468319855642
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut 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.pmid31259250
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record