A MATTERS APPROACH TO

CLINICIAN ENGAGEMENT

LISA PYKE, MA, RTR, RTMR, CHE CADTH LIAISON OFFICER, PRINCE EDWARD ISLAND & VETERANS AFFAIRS CANADA JENNIFER BOSWELL, BSCPHARM ANTIMICROBIAL STEWARDSHIP PHARMACIST, HEALTH PEI, CONTRACT CADTH LIAISON OFFICER, PRINCE EDWARD ISLAND

Disclosure I Lisa Pyke, have no actual or potential conflict of interest in relation to this topic or presentation. I Jennifer Boswell, have no actual or potential conflict of interest in relation to this topic or presentation.

Disclosure of Support The MATTERS programs received financial support from : • Health PEI • The Medical Society of PEI • The Queen Elizabeth Hospital (QEH) Medical Staff • Dept. of Health and Wellness , Prince Edward Island • The Canadian Agency for Drugs and Technologies in Health • This program has received in-kind support in the form of: logistical

and planning support from various persons from : CADTH, Health PEI, QEH Volunteer Services, and PEI Department of Health and Wellness

• Potential for conflict(s) of interest: • none

Outline • A Matters Mindset • Matters Principals • Design & Tools • Antimicrobial Stewardship Activities • Lessons Learned • Future Matters Events

KNOWLEDGE SHARING: A CADTH SERVICE

BIG PICTURE • 3 Engagement events ¾ day long educational events

• Urine Matters – February 2015 • Cough Matters – November 2015 • Antibiotic Matters – November 2016

• 100-150 Health Care workers at each event

• Promotion of evidence based local guidelines

• Showcased CADTH’s Rapid Response service

• Facilitated discussions included interactive audience participation

and town hall discussion

Evidence-informed decision-making

Evidence-based decision-making

BEST AVAILABLE SCIENTIFIC EVIDENCE

Patient perspectives and values

CLINCIAL EXPERIENCE

Available resources

Local issues, context

Principles EMBRACE A CLINICIAN AND PATIENT-CENTERED APPROACH: TO MAKE MEANINGFUL CONTRIBUTIONS TO IMPROVE OUTCOMES FOR PATIENTS AND THE HEALTH SYSTEM. EMPHASIZE EVIDENCE: TO APPLY RIGOROUS METHODOLOGIES AND DEVELOP STRONG EVIDENCE BASES TO SUPPORT GUIDELINE DEVELOPMENT, TOOLS AND APPROACHES. COLLABORATE AND CULTIVATE PARTNERSHIPS: TO BOLSTER IMPACT BY WORKING COLLABORATIVELY WITH PARTNERS, BY LEVERAGING THE INSIGHT, EXPERTISE, RESOURCES, AND RELATIONSHIPS

A MATTERS MINDSET We learn better :

together;

with our patients;

with local data; local guidelines; and local

engagement to influence change;

using CADTH tools to discuss clinical questions

allowing for evidence informed collaborations.

MATTERS FORMAT Learning, Information, Discussion

2002, Third Edition, Tools: For Leadership and Learning: Building a Learning Culture retrieved from https://www.scribd.com/document/48921834/Bob-Chartier-toolkit-e

Chest X-rays

1. What is the clinical effectiveness of chest X-ray use for preliminary screening of pediatric and adult patients suspected of having pneumonia or for post treatment follow up assessment?

2. What is the cost-effectiveness of chest X-rays use for preliminary screening of pediatric and adult patients suspected of having pneumonia or for post treatment follow up assessment?

3. What are the evidence-based guidelines regarding chest X-ray use for preliminary screening of pediatric and adult patients suspected of having pneumonia or for post treatment follow-up assessment?

Serum IgM vs. Molecular testing 4. What is the diagnostic accuracy of the serum IgM test compared

with molecular test for the detection of Mycoplasma pneumonia in patients with respiratory infections?

5. What is the clinical effectiveness of the serum IgM test compared with molecular test for the detection of Mycoplasma pneumonia in patients with respiratory infections?

6. What is the cost-effectiveness of the serum IgM test compared with molecular test for the detection of Mycoplasma pneumonia with respiratory infections?

7. What are the evidence-based guidelines regarding the use of the serum IgM test and molecular test for the detection of Mycoplasma pneumonia in patients with respiratory infections?

WHAT DOES THE EVIDENCE SAY ABOUT STREPTOCOCCAL URINE ANTIGEN TEST? 8. What is the clinical effectiveness of the streptococcal antigen

test for the detection of pneumonia in pediatric and adult patients?

9. What is the cost-effectiveness of the streptococcal antigen test for the detection of pneumonia in pediatric and adult patients?

10. What are the evidence-based guidelines associated with the use of the streptococcal antigen test for the detection of pneumonia in pediatric and adult patients?

ANTIBIOTICS MATTERS 2016

What does the evidence say on Cranberry products and estrogen-based therapy for prevention of UTI?

1. What is the clinical effectiveness of cranberry products for the prevention of urinary tract infections?

2. What is the clinical effectiveness of topical estrogen-based therapy for the prevention of urinary tract infections?

3. What are the evidence-based guidelines regarding the prevention of urinary tract infections?

STEWARDSHIP ACTIVITIES

• New Provincial Long-Term Care Urinary Tract Infection Diagnosis and Management Medical Directive • Pilot in 3 public LTC facilities • Better triage of residents • Microbiology lab process optimized • Better urine samples • Drug resistant urinary tract organisms have

reduced by about 2/3 since 2014.

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2014 16 8 15 14 12 15 11 9 15 16 11 202015 18 14 11 13 9 9 15 11 7 13 10 102016 12 10 6 8 6 3 6 2 2 8 7 2

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25Test Volumes Public LTC - Medical Directive Pilot

2014 2015 2016

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2014 59 33 22 31 34 52 42 46 45 37 42 302015 52 32 41 59 47 42 45 53 69 68 54 492016 70 42 64 62 61 51 55 54 47 65 54 49

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Test Volumes Public LTC (excluding Med Dir)

2014 2015 2016

STEWARDSHIP ACTIVITIES

• Development of new clinician resources • Community acquired

pneumonia empiric treatment guidelines for adults

• Virus Plan

STEWARDSHIP ACTIVITIES • Promote and cultivate the Antimicrobial

Stewardship Program • Survey of the Antimicrobial Stewardship Program

• sent to PEI MDs, Pharmacists, NPs and select nurses • Education to HCPs on new initiatives • 2 Matters events coincided with World Antibiotic

Awareness Week • Education to public on antibiotics and

antimicrobial resistance • Patient and HCP shared antibiotic stories

World Health Organization (WHO)

www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week

“Islanders using antibiotics wisely so that antibiotics can

better save Islanders.”

PARTNERSHIPS & COLLABORATIONS

•Collaborative practices were modeled with multidisciplinary clinicians to ensure robust discussions and that key learning points were applied and shared outside of the event

•CADTH evidence was incorporated into discussions supporting the development of contextualized guidelines, and practice tools.

METRIC & MEASURES •MRSA colonization and infections decreased by 40%

•C-diff cases decreased by ~40% in hospital and ~20% within community

•High risk fluoroquinolone antibiotics prescriptions used in community reduced by ~20%

•Use of clindamycin, meropenem, and fluoroquinolones reduced at the main acute care hospital between 2013 to 2015

MRSA

Clostridium difficile Infections

LESSONS LEARNED • Critical pieces:

• Communications • Leadership support • Content, Process, Principles • Free CME • Good food • Collaborative partnerships • Expectations and setting the stage • Continually evaluating and being open to emergence • Building community momentum • Measures and outcomes

COMMITMENT TO CLINICIAN ENGAGEMENT

• Increasing uptake, acceptance and active engagement in using CADTH products and service in providing evidence-informed interventions.

• Enhancing the engagement of clinicians contributing and supporting CADTH product development and services.

• Meeting clinicians evidence needs with CADTH tools and evidence to support clinical decisions on health technologies

• Cultivating a clinician learning community focused on CADTH evidence designed for a clinician audience

DIABETES MATTERS

FUTURE MATTERS

• Geriatric Matters- Fall 2017 • Transitions in care • Assessments of frail elderly

• Women’s Health Matters- TBA

Contact us

• Lisa Pyke, CADTH Liaison Officer, Prince Edward

Island and Veterans Affairs Canada, Contact number: 1-902-940-1012 Lisap@cadth.ca

• Jennifer Boswell, Health PEI Antimicrobial Stewardship Pharmacist / Co-chair of Provincial Drugs and Therapeutics Antimicrobial Stewardship Subcommittee, Contact number: 1-902-894-2587 JLBoswell@ihis.org

• Dr Greg German, Health PEI Medical Microbiologist & Infectious Diseases Consultant / Co-chair of Provincial Drugs and Therapeutics Antimicrobial Stewardship Subcommittee

THANK YOU