Recommending an Evidence-Based Practice Change

Full Answer Section

• Ethical Concerns: Failing to fully involve patients in decisions about their own bodies and care compromises their autonomy and the principle of shared decision-making.
• Challenges in Rural Expansion: As we consider the Canadian market, particularly rural areas with potentially fewer specialized prosthetic centers, ensuring effective remote patient education and shared decision-making will be crucial for successful adoption and patient satisfaction.

Proposed Idea for a Change in Practice (Supported by EBP):

Implement a Telehealth-Enhanced Patient Education and Shared Decision-Making Program for prosthetic device selection and training, specifically targeting patients in rural areas (both in our current US operations and proactively for the future Canadian expansion).

EBP Approach and Supporting Evidence:

This proposed change is supported by evidence in several key areas:

• Telehealth Effectiveness in Patient Education: Numerous studies have demonstrated the effectiveness of telehealth interventions (including video conferencing, interactive modules, and mobile health apps) in delivering patient education across various healthcare domains. Telehealth can provide visual aids, allow for real-time interaction with clinicians, and offer convenient access to information for patients in remote locations (e.g., (1) A systematic review by Cottrell & Schultz, 2018, in the Journal of Telemedicine and Telecare found that telehealth interventions improved patient knowledge and self-management skills in chronic conditions.).

• Benefits of Shared Decision-Making: Research consistently shows that involving patients in treatment decisions leads to increased patient satisfaction, improved adherence, and better health outcomes. Providing patients with clear information about their options, including the pros and cons of different prosthetic devices, and actively involving them in the selection process empowers them and leads to more informed choices (e.g., (2) A meta-analysis by Stacey et al., 2017, in the Cochrane Database of Systematic Reviews concluded that patient decision aids significantly improve patient knowledge, risk perception accuracy, and participation in decision-making.).

• Telehealth for Prosthetic and Orthotic Care: While the evidence base is still growing, studies have shown the feasibility and potential benefits of telehealth in various aspects of prosthetic and orthotic care, including initial consultations, gait training follow-ups, and remote adjustments (e.g., (3) A pilot study by Gerschutz et al., 2020, in the Journal of Prosthetics and Orthotics explored the use of telerehabilitation for prosthetic gait training and found it to be a feasible and acceptable alternative to in-person sessions for some patients.).

• Addressing Rural Healthcare Disparities: Telehealth is a recognized strategy for overcoming geographical barriers and improving access to specialized care for individuals in rural communities, who often face significant challenges in accessing healthcare services (e.g., (4) The National Rural Health Association advocates for the expansion of telehealth services to address healthcare disparities in rural America.).

Implementation Plan (Brief Overview):

1. Develop Comprehensive Telehealth Education Modules: Create interactive video modules, downloadable resources, and virtual reality simulations explaining different prosthetic device options, their features, benefits, limitations, and the rehabilitation process.
2. Implement Virtual Shared Decision-Making Consultations: Train clinicians on facilitating effective shared decision-making via video conferencing, utilizing visual aids and addressing patient questions thoroughly.
3. Utilize Mobile Health Apps: Explore the use of apps for providing ongoing education, tracking progress, and facilitating communication between patients and clinicians.
4. Provide Remote Support and Training: Offer virtual follow-up appointments and remote gait training sessions using video technology.
5. Evaluate Outcomes: Track patient satisfaction, device abandonment rates, adherence to training, and functional outcomes for patients receiving care through the telehealth-enhanced program compared to traditional in-person care.

Expected Positive Outcomes:

• Improved patient understanding of their prosthetic options.
• Increased patient involvement and satisfaction with the device selection process.
• Enhanced adherence to training programs.
• Potentially better functional outcomes and reduced device abandonment.
• Improved access to specialized care for patients in rural areas.
• More efficient use of clinician time through well-informed patients.
• A strong foundation for successful expansion into the Canadian market, particularly in underserved rural regions.

By implementing this telehealth-enhanced patient education and shared decision-making program, supported by the growing body of evidence in telehealth, shared decision-making, and remote rehabilitation, our organization can improve the quality of care, enhance patient outcomes, and strategically position itself for successful growth, including our entry into the Canadian market.

(References - Example Citations):

1. Cottrell, M. A., & Schultz, T. J. (2018). Telemedicine for patient education in chronic diseases: a systematic review and meta-analysis. Journal of Telemedicine and Telecare, 24(10), 635-642.

Sample Answer

Okay, considering my simulated role as a Director of Leadership and Learning for a prosthetics organization with a focus on expanding into Canada, here's an identified issue and a proposed change in practice supported by an Evidence-Based Practice (EBP) approach:

Issue: Inconsistent and potentially inadequate patient education and shared decision-making processes regarding prosthetic device selection and training, particularly for patients in rural areas who may have limited access to specialized information and support.

Why is this an issue?

• Suboptimal Patient Outcomes: Lack of comprehensive education can lead to patients choosing devices that don't fully meet their needs or preferences, resulting in dissatisfaction, abandonment of the device, and poorer functional outcomes.
• Reduced Adherence and Compliance: Inadequate understanding of device use, maintenance, and potential challenges can lead to poor adherence to training programs and ultimately limit the benefits of the prosthetic.
• Increased Burden on Clinicians: When patients are not well-informed and actively involved in the decision-making process, it can lead to more questions, troubleshooting, and potentially rework for clinicians.