Simon L. Bacon, PhD, FTOS, FCCS, FABMR Spring Meeting/2. Bacon... · Disclosures •Grants/Research...
Transcript of Simon L. Bacon, PhD, FTOS, FCCS, FABMR Spring Meeting/2. Bacon... · Disclosures •Grants/Research...
Simon L. Bacon, PhD, FTOS, FCCS, FABMRTitulaire de la Chaire SRAP-IRSC sur les essais cliniques comportementaux novateurs axés sur les patients
Titulaire de la Chaire du FRQS en médecine comportementale
Professeur titulaire, Département de santé, kinésiologie et physiologie appliquée, Université Concordia
Co-directeur, Centre de médecine comportementale de Montréal, CIUSSS-NIM
CACPR Spring conference, online29th May 2020
Disclosures
• Grants/Research Support: GSK, Abbvie▫ Investigator-initiated
• Consulting Fees: Schering-Plough, Merck, Astra-Zenica, Sygesa▫ Behaviour change related CME▫ Statistical analyses
• Speaker Fees: Novartis, Jansen▫ Behaviour change, exercise, and asthma
• Advisory Board: BayerBayer, Sanofi, Lucilab▫ Development of medication adherence education and ehealth behaviour change
programs
Overview of Guideline process
• Background of CACPR Guidelines
• New Guideline structure
• Guidelines vs. Position statements
• Overview of the steps/process
• Next steps
Background - CACPR Guidelines
• The increasing amount of new evidence is a challenge to integration into practice▫ Accessible summarized evidence would help to bridge this gap
• CACPR had 3 editions (1999, 2003 and 2009)▫ Latest issue includes 12 chapters including 165 formal recommendations.
• Last edition ▫ 2 years to complete;▫ Contributions from over 100 authors and reviewers; ▫ Editor-in-chief donating over 5,000 hours;▫ Around $300,000 cost
The new Guideline Structure
• Only ‘strong’ evidence-based recommendations should be supported
• All guidelines will be in an “implementable” format
• Literature reviewed using a formal recognized system
• The guidelines will be continually updated and the regular review process will be pre-determined
• The recommendations should be open access
• Development of tools to support guidelines
CACPR Guidelines Organisational Chart
Executive Committee
Systematic Review Specialist
MBMC
PAULA A B RIBEIRO PhD
CO-DIRECTOR MBMC
Committee chair
SIMON BACON PhD
Division of Prevention and Rehabilitation
– Ottawa University
JENNIFER REED PhD
UNT- Cardiologist
University of Toronto
PAUL OH MD
School of Rehabilitation Therapy
Queen's University
DIANA HOPKINS-ROSSEEL PT
Director of the Cardiac Rehabilitation
Western University
NEVILLE SUSKIN MD ARIANY VIEIRA MSc
PhD student
MBMC / Concordia University
Post-Doc Fellow
MBMC / Concordia University
DAVID ANEKWE PhD NICOLA PAINE PhD
School of Sports, Exercise and Health
Sciences
Loughborough University
Guidelines vs. Position Statements
Clinical Guidelines Position Statements
• A clinical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare.
• Central ‘core’ recommendations with a solid evidence base which form the foundation of cardiovascular rehab and prevention. Built on strong systematic review evidence.
In case of lack of enough high-quality evidence, a position statement will be produced instead of a
guideline.
• Weaker evidence-based recommendations, less critical/peripheral recommendations (i.e., those that have lower impact on care)
• Don’t replace a guideline but provide recommendation when lacking body of evidence to develop a guideline.
Newer evidence-based recommendations
Who will use our Guidelines?
Knowledge Users
Defined as individuals who is likely to be able to use research results to make informed decisions about health policies, programs and/or practices
Professionals Educators Patients Decision - maker
http://www.cihr-irsc.gc.ca/e/49505.html
The guidelines process in 5 steps
CACPR 2019 Guideline Survey
CACPR 2019 Guidelines Survey
Survey - 23 items• 3 profiles
▫ Healthcare professional▫ Administrator▫ Patient
• 434 responses▫ 64 HCP and administrator▫ 370 patients
Pre-Priority list of 12 topics:• Exercise • Nutrition• Physical activity • Optimization of cardiovascular drug therapy• General behaviour change program • Return to work• Sex education • General educational program (e.g. readings,
classes) • Smoking cessation• Cardiovascular Rehabilitation with focus on
women's health • Stress management • Alternative programs (e.g. home-based, e-
Health)
Results – All participants
26%
18% 17%
13%
9%7%
4% 4% 3%
Exercise Nutrition PA Stress Alternative Programs CardioProg [WomenHealth]
ReturToWork Smoking Sex Educ
Results
Healthcare professionals Administrators
15% 15%12%
10%11%
8% 7%
12%
9%
18%
9%
14%
9%10% 10%
7%
14%
8%
Summary
• Starting priorities1. Exercise
2. Nutrition
3. General behaviour change
• Process▫ Advertising for interested individuals (October 2019)
▫ Selected 1st group: Exercise (January 2020)
▫ 1st meeting: 27th Feb 2020
Exercise Working Group
• Diana Hopkins-Rosseel Chair: Administrator, Ontario• Jennifer Harris Vice-Chair: PT, Ontario• Nancy Hansen Patient, Ontario• Tim Hartley Exercise specialist, Ontario• Andree-Anne Hebert Exercise specialist, Quebec• Dustin Kimber Exercise specialist, Manitoba• Billie-Jo Mabey Nurse, New Brunswick• Patrick Warner Patient, Ontario• Kimberley Way Researcher, Ontario• Colin Yeung Physician, Saskatchewan
Next steps
• Systematic review of current Exercise CR Recommendations▫ Identify recommendations which do not need to be revisited▫ Completed in June (META Group)
• Creation of ca. 4 PICO/PECO statements▫ Identification of key issues for CR that have not been addressed▫ Over the summer (Working group)
• Rapid review for each of the PCIO/PECO▫ What evidence supports the question▫ To be completed by October (META Group & SPOR Evidence Alliance)
• Evaluation of evidence, generation of initial guideline▫ Creation of implementable recommendations▫ To be completed by November (Working group)
• Revision by the Central Review Committee▫ Guideline to be completed by January 2021
Acknowledgements
META group
• Dr. Paula Ribeiro, Team lead
• Ariany Viera, PhD Student
• Dr. David Anekwe, Postdoc
• Reyhaneh Yousefi, PhD Student
• Dr. Jovana Stojanovic, Postdoc