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For people whose stroke risk would be reduced by taking a long-term oral anticoagulant (OAC), it is important to implement effective strategies to support medication initiation, adherence and persistence. To do this, a better understanding of the factors associated with implementation of interventions to optimise OAC management is needed.
This scoping review aimed to summarise the evidence-based characteristics associated with implementing interventions designed to optimise long-term OAC adherence.
Primary research (published post-2000) evaluating any intervention designed to optimise implementation of long-term OAC for stroke prevention by way of change in OAC services, staff or patient behaviour.
Five databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Cochrane Library) were searched from 1 January 2000 to 4 August 2023 using a combination of terms relating to population, intervention and study design.
Titles/abstracts were screened by at least one reviewer. Data from each full text were abstracted (with 20% double-checked for accuracy) and its implementation content reviewed, guided by the Expert Recommendations for Implementing Change strategies.
216 studies were included, with varying descriptive reporting of implementation strategies, and only 61 (28%) self-identifying as an implementation study. The median number of implementation strategies used was three, with recently published studies (2015 onwards), those including patients receiving either direct OACs (DOACs) or vitamin K antagonists (VKAs) and those including multiple intervention targets (service, staff or patients) associated with using more implementation strategies. ‘Train and educate stakeholders’ strategies were the most commonly used, and ‘Adapt and tailor to the context’ strategies were the least used by included studies. Conversely, self-defined implementation studies were less likely to use ‘Train and educate stakeholders’ strategies, although they were positively associated with use of ‘Adapt and tailor to the context’. ‘Use evaluative & iterative’ strategies were used more frequently in studies where patients used either VKAs or DOACs, or were published more recently.
Studies need to self-define as implementation studies, improve implementation strategy reporting and be transparently registered, alongside conducting process evaluations or more richly describing implementation processes. Future research could explore why some implementation strategies are used more than others and whether aligning strategy clusters with intervention targets results in clinically significant differences in patient care.
Codes of ethics are, for many, important documents that define the key values and behaviours expected of healthcare professionals. They are also documents that have been widely criticised. These criticisms range from being vague to failing to provide guidance on many important issues. Codes, however, vary substantially in their scope, content and the guidance they provide.
This scoping review sought, in the context of comparative studies of codes, to examine the form (i.e., the structure of the code, its contents, principles or rules for example) and function (what the code says it does, either explicitly or implicitly) of codes, along with their points of con/divergence.
A systematic search was carried out using Scopus, PsycInfo, CINAHL and Medline.
Thirty-one papers met inclusion criteria and were included in this review. Results suggest that while there were a number of similarities seen across codes, there were also substantial points of divergence related to the content of codes and structure. These differences were seen across professions, countries and time, suggesting that culture, history, politics and perhaps even geography influence the content of codes.
These findings are discussed in light of the broader literature that examines and critiques codes.
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