The Development of Actionable Nuggets

Actionable Nuggets were originally designed to assist family physicians to provide the latest evidence-Man with hand on wheelchairbased care to their patients with spinal cord injuries.

Based on research conducted between 1992 and 2008, it was apparent that:

  • family physicians found patients with physical disabilities challenging to serve (McColl, Aiken, & Schaub, 2015, McColl et al., 2008, Donnelly et al., 2007, McColl, & Shortt, 2006)
  • people with SCI  experienced unmet needs in primary care, and often did not receive guideline-compliant care (McColl et al., 2010, McColl, Jarzynowska, & Shortt, 2010, McColl, Shortt, Gignac, & Lam, 2010)
  • the most common barriers to excellent primary care for people with SCI was the difficulty of keeping up with the literature when a family doctor had only 1 or 2 patients with SCI (McColl, Aiken, McColl, Sakakibara, & Smith, 2012, Smith, Naumann, McDiarmid, McColl, & Aiken, 2014, McColl et al., 2015)

In 2009, with funding from Rick Hansen Institute, our research team conducted a comprehensive review of the peer-reviewed and grey literature on SCI and primary care, and identified 20 issues that both doctors and patients agreed were difficult to deal with in primary care (see table below).

Scoping review search strategy:
Keywords:

  •  spinal cord injury, paraplegia, quadra/tetraplegia;
  • primary care, primary health care, family physician, medical care, health promotion, family practice, care gaps, quality of care;
  • long-term health, aging, health outcomes, health promotion, disease prevention, chronic disease management, long-term care, secondary complications;
  • evidence-based practice, best practice, clinical guidelines, care guidelines.

Databases: Peer-reviewed journals were searched using the following electronic databases: CINAHL, MEDLINE, EMBASE, Pubmed, and the Cochrane Collaboration.

Years: The electronic search of peer-reviewed literature spanned the interval between 2000 to present.

In addition, the Canadian Medical Association Journal and Canadian Family Physician were searched manually from 2000 on for any articles pertaining to secondary complications and long-term health issues associated with spinal cord injury, as well as best practice guidelines for any health issues associated with spinal cord injury (eg. urinary tract infection, chronic pain, bowel management).

Selection Criteria:

Articles were included in the review if they:

  • focussed on SCI or specifically identified patients with SCI as part of the sample;
  • were available in English or French;
  • dealt with patients living in the community.

No methodological limitations were applied to screen for levels of evidence. This inclusive approach offers the broadest current knowledge and best practices associated with long-term health care of people with spinal cord injuries in primary care.  Standards of evidence were assessed for each article by the reviewers and Expert Panel.

Donnelly, C., McColl, M.A., Charlifue, S., Glass, C., Savic, G., Smith, K. (2007).  Utilization, access and satisfaction of primary care among people with spinal cord injuries:  A comparison of three countries.  Spinal Cord, 45, 25-36.
McColl, M.A., Aiken, A., Schaub, M. (2015). Do people with disabilities have trouble finding a family physician? International Journal of Environmental Research and Public Health, 2015 (12), 4638-4651.
McColl, M.A., Aiken, A., Smith, K., Green, M., McColl, S., Birtwhistle, R., Godwin, M., Norman, K., Brankston, G. (2015). Actionable Nuggets: Knowledge translation tool for the needs of patients with spinal cord injury. Canadian Family Physician, 2015 (61), e240-248.
McColl, M.A., Aiken, A., McColl, A.R., Sakakibara, B., Smith, K. (2012).  Primary care of people with spinal cord injury:  A scoping review.  Canadian Family Physician, 58:1207-16.
McColl, M.A, Jarzynowska, A., Shortt, S.E.D. (2010).  Unmet health care needs of people with disabilities:  Population- level evidence.  Disability & Society, 25(2), 205-218.
McColl, M.A., Shortt, S., Gignac, M., Lam, M. (2010).  Disentangling the effects of age and disability on health service utilization.  Disability and Rehabilitation, Epublication -21 October, 2010.
McColl, M.A., Shortt, S., Hunter, D., Dorland, J., Godwin, M., Rosser, W. & Shaw, R. (2010).  Access and quality of primary care for people with disabilities:  A comparison of practice factors.  Journal of Disability Policy Studies, 21(3), 131-140.
McColl, M.A., Forster, D., Shortt, S., Hunter, D., Dorland, J., Benecki, L., Godwin, M.  & Rosser, W. (2008).  Physician experiences providing primary care to people with disabilities.  Healthcare Policy, 4(1), 129-147.
McColl, M.A. & Shortt, S. (2006).  Another way to look at high service utilization:  The contribution of disability.  Journal of Health Services Research & Policy, 11 (2), 74-80.
Smith, K., Naumann, D., McDiarmid Antony, L., McColl, M.A., Aiken, A. (2014). Using developmental research design innovative knowledge translation technology for spinal cord injury in primary care: Actionable Nuggets™ on SkillScribe.™ The Journal of Spinal Cord Medicine. 37 (5), 582-588.