ESOC 2023 | Feasibility and acceptability of the INTERACT3 care bundle in ICH management
Menglu Ouyang, PhD, MPH, BN, The George Institute for Global Health, University of New South Wales, Sydney, Australia, discusses the results of a process evaluation performed as part of the INTERACT3 trial (NCT03209258). INTERACT3 assessed the effectiveness of a goal-directed care bundle protocol for acute intracerebral hemorrhage (ICH), incorporating blood pressure control, glycemic control, treatment of pyrexia, and anticoagulation reversal. To get a better understanding of the feasibility of implementing such a protocol in routine care, the study authors conducted surveys, interviews, and focused group discussions, and assessed routine monitoring data and field notes. The evaluation involved 26 representative hospital sites and engaged various stakeholders, including department directors, physicians, nurses, and patients. The findings revealed that, overall, the care bundle was delivered as planned and deemed acceptable by doctors and nurses. However, challenges were reported in achieving blood pressure and glycemic targets. Several barriers to implementation were noted including staffing limitations, the availability of intravenous antihypertensive drugs, and delays in patient triage. Dr Ouyang comments on the insights gathered on how to enhance implementation and the global relevance of the positive INTERACT3 findings. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.
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Transcript (edited for clarity)
The process evaluation in INTERACT3 has been designed at the beginning, which aims to understand the feasibility, acceptability, and also the implementation of the care bundle within the INTERACT3, which is the intervention. So because the bundle has involved four components, including intensive blood pressure lowering, blood glucose level control, temperature control and also the anticoagulant reversal...
The process evaluation in INTERACT3 has been designed at the beginning, which aims to understand the feasibility, acceptability, and also the implementation of the care bundle within the INTERACT3, which is the intervention. So because the bundle has involved four components, including intensive blood pressure lowering, blood glucose level control, temperature control and also the anticoagulant reversal. So it’s a kind of complex intervention and it’s very important to look at if the components has been delivered as planned and also looking at what are the barriers and facilitators to implementation of each of the components. So that’s why we designed the process evaluation in the INTERACT3. And for this design we used a mixed method approach which included to collect some surveys and hospital organization questionnaire which are mostly the quantitative data. And also we did some focus group discussion with the investigators from the ten countries we recruited patients from and also the interviews with the investigators, both clinicians and also the nurses, to discuss what their conceptions and also what are the barriers and anything else like their feedback on the care bundle.
So we actually involved nearly 26 sites for the process evaluation and this was sampled according to the criteria which called purposive sampling. So we chose the sites which are mostly representative from the whole sites recruited in the INTERACT3 and we did interviews and focus group discussion and also analyzed the results. So we found that, overall, the care bundle which is the implementation of the intervention, is accepted and also it’s feasible. But there are some feedbacks of like barriers to reach the blood pressure target and also to reach the blood glucose level control. For example, for the blood pressure lowering, some barriers would be shortage of the staff resources because in the intervention we require them to do a frequent monitoring on that. So, particularly during the Covid pandemic there are shortage of staff so it’s difficult for them to implement this kind of frequent monitoring. And also there are some barriers mentioned by the clinicians that the multiple department collaboration which involved the emergency department and also neurological and neurosurgical department, sometimes the communication is difficult because when we’re trying to recruit patients we have to initiate the intervention as soon as possible. But if the patients have been admitted in the emergency department, due to some reasons, for example, the workload and also, you know, the emergency is very busy, so then it’s difficult for them to initiate this intervention as soon as possible.
From INTERACT3 we have got the main result published and we found that there is solid evidence that the care bundle can improve patient recovery for the intracerebral hemorrhage. So we think for the clinical guidelines, this evidence should be considered and also to applied to the low social settings to improve the patients recovery. So we decided to do a dissemination and implementation campaign based on the INTERACT3 results. So we hope as many as the hospitals and also the stroke associations and societies, they can have attention on the results of INTERACT3 and hope there are some protocol changes in the local hospitals, as well as some guideline management changes and improvements, and also probably policy changes in some countries, particularly in those with short funding for the equipment and medication supplies. There are many people that would be like affected by those changes and probably many lives can be saved from this care bundle.
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