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Wood E, Ohlsen S, Ricketts T. What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review. J Affect Disord 2017; 214:26-43. [PMID: 28266319 DOI: 10.1016/j.jad.2017.02.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care. METHODS A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care. RESULTS The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities. LIMITATIONS Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators. CONCLUSIONS Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified.
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Affiliation(s)
- Emily Wood
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, United Kingdom.
| | - Sally Ohlsen
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, United Kingdom
| | - Thomas Ricketts
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, United Kingdom; Sheffield Health and Social Care NHS FT, St George's Community Health Centre, Winter Street, Sheffield S3 7ND, United Kingdom
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102
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Harris M, Lawn SJ, Morello A, Battersby MW, Ratcliffe J, McEvoy RD, Tieman JJ. Practice change in chronic conditions care: an appraisal of theories. BMC Health Serv Res 2017; 17:170. [PMID: 28245813 PMCID: PMC5331688 DOI: 10.1186/s12913-017-2102-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background Management of chronic conditions can be complex and burdensome for patients and complex and costly for health systems. Outcomes could be improved and costs reduced if proven clinical interventions were better implemented, but the complexity of chronic care services appears to make clinical change particularly challenging. Explicit use of theories may improve the success of clinical change in this area of care provision. Whilst theories to support implementation of practice change are apparent in the broad healthcare arena, the most applicable theories for the complexities of practice change in chronic care have not yet been identified. Methods We developed criteria to review the usefulness of change implementation theories for informing chronic care management and applied them to an existing list of theories used more widely in healthcare. Results Criteria related to the following characteristics of chronic care: breadth of the field; multi-disciplinarity; micro, meso and macro program levels; need for field-specific research on implementation requirements; and need for measurement. Six theories met the criteria to the greatest extent: the Consolidate Framework for Implementation Research; Normalization Process Theory and its extension General Theory of Implementation; two versions of the Promoting Action on Research Implementation in Health Services framework and Sticky Knowledge. None fully met all criteria. Involvement of several care provision organizations and groups, involvement of patients and carers, and policy level change are not well covered by most theories. However, adaptation may be possible to include multiple groups including patients and carers, and separate theories may be needed on policy change. Ways of qualitatively assessing theory constructs are available but quantitative measures are currently partial and under development for all theories. Conclusions Theoretical bases are available to structure clinical change research in chronic condition care. Theories will however need to be adapted and supplemented to account for the particular features of care in this field, particularly in relation to involvement of multiple organizations and groups, including patients, and in relation to policy influence. Quantitative measurement of theory constructs may present difficulties.
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Affiliation(s)
- Melanie Harris
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Sharon J Lawn
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Andrea Morello
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Health Economics Unit, Flinders Health Care and Workforce Innovations, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - R Doug McEvoy
- Flinders Southern Adelaide Clinical School, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Jennifer J Tieman
- Palliative & Supportive Services, School of Health Sciences, Flinders University, Adelaide, SA, Australia
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103
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Volker N, Williams LT, Davey RC, Cochrane T, Clancy T. Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory. BMC FAMILY PRACTICE 2017; 18:28. [PMID: 28235400 PMCID: PMC5324228 DOI: 10.1186/s12875-017-0580-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022]
Abstract
Background The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Methods Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Results Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a ‘hard sell’, is going to rely on improving the value proposition for all stakeholders. Conclusions The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0580-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nerida Volker
- Health Research Institute, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT, 2601, Australia.
| | - Lauren T Williams
- Health Research Institute, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT, 2601, Australia.,Menzies Health Institute of Queensland, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Rachel C Davey
- Health Research Institute, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT, 2601, Australia
| | - Thomas Cochrane
- Health Research Institute, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT, 2601, Australia
| | - Tanya Clancy
- Health Research Institute, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT, 2601, Australia
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104
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Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. THE GERONTOLOGIST 2017; 56 Suppl 2:S243-55. [PMID: 26994264 DOI: 10.1093/geront/gnw002] [Citation(s) in RCA: 373] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. Arthritis and Osteoporosis Victoria, Caulfield South, Melbourne, Australia.
| | - Marita J Cross
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
| | - Damian G Hoy
- School of Population Health, University of Queensland, Herston, Brisbane, Australia. Secretariat of the Pacific Community, Public Health Division, Noumea, New Caledonia
| | - Lídia Sànchez-Riera
- Institut d'Investigació, Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Department Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, New South Wales, Australia
| | - Anthony D Woolf
- Bone and Joint Research Office, The Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
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105
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Sopcak N, Aguilar C, O'Brien MA, Nykiforuk C, Aubrey-Bassler K, Cullen R, Grunfeld E, Manca DP. Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care. Implement Sci 2016; 11:158. [PMID: 27906041 PMCID: PMC5134230 DOI: 10.1186/s13012-016-0525-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/25/2016] [Indexed: 11/23/2022] Open
Abstract
Background BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. Methods We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. Results The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics—complexity and cost of the intervention; (2) outer setting—perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients’ needs as perceived by physicians and patients; (3) characteristics of prevention practitioners—interest in prevention and ability to support and motivate patients; (4) inner setting—the availability of a local champion and working in a team versus working as a team; and (5) process—planning and engaging, collaboration, and teamwork. Conclusions The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.
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Affiliation(s)
- Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada.
| | - Carolina Aguilar
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Candace Nykiforuk
- School of Public Health, University of Alberta, 3-291 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Richard Cullen
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.,Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
| | - Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada.,Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, Alberta, T6L 5X8, Canada
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106
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Dziedzic KS, French S, Davis AM, Geelhoed E, Porcheret M. Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies. Best Pract Res Clin Rheumatol 2016; 30:375-397. [DOI: 10.1016/j.berh.2016.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
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107
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Horn BP, Crandall C, Moffett M, Hensley M, Howarth S, Binder DS, Sklar D. The Economic Impact of Intensive Care Management for High-Cost Medically Complex Patients: An Evaluation of New Mexico's Care One Program. Popul Health Manag 2016; 19:398-404. [PMID: 27031738 DOI: 10.1089/pop.2015.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
High-cost, medically complex patients have been a challenging population to manage in the US health care system, in terms of both improving health outcomes and containing costs. This paper evaluated the economic impact of Care One, an intensive care management program (data analysis, evaluation, empanelment, specialist disease management, nurse case management, and social support) designed to target the most expensive 1% of patients in a university health care system. Data were collected for a cohort of high-cost, medically complex patients (N = 753) who received care management and a control group (N = 794) of similarly complex health system users who did not receive access to the program. A pre-post empirical model estimated the Care One program to be associated with a per-patient reduction in billed charges of $92,227 (95% confidence interval [CI]: $83,988 to $100,466). A difference-in-difference model, which utilized the control group, estimated a per-patient reduction in billing charges of $44,504 (95% CI: $29,195 to $59,813). Results suggest that care management for high-cost, medically complex patients in primary care can reduce costs compared to a control group. In addition, significant reversion to the mean is found, providing support for the use of a difference-in-difference estimator when evaluating health programs for high-cost, medically complex patients.
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Affiliation(s)
- Brady P Horn
- 1 Department of Economics, University of New Mexico , Albuquerque, New Mexico
| | - Cameron Crandall
- 2 Department of Emergency Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Maurice Moffett
- 3 Department of Family and Community Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Michael Hensley
- 1 Department of Economics, University of New Mexico , Albuquerque, New Mexico
| | - Sam Howarth
- 1 Department of Economics, University of New Mexico , Albuquerque, New Mexico
| | - Douglas S Binder
- 2 Department of Emergency Medicine, University of New Mexico , Albuquerque, New Mexico
| | - David Sklar
- 2 Department of Emergency Medicine, University of New Mexico , Albuquerque, New Mexico
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108
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Hosey GM, Rengiil A, Maddison R, Agapito AU, Lippwe K, Wally OD, Agapito DD, Seremai J, Primo S, Luther XN, Ikerdeu E, Satterfield D. U.S. Associated Pacific Islands Health Care Teams Chart a Course for Improved Health Systems: Implementation and Evaluation of a Non-communicable Disease Collaborative Model. J Health Care Poor Underserved 2016; 27:19-38. [PMID: 27818410 PMCID: PMC5465969 DOI: 10.1353/hpu.2016.0187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The burden of non-communicable disease (NCD) is increasing in the U.S. Associated Pacific Islands (USAPI). We describe the implementation and evaluation of a NCD Collaborative pilot, using local trainers, as an evidence-based strategy to systematically strengthen NCD health care quality and outcomes, focusing on diabetes preventive care across five health systems in the region.
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109
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Briggs AM, Jordan JE, Speerin R, Jennings M, Bragge P, Chua J, Slater H. Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation. BMC Health Serv Res 2015; 15:509. [PMID: 26573487 PMCID: PMC4647615 DOI: 10.1186/s12913-015-1173-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach. METHODS A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes. RESULTS Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the health system had been considered prior to implementation was strongly supported, while 'success' was perceived as an already familiar evaluation concept. Perceived challenges associated with standardised evaluation included identifying, defining and measuring key 'readiness' and 'success' indicators; impacts of systems and context changes; cost; meaningful stakeholder consultation and developing a widely applicable framework. CONCLUSIONS A standardised evaluation framework that includes a strong focus on 'readiness' is important to ensure successful and sustainable implementation of musculoskeletal MoCs.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Australia.
| | | | - Robyn Speerin
- New South Wales Agency for Clinical Innovation, PO Box 699, Chatswood, NSW, 2057, Australia.
| | - Matthew Jennings
- New South Wales Agency for Clinical Innovation, PO Box 699, Chatswood, NSW, 2057, Australia.
- Liverpool Hospital, South Western Sydney Local Health District, Locked bag 7103, Liverpool Business Centre, Liverpool, NSW, 1871, Australia.
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainability Institute, 8 Scenic Boulevard, Monash University, Melbourne, VIC, 3800, Australia.
| | - Jason Chua
- Department of Health, Government of Western Australia, PO Box 8172, Perth Business Centre, Perth, 6849, Australia.
| | - Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Australia.
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110
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Ring N, Booth H, Wilson C, Hoskins G, Pinnock H, Sheikh A, Jepson R. The 'vicious cycle' of personalised asthma action plan implementation in primary care: a qualitative study of patients and health professionals' views. BMC FAMILY PRACTICE 2015; 16:145. [PMID: 26487557 PMCID: PMC4618358 DOI: 10.1186/s12875-015-0352-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Personal asthma action plans (PAAPs) have been guideline recommended for years, but consistently under-issued by health professionals and under-utilised by patients. Previous studies have investigated sub-optimal PAAP implementation but more insight is needed into barriers to their use from the perspective of professionals, patients and primary care teams. METHODS A maximum variation sample of professional and patient participants were recruited from five demographically diverse general practices and another group of primary care professionals in one Scottish region. Interviews were digitally recorded and data thematically analysed using NVivo. RESULTS Twenty-nine semi-structured interviews were conducted (11 adults with asthma, seven general practitioners, ten practice nurses, one hospital respiratory nurse). Three over-arching themes emerged: 1) patients generally do not value PAAPs, 2) professionals do not fully value PAAPs and, 3) multiple barriers reduce the value of PAAPs in primary care. Six patients had a PAAP but these were outdated, not reflecting their needs and not used. Patients reported not wanting or needing PAAPs, yet identified circumstances when these could be useful. Fifteen professionals had selectively issued PAAPs with eight having reviewed one. Many professionals did not value PAAPs as they did not see patients using these and lacked awareness of times when patients could have benefited from one. Multi-level compounding barriers emerged. Individual barriers included poor patient awareness and professionals not reinforcing PAAP use. Organisational barriers included professionals having difficulty accessing PAAP templates and fragmented processes including patients not being asked to bring PAAPs to their asthma appointments. CONCLUSIONS Primary care PAAP implementation is in a vicious cycle. Professionals infrequently review/update PAAPs with patients; patients with out-dated PAAPs do not value or use these; professionals observing patients' lack of interest in PAAPs do not discuss these. Patients observing this do not refer to their plans and perceive them to be of little value in asthma self-management. Twenty-five years after PAAPs were first recommended, primary care practices are still not ready to support their implementation. Breaking this vicious cycle to create a healthcare context more conducive to PAAP implementation requires a whole systems approach with multi-faceted interventions addressing patient, professional and organisational barriers.
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Affiliation(s)
- Nicola Ring
- School of Health Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Hazel Booth
- School of Health Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Caroline Wilson
- School of Health Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Gaylor Hoskins
- Nursing, Midwifery and Allied Health Profession Research Unit, University of Stirling, Stirling, Scotland, UK.
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK.
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK.
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, West Richmond Street, Edinburgh, Scotland, UK.
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111
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Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Factors influencing the implementation of chronic care models: A systematic literature review. BMC FAMILY PRACTICE 2015; 16:102. [PMID: 26286614 PMCID: PMC4545323 DOI: 10.1186/s12875-015-0319-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/07/2015] [Indexed: 12/16/2022]
Abstract
Background The increasing prevalence of chronic disease faced by both developed and developing countries is of considerable concern to a number of international organisations. Many of the interventions to address this concern within primary healthcare settings are based on the chronic care model (CCM). The implementation of complex interventions such as CCMs requires careful consideration and planning. Success depends on a number of factors at the healthcare provider, team, organisation and system levels. Methods The aim of this systematic review was to systematically examine the scientific literature in order to understand the facilitators and barriers to implementing CCMs within a primary healthcare setting. This review focused on both quantitative and qualitative studies which included patients with chronic disease (cardiovascular disease, chronic kidney disease, chronic respiratory disease, type 2 diabetes mellitus, depression and HIV/AIDS) receiving care in primary healthcare settings, as well as primary healthcare providers such as doctors, nurses and administrators. Papers were limited to those published in English between 1998 and 2013. Results The search returned 3492 articles. The majority of these studies were subsequently excluded based on their title or abstract because they clearly did not meet the inclusion criteria for this review. A total of 226 full text articles were obtained and a further 188 were excluded as they did not meet the criteria. Thirty eight published peer-reviewed articles were ultimately included in this review. Five primary themes emerged. In addition to ensuring appropriate resources to support implementation and sustainability, the acceptability of the intervention for both patients and healthcare providers contributed to the success of the intervention. There was also a need to prepare healthcare providers for the implementation of a CCM, and to support patients as the way in which they receive care changes. Conclusion This systematic review demonstrated the importance of considering human factors including the influence that different stakeholders have on the success or otherwise of the implementing a CCM. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0319-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jonathan Bleasel
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Maria Tchan
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Sharon Ponniah
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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