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Holtrop JS, Gurfinkel D, Nederveld A, Reedy J, Rubinson C, Kwan BM. What works in implementing shared medical appointments for patients with diabetes in primary care to enhance reach: a qualitative comparative analysis from the Invested in Diabetes study. Implement Sci Commun 2024; 5:82. [PMID: 39049078 PMCID: PMC11267890 DOI: 10.1186/s43058-024-00608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Diabetes is a serious public health problem affecting 37.3 million Americans. Diabetes shared medical appointments (SMAs) are an effective strategy for providing diabetes self-management support and education in primary care. However, practices delivering SMAs experience implementation challenges. This analysis examined conditions associated with successful practice implementation of diabetes SMAs in the context of participation in a pragmatic trial. METHODS Mixed methods study using qualitative and quantitative data collected from interviews, observations, surveys, and practice-reported data, guided by the practical, robust implementation and sustainability model (PRISM). Data were analyzed using qualitative comparative analysis (QCA). Successful implementation was defined as meeting patient recruitment targets (Reach) during the study period. Participants were clinicians and staff members from 22 primary care practices in Colorado and Missouri, USA. RESULTS The first necessary condition identified from the QCA was the presence of additional resources for patients with diabetes in the practice. Within practices that had these additional resources, we found that a sufficiency condition was the presence of an effective key person to make things happen with the SMAs. A second QCA was conducted to determine conditions underlying the presence of the effective key person (often performing functions of an implementation champion), which revealed factors including low or managed employee turnover, a strong baseline practice culture, and previous experience delivering SMAs. CONCLUSIONS Identification of key factors necessary and sufficient for implementation of new care processes is important to enhance patient access to evidence-based interventions. This study suggests that practice features and resources have important implications for implementation of diabetes SMAs. There may be opportunities to support practices with SMA implementation by enabling the presence of skilled implementation champions. TRIAL REGISTRATION Registered at clinicaltrials.gov under trial ID NCT03590041, registered on July 18, 2018.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA.
| | - Dennis Gurfinkel
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Julia Reedy
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Claude Rubinson
- Department of Social Sciences, University of Houston-Downtown, 1 Main Street, Houston, TX, 77009, USA
| | - Bethany Matthews Kwan
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
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Manko CD, Apple BJ, Chang AR, Romagnoli KM, Johannes BL. Telemedicine in Advanced Kidney Disease and Kidney Transplant: A Qualitative Meta-Analysis of Studies of Patient Perspectives. Kidney Med 2024; 6:100849. [PMID: 39040545 PMCID: PMC11261003 DOI: 10.1016/j.xkme.2024.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Rationale & Objective While the use of telemedicine has increased dramatically across disciplines, patient perspectives on telemedicine related to chronic kidney disease are not well understood. We systematically reviewed qualitative studies on patients with chronic kidney disease as well as those with kidney transplant to better understand these patients' perspectives related to telemedicine. Study Design Qualitative meta-analysis. Setting & Participants Pre-dialysis chronic kidney disease and kidney transplant patients that used telemedicine. Selection Criteria for Studies English language studies published in the year 2000 and beyond that investigated patient perspectives in a qualitative manner. Works that were not qualitative or did not focus on provider-patient interactive modes of telemedicine were excluded. Data Extraction 375 articles were pulled from PubMed, Embase, and Academic Science Premier. After filtering, 8 final articles were selected. These articles were critically appraised for quality and were used in the final analysis. Analytical Approach We used a grounded theory approach to develop a codebook to systematically review each of the selected articles through a qualitative meta-analysis of the included literature. Results Telemedicine was seen by patients to have notable strengths as well as weaknesses. These characteristics can be organized into 4 primary themes (autonomy, logistics, privacy/confidentiality, and trust). Within each primary theme, we identified subthemes. Universally, all articles included the subtheme "fewer trips to the health care facility" as a beneficial factor of telemedicine within the primary theme "logistics." A majority (6 of 8) of the articles included positive patient perspectives on the primary theme "autonomy" in terms of telemedicine promoting the subtheme of "engagement." Patients' views on telemedicine were mixed regarding the primary themes of "privacy/confidentiality" and "trust" related to telemedicine. Limitations Lack of provider perspectives, non-English studies, and studies published before the year 2000. Articles published after the start of data extraction were also not included. Conclusions Telemedicine should continue to be offered to patients with chronic kidney disease and kidney transplant patients to facilitate access. Additional research should focus on ways to decrease negative factors experienced by some patients such as difficulty using the technology.
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Affiliation(s)
- Christopher D. Manko
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Benjamin J. Apple
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Alexander R. Chang
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA
- Department of Population Health Sciences, Geisinger College of Health Sciences, Scranton, PA
| | - Katrina M. Romagnoli
- Department of Population Health Sciences, Geisinger College of Health Sciences, Scranton, PA
| | - Bobbie L. Johannes
- Department of Population Health Sciences, Geisinger College of Health Sciences, Scranton, PA
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Kirbach K, Marshall-Moreno I, Shen A, Cullen C, Sanigepalli S, Bobadilla A, MacElhern L, Grunvald E, Kallenberg G, Tristão Parra M, Sannidhi D. Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program. Front Nutr 2024; 11:1338727. [PMID: 38962444 PMCID: PMC11220244 DOI: 10.3389/fnut.2024.1338727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/24/2024] [Indexed: 07/05/2024] Open
Abstract
Background Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Methods Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. Results 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. Conclusion The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.
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Affiliation(s)
- Kyleigh Kirbach
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Alice Shen
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Curtis Cullen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | | | - Alejandra Bobadilla
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Lauray MacElhern
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Eduardo Grunvald
- Bariatric and Metabolic Institute, University of California San Diego, San Diego, CA, United States
| | - Gene Kallenberg
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Deepa Sannidhi
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
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Roth I, Tiedt M, Brintz C, Thompson-Lastad A, Ferguson G, Agha E, Holcomb J, Gardiner P, Leeman J. Determinants of implementation for group medical visits for patients with chronic pain: a systematic review. Implement Sci Commun 2024; 5:59. [PMID: 38783388 PMCID: PMC11112917 DOI: 10.1186/s43058-024-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain. METHODS The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research. RESULTS Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting. CONCLUSIONS Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain. TRIAL REGISTRATION This systematic review was registered with PROSPERO 2021 CRD42021231310 .
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Affiliation(s)
- Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Malik Tiedt
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Health Studies and Applied Educational Psychology, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Carrie Brintz
- Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ariana Thompson-Lastad
- Department of Family and Community Medicine, Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, USA
| | - Gayla Ferguson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Erum Agha
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Paula Gardiner
- Department of Family Medicine, Cambridge Health Alliance, University of Massachusetts Medical School, Boston, MA, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Tang MY, Graham F, O'Donnell A, Beyer F, Richmond C, Dhami R, Sniehotta FF, Kaner EFS. Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials. BMJ Open 2024; 14:e067252. [PMID: 38453205 PMCID: PMC10921542 DOI: 10.1136/bmjopen-2022-067252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES To examine the effectiveness of shared medical appointments (SMAs) compared with one-to-one appointments in primary care for improving health outcomes and reducing demand on healthcare services by people with one or more long-term conditions (LTCs). DESIGN A systematic review of the published literature. DATA SOURCES Six databases, including MEDLINE and Web of Science, were searched 2013-2023. Relevant pre-2013 trials identified by forward and backward citation searches of the included trials were included. ELIGIBILITY CRITERIA Randomised controlled trials of SMAs delivered in a primary care setting involving adults over 18 years with one or more LTCs. Studies were excluded if the SMA did not include one-to-one patient-clinician time. All countries were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS Data were extracted and outcomes narratively synthesised, meta-analysis was undertaken where possible. RESULTS Twenty-nine unique trials were included. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, most commonly diabetes (n=16). There was substantial heterogeneity in outcome measures. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.086, 95% CI=-0.16 to -0.02, n=10) (p=0.014). No statistically significant differences were found across other outcomes. Compared with usual care, SMAs had no significant effect on healthcare service use. For example, no difference between SMAs and usual care was found for admissions to emergency departments at follow-up (d=-0.094, 95% CI=-0.27 to 0.08, n=6, p=0.289). CONCLUSIONS There was a little difference in the effectiveness of SMAs compared with usual care in terms of health outcomes or healthcare service use in the short-term (range 12 weeks to 24 months). To strengthen the evidence base, future studies should include a wider array of LTCs, standardised outcome measures and more details on SMA components to help inform economic evaluation. PROSPERO REGISTRATION NUMBER CRD42020173084.
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Affiliation(s)
- Mei Yee Tang
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Fiona Graham
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O'Donnell
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Raenhha Dhami
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Preventive and Social Medicine, Heidelberg University, Mannheim, Germany
| | - Falko F Sniehotta
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Preventive and Social Medicine, Heidelberg University, Mannheim, Germany
| | - Eileen F S Kaner
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
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Palay J, Bolton JM, Sareen J, Hensel JM. Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic. FRONTIERS IN HEALTH SERVICES 2023; 3:1127725. [PMID: 37435511 PMCID: PMC10332818 DOI: 10.3389/frhs.2023.1127725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Background Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. Methods A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Results Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). Conclusions This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
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Nederveld A, Phimphasone-Brady P, Gurfinkel D, Waxmonsky JA, Kwan BM, Holtrop JS. Delivering diabetes shared medical appointments in primary care: early and mid-program adaptations and implications for successful implementation. BMC PRIMARY CARE 2023; 24:52. [PMID: 36803773 PMCID: PMC9936115 DOI: 10.1186/s12875-023-02006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Self-management is essential for good outcomes in type 2 diabetes and patients often benefit from self-management education. Shared medical appointments (SMAs) can increase self-efficacy for self management but are difficult for some primary care practices to implement. Understanding how practices adapt processes and delivery of SMAs for patients with type 2 diabetes may provide helpful strategies for other practices interested in implementing SMAs. METHODS The Invested in Diabetes study was a pragmatic cluster-randomized, comparative effectiveness trial designed to compare two different models of diabetes SMAs delivered in primary care. We used a multi-method approach guided by the FRAME to assess practices' experience with implementation, including any planned and unplanned adaptations. Data sources included interviews, practice observations and field notes from practice facilitator check-ins. RESULTS Several findings were identified from the data: 1) Modifications and adaptations are common in implementation of SMAs, 2) while most adaptations were fidelity-consistent supporting the core components of the intervention conditions as designed, some were not, 3) Adaptations were perceived to be necessary to help SMAs meet patient and practice needs and overcome implementation challenges, and 4) Content changes in the sessions were often planned and enacted to better address the contextual circumstances such as patient needs and culture. DISCUSSION Implementing SMAs in primary care can be challenging and adaptations of both implementation processes and content and delivery of SMAS for patients with type 2 diabetes were common in the Invested in Diabetes study. Recognizing the need for adaptations based on practice context prior to implementation may help improve fit and success with SMAs, but care needs to be given to ensure that adaptations do not weaken the impact of the intervention. Practices may be able to assess what might need to adapted for them to be successful prior to implementation but likely will continue to adapt after implementation. CONCLUSION Adaptations were common in the Invested in Diabetes study. Practices may benefit from understanding common challenges in implementing SMAs and adapting processes and delivery based on their own context. TRIAL REGISTRATION This trial is registered on clinicaltrials.gov under Trial number NCT03590041, posted 18/07/2018.
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Affiliation(s)
- Andrea Nederveld
- Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Phoutdavone Phimphasone-Brady
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Dennis Gurfinkel
- grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Jeanette A. Waxmonsky
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Bethany M. Kwan
- grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XDeparment of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Jodi Summers Holtrop
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
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Green D, Bryant V, Edwards S, Kemp C, McKenzie M, Shah S, Soulsby I. Then there were seven: a commentary on creating a public involvement strategy group for a policy research unit in behavioural science. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:1. [PMID: 36739420 PMCID: PMC9899059 DOI: 10.1186/s40900-023-00413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
The National Institute for Health and Care Research (NIHR) Policy Research Unit in Behavioural Science (PRU-BS) was funded to inform government on the application of behavioural science in health and social care policy. What makes this unit different to other topic specific ones, was the wide range of its brief. Because of this, the PPI group would need to include a wide range of experience and expertise and be prepared to learn. We were a different type of public group for a different type of task. This paper deals with how we approached this. In this paper we outline how the PPI plan in the funding proposal for the PRU-BS was adapted to real world challenges. We describe the stages in the formation of the PPI Strategy Group and how a virtual platform was created to ensure good communication. We discuss our pragmatic approach of developing Terms of Reference and a PPI strategy document. Given the restrictions imposed by the Covid-19 pandemic we explain how we tackled PPI SG member induction sessions, meetings and training sessions. To illustrate how the group operates we provide an example of our involvement in a PRU-BS project. Central to our paper is the lessons we learned. We hope the challenges we met in forming the unique PPI SG, how these were overcome, and our recommendations will help others faced with a similar task.
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Affiliation(s)
- Dave Green
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK.
| | - Val Bryant
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Stuart Edwards
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Caroline Kemp
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Maisie McKenzie
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Sudhir Shah
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Irene Soulsby
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
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Graham F, Martin H, Lecouturier J, O’Donnell A, Tang MY, Jackson K, Sniehotta FF, Kaner E. Shared medical appointments in English primary care for long-term conditions: a qualitative study of the views and experiences of patients, primary care staff and other stakeholders. BMC PRIMARY CARE 2022; 23:180. [PMID: 35858833 PMCID: PMC9298712 DOI: 10.1186/s12875-022-01790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022]
Abstract
Background Shared medical appointments (SMAs) or group consultations have been promoted in primary care to improve workload pressures, resource-use efficiency and patient self-management of long-term conditions (LTCs). However, few studies have explored stakeholders’ perspectives of this novel care delivery model in the English NHS context, particularly patients’ views and experiences of SMAs. Method Semi-structured interviews were used to explore the perspectives of stakeholders (21 patients, 17 primary care staff, 2 commissioners and 2 SMA training providers) with and without SMA experience from a range of geographical and socio-economic backgrounds in the North East and North Cumbrian region of England. Thematic analysis was conducted to examine perceptions around impact on patient care and outcomes and barriers and facilitators to implementation. Results Three main themes were identified: ‘Value of sharing’, ‘Appropriateness of group setting’, ‘Implementation processes’. Patients experiences and perceptions of SMAs were largely positive yet several reported reservations about sharing personal information, particularly in close-knit communities where the risk of breaching confidentiality was perceived to be greater. SMAs were considered by patients and staff to be inappropriate for certain personal conditions or for some patient groups. Staff reported difficulties engaging sufficient numbers of patients to make them viable and having the resources to plan and set them up in practice. Whilst patients and staff anticipated that SMAs could deliver high quality care more efficiently than 1:1 appointments, none of the practices had evaluated the impact SMAs had on patient health outcomes or staff time. Conclusion Stakeholder experiences of SMA use in English primary care are largely similar to those reported in other countries. However, several important cultural barriers were identified in this setting. Further work is needed to better understand how patient and staff perceptions, experiences and engagement with SMAs change with regular use over time. Concerns regarding staff capacity, additional resource requirements and numbers of eligible patients per practice suggest SMAs may only be feasible in some smaller practices if facilitated by primary care networks. Further mixed-method evaluations of SMAs are needed to inform the evidence base regarding the effectiveness, efficiency and feasibility of SMAs long-term and subsequently their wider roll-out in English primary care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01790-z.
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Papoutsi C, Hargreaves D, Hagell A, Hounsome N, Skirrow H, Muralidhara K, Colligan G, Ferrey A, Vijayaraghavan S, Greenhalgh T, Finer S. Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings. BMC Med 2022; 20:459. [PMID: 36434593 PMCID: PMC9701006 DOI: 10.1186/s12916-022-02654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings. METHODS This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. RESULTS Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. CONCLUSIONS Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision. TRIAL REGISTRATION ISRCTN reference 27989430.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | - Ann Hagell
- Association for Young People's Health, London, UK
| | | | - Helen Skirrow
- School of Public Health, Imperial College London, London, UK
| | | | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | | | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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11
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Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care. DESIGN Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science. STUDY SELECTION In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020. DATA EXTRACTION AND SYNTHESIS From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors. RESULTS The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. CONCLUSIONS We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
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Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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12
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Mace RA, Mattos MK, Vranceanu AM. Older adults can use technology: why healthcare professionals must overcome ageism in digital health. Transl Behav Med 2022; 12:1102-1105. [PMID: 36073770 PMCID: PMC9494377 DOI: 10.1093/tbm/ibac070] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Older adults rapidly adopted technology for healthcare, known as digital health, during the COVID-19 pandemic. Older adults are increasingly using telehealth, smartphone apps, and other digital health technologies to reduce barriers to care, maintain patient-provider communication, and promote disease self-management. Yet, many healthcare professionals have maintained outdated beliefs rooted in societal ageism that digital health and older adults are incompatible. As a result, older adults have been disproportionally excluded from health services and clinical trials that use digital health relative to their younger counterparts. In this commentary, we urge all healthcare disciplines to challenge ageist beliefs and practices that have contributed to the "digital health divide" among older patients. We provide examples of evidence-based strategies and current scientific initiatives that can promote digital health inclusion in research, clinical practice, and training. By achieving digital health inclusion, we can increase access, provide preventative and comprehensive care, and decrease healthcare costs for older patients.
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Affiliation(s)
| | - Meghan K Mattos
- University of Virginia School of Nursing, Charlottesville, VA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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13
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Implementing video group consultations in general practice during COVID-19: a qualitative study. Br J Gen Pract 2022; 72:e483-e491. [PMID: 35636969 PMCID: PMC9256071 DOI: 10.3399/bjgp.2021.0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 01/23/2023] Open
Abstract
Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs). Design and setting Qualitative study in general practice in England. Method a) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework. Results In the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation. Conclusion Small scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.
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