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Green J, Bagge ASL, Olausson S, Andiné P, Wallinius M, Karlén MH. Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff. J Subst Abuse Treat 2023; 144:108899. [PMID: 36270196 DOI: 10.1016/j.jsat.2022.108899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/04/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. METHODS Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. RESULTS Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. CONCLUSIONS Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the "gap" between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.
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Affiliation(s)
- J Green
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
| | - A S Lindqvist Bagge
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - S Olausson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - P Andiné
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden; Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Wallinius
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - M Hildebrand Karlén
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
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Saxena D, Trivedi P, Bhatt R, Yasobant S, Bhavsar P, Kansara K, Memon F, Mavalankar D. Challenges in the execution of public health research: Reflections from Public Health Research Initiative (PHRI) grant management in India. DIALOGUES IN HEALTH 2022; 1:100020. [PMID: 38515896 PMCID: PMC10953995 DOI: 10.1016/j.dialog.2022.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 03/23/2024]
Abstract
Background Well-planned health research is fundamental to the success of any public health system in leading to better population health outcomes. Although the Indian public health system is unique, it lacks strong linkages between research and practice. There is a pressing need to address the gap in the research to reduce the disease burden in the country. Although various efforts are made to enhance public health research, such research is rarely documented as a process. The objective of the present paper is to document issues and challenges in managing public health research grants awarded to the PHRI fellows from 2013-to 2021 under the PHRI project. Method A mixed-method approach, including qualitative (in-depth) interviews and secondary review, was adopted to collect the challenges in executing PHRI grants (during 2013-2021). The in-depth interviews were conducted among the PHRI execution team, whereas the secondary document review was conducted among the PHRI fellows, and the findings are documented under major themes like administrative, technical, and financial issues and/or challenges. Result A total of 35 candidates 16 intramural (IM) candidates affiliated with PHFI or IIPH institutes and 19 extramural (EM) candidates affiliated to other academic institutes were selected for the fellowship, The common challenges identified amongst intra & extramural fellows were inability to disseminate the study findings, challenges in communication and getting audited statements, changes in study methods without prior permission, mid study attrition of CO-PIs and high budget utilization. The specific difficulties identified from extramural fellows were change in institute affiliation, lack of support to fund utilization from the parent institute and difficulties in field validation. Conclusion The present perspective emphasizes that the management and implementation of a research grant is the crucial part of achieving a project's desired outcome. The learnings of PHRI grant execution allows the researchers to understand the issues in terms of methodological rigour and financial guidelines, rigorous tracking of the project activities, and complying with the terms of funding agreement are crucial. The challenges explored in this grant execution recommend developing a structured public health grant management leadership program for researchers and executors.
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Affiliation(s)
- Deepak Saxena
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
- School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha 442004, India
- Center for One Health Education, Research, and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), 382042 Gandhinagar, India
| | - Poonam Trivedi
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Ruchi Bhatt
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Sandul Yasobant
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
- School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha 442004, India
- Center for One Health Education, Research, and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), 382042 Gandhinagar, India
| | - Priya Bhavsar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Khushi Kansara
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Farjana Memon
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
| | - Dileep Mavalankar
- Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar 382042, India
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Mukherjee A, Daniel M, Kaur A, Devarapalli S, Kallakuri S, Essue B, Raman U, Thornicroft G, Saxena S, Peiris D, Maulik PK. Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health. Int J Ment Health Syst 2022; 16:42. [PMID: 35974341 PMCID: PMC9379869 DOI: 10.1186/s13033-022-00549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India. METHODS We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings. RESULTS Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project. CONCLUSION Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
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Affiliation(s)
| | - Mercian Daniel
- The George Institute for Global Health, New Delhi, India
| | - Amanpreet Kaur
- The George Institute for Global Health, New Delhi, India
| | | | | | - Beverley Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
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McGrath A, Richardson N, Murphy N. Strategies for effective implementation and scale-up of a multi-level co-designed men's health initiative "Sheds for Life" in Irish Men's Sheds. FRONTIERS IN HEALTH SERVICES 2022; 2:940031. [PMID: 36925798 PMCID: PMC10012692 DOI: 10.3389/frhs.2022.940031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Sheds for Life is a gender-specific tailored men's health initiative engaging "hard-to-reach" men in the Men's Shed setting in Ireland. It is implemented by multiple stakeholders at individual, provider, organization and systems level and thus multiple contextual factors influence its scalability. This research used established implementation science frameworks to guide participatory research approaches that captured the process and identified facilitators of and barriers to implementation and scale-up. Active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Findings make a valuable contribution to knowledge by capturing the process involved in the implementation of a complex multi-level men's health intervention. It provides a "how to" guide of strategies to engage hard-to-reach men with health promotion, the operationalization and application of implementation frameworks in community-based health promotion, and the implementation of health promotion in Men's Sheds. Documented barriers and facilitators that impact implementation of a community-based men's health program are rare and provide a valuable blueprint for practitioners, researchers and policy makers in the field.
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Affiliation(s)
- Aisling McGrath
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Noel Richardson
- National Centre for Men's Health, South East Technological University, Carlow, Ireland
| | - Niamh Murphy
- School of Health Sciences, South East Technological University, Waterford, Ireland
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Implementing a Standardized Care Pathway Integrating Oncology, Palliative Care and Community Care in a Rural Region of Mid-Norway. Oncol Ther 2021; 9:671-693. [PMID: 34731447 PMCID: PMC8593089 DOI: 10.1007/s40487-021-00176-y] [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] [Received: 08/19/2021] [Accepted: 10/19/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION To improve quality across levels of care, we developed a standardized care pathway (SCP) integrating palliative and oncology services for hospitalized and home-dwelling palliative cancer patients in a rural region. METHODS A multifaceted implementation strategy was directed towards a combination of target groups. The implementation was conducted on a system level, and implementation-related activities were registered prospectively. Adult patients with advanced cancer treated with non-curative intent were included and interviewed. Healthcare leaders (HCLs) and healthcare professionals (HCPs) involved in the development of the SCP or exposed to the implementation strategy were interviewed. In addition, HCLs and HCPs exposed to the implementation strategy answered standardized questionnaires. Hospital admissions were registered prospectively. RESULTS To assess the use of the SCP, 129 cancer patients were included. Fifteen patients were interviewed about their experiences with the patient-held record (PHR). Sixty interviews were performed among 1320 HCPs exposed to the implementation strategy. Two hundred and eighty-seven HCPs reported on their training in and use of the SCP. Despite organizational cultural differences, developing an SCP integrating palliative and oncology services across levels of care was feasible. Both HCLs and HCPs reported improved quality of care in the wake of the implementation process. Two and a half years after the implementation was launched, 28% of the HCPs used the SCP and 41% had received training in its use. Patients reported limited use and benefit of the PHR. CONCLUSION An SCP may be a usable tool for integrating palliative and oncology services across care levels in a rural region. An extensive implementation process resulted in improvements of process outcomes, yet still limited use of the SCP in clinical practice. HCLs and HCPs reported improved quality of cancer care following the implementation process. Future research should address mandatory elements for usefulness and successful implementation of SCPs for palliative cancer patients.
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Sibbald SL, Ziegler BR, Maskell R, Schouten K. Implementation of interprofessional team-based care: A cross-case analysis. J Interprof Care 2020; 35:654-661. [PMID: 32835539 DOI: 10.1080/13561820.2020.1803228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Two out of five Canadians have at least one chronic disease and four out of five are at risk of developing a chronic disease. Successful disease management relies on interprofessional team-based approaches, yet lack of purposeful cultivation and patient engagement has led to systematic inefficiencies. Two primary care teams in Southwestern Ontario implementing interprofessional chronic care programs for patients with chronic obstructive pulmonary disease were compared. A mixed-methods cross-case analysis was conducted including interviews, focus groups, observations and document analysis. Cases (n = 2) were chosen based on intrinsic and unique value. Participants (n = 46) were sampled using a combination of purposive and multi-level sampling. Data was analyzed using an iterative process; inductive coding was used to gain a sense of context followed by a deductive cross-case analysis to compare and contrast themes across sites. Kompier's five-step framework was used to assess factors contributing to successful implementation and to provide insight into interactions between teams, providers and patients. Both cases satisfied all five factors (systemic and gradual approach, identification of risk factors, theory-driven, participatory approach and sustained committed support). However, one case was more successful at fully implementing their model, attributed to a flexible implementation, plans to mitigate risks, theory use, a supportive team and continued buy-in from leadership. By better understanding key facilitators and barriers, we can support the implementation of chronic disease management programs, foster sustainability of high-performing interprofessional teams, and engage patients in the development and maintenance of team-based chronic disease management.
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Affiliation(s)
- Shannon L Sibbald
- School of Health Studies, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Bianca R Ziegler
- Environment Health and Hazards Laboratory, Department of Geography, Western University, London, ON, Canada
| | - Rachelle Maskell
- School of Health Studies, Western University, London, ON, Canada
| | - Karen Schouten
- School of Health Studies, Western University, London, ON, Canada
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Willcox JC, Dobson R, Whittaker R. Old-Fashioned Technology in the Era of "Bling": Is There a Future for Text Messaging in Health Care? J Med Internet Res 2019; 21:e16630. [PMID: 31859678 PMCID: PMC6942182 DOI: 10.2196/16630] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/20/2023] Open
Abstract
In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more "technologically advanced" systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model.
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Affiliation(s)
- Jane C Willcox
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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Porte PJ, Meijs JD, Verweij LM, de Bruijne MC, van der Vleuten CP, Wagner C. Hospitals need more guidance on implementing guidelines for the safe use of medical devices. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rangachari P. Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success. ACTA ACUST UNITED AC 2018; 5:1-14. [PMID: 29546884 DOI: 10.2147/ieh.s151040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
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Affiliation(s)
- Pavani Rangachari
- College of Allied Health Sciences, Augusta University, Augusta, Georgia, United States
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Mahoney N, Gladstone T, DeFrino D, Stinson A, Nidetz J, Canel J, Ching E, Berry A, Cantorna J, Fogel J, Eder M, Bolotin M, Van Voorhees BW. Prevention of Adolescent Depression in Primary Care: Barriers and Relational Work Solutions. CALIFORNIAN JOURNAL OF HEALTH PROMOTION 2017; 15:1-12. [PMID: 30393470 PMCID: PMC6214481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. METHODS From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). RESULTS A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. CONCLUSION We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.
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Affiliation(s)
- Nicholas Mahoney
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Tracy Gladstone
- The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College
| | - Daniela DeFrino
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Allison Stinson
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Jennifer Nidetz
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Jason Canel
- Northshore University Health Systems, Evanston, Illinois
| | | | - Anita Berry
- Advocate Children's Hospital, Downers Grove, Illinois
| | | | - Joshua Fogel
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
- Department of Business Management, Brooklyn College, New York
| | - Milton Eder
- Access Community Health Network, Chicago, Illinois
| | - Megan Bolotin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Benjamin W Van Voorhees
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
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Leavy B, Kwak L, Hagströmer M, Franzén E. Evaluation and implementation of highly challenging balance training in clinical practice for people with Parkinson's disease: protocol for the HiBalance effectiveness-implementation trial. BMC Neurol 2017; 17:27. [PMID: 28173775 PMCID: PMC5297172 DOI: 10.1186/s12883-017-0809-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If people with progressive neurological diseases are to avail of evidence-based rehabilitation, programs found effective in randomized controlled trials (RCT's) must firstly be adapted and tested in clinical effectiveness studies as a means of strengthening their evidence base. This paper describes the protocol for an effectiveness-implementation trial that will assess the clinical effectiveness of a highly challenging balance training program (the HiBalance program) for people with mild-moderate Parkinson's disease (PD) while simultaneously collecting data concerning the way in which the program is implemented. The HiBalance program is systemically designed to target balance impairments in PD and has been shown effective at improving balance control and gait in a previous RCT. Study aims are to i) determine the effectiveness of the adapted HiBalance program on performance and self-rated outcomes such as balance control, gait and physical activity level ii) conduct a process evaluation of program implementation at the various clinics iii) determine barriers and facilitators to program implementation in these settings. METHODS This effectiveness-implementation type 1 hybrid study will use a non-randomized controlled design with consecutive inclusion of people with PD at multiple clinical sites. A mixed method approach will be used to collect clinical effectiveness data and process evaluation data which is both quantitative and qualitative in nature. The consolidated framework for implementation research (CFIR) will be used to guide the planning and collection of data concerning implementation barriers and facilitators. The HiBalance program will be provided by physical therapists as a part of standard rehabilitation care at the clinical sites, while the evaluation of the implementation process will be performed by the research group and funded by research grants. DISCUSSION An effectiveness-implementation study design benefits patients by speeding up the process of translating findings from research settings to routine health care. Findings from this study will also be highly relevant for those working with neurological rehabilitation when faced with decisions concerning the translation of training programs from efficacy studies to everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov march 2016, NCT02727478 .
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden. .,Stockholms Sjukhem Foundation, Stockholm, Sweden.
| | - Lydia Kwak
- Institute of Environmental Medicine, Intervention and implementation research, Karolinska Institute, Solna, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden.,Function Area Occupational therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden.,Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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