1
|
Cardo Miota A, Valls Pérez B, Gil García E, Hernán García M. [Proposals for the community orientation of primary health care: to identify key agents for training]. GACETA SANITARIA 2022; 37:102269. [PMID: 36399988 DOI: 10.1016/j.gaceta.2022.102269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the strengths available for the community orientation of primary health care (PHC) in the context of the evaluation of the piloting of a training program in Community Health for Resident Internal Specialists in Andalusia (Spain). METHOD We will conduct a qualitative, phenomenologically-oriented, explanatory research in which the opinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusia which were part of the training program called Project to Support the Revitalization of Primary Care Assets for Community Health (PARAC) were interviewed. RESULTS There is consensus in giving training a key weight in the community orientation of PHC. For this reason, those agents linked to training are identified as assets: general practice (GP) trainers, young professionals in training who bring updated perspectives and approaches to accredited PHC training centers, whose professionals must respond to the needs of their GP trainees, the multi-professional teaching units responsible for the GP trainees training and a medium and long-term health system thinking along with structures that coordinate and support the community work at the PHC centers. CONCLUSIONS The community orientation of PHC is an objective that requires the participation of all levels of the health system. Knowing its assets and working with them can contribute to provide proposals to advance towards a community-oriented PHC system.
Collapse
|
2
|
Carlsson N, Johansson A. Adapting healthcare services to a more intense way of tobacco prevention in child health care: A comparison between active and passive spreading. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1664706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Noomi Carlsson
- Department of Public Health & Healthcare, Regional Executive Office, Jönköping, Sweden
| | | |
Collapse
|
3
|
Dzidowska M, Lee KSK, Wylie C, Bailie J, Percival N, Conigrave JH, Hayman N, Conigrave KM. A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement. BMC FAMILY PRACTICE 2020; 21:33. [PMID: 32054450 PMCID: PMC7020510 DOI: 10.1186/s12875-020-1101-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. METHODS We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. RESULTS Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements. CONCLUSION Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).
Collapse
Affiliation(s)
- Monika Dzidowska
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), The University of Sydney, NSW 2006 Australia
| | - K. S. Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), The University of Sydney, NSW 2006 Australia
- Centre for Alcohol Policy Research, La Trobe University, Level 5, HS2, Bundoora, VIC 3086 Australia
| | - Claire Wylie
- Faculty of Medicine and Health, Translational Australian Clinical Toxicology Program, The University of Sydney, Lev3, 1-3 Ross Street (K06), The University of Sydney, NSW 2006 Australia
| | - Jodie Bailie
- The University of Sydney, Faculty of Medicine and Health, University Centre for Rural Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Nikki Percival
- Faculty of Health, Australian Centre for Public and Population Health Research, University of Technology Sydney, UTS Building 10, 235-253 Jones Street, Ultimo, NSW 2007 Australia
| | - James H. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), The University of Sydney, NSW 2006 Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), 37 Wirraway Parade, Inala, QLD 4077 Australia
- School of Medicine, Griffith University, Griffith Health Centre (G40), Gold Coast campus, Gold Coast, QLD 4222 Australia
- School of Medicine, University of Queensland, Herston Road, Herston, QLD 4006 Australia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Lev 6, King George V Building (C39), The University of Sydney, NSW 2006 Australia
- Sydney Local Health District, Royal Prince Alfred Hospital, Drug Health Service, King George V Building, 83-117 Missenden Road, Camperdown, NSW 2050 Australia
| |
Collapse
|
4
|
Grandes G, Bully P, Martinez C, Gagnon MP. Validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire. Implement Sci 2017; 12:128. [PMID: 29126428 PMCID: PMC5681775 DOI: 10.1186/s13012-017-0664-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational readiness to change healthcare practice is a major determinant of successful implementation of evidence-based interventions. However, we lack of comprehensive, valid, and reliable instruments to measure it. We assessed the validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire in the context of the implementation of the Prescribe Vida Saludable III project, which seeks to strengthen health promotion and chronic disease prevention in primary healthcare organizations of the Osakidetza (Basque Health Service, Spain). METHODS A cross-sectional study was conducted including 127 professionals from 20 primary care centers within Osakidetza. They filled in the OR4KT questionnaire twice in a 15- to 30-day period to test repeatability. In addition, we used the Survey of Organizational Attributes for Primary Care (SOAPC) and we documented the number of healthcare professionals who formally engaged in the Prescribe Vida Saludable III project within each participating center to assess concurrent validity. RESULTS Cronbach's alpha for the overall OR4KT was .95, and the overall repeatability coefficient was 6.95%, both excellent results. Confirmatory factor analysis supported the underlying theoretical structure of 6 dimensions and 23 sub-dimensions. There were positive moderate-to-high internal correlations between these six dimensions, and there was evidence of good concurrent validity (correlation coefficient of .76 with SOAPC, and .80 with the proportion of professionals engaged by center). A score higher than 64 (out of 100) would be indicative of an organization with high level of readiness to implement the intervention (sensitivity = .75, specificity = 1). CONCLUSIONS The Spanish version of the OR4KT exhibits very strong reliability and good validity, although it needs to be validated in a larger sample and in different implementation contexts.
Collapse
Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain. .,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain.
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, QC, Québec, G1V 0A6, Canada.,Faculty of Nursing, Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
| |
Collapse
|
5
|
Korownyk C, McCormack J, Kolber MR, Garrison S, Michael Allan G. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e371-e376. [PMID: 28904046 PMCID: PMC5597026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Christina Korownyk
- Professeure agrégée au Département de médecine familiale de l'Université de l'Alberta à Edmonton.
| | - James McCormack
- Professeur à la Faculté des sciences pharmaceutiques de l'Université de la Colombie-Britannique à Vancouver
| | - Michael R Kolber
- Professeur agrégé au Département de médecine familiale de l'Université de l'Alberta
| | - Scott Garrison
- Professeur agrégé au Département de médecine familiale de l'Université de l'Alberta
| | - G Michael Allan
- Professeur et directeur de la Médecine fondée sur des données probantes à l'Université de l'Alberta
| |
Collapse
|
6
|
Korownyk C, McCormack J, Kolber MR, Garrison S, Allan GM. Competing demands and opportunities in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:664-668. [PMID: 28904027 PMCID: PMC5597006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Christina Korownyk
- Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
| | - James McCormack
- Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver
| | - Michael R Kolber
- Associate Professor in the Department of Family Medicine at the University of Alberta
| | - Scott Garrison
- Associate Professor in the Department of Family Medicine at the University of Alberta
| | - G Michael Allan
- Professor and Director of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta
| |
Collapse
|
7
|
Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study. Int J Integr Care 2015; 15:e030. [PMID: 26312058 PMCID: PMC4548708 DOI: 10.5334/ijic.1741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 07/18/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. Methods A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources. Results Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles. Conclusions The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.
Collapse
|