scholarly journals Successful implementation of a Fracture Liaison Service through effective change management: a qualitative study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Lisa A. Wozniak ◽  
Lauren A. Beaupre ◽  
Angela Juby ◽  
Paul Kivi ◽  
Sumit R. Majumdar ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Change Management ◽  
Fracture Liaison Service ◽  
Successful Implementation ◽  
Effective Change ◽  
Fracture Liaison

scholarly journals Guideline Implementation in Standardized Office Workflows and Exam Types

2019 ◽  
Vol 10 ◽  
pp. 215013271983689
Author(s):  
Amy Dawson ◽  
Brian Henriksen ◽  
Penny Cortvriend
Keyword(s):  
Chronic Disease ◽  
Chronic Illness ◽  
Family Medicine ◽  
Disease Management ◽  
Qualitative Study ◽  
Change Management ◽  
Chronic Disease Management ◽  
Medical Society ◽  
Successful Implementation ◽  
Card Sort

Background: Clinical practice guidelines (CPGs) in medicine are recommendations supported by systematic review of evidence to facilitate optimal patient outcomes. Primary care practices are expected to implement more than 200 CPGs, overwhelming many practices. This qualitative study elucidated the perspectives and priorities of family medicine physicians and office managers in grouping CPGs to facilitate implementation. Methods: A qualitative study was performed using individual, semistructured interviews. During the interviews the participants completed an open card-sort exercise grouping 20 CPGs. Purposive sampling was used to identify family medicine physicians and office managers practicing in medically underserved zip codes listed in the local medical society directory. Seven physicians and 6 office managers were interviewed. The interviews were transcribed and analyzed using thematic analysis and compared with the card-sort results. Results: Thematic content analysis identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for implementation: delegation, personalization, triggers, and change management. The card sort exercise revealed grouping by standardized preventive care visit, standardized rooming and discharge processes, and chronic illness. Chronic illness-based groupings and personalization of guidelines were recognized as presenting barriers to delegation of CPGs to the care team. Development of standardized preventive exams, standard rooming and discharge processes and chronic disease management were identified as promoting CPG adherence through team-based care. Standardized workflows provided opportunities for task delegation through predicable roles. Medicalization of CPG implementation relied heavily on the physician alone to remember to adhere to CPGs and inhibited task sharing by not giving office staff clear disease-based protocols to follow. Conclusions: This study identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for concomitant implementation: delegation, personalization, triggers, and change management. Successful implementation was perceived to be associated with standardized preventive exams, standard rooming and discharge processes, and chronic disease management.

scholarly journals Making the case for a fracture liaison service: a qualitative study of the experiences of clinicians and service managers

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Sarah Drew ◽  
◽  
Rachael Gooberman-Hill ◽  
Andrew Farmer ◽  
Laura Graham ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Fracture Liaison Service ◽  
Service Managers ◽  
Fracture Liaison

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

Optimizing fracture prevention: the fracture liaison service, an observational study

2013 ◽  
Author(s):  
Danielle Eekman ◽  
Helden Sven van ◽  
Margriet Huisman ◽  
Harald Verhaar ◽  
Irene Bultink ◽  
...  
Keyword(s):  
Observational Study ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Fracture Liaison

scholarly journals Seasonality of adult fragility fractures and association with weather: 12-year experience of a UK fracture liaison service

Bone ◽  
2021 ◽  
pp. 115916
Author(s):  
Giulia Ogliari ◽  
Terence Ong ◽  
Lindsey Marshall ◽  
Opinder Sahota
Keyword(s):  
Fragility Fractures ◽  
Fracture Liaison Service ◽  
Fracture Liaison

scholarly journals EXPRESS: Unlearning and Consent in the UK Fire and Rescue Service

2021 ◽  
pp. 001872672110311
Author(s):  
James Brooks ◽  
Irena Grugulis ◽  
Hugh Cook
Keyword(s):  
Qualitative Study ◽  
Social Aspects ◽  
Successful Implementation ◽  
Human System ◽  
Rescue Service ◽  
Rescue Services ◽  
The People ◽  
The Social ◽  
New Knowledge ◽  
The Uk

Why does so much literature on unlearning ignore the people who do the unlearning? What would we understand differently if we focused on those people? Much of the existing literature argues that unlearning can only be achieved, and new knowledge acquired, if old knowledge is discarded: the clean slate approach. This might be a reasonable way of organising stock in a warehouse, where room needs to be created for new deliveries, but it is not an accurate description of a human system. This article draws on a detailed qualitative study of learning in the UK Fire and Rescue Services to challenge the clean slate approach and demonstrate that, not only did firefighters retain their old knowledge, they used it as a benchmark to assess new routines and practices. This meant that firefighters’ trust in, and consent to, innovation was key to successful implementation. In order to understand the social aspects of unlearning, this research focuses on the people involved as active agents, rather than passive recipients or discarders of knowledge.

scholarly journals Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurna Bullock ◽  
Fay Crawford-Manning ◽  
Elizabeth Cottrell ◽  
Jane Fleming ◽  
Sarah Leyland ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Evidence Synthesis ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Delphi Survey ◽  
Shared Decision ◽  
Secondary Fracture ◽  
Drug Treatments ◽  
Fracture Liaison

Abstract Summary Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. Purpose The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the ‘model Fracture Liaison Service (FLS) consultation’ within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. Methods A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was ‘essential’ and percentage agreement calculated; the study team subsequently determined the threshold for essential content. Results Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. Conclusions This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.

scholarly journals Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042547
Author(s):  
Atif Riaz ◽  
Olga Cambaco ◽  
Laura Elizabeth Ellington ◽  
Jennifer L Lenahan ◽  
Khatia Munguambe ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Low Income ◽  
Lung Ultrasound ◽  
New Technology ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Local Context ◽  
Future Research ◽  
Successful Implementation ◽  
Pneumonia Diagnosis

ObjectivesPaediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia.DesignProspective qualitative study using semistructured interviewsSettingTwo referral hospitals in Mozambique and PakistanParticipantsA total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled.ResultsHCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS.ConclusionsThis was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation.Trial registration numberNCT03187067.

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