scholarly journals Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 905-906
Author(s):  
Ellen Roberts ◽  
Cristine Henage ◽  
Lori Armistead ◽  
Tamera Hughes ◽  
Joshua Niznik ◽  
...  
Keyword(s):  
Focus Group ◽  
Healthcare Providers ◽  
Barriers And Facilitators ◽  
Prescribing Practices ◽  
Alternative Interventions ◽  
Primary Care Clinics ◽  
Included Patient ◽  
Abrupt Discontinuation ◽  
Randomized Control ◽  
Patient Resistance

Abstract As part of a randomized control trial for deprescribing opioids and benzodiazepines (BZD) to reduce falls (funded by Centers for Disease Control), we conducted a virtual focus group and surveys to evaluate opioid and BZD prescribing practices among healthcare providers in four primary care clinics in North Carolina. Survey and focus group questions measured providers’ confidence in their abilities to weigh benefits and harms of opioids and/or BZDs in older adults; determine alternative interventions; create a safe dosing plan; and incorporate patient preferences. A validated pre-intervention survey, adapted from a survey by the Canadian Deprescribing Network, was administered to providers in control and intervention clinics (n=29). Providers expressed high confidence in their abilities to weigh risks and benefits of deprescribing opioids and BZDs, but low confidence in deprescribing under impeding circumstances (e.g. when not the original prescriber or when there is no evidence to inform them). Results were similar across opioids and BZDs. A focus group was conducted among seven providers from the two intervention clinics. Barriers to deprescribing identified included patient resistance, lack of knowledge of deprescribing best practices, and lack of time to discuss deprescribing during regular clinic visits. Providers also expressed concerns about deprescribing medications initiated by or managed by other prescribers. Key facilitators of deprescribing included patient trust in physician, patients being agreeable to reduce medications, and use of gradual tapering rather than abrupt discontinuation. Barriers and facilitators were subsequently used to optimize training and provider resources for the deprescribing intervention, which is currently being implemented.

scholarly journals A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 41-42
Author(s):  
E Johnson ◽  
M Carbonneau ◽  
D Campbell-Scherer ◽  
P Tandon ◽  
A Hyde
Keyword(s):  
Focus Groups ◽  
Gastrointestinal Disease ◽  
Pragmatic Trial ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Care Utilization ◽  
Implementation Barriers ◽  
Mortality And Morbidity ◽  
Order Set

Abstract Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates

scholarly journals Physical Activity in First Generation South Asian Women Living in Canada: Barriers and Facilitators to Participation

2016 ◽  
Vol 24 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Kiruthika Rathanaswami ◽  
Enrique Garcia Bengoechea ◽  
Paula Louise Bush
Keyword(s):  
Physical Activity ◽  
Focus Group ◽  
South Asian ◽  
Living Environment ◽  
Barriers And Facilitators ◽  
Asian Women ◽  
South Asian Women ◽  
Family Responsibilities ◽  
Women Employees ◽  
The Individual

The aim of this study was to understand the physical activity (PA) experiences of South Asian women employees and their perceptions of new immigrant South Asian women in regards to barriers and facilitators to participation. This was examined using an interpretive description approach where similarities and differences between South Asian Women’s Centre employees and their perception of new South Asian immigrants were explored. Eight South Asian women employees (Mean age = 45.57 years) working at a South Asian Women’s Centre in Canada participated in this study. Five South Asian women employees participated in a focus group, three in an individual interview and one participant from the focus group took part in a follow-up interview to better understand their PA experiences. Barriers found included: family responsibilities, upbringing, feeling guilty, immediate living environment, clothing, cost, and location of activity. PA facilitators found included: help at home, cultural sports events, group support, female only programs, design of PA facilities, health and self-image benefits, providing PA for children at the same time as adults and collaborations. The main differences found between South Asian Women’s Centre employees and their clients concerned time, language and their partners. For this population of women, programs need to be affordable, close to home, female only and allow their own choice of clothing. The results suggest the importance for those working with South Asian women to take into consideration the many factors between the individual and the environment that may inhibit or facilitate PA behavior change in this population.

scholarly journals A focus group study of older Chinese people with CVD patients in the North West of the UK

2021 ◽  
Vol 22 ◽  
Author(s):  
Shaun Speed ◽  
Zeyuan Sun ◽  
Zhenmi Liu
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Focus Group ◽  
Cultural Values ◽  
Help Seeking ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Chinese Patients ◽  
Focus Group Study ◽  
North West

Abstract Background: Cardiovascular disease (CVD) is the leading cause of death for Chinese migrants around the world. Chinese CVD patients rely heavily on their native Chinese language, cultural values and beliefs, which adds challenges for the healthcare providers to offer primary healthcare services with standard protocol. The inappropriate treatment could lead to life loss, mistrust in doctor-patient relationship and heavy burden for healthcare funding. Methods: 28 participants were included for focus group study with the grounded theory methodology. Results: There is considerable misunderstanding among the Chinese community about the role of primary care doctors in the treatment of cardiovascular disease resulting in the variable use of primary care services. Conclusion: Chinese CVD patients or identified risk factors for CVD arguably need closer management, culturally sensitive advice, support and robust follow-up compared to the general population. Doctors and nurses should enhance their practice and give them confidence in their interaction with Chinese patients on the basis of how they think and behave in relation to help seeking.

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

2021 ◽  
pp. 1-8
Author(s):  
Kim D. Lu ◽  
Dan Cooper ◽  
Raluca Dubrowski ◽  
Melanie Barwick ◽  
Shlomit Radom-Aizik
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Barriers And Facilitators ◽  
Pediatric Care ◽  
Team Approach ◽  
Implementation Barriers ◽  
Primary Care Clinics ◽  
Exercise Medicine ◽  
Practice Variability ◽  
Facilitators And Barriers

Purpose: Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians’ thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. Methods: The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. Results: Despite the pediatricians’ beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. Conclusion: The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

Healthcare providers’ caring for Thai teenage parents: A focus group study

Midwifery ◽  
2019 ◽  
Vol 69 ◽  
pp. 172-178
Author(s):  
Atcharawadee Sriyasak ◽  
Anna-Lena Almqvist ◽  
Chaweewan Sridawruang ◽  
Elisabet Häggström-Nordin
Keyword(s):  
Focus Group ◽  
Healthcare Providers ◽  
Focus Group Study ◽  
Teenage Parents

scholarly journals Barriers and Facilitators to COVID-19 screening at Jaipur International Airport, India.

2021 ◽  
Author(s):  
Neha Mantri ◽  
Nitin Kumar Joshi ◽  
Pankaj Bhardwaj ◽  
Akhil Dhanesh Goel ◽  
Manoj Kumar Gupta ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Healthcare Providers ◽  
Health Department ◽  
International Travel ◽  
Barriers And Facilitators ◽  
Organization Behavior ◽  
Travel History ◽  
International Airport ◽  
Key Stakeholders ◽  
The Mean

Abstract Background:Airports pose a possible threat in facilitating global disease transmission within the community which may be prevented by rigorous systematic entry-exit screening. With the aim to capture the perception of stakeholders associated with COVID-19 on barriers and facilitators of airport screening at Jaipur International Airport. Also, to assess key outcomes viz. total passengers screened, suspected cases, & confirmed cases.Methods:An inductive-deductive mix-method thematic analysis was conducted to capture qualitative data of key stakeholders. Additionally, quantitative data was obtained from the Rajasthan Medical & Health Department team deployed for COVID-19 airport screening.Results:Jaipur International Airport screened 4565 passengers (Males=4073 and Females=492) with 23 suspected cases during an outlined period of declaration of Pandemic to Lockdown in India (11th to 24th March 2020). Total 65 passengers had travel history from China (3 from Wuhan). The mean average age of passengers was 40.95 ± 7.8 years. The average screening time per passenger was 2-3 minutes with a load of 25-90 passengers per team per flight. Fishbone analysis of screening challenges revealed poor cooperation of passengers, masking symptoms, apprehension, and stigma related to quarantine. Moreover, inadequate human resources and changing guidelines overburdened healthcare providers. But, perception of risk, and social responsibility of travelers together with supportive organization behavior act as facilitators. Overall, groundwork on airport screening was insightful to propose key action areas for screening.Conclusions:Globally, COVID-19 has an impact on health infrastructure and international travel. International coordination with streamlined screening will go a LONG way in virus containment.

scholarly journals International barriers and facilitators for cervical cancer screening among young people: a systematic review

2021 ◽  
Author(s):  
Abirami Kirubarajan ◽  
Shannon Leung ◽  
Xinglin Li ◽  
Matthew Yau ◽  
Mara Sobel
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Young People ◽  
Cervical Cancer Screening ◽  
Low Income ◽  
Healthcare Providers ◽  
Barriers And Facilitators ◽  
Low Income Countries ◽  
Age Group

Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines and in many countries, screening rates for this age-group have even dropped. Objectives The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young people globally. Search Strategy We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Selection Criteria We only examined original, peer-reviewed literature. Databases were examined from inception until the date of our literature searches (12/03/2020). Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young people, or did not report outcomes or evaluation. Data Collection and Analysis All screening and extraction was completed in duplicate with two independent reviewers. Main Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions Health systems worldwide should address the barriers and facilitators to increase cervical cancer screening rates in young people. Further research is required to understand this age group.

Exploring the experience and challenges of maternity waiting homes in Jimma, southwest Ethiopia

2021 ◽  
pp. 1-11
Author(s):  
Woubishet Girma ◽  
Dessalegn Tamiru ◽  
Mirkuzie Woldie ◽  
Ayantu Kebede ◽  
Zewdie Birhanu ◽  
...  
Keyword(s):  
Focus Group ◽  
Rural Areas ◽  
Healthcare Providers ◽  
Computer Software ◽  
Obstetric Care ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Transportation Services ◽  
Care Access ◽  
Maternity Waiting Homes

Background Establishing maternity waiting homes is a key strategy to address the geographic barrier to obstetric care access among women living in rural areas. In Ethiopia, maternity waiting homes have been in use for several years, with a sharp increase in the number of such facilities recently. However, there is little empirical evidence detailing the experiences and challenges faced by women during the implementation of this initiative in Ethiopia. Methods This study used a multiple case study design with qualitative data collection methods, and was conducted from October to November 2016. Data were collected using focus group discussions, in-depth interviews and direct observation of each maternity waiting home. All interviews and focus group discussions were recorded using a digital voice recorder. Data were transcribed and translated into English. The coding process and formation of thematic structure was assisted by Atlas ti7.5 computer software. Results The participants reported that they were satisfied and comfortable with the services at the maternity waiting homes, as were their husbands and community leaders. Facility, social and environmental challenges were identified as common barriers to the utilisation of maternity waiting homes by stakeholders at different levels. Healthcare providers reported common challenges at maternity waiting homes include a lack of basic utilities (water and electric supply), and overcrowding because of a shortage of space and lack of medical supplies. Some women reported that poor transportation services and the distance to facilities hindered the utilisation of maternity waiting homes. Conclusions There are social and facility challenges related to the use of maternity waiting homes in Ethiopia. Policymakers and health managers should work with relevant sectors to mitigate the effect of facility, social and environmental barriers and maximise the use of maternity waiting homes.

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