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 Barriers and facilitators for optimizing oral anticoagulant management: Perspectives of patients, caregivers, and providers

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257798
Author(s):  
Anne Holbrook ◽  
Mei Wang ◽  
Marilyn Swinton ◽  
Sue Troyan ◽  
Joanne M. W. Ho ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Oral Anticoagulants ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Vascular Events ◽  
Medication Access ◽  
Adherence Monitoring

Background Oral anticoagulants (OACs) are very commonly prescribed for prevention of serious vascular events, but are also associated with serious medication-related bleeding. Mitigation of harm is believed to require high-quality OAC management. This study aimed to identify barriers and facilitators for optimal OAC management from the perspective of patients, caregivers and healthcare providers. Methods Using a qualitative descriptive study design, we conducted five focus groups, three with patients and caregivers and two with health care providers, in two health regions in Southwestern Ontario. An expert facilitator led the discussions using a semi-structured interview guide. Each session was digitally recorded, transcribed verbatim and anonymized. Transcripts were analyzed in duplicate using conventional content analysis. Results Forty-two (19 patients, 7 caregivers, and 16 providers including physicians, nurses and pharmacists) participated. More than half of the patients received OAC for the treatment of venous thromboembolism (57.9%) and the majority (94.7%) were on chronic therapy (defined as >3 years). Data analysis organized codes describing barriers and facilitators into 4 main themes—medication-related, patient-related, provider-related, and system-related. Barriers highlighted were problems with medication access due to cost, patient difficulties with adherence, knowledge and adjusting their lifestyles to OAC therapy, provider expertise, time for adequate communication amongst providers and their patients, and health care system inadequacies in supporting communications and monitoring. Facilitators identified generally addressed these barriers. Conclusions Many barriers to optimal OAC management exist even in the era of DOACs, many of which are amenable to facilitators of improved care coordination, patient education, and adherence monitoring.

scholarly journals Tracking the Randomized Rollout of a Veterans Affairs Opioid Risk Management Tool: A Multi-method Implementation Evaluation Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Sharon McCarthy ◽  
Matthew Chinman ◽  
Shari Rogal ◽  
Gloria Klima ◽  
Leslie Hausmann ◽  
...  
Keyword(s):  
Implementation Research ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Management Tool ◽  
Opioid Overdose ◽  
Veterans Health ◽  
Health Administration ◽  
Implementation Barriers ◽  
Implementation Climate ◽  
The Mean

Abstract BackgroundThe Veterans Health Administration (VHA) developed the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard to assist VHA clinicians in identifying Veterans at risk for adverse opioid overdose or suicide-related events. In 2018, a national policy was implemented requiring providers at all VHA facilities to complete case reviews of Veterans identified by STORM as very high risk for adverse events. Nationally, facilities were randomized by the type of oversight required when sufficient case reviews were not completed and also by the timing of an increase in the number of required case reviews. As part of a comprehensive assessment of this policy intervention, we aimed to 1) identify barriers and facilitators to implementing case reviews as required in the policy; 2) assess variation across the four arms of the study; and 3) evaluate associations between facility characteristics and implementation barriers and facilitators.MethodsUsing the Consolidated Framework for Implementation Research (CFIR), we developed a semi-structured interview guide to examine barriers to and facilitators of implementing the STORM policy. Staff from 40 purposefully selected facilities who were involved in implementation were invited to participate in telephone interviews. Interview transcripts were coded and then organized into memos, which were numerically rated using the -2 to +2 CFIR rating system for each construct. Descriptive statistics were used to evaluate the mean ratings on each CFIR construct, the associations between ratings and study arm, and three facility characteristics (size, rurality, and level of academic detailing) associated with CFIR ratings. We used the mean CFIR rating for each site to determine which constructs differed between the sites with highest and lowest overall CFIR scores, and these constructs were described in detail. ResultsInterviews with 78 staff at 39 VHA facilities identified a slightly positive (+0.2) overall mean CFIR rating. CFIR ratings were not significantly different between the four study arms, nor associated with facility characteristics. Overall, two important barriers to implementation were CFIR constructs Access to knowledge and information and Evaluating and reflecting. Having time to complete the reviews was a pervasive barrier. Sites with higher overall CFIR scores showed three important facilitators: Leadership engagement, Engaging, and Implementation climate. ConclusionAlthough there was variability in implementation barriers and facilitators across facilities, these were unrelated to study arms and facility characteristics. Leadership, resources, and overall implementation climate were the strongest facilitators of policy implementation.

scholarly journals Collaborating with healthcare providers to understand their perspectives on a hospital-to-home warning signs intervention for rural transitional care: protocol of a multimethod descriptive study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e034698 ◽  
Author(s):  
Mary T Fox ◽  
Jeffrey I Butler ◽  
Souraya Sidani ◽  
Evelyne Durocher ◽  
Behdin Nowrouzi-Kia ◽  
...  
Keyword(s):  
Rural Communities ◽  
Focus Groups ◽  
Research Ethics ◽  
Transitional Care ◽  
Healthcare Providers ◽  
Descriptive Study ◽  
Warning Signs ◽  
Barriers And Facilitators ◽  
Health Conditions ◽  
Plain Language

IntroductionThis study builds on our prior research, which identified that older rural patients and families (1) view preparation for detecting and responding to worsening health conditions as their most pressing unmet transitional care (TC) need and (2) perceive an evidence-based intervention, preparing them to detect and respond to warning signs of worsening health conditions, as highly likely to meet this need. Yet, what healthcare providers need to implement a warning signs intervention in rural TC is unclear. The objectives of this study are (1) to examine healthcare providers’ perspectives on the acceptability of a warning signs intervention and (2) to identify barriers and facilitators to healthcare providers’ provision of the intervention in rural communities.Methods and analysisThis multimethod descriptive study uses a community-based, participatory research approach. We will examine healthcare providers’ perspectives on a warning signs intervention. A purposive, criterion-based sample of healthcare providers stratified by professional designation (three strata: nurses, physicians and allied healthcare professionals) in two regions (Southwestern and Northeastern Ontario, Canada) will (1) rate the acceptability of the intervention and (2) participate in small (n=4–6 healthcare providers), semistructured telephone focus group discussions on barriers and facilitators to delivering the intervention in rural communities. Two to three focus groups per stratum will be held in each region for a total of 12–18 focus groups. Data will be analysed using conventional qualitative content analysis and descriptive statistics.Ethics and disseminationEthics approval was obtained from the Office of Research Ethics at York University and the Health Sciences North Research Ethics Board. Findings will be communicated through plain language summary and policy briefs, press releases, manuscripts and conferences.

scholarly journals Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeroen Deenik ◽  
Diederik E. Tenback ◽  
Erwin C. P. M. Tak ◽  
Olivier A. Blanson Henkemans ◽  
Simon Rosenbaum ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Clinical Care ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Positive Health ◽  
Online Questionnaire ◽  
Positive Attitudes ◽  
Organisational Factors

Abstract Background Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation. Methods Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively (“totally disagree/disagree”, score < 3) as barriers and to which ≥80% of HCPs or patients responded positively (“agree/totally agree”, score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. Results Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. Conclusions This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

A Process Evaluation of San Francisco’s Law Enforcement Assisted Diversion Program

2021 ◽  
pp. 088740342110333
Author(s):  
Erica Jovanna Magaña ◽  
Dina Perrone ◽  
Aili Malm
Keyword(s):  
Law Enforcement ◽  
San Francisco ◽  
Program Implementation ◽  
Relationship Building ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Diversion Program ◽  
Drug Laws ◽  
Point Of Entry ◽  
Reducing Recidivism

In 2016, San Francisco (SF) implemented the Law Enforcement Assisted Diversion (LEAD) program, a harm reduction–based pre-booking diversion system for people who violate drug laws and/or are engaged in sex work. LEAD is set apart from existing diversion programs, as it uses police as point of entry. Prior LEAD studies indicate some success in reducing recidivism and improving life outcomes. However, less is known about program implementation, including barriers and facilitators. Relying on policy documents, interviews, and focus groups, this study describes the LEAD SF’s development, operations, adaptations, and challenges. It also identifies the unique context of LEAD SF that led to implementation barriers and facilitators. Results show that SF experienced success in collaboration, relationship building, and client connections to services but experienced challenges in securing and maintaining police officer buy-in and keeping clear and open lines of communication regarding LEAD goals, objectives, policies, and procedures. This led to the termination of LEAD SF in 2020.

scholarly journals Strategies for developing and implementing a rheumatoid arthritis healthcare quality framework: a thematic analysis of perspectives from arthritis stakeholders

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043759
Author(s):  
Claire Barber ◽  
Diane Lacaille ◽  
Marc Hall ◽  
Victoria Bohm ◽  
Linda C Li ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Outcome Measurement ◽  
Healthcare Providers ◽  
Healthcare Quality ◽  
Quality Measurement ◽  
Measurement Development ◽  
Business World ◽  
Measurement Framework

ObjectivesTo obtain stakeholder perspectives to inform the development and implementation of a rheumatoid arthritis (RA) healthcare quality measurement framework.DesignQualitative study using thematic analysis of focus groups and interviews.SettingArthritis stakeholders from across Canada including healthcare providers, persons living with RA, clinic managers and policy leaders were recruited for the focus groups and interviews.ParticipantsFifty-four stakeholders from nine provinces.InterventionsQualitative researchers led each focus group/interview using a semistructured guide; the digitally recorded data were transcribed verbatim. Two teams of two coders independently analysed the transcripts using thematic analysis.ResultsPerspectives on the use of different types of measurement frameworks in healthcare were obtained. In particular, stakeholders advocated for the use of existing healthcare frameworks over frameworks developed in the business world and adapted for healthcare. Persons living with RA were less familiar with specific measurement frameworks, however, they had used existing online public forums for rating their experience and quality of healthcare provided. They viewed a standardised framework as potentially useful for assisting with monitoring the care provided to them individually. Nine guiding principles for framework development and 13 measurement themes were identified. Perceived barriers identified included access to data and concerns about how measures in the framework were developed and used. Effective approaches to framework implementation included having sound knowledge translation strategies and involving stakeholders throughout the measurement development and reporting process. Clinical models of care and health policies conducive to outcome measurement were highlighted as drivers of successful measurement initiatives.ConclusionThese important perspectives will be used to inform a healthcare quality measurement framework for RA.

Implementing early exome sequencing to shorten the diagnostic odyssey: identifying barriers and facilitators through clinician focus groups

2021 ◽  
Vol 132 ◽  
pp. S360
Author(s):  
Ann Katherine Foreman ◽  
Hannah Margaret Clare ◽  
Jeannette Bensen ◽  
Jonathan Berg ◽  
Kristen Hassmiller Lich
Keyword(s):  
Focus Groups ◽  
Exome Sequencing ◽  
Barriers And Facilitators ◽  
Diagnostic Odyssey

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.

scholarly journals Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population

2018 ◽  
Vol 17 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Theresa L. Byrd ◽  
Jessica Calderón-Mora ◽  
Rebekah Salaiz ◽  
Navkiran K. Shokar
Keyword(s):  
Colorectal Cancer ◽  
Focus Groups ◽  
Screening Program ◽  
El Paso ◽  
Barriers And Facilitators ◽  
Hispanic Population ◽  
Community Based ◽  
Crc Screening ◽  
Predominantly Hispanic ◽  
9Th Grade

Introduction: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. Method: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. Results: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. Conclusion: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

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