Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research

2021 ◽  
Author(s):  
Hallie M Espel-Huynh ◽  
Carly M Goldstein ◽  
Michael L Stephens ◽  
Olivia L Finnegan ◽  
A Rani Elwy ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Research ◽  
Formative Evaluation ◽  
Qualitative Interviews ◽  
Implementation Strategies ◽  
Negative Influence ◽  
Obesity Treatment ◽  
Care Practice ◽  
Contextual Influences ◽  
Design Quality

Abstract Online behavioral obesity treatment is a promising first-line approach to weight management in primary care. However, little is known about contextual influences on implementation. Understand qualitative contextual factors that affect the implementation process, as experienced by key primary care stakeholders implementing the program. Online behavioral obesity treatment was implemented across a 60-clinic primary care practice network. Patients were enrolled by nurse care managers (NCMs; N = 14), each serving 2–5 practices. NCMs were randomized to one of two implementation conditions—“Basic” (standard implementation) or “Enhanced” (i.e., with added patient tracking features and more implementation strategies employed). NCMs completed qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and analyzed via directed content analysis. Emergent categories were summarized by implementation condition and assigned a valence according to positive/negative influence. Individuals in the Enhanced condition viewed two aspects of the intervention as more positively influencing than Basic NCMs: Design Quality & Packaging (i.e., online program aesthetics), and Cost (i.e., no-cost program, clinician time savings). In both conditions, strongly facilitating factors included: Compatibility between intervention and clinical context; Intervention Source (from a trusted local university); and Evidence Strength & Quality supporting effectiveness. Findings highlight the importance of considering stakeholders’ perspectives on the most valued types of evidence when introducing a new intervention, ensuring the program aligns with organizational priorities, and considering how training resources and feedback on patient progress can improve implementation success for online behavioral obesity treatment in primary care.

Challenges and strategies for hypertension management: qualitative analysis of small primary care practices with varying blood pressure control

2019 ◽  
Vol 36 (5) ◽  
pp. 644-649 ◽  
Author(s):  
Jenny R Smolen ◽  
Jason J Wang ◽  
Sheila P Anane
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Quality Improvement ◽  
Qualitative Interviews ◽  
Pressure Control ◽  
Care Practice ◽  
Hypertension Management ◽  
Small Primary ◽  
Average Control ◽  
High Control

Abstract Background Electronic health record (EHR) data on blood pressure (BP) control among patients with hypertension show that practices’ rates vary greatly. This suggests providers use different approaches in managing hypertension, and so we aimed to explore challenges small primary care practice providers face and strategies they use to manage patients’ BP. We explored differences between providers with high and low BP control rates to help inform future quality improvement work. Methods In 2015, we recruited practices in New York City with five or fewer providers. We employed a stratified purposeful sampling method, using EHR data to categorize small practices into groups based on the proportion of patients with hypertension whose last BP was <140/90: high control (>= 80%), average control (60–80%) and low control (<60%). We conducted semi-structured qualitative interviews with clinicians from 23 practices—7 high control, 10 average control and 6 low control—regarding hypertension management. We used a combined inductive/deductive approach to identify key themes, and these themes guided a comparison of high and low BP control providers. Results Small practice providers reported treatment non-adherence as one of the primary challenges in managing patients’ hypertension, and described using patient education, relationship building and self-management tools to address this issue. Providers differed qualitatively in the way they described using these strategies; high BP control providers described more actively engaging and listening to patients than low control providers did. Conclusions How providers communicate with patients may impact outcomes—future quality improvement initiatives should consider trainings to improve patient–provider communication.

scholarly journals Implementation of the Human Papillomavirus School-entry Requirement in Puerto Rico: Barriers and Facilitators Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Vivian Colón-López ◽  
Roxana Soto-Abreu ◽  
Diana T. Medina-Laabes ◽  
Olga L. Díaz-Miranda ◽  
Ana P. Ortiz ◽  
...  
Keyword(s):  
Puerto Rico ◽  
Human Papillomavirus ◽  
Implementation Research ◽  
Hpv Vaccine ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Negative Influence ◽  
Barriers And Facilitators ◽  
School Entry ◽  
Relative Advantage

Abstract Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.

scholarly journals A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice

2011 ◽  
Vol 365 (21) ◽  
pp. 1969-1979 ◽  
Author(s):  
Thomas A. Wadden ◽  
Sheri Volger ◽  
David B. Sarwer ◽  
Marion L. Vetter ◽  
Adam G. Tsai ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Trial ◽  
Primary Care Practice ◽  
Obesity Treatment ◽  
Care Practice

scholarly journals Formative evaluation of practice changes for managing depression within a Shared Care model in primary care

2016 ◽  
Vol 18 (01) ◽  
pp. 50-63
Author(s):  
Julie Beaulac ◽  
Jeanette Edwards ◽  
Angus Steele
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Formative Evaluation ◽  
Longitudinal Design ◽  
Health Indicators ◽  
Care Practice ◽  
Integrated Network

AimTo investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.BackgroundManitoba Health undertook a primary care renewal initiative in 2006 called the PIN, which included the development of mental health indicators specific to screening and managing follow-up for depression. These indicators were implemented in three PIN group practice sites in Manitoba, which are also part of Shared Mental Health Care.MethodsThe design was a non-experimental longitudinal design. A formative evaluation investigated the implementation and initial impact of the mental health indicators using mixed methods (document review, survey, and interview). Quantitative data was explored using descriptive and comparative statistics and a content and theme analysis of the qualitative interviews was conducted. Survey responses were received from 32 out of 36 physicians from the three sites. Interviews were conducted with 15 providers.FindingsThis evaluation illustrated providers’ perceived attitudes, knowledge, skills, and behaviours related to recognizing and treating depression and expanded our understanding of primary care processes related to managing depression related to the implementation of a new initiative. Depression is viewed as an important problem in primary care practice that is time consuming to diagnose, manage and treat and requires further investigation. Implementation of the PIN mental health indicators was variable across sites and providers. There was an increase in use of the indicators across time and a general sentiment that benefits of screening outweigh the costs; however, the benefit of screening for depression remains unclear. Consistent with current guidelines, a question the findings of this evaluation suggests is whether there are more effective ways of having an impact on depression within primary care than screening.

scholarly journals THE UNINTENDED CONSEQUENCES OF SEAMLESS IMPLEMENTATION OF A RURAL TELEMEDICINE CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S607-S608
Author(s):  
Samantha Solimeo ◽  
Melissa J Steffen ◽  
Aaron Seaman ◽  
Karla L Miller
Keyword(s):  
Primary Care ◽  
Rural Communities ◽  
Positive Impact ◽  
Qualitative Interviews ◽  
Implementation Strategies ◽  
Primary Care Providers ◽  
Unintended Consequences ◽  
Care Providers ◽  
Workload Analysis ◽  
Care Processes

Abstract Osteoporosis is largely undetected and untreated in older men who are at-risk, with even lower rates of detection and treatment in rural communities. In this presentation we report the consequences for primary care providers (PCPs) of the implementation of an osteoporosis telemedicine clinic that targeted rural patients and is purposefully designed to minimize PCP workload. Analysis of qualitative interviews with PCPs who co-managed patients with the telemedicine clinic confirmed that implementation strategies used by the telemedicine clinic were successful at minimizing workload and had a positive impact on PCPs’ work. However, the clinic’s seamless approach may have contributed to unintended consequences of low PCP awareness of program care processes and selection criteria and a missed opportunity for PCPs to reinforce osteoporosis care goals in the primary care setting.

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