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 Implementation of Social Needs Screening in Primary Care: A Qualitative Study Using the Health Equity Implementation Framework

2021 ◽  
Author(s):  
Connor Drake ◽  
Heather Batchelder ◽  
Tyler Lian ◽  
Meagan Cannady ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Health Equity ◽  
Social Needs ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Implementation Barriers ◽  
Patient Acceptability ◽  
Implementation Framework ◽  
Clinical Encounters

Abstract Background: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing the deleterious effects on patients’ health outcomes. Evidence is needed regarding approaches to implementing such screening in routine clinical encounters to enhance social care integration. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices.Methods: Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from providers and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients (n = 2,192) who received the PRAPARE as a standard of care at three of the center’s clinics (Adult Medicine, Family Medicine, and Pediatrics) were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. We used HEIF domains to inform a directed content analysis.Results: Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple levels (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach.Conclusion: Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care. Our findings highlight the dynamic relationship between barriers and facilitators to implementation at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

scholarly journals Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e026433 ◽  
Author(s):  
Catherine Hudon ◽  
Maud-Christine Chouinard ◽  
Kris Aubrey-Bassler ◽  
Frederick Burge ◽  
Shelley Doucet ◽  
...  
Keyword(s):  
Primary Care ◽  
Case Management ◽  
Healthcare Services ◽  
Realist Evaluation ◽  
Care Needs ◽  
Frequent Users ◽  
Primary Care Clinics ◽  
Healthcare Needs ◽  
Facilitators And Barriers ◽  
The Individual

IntroductionSignificant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada.Methods and analysisWe will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method.Ethics and disseminationThis study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.

scholarly journals Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022594 ◽  
Author(s):  
Yao Liu ◽  
Nicholas J Zupan ◽  
Rebecca Swearingen ◽  
Nora Jacobson ◽  
Julia N Carlson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Referral Process ◽  
Provider Education ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Eye Screening ◽  
Diabetic Eye Screening

ObjectiveTeleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. We sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use.DesignWe conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use. The Chronic Care Model was used as a framework for the development of the interview guide and for categorising implementation strategies to increase teleophthalmology use.SettingA rural, US multipayer primary care clinic with an established teleophthalmology programme for diabetic eye screening.ParticipantsWe conducted interviews with 29 participants (20 patients with diabetes and 9 PCPs).ResultsMajor patient barriers to teleophthalmology use included being unfamiliar with teleophthalmology, misconceptions about diabetic eye screening and logistical challenges. Major patient facilitators included a recommendation from the patient’s PCP and factors related to convenience. Major PCP barriers to referring patients for teleophthalmology included difficulty identifying when patients are due for diabetic eye screening and being unfamiliar with teleophthalmology. Major PCP facilitators included the ease of the referral process and the communication of screening results. Based on our results, we developed a model that maps where these key patient and PCP barriers occur in the teleophthalmology referral process. Patients and PCPs also identified implementation strategies to directly address barriers and facilitators to teleophthalmology use.ConclusionsPatients and PCPs have limited familiarity with teleophthalmology for diabetic eye screening. PCPs were expected to initiate teleophthalmology referrals, but reported significant difficulty identifying when patients are due for diabetic eye screening. System-based implementation strategies primarily targeting PCP barriers in conjunction with improved patient and provider education may increase teleophthalmology use in rural, US multipayer primary care clinics.

scholarly journals Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Connor Drake ◽  
Heather Batchelder ◽  
Tyler Lian ◽  
Meagan Cannady ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Health Equity ◽  
Social Needs ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Acceptability ◽  
Implementation Framework

Abstract Background Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients’ health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. Methods Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. Results Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. Conclusion Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

Spectrum of liver disease in hepatitis C patients presenting to primary care clinics

2001 ◽  
Vol 120 (5) ◽  
pp. A366-A366
Author(s):  
T SHEHAB ◽  
M ORREGO ◽  
A LOK
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Hepatitis C ◽  
Primary Care Clinics
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