scholarly journals Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046914
Author(s):  
Patrice Ngangue ◽  
Judith Belle Brown ◽  
Catherine Forgues ◽  
Mohamed Ali Ag Ahmed ◽  
Tu Ngoc Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Structural Characteristics ◽  
Interdisciplinary Teams ◽  
Relative Advantage ◽  
Multiple Chronic Conditions ◽  
Design Quality ◽  
Patient Centred Care ◽  
Data Coding ◽  
Inner Setting

ObjectiveA patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.DesignA descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.SettingThe study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.ParticipantsTen managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.ResultsMany key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.ConclusionThis study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.Trial registration numberNCT02789800.

scholarly journals Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study

2020 ◽  
Vol 35 (12) ◽  
pp. 3556-3563
Author(s):  
Ariel R. Green ◽  
Cynthia M. Boyd ◽  
Kathy S. Gleason ◽  
Leslie Wright ◽  
Courtney R. Kraus ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions

Factors Affecting Primary Care Physician Decision-Making for Patients with Complex Multimorbidity: A Qualitative Study

2021 ◽  
Author(s):  
Linnaea Schuttner ◽  
Stacey Hockett Sherlock ◽  
Carol Simons ◽  
James D Ralston ◽  
Ann-Marie Rosland ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Multiple Chronic Conditions ◽  
Care Planning ◽  
Health Administration ◽  
Factors Affecting ◽  
Care Plans ◽  
Physician Decision Making ◽  
Complex Patients

Abstract Background Patients with multiple chronic conditions (multimorbidity) and additional psychosocial complexity are at higher risk of adverse outcomes. Establishing treatment or care plans for these patients must account for their disease interactions, finite self-management abilities, and even conflicting treatment recommendations from clinical practice guidelines. Despite existing insight into how primary care physicians (PCPs) approach care decisions for their patients in general, less is known about how PCPs make care planning decisions for more complex populations. We therefore sought to describe factors affecting physician decision-making when care planning for complex patients with multimorbidity Methods This was a qualitative study involving semi-structured telephone interviews with PCPs working ≥ 40% time in a team-based, patient-centered medical home setting in the integrated healthcare system of the U.S. Department of Veterans Affairs, the Veterans Health Administration (VHA). Interviews were conducted from April to July, 2020. Content was analyzed with inductive thematic analysis. Results 25 physicians participated in interviews; most were MDs (n = 21) and worked in hospital-affiliated clinics (n = 14) across all regions of the VHA’s national clinic network. Seven major themes emerged for factors affecting decision-making for complex patients with multimorbidity. Physicians described collaborating on care plans with their care team; considering impacts from patient access and resources on care plans; the boundaries provided by organizational structures; tailoring decisions to individual patients; making decisions in keeping with an underlying internal style or habit; working towards an overarching goal for care; and impacts on decisions from their own emotions and relationship with patient. Conclusions PCPs described individual, relationship-based, and environmental factors affecting their care planning for high-risk and complex patients with multimorbidity in the VHA. Findings offer useful strategies employed by physicians to effectively conduct care planning for complex patients, such as delegation of follow-up within care teams, optimizing visit time vs frequency, and deliberate investment in patient relationship building to gain buy-in to care plans.

scholarly journals Health care workers’ experiences with implementation of “screen and treat” for cervical cancer prevention in Malawi: A qualitative study

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Corrina Moucheraud ◽  
Paul Kawale ◽  
Savel Kafwafwa ◽  
Roshan Bastani ◽  
Risa M. Hoffman
Keyword(s):  
Cervical Cancer ◽  
Low Income ◽  
Health Workers ◽  
Structural Characteristics ◽  
Individual Characteristics ◽  
Relative Advantage ◽  
Implementation Climate ◽  
Effective Prevention ◽  
The Government ◽  
Inner Setting

Abstract Background Cervical cancer remains a major cause of mortality and morbidity in low- and middle-income countries, despite the availability of effective prevention approaches. “Screen and treat” (a single-visit strategy to identify and remove abnormal cervical cells) is the recommended secondary prevention approach in low-resource settings, but there has been relatively scarce robust implementation science evidence on barriers and facilitators to providing “screen and treat” from the provider perspective, or about thermocoagulation as a lesion removal technique. Methods Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted interviews with ten experienced “screen and treat” providers in Malawi. We asked questions based on the CFIR Guide, used the CFIR Guide codebook for a descriptive analysis in NVivo, and added recommended modifications for studies in low-income settings. Results Seven CFIR constructs were identified as positively influencing implementation, and six as negatively influencing implementation. The two strong positive influences were the relative advantage of thermocoagulation versus cryotherapy (Innovation Characteristics) and respondents’ knowledge and beliefs about providing “screen and treat” (Individual Characteristics). The two strong negative influences were the availability of ongoing refresher trainings to stay up-to-date on skills (Inner Setting, Implementation Climate) and insufficient resources (staffing, infrastructure, supplies) to provide “screen and treat” to all women who need it (Inner Setting, Readiness for Implementation). Weak positive factors included perceived scalability and access to knowledge/information, as well as compatibility, leadership engagement, and team characteristics, but these latter three were mixed in valence. Weak negative influences were structural characteristics and donor priorities; and mixed but weakly negative influences were relative priority and engaging clients. Cross-cutting themes included the importance of broad buy-in (including different cadres of health workers and leadership at the facility and in the government) and the opportunities and challenges of offering integrated care (screening plus other services). Conclusions Although “screen and treat” is viewed as effective and important, many implementation barriers remain. Our findings suggest that implementation strategies will need to be multi-level, include a diverse set of stakeholders, and explicitly address both screening and treatment.

scholarly journals INTERDISCIPLINARY CURRICULUM FOR THE CARE OF OLDER ADULTS: CREATING NETWORKS OF COLLABORATIVE LEARNERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S294-S294
Author(s):  
Pamela Yankeelov ◽  
Anna Faul ◽  
Joe D'Ambrosio ◽  
and Samantha G Cotton
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Self Efficacy ◽  
Interprofessional Education ◽  
Evaluation Model ◽  
Interdisciplinary Approach ◽  
Knowledge Score ◽  
Interdisciplinary Teams ◽  
Multiple Chronic Conditions ◽  
Patient Centered

Abstract Serving older adults with multiple chronic conditions and variable social, emotional, or physical support effectively within the primary care setting requires an interdisciplinary approach to care. Our GWEP program has developed an interprofessional education center that educates and prepares students and professionals from social work, medicine, nursing, dentistry, pharmacy, and community health partners, to function within a transformed integrated patient-centered geriatric primary care and community-based service delivery system. Learners from multiple disciplines attend a face-to-face Interdisciplinary Case Management Experience (ICME) session lasting 2.5 hours. Sessions include learners from each discipline and, if possible, at least one community practitioner in small groups of 6–8 learners at each table facilitated by 1 faculty member. Approximately 1,200 learners have received the curriculum. To evaluate the program, Kirkpatrick’s Training Evaluation Model was used to determine if learners were satisfied with the content, skilled, and confident in their abilities to utilize the curriculum. Learners completed a satisfaction survey after taking each module, along with an interdisciplinary geriatric care knowledge test and self-efficacy test before and after taking each module to measure learning outcomes. Analysis showed that learners, irrespective of discipline, were satisfied with the program. All disciplines showed a significant increase from pre- to posttest for all 5 online modules achieving a mean post-knowledge score of 85% across all 5 online training modules. All disciplines experienced significant differences in their self-efficacy with working on interdisciplinary teams from pre to post ICME. Implications for future interprofessional curriculum will be discussed.

scholarly journals Fostering an Understanding of Interprofessional Approaches to Geriatrics

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 444-444
Author(s):  
Anna Faul ◽  
Pamela Yankeelov ◽  
Sam Cotton
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Social Work ◽  
Healthcare System ◽  
Evaluation Model ◽  
Interdisciplinary Approach ◽  
Interdisciplinary Teams ◽  
Multiple Chronic Conditions ◽  
Social Emotional ◽  
Physical Support

Abstract Serving older adults with multiple chronic conditions and variable social, emotional, or physical support effectively within the primary care setting requires an interdisciplinary approach to care, together with the integration of novel approaches to care coordination (Dorr et al, 2006). The purpose of this study is to examine the use of interprofessional learning models to educate a healthcare workforce that meets the needs of older adults by integrating geriatrics with primary care, maximizing patient engagement, and transforming the healthcare system. Specifically, the targeted learners for this curriculum were from a healthcare system in Belize that had no previous specialty training in interprofessional geriatrics care. The 4-day training took place in Belize with an interprofessional group of healthcare professionals that included social work, nursing and medicine. 100 learners participated in the trainings and including participants from social work, nursing and medicine. To evaluate the program, Kirkpatrick’s Training Evaluation Model (Kirkpatrick & Kirkpatrick, 2005) was used to determine if learners were satisfied with the content (reaction), skilled (knowledge & skill) and confident in their abilities to utilize the curriculum (application of knowledge & skills). Analysis showed that learners, irrespective of discipline, were satisfied with the program. All disciplines experienced significant differences in their self-efficacy with working on interdisciplinary teams from pre to post assessments. Specifically, there was an increase in learner’s confidence related to learning to work together cooperatively with other professions and how to communicate effectively with other members of an interprofessional team. Implications for future interprofessional curriculum will be discussed.

scholarly journals Scaling Mhealth in Africa: Lessons From The Implementation of The MomConnect Program

2020 ◽  
Author(s):  
obidimma Ezezika ◽  
Chareena Varatharajan ◽  
Shanelle Racine
Keyword(s):  
Qualitative Study ◽  
Mobile Health ◽  
A Priori ◽  
Barriers And Facilitators ◽  
Strategic Partnership ◽  
Implementation Climate ◽  
Design Quality ◽  
Middle Income ◽  
Inner Setting ◽  
Access To Knowledge

Abstract Background: Mobile health programs have strengthened health systems in Low- and Middle-Income Countries (LMICs) to achieve health-related goals. MomConnect, a mobile health program in South Africa targeted at improving antenatal and maternal health, has scaled rapidly since its creation in 2014. This study explores the barriers and facilitators to the implementation and scaling of the MomConnect program and the applicable lessons for the scaling of mhealth programs in the region. Methods: We conducted a qualitative study with key project partners and leaders who worked on the MomConnect project. Interviewees were initially identified through a literature review, publications, and evaluations of the project. Interviewees included individuals serving in implementation oversight, champions, partners, funders and frontline implementer roles. The Consolidated Framework for Implementation Research (CFIR) informed the a priori codes for directed content analysis. In total, 15 key stakeholders were interviewed. Interviewees were asked to identify any barriers or facilitators to the implementation of MomConnect and how they would overcome those barriers and strengthen the facilitators. Results: This qualitative study identified multiple barriers and facilitators to implementation within our domain of CFIR: characteristics of the intervention (complexity, trialability, evidence strength & quality, cost, design quality & packaging, adaptability), inner setting (available resources, compatibility, implementation climate, access to knowledge & information), outer setting (cosmopolitanism, external policy & incentives) and process (planning, external change agents, champions, formally appointed internal implementation leaders). Overarching thematic areas spanning the barriers and facilitators included: (1) strategic partnership and coordination across multiple sectors, (2) innovation costs and funding, (3) operationalization of the innovation to local and national settings and (4) mhealth policy and legislation frameworks.Conclusion: The barriers and facilitators identified under the CFIR domains can be used to build knowledge on how to strengthen mhealth programs in Africa. The continued success of the MomConnect program will require overcoming identified barriers and capitalizing on known facilitators. These findings can serve as a foundation for the effective design and scale of mhealth interventions in the region.

GPS' PERCEPTION OF THE PATIENT ORIENTED INTERVENTIONS AS KEY ELEMENTS OF PATIENT CENTRED CARE FOR PEOPLE WITH MULTIMORBIDITY.pdf

2018 ◽  
Vol 28 (2) ◽  
pp. 561-565
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva
Keyword(s):  
Chronic Conditions ◽  
Patient Centered Care ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Positive Health ◽  
Patient Centered ◽  
Effective Response ◽  
Patient Centred Care ◽  
Centered Care ◽  
Health Related

Background: Patients with multimorbidity represent a significant portion of the primary healthcare population. For healthcare providers, managing patients with multiple chronic conditions represents a challenge given the complexity and the intensity of interventions. Integrated and patient-centered care is considered an effective response to the needs of people who suffer from multiple chronic conditions. According to the literature providing patient-centered care is one of the most important interventions in terms of positive health-related outcomes for patients with multimorbidity.Aim: The aim of the study is to evaluate the GPs’ perception of patient oriented interventions as key elements of patient centred care for patients with multimorbidity.Material and methods: A cross-sectional pilot study was conducted among randomly selected 73 GPs. A direct individual anonymous survey was performed to explore the opinion of respondents about the importance of two patient-oriented interventions, each one including specific elements of patient-centered care for patients with multimorbidity. The tool was developed as a result of the scoping review performed by Smith et al. (2012;2016). A 5-point Likert scale (0-not at all, 1-little, 2-rather, 3-much, 4-very strong) was used. The data were analysed using descriptive statistics. In processing the data, the software product for statistical analyses - SPSS version 17 was performed for Windows XP.Results: Our results show that both categories - providing patient-oriented approach and self-management support interventions were highly accessed by the respondents. The most frequent categories of interventions identified in our study were Creating individualized and adapted interventions, Performing regular contacts and Reinforcing adherence. Less frequently reported elements such as Considering relatives’ needs and Developing self-management plan are still underestimated by the Bulgarian GPs.Conclusions: The acceptance and understanding of innovative patient-centered interventions adapted to patients with multimorbidity could be accepted as a good indicator for improving health-related outcomes and care for patients with multiple chronic conditions.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

scholarly journals Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam

2021 ◽  
Author(s):  
Noah A. Schuster ◽  
Sascha de Breij ◽  
Laura A. Schaap ◽  
Natasja M. van Schoor ◽  
Mike J. L. Peters ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medical Care ◽  
Help Seeking ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Hospital Outpatient ◽  
Longitudinal Aging Study Amsterdam ◽  
Aging Study ◽  
Longitudinal Aging Study

Abstract Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.

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