Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

IntroductionIntegrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa.MethodologyWe will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study.Ethics and dissemination planEthical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals.

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Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

BMC Family Practice ◽

10.1186/s12875-021-01406-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kelley Kilpatrick ◽

Eric Tchouaket ◽

Nicolas Fernandez ◽

Mira Jabbour ◽

Carl-Ardy Dubois ◽

...

Keyword(s):

Urban Area ◽

Nurse Practitioners ◽

Primary Healthcare ◽

Organizational Characteristics ◽

Role Clarity ◽

Team Processes ◽

Healthcare Teams ◽

Outcomes Of Care ◽

Patient Reported ◽

Team Functioning

Abstract Background Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. Methods A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. Results Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. Conclusions This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

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Barriers and facilitators to the integration of mental health services into primary healthcare: a qualitative study among Ugandan primary care providers using the COM-B framework

BMC Health Services Research ◽

10.1186/s12913-018-3684-7 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Edith K. Wakida ◽

Celestino Obua ◽

Godfrey Z. Rukundo ◽

Samuel Maling ◽

Zohray M. Talib ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Qualitative Study ◽

Health Services ◽

Primary Healthcare ◽

Primary Care Providers ◽

Barriers And Facilitators ◽

Care Providers

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Barriers and facilitators of completing the steps in the PMTCT cascade at Midwife Obstetric Units in Gauteng - Healthcare Provider and Patient's views

10.21203/rs.3.rs-24824/v1 ◽

2020 ◽

Author(s):

Constance Mongwenyana ◽

Nelly Jinga ◽

Given Mohomi ◽

Sindisiwe Buthelezi ◽

Nancy Nkopane ◽

...

Keyword(s):

Primary Healthcare ◽

Healthcare Providers ◽

Turnaround Time ◽

Postpartum Care ◽

Barriers And Facilitators ◽

Hiv Status ◽

Hiv Diagnosis ◽

Hiv Test ◽

Increase Risk ◽

Pmtct Cascade

Abstract Background: The implementation of Prevention of Mother to Child Transmission (PMTCT) programmes at midwifes obstetric units (MOU) involves the confirmation of HIV diagnosis during labour, early infant HIV diagnosis (EID), initiation/continuation of antiretroviral therapy (ART) for mother and baby as appropriate and counselling for postpartum care. Objectives: The aim of this study was to explore the barriers and facilitators to completing the steps in the PMTCT cascade at MOUs as defined by healthcare providers and recently postpartum women. Methods: We conducted 10 in-depth interviews with healthcare providers, and 24 HIV positive and HIV negative women at the four MOUs and Primary Healthcare Centres (PHC’s) in Gauteng South Africa (SA). Results: The implementation of PMTCT at MOU is impeded by maternal denial of HIV status (both new diagnoses and ANC diagnoses). Challenges with acceptance and disclosure of HIV status were thought to compromise patient commitment to EID tests and postpartum adherence to infant ART. Newly diagnosed (during labour) patients have limited time to process new HIV diagnosis and clinics have limited nurse/counsellor capacity for further one on one counselling. Additional challenges include communication challenges with foreign women and turnaround time for birth HIV tests. Results are often not available at postnatal visit and unclear processes for referral to Primary Healthcare Centre (PHC) for postpartum care increase risk of postpartum loss to follow up. Conclusion: We need to strengthen MOU capacity to prepare women for postpartum PMTCT requirements and facilitate access to EID results. Patient referral processes, including communication of infant HIV test results to the referral PHC, needs improvement.

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Effectiveness of a psychoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity: study protocol for a randomized, controlled trial

BMC Health Services Research ◽

10.1186/s12913-019-4198-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Rocío Casañas ◽

Jaume Martín Royo ◽

Maria Isabel Fernandez-San-Martín ◽

Antonia Raya Tena ◽

Jacobo Mendioroz ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Study Protocol ◽

Primary Healthcare ◽

Group Intervention ◽

Controlled Trial ◽

Randomized Controlled

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Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9

BMC Public Health ◽

10.1186/s12889-019-7569-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Sara Farnbach ◽

◽

Graham Gee ◽

Anne-Marie Eades ◽

John Robert Evans ◽

...

Keyword(s):

Indigenous People ◽

Process Evaluation ◽

Study Protocol ◽

Primary Healthcare ◽

Screening Tool ◽

Trial Registration ◽

Free Text ◽

Healthcare Staff ◽

Clinical Trial Registry ◽

Culturally Adapted

Abstract Background The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Methods Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Results Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Conclusion Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Trial registration Australian New Zealand Clinical Trial Registry ANZCTR12614000705684, 03/07/2014.

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