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.

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 Addressing medical and social needs to reduce unnecessary health care utilization and costs: a qualitative study

2021 ◽  
Author(s):  
DAVID T LISS ◽  
Adriana Guzman ◽  
Emily Walsh ◽  
Sara Shaunfield ◽  
Tiffany Brown
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Coordination ◽  
Social Needs ◽  
Care Utilization ◽  
Future Research ◽  
Structured Interviews ◽  
Medical Needs

Background: There are few if any well-known approaches to reducing avoidable health care utilization and costs in patients with social needs. This study's objective was to explore the goals, and approaches to organizing and delivering care, of interventions attempting to reduce avoidable resource use by addressing patients' medical and social needs. Methods: Semi-structured interviews were conducted with study investigators about early interventions in the peer-reviewed literature. A template analysis approach was used to review interview transcripts for common themes and create a final code list. Coder dyads separately coded each interview and resolved any discrepancies. Results: Interviews were conducted with 15 investigators of interventions that delivered a variety of health services and addressed several individual social needs. Participants frequently described their overall goal as meeting patients' diverse needs to prevent unnecessary acute care utilization. Reported approaches to addressing medical needs included assistance with receipt of primary care and care coordination across settings. Social needs were described as tightly linked with medical needs; addressing social support and housing were perceived as distinct from addressing other social needs. Participants described their overall approach to meeting patients' needs in terms of establishing connections, partnership, respect, and being adaptable to patients' priorities. Conclusions: Findings shed new light on how to simultaneously address medical and social needs. Opportunities for future research include evaluating different approaches to addressing medical needs (primary care versus care coordination), separately evaluating the impacts of housing or social support, and hiring and training procedures to promote trauma-informed, patient-centered care.

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 Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

2019 ◽  
Author(s):  
Daniel Flynn ◽  
Mary Joyce ◽  
Conall Gillespie ◽  
Mary Kells ◽  
Michaela Swales ◽  
...  
Keyword(s):  
Mixed Methods ◽  
National Level ◽  
Team Leader ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Evidence Based ◽  
Community Settings ◽  
Team Leaders ◽  
Implementation Framework ◽  
Mixed Methods Approach

Abstract Background The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation.Methods A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders ( n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists ( n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.Results Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.Conclusions The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.

Staff Perceptions of Implementation of a Team-Based Model of Patient-Centered Primary Care

2015 ◽  
Vol 4 (4) ◽  
pp. 244-250
Author(s):  
Sherri L LaVela ◽  
Jennifer N Hill
Keyword(s):  
Primary Care ◽  
Team Building ◽  
Organizational Factors ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Optimal Care ◽  
Team Based Care

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

scholarly journals Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Jenerius A. Aminawung ◽  
Tyler D. Harvey ◽  
Jerry Smart ◽  
Joseph Calderon ◽  
Anna Steiner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Care Clinic ◽  
Social Needs ◽  
Care Clinic ◽  
Primary Care Teams ◽  
Improve Health

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

scholarly journals Awareness of ADHD in primary care: stakeholder perspectives

2019 ◽  
Author(s):  
Blandine French ◽  
Elvira Perez-Vallejos ◽  
Kapil Sayal ◽  
David Daley
Keyword(s):  
Primary Care ◽  
Future Research ◽  
Care Pathways ◽  
Clear Understanding ◽  
Structured Interviews ◽  
Multiple Stakeholders ◽  
Adhd Assessment ◽  
Hyperactivity Disorder ◽  
Stakeholder Perspectives ◽  
Key Issues

Abstract Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5), patients (adults with ADHD n=5) and parents (n=5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

scholarly journals Physiotherapy managers’ views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study

2017 ◽  
Vol 19 (01) ◽  
pp. 77-87 ◽  
Author(s):  
Helen P. French ◽  
Rose Galvin
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Service Provision ◽  
Urban Areas ◽  
Resource Constraints ◽  
Early Stage ◽  
Future Research ◽  
Structured Interviews ◽  
Physiotherapy Service ◽  
Stage Of Development

Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers’ experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed. Results Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy. Conclusions A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

scholarly journals Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework

2020 ◽  
Vol 9 (3) ◽  
pp. 814 ◽  
Author(s):  
Cathelijne H. van der Wouden ◽  
Ellen Paasman ◽  
Martina Teichert ◽  
Matty R. Crone ◽  
Henk-Jan Guchelaar ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Clinical Utility ◽  
Structured Interview ◽  
Routine Practice ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Beneficial Effects ◽  
Panel Testing ◽  
Tailored Implementation

Despite overcoming many implementation barriers, pharmacogenomic (PGx) panel-testing is not routine practice in the Netherlands. Therefore, we aim to study pharmacists’ perceived enablers and barriers for PGx panel-testing among pharmacists participating in a PGx implementation study. Here, pharmacists identify primary care patients, initiating one of 39 drugs with a Dutch Pharmacogenetic Working Group (DPWG) recommendation and subsequently utilizing the results of a 12 gene PGx panel test to guide dose and drug selection. Pharmacists were invited for a general survey and a semi-structured interview based on the Tailored Implementation for Chronic Diseases (TICD) framework, aiming to identify implementation enablers and barriers, if they had managed at least two patients with actionable PGx results. In total, 15 semi-structured interviews were performed before saturation point was reached. Of these, five barrier themes emerged: (1) unclear procedures, (2) undetermined reimbursement for PGx test and consult, (3) insufficient evidence of clinical utility for PGx panel-testing, (4) infrastructure inefficiencies, and (5) HCP PGx knowledge and awareness; and two enabler themes: (1) pharmacist perceived role in delivering PGx, and (2) believed clinical utility of PGx. Despite a strong belief in the beneficial effects of PGx, pharmacists’ barriers remain, an these hinder implementation in primary care.

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

2021 ◽  
pp. 108482232110028
Author(s):  
Angela M. Gerolamo ◽  
Monika Pogorzelska-Maziarz ◽  
Alexzandra Gentsch ◽  
Ashley Traczuk ◽  
TingAnn Hsiao ◽  
...  
Keyword(s):  
Behavioral Health ◽  
Integrated Care ◽  
Public Health Problem ◽  
Social Needs ◽  
Home Healthcare ◽  
Health Needs ◽  
Future Research ◽  
Structured Interviews ◽  
Care Models ◽  
Integrated Care Models

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

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