scholarly journals The Tennessee Medicaid medication therapy management program: early stage contextual factors and implementation outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kenneth C. Hohmeier ◽  
Chelsea Renfro ◽  
Kea Turner ◽  
Parin Patel ◽  
Estrella Ndrianasy ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Early Stage ◽  
Implementation Strategies ◽  
Medication Therapy Management ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Pilot Program ◽  
Individual Level ◽  
Medication Therapy ◽  
Implementation Outcomes

Abstract Background First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient’s medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. Methods The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid’s (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. Results The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (μ = 16.22, SD = 0.28), appropriate (μ = 15.33, SD = 0.03), and feasible (μ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. Conclusion The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid’s MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

scholarly journals The U.S. State of Tennessee's Medicaid Medication Therapy Management Program: Early Stage Contextual Factors and Implementation Outcomes

2021 ◽  
Author(s):  
Kenneth C Hohmeier ◽  
Chelsea Renfro ◽  
Kea Turner ◽  
Parin Patel ◽  
Estrella Ndrianasy ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Early Stage ◽  
Implementation Strategies ◽  
Medication Therapy Management ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Pilot Program ◽  
Individual Level ◽  
Medication Therapy ◽  
Implementation Outcomes

Abstract Background First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient’s medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. Methods The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid’s (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. Results The total reach of the program through June 2020 was 2,033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (µ = 16.22, SD = 0.28), appropriate (µ = 15.33, SD = 0.03), and feasible (µ = 14.72, SD = 0.46) (Table 4). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α=0.91; acceptability, α=0.96; appropriateness, α=0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. Conclusion The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid’s MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

scholarly journals Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
J. Edward Murrell ◽  
Janell L. Pisegna ◽  
Lisa A. Juckett
Keyword(s):  
Occupational Therapy ◽  
Scoping Review ◽  
Stroke Rehabilitation ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Stroke Care ◽  
Stroke Survivor ◽  
Educational Outreach ◽  
Evidence Based ◽  
Implementation Outcomes

Abstract Background Stroke survivors often encounter occupational therapy practitioners in rehabilitation practice settings. Occupational therapy researchers have recently begun to examine the implementation strategies that promote the use of evidence-based occupational therapy practices in stroke rehabilitation; however, the heterogeneity in how occupational therapy research is reported has led to confusion about the types of implementation strategies used in occupational therapy and their association with implementation outcomes. This review presents these strategies and corresponding outcomes using uniform language and identifies the extent to which strategy selection has been guided by theories, models, and frameworks (TMFs). Methods A scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies, outcomes, and TMFs in the stroke rehabilitation field. Five electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting the inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer to achieve consensus. The 73-item Expert Recommendations for Implementing Change (ERIC) implementation strategy taxonomy guided the synthesis of implementation strategies. The Implementation Outcomes Framework guided the analysis of measured outcomes. Results The initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were described in the included studies. The most used implementation strategies were “distribute educational materials” (n = 11), “assess for readiness and identify barriers and facilitators” (n = 11), and “conduct educational outreach visits” (n = 10). “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings supporting the effectiveness of their implementation strategy or strategies; eleven reported inconclusive findings, and four found that their strategies did not lead to improved implementation outcomes. In twelve studies, at least partially beneficial outcomes were reported, corresponding with researchers using TMFs to guide implementation strategies. Conclusions This scoping review synthesized implementation strategies and outcomes that have been examined in occupational therapy and stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the use of evidence-based practices in routine stroke care and describe those strategies, as well as associated outcomes, using uniform nomenclature. Doing so could advance the occupational therapy field’s ability to draw conclusions about effective implementation strategies across diverse practice settings.

scholarly journals Implementation Strategies and Outcomes for Occupational Therapy in Adult Stroke Rehabilitation: A Scoping Review

2021 ◽  
Author(s):  
J. Edward Murrell ◽  
Janell L. Pisegna ◽  
Lisa A. Juckett
Keyword(s):  
Occupational Therapy ◽  
Scoping Review ◽  
Stroke Rehabilitation ◽  
Implementation Strategies ◽  
Stroke Care ◽  
Barriers And Facilitators ◽  
Educational Outreach ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Implementation Outcomes

Abstract BackgroundEvery year, millions of people worldwide experience a stroke. Given the degree of physical, cognitive, visual, and behavioral impairments post-stroke, stroke survivors often encounter occupational therapy practitioners in the rehabilitation practice settings. Although evidence-based occupational therapy practices have been well-established in the stroke literature, it remains unclear what strategies have been used to promote these practices' effective implementation in the real-world context. The present review identifies these strategies and the extent to which researchers have measured implementation outcomes. MethodsA scoping review protocol was developed to assess the breadth and depth of occupational therapy literature examining implementation strategies and outcomes in the stroke rehabilitation field. Four electronic databases and two peer-reviewed implementation science journals were searched to identify studies meeting inclusion criteria. Two reviewers applied the inclusion parameters and consulted with a third reviewer, as needed, to achieve consensus. The Expert Change guided synthesis of review findings for Implementing Change project and the Implementation Outcomes Framework. ResultsThe initial search yielded 1219 studies, and 26 were included in the final review. A total of 48 out of 73 discrete implementation strategies were deployed in the included studies. The most used implementation strategies were “distribute educational materials,” “assess for readiness and identify barriers and facilitators,” and “conduct educational outreach visits.” “Adoption” was the most frequently measured implementation outcome, while “cost” was not measured in any included studies. Eleven studies reported findings to support the effectiveness of their implementation strategy or strategies; eleven studies reported inconclusive findings, and four studies found that their strategies did not lead to improved implementation outcomes. ConclusionsThis scoping review identified occupational therapy literature examining implementation strategies and outcomes in the context of stroke rehabilitation. With the growth of the stroke survivor population, the occupational therapy profession must identify effective strategies that promote the uptake of evidence-based practices into routine stroke care. Occupational therapy researchers and practitioners are encouraged to collaborate to develop and deploy implementation strategies responsive to known implementation barriers and facilitators in the stroke rehabilitation setting.

scholarly journals Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Aaron R. Lyon ◽  
Michael D. Pullmann ◽  
Shannon Dorsey ◽  
Carol Levin ◽  
Larissa M. Gaias ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Behavior Change ◽  
Implementation Strategy ◽  
Youth Mental Health ◽  
Successful Implementation ◽  
Individual Level ◽  
Implementation Outcomes ◽  
Cluster Randomized

Abstract Background More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services—schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes. Methods Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4–6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness. Discussion This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS—a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation—to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting. Trial registration ClinicalTrials.gov registration number NCT04451161. Registered on June 30, 2020.

scholarly journals Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Promotion ◽  
Scale Up ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Physical Activity Program ◽  
Evidence Based ◽  
Church Staff ◽  
Faith Based ◽  
Activity Program

Abstract Background: Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.Methods: We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results: Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support.Conclusions: While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.

scholarly journals Engaging Stakeholders to Retrospectively Discern Implementation Strategies in Support of Program Evaluation

2021 ◽  
Author(s):  
Jacob T. Painter ◽  
Rebecca A. Raciborski ◽  
Monica M. Matthieu ◽  
Ciara Oliver ◽  
David A. Adkins ◽  
...  
Keyword(s):  
Program Evaluation ◽  
Quality Improvement ◽  
Data Collection ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based ◽  
Main Body ◽  
Strategy Selection ◽  
Evidence Based Practices

Abstract Background: Successful implementation of evidence-based practices is key to healthcare quality improvement. However, it depends on appropriate selection of implementation strategies, the techniques that improve practice adoption or sustainment. When studying implementation of an evidence-based practice as part of a program evaluation, implementation scientists confront a challenge: the timing of strategy selection rarely aligns with the establishment of data collection protocols. Indeed, the exact implementation strategies used by an organization during a quality improvement initiative may be determined during implementation. Nevertheless, discernment of strategies is necessary to accurately estimate implementation effect and cost because this information can support decision making for sustainment, guide replication efforts, and inform the choice of implementation strategies for other evidence-based practices. Main body: We propose an iterative, stakeholder engaged process to discern implementation strategies when strategy choice was not made before data collection began. Stakeholders are centered in the process, providing a list of current and potential implementation activities. These activities are then mapped by an implementation science expert to an established taxonomy of implementation strategies. The mapping is then presented back to stakeholders for member checking and refinement. The final list can be used to survey those engaged in implementation activities in a language they are familiar with. A case study using this process is provided. Conclusion: It is challenging to estimate implementation effort when implementation strategy selection is disconnected from the data collection process. In these cases, a stakeholder-informed process to retrospectively identify implementation strategies by classifying activities performed using an established implementation strategy taxonomy provides the necessary information.

scholarly journals Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review

2019 ◽  
Vol 7 (7) ◽  
pp. 76 ◽  
Author(s):  
Blackshaw ◽  
Chhour ◽  
Stepto ◽  
Lim
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Evidence Based ◽  
Ovary Syndrome ◽  
Lifestyle Management ◽  
Increased Risk ◽  
Evidence Based Guideline

Polycystic ovary syndrome (PCOS) is a complex condition that involves metabolic, psychological and reproductive complications. Insulin resistance underlies much of the pathophysiology and symptomatology of the condition and contributes to long term complications including cardiovascular disease and diabetes. Women with PCOS are at increased risk of obesity which further compounds metabolic, reproductive and psychological risks. Lifestyle interventions including diet, exercise and behavioural management have been shown to improve PCOS presentations across the reproductive, metabolic and psychological spectrum and are recommended as first line treatment for any presentation of PCOS in women with excess weight by the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. However, there is a paucity of research on the implementation lifestyle management in women with PCOS by healthcare providers. Limited existing evidence indicates lifestyle management is not consistently provided and not meeting the needs of the patients. In this review, barriers and facilitators to the implementation of evidence-based lifestyle management in reference to PCOS are discussed in the context of a federally-funded health system. This review highlights the need for targeted research on the knowledge and practice of PCOS healthcare providers to best inform implementation strategies for the translation of the PCOS guidelines on lifestyle management in PCOS.

scholarly journals Engaging stakeholders to identify implementation strategies for a faith-based physical activity program

2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Promotion ◽  
Scale Up ◽  
Implementation Strategies ◽  
Health Behavior Change ◽  
Barriers And Facilitators ◽  
Physical Activity Program ◽  
Evidence Based ◽  
Faith Based ◽  
Activity Program

Abstract Background Stakeholder engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community stakeholders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action ( Fe en Acción ) is an evidence-based promotora -led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women. Methods We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of a Faith in Action and to identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results Stakeholders described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of PA; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support. Conclusions While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.

scholarly journals Engaging stakeholders to identify implementation strategies for a faith-based physical activity program

2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Promotion ◽  
Scale Up ◽  
Implementation Strategies ◽  
Health Behavior Change ◽  
Barriers And Facilitators ◽  
Physical Activity Program ◽  
Evidence Based ◽  
Faith Based ◽  
Activity Program

Abstract Background: Stakeholder engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community stakeholders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action ( Fe en Acción ) is an evidence-based promotora -led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.Methods: We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of a Faith in Action and to identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach.Results: Stakeholders described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of PA; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support.Conclusions: While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.

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