scholarly journals A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260951
Author(s):  
Sarah M. Khayyat ◽  
Zachariah Nazar ◽  
Hamde Nazar
Keyword(s):  
Community Pharmacy ◽  
Implementation Process ◽  
Evidence Base ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Intervention Fidelity ◽  
Intervention Implementation ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Transfer Of Care

Background Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. Methods The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. Results Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. Conclusions This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Barriers And Facilitators ◽  
Rural India ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

scholarly journals The anticipated and the lived experience of home and in-centre haemodialysis: Is there a disconnect?

2016 ◽  
Vol 22 (12) ◽  
pp. 1524-1533 ◽  
Author(s):  
Rabiya Majeed-Ariss ◽  
A Jayanti ◽  
T Schulz ◽  
A Wearden ◽  
S Mitra
Keyword(s):  
Qualitative Study ◽  
Lived Experience ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Patient Factors ◽  
Home Haemodialysis ◽  
Advantages And Disadvantages ◽  
Patients Experience

This qualitative study aimed to explore home haemodialysis and in-centre haemodialysis patients’ experience, to illuminate barriers and facilitators in the uptake and maintenance of home haemodialysis. Thirty-two semi-structured interviews with patients receiving home haemodialysis or in-centre haemodialysis were analysed using framework analysis. Four themes emerged: ‘perceptions of self’; ‘impact of haemodialysis on family’; ‘perceived advantages and disadvantages of home haemodialysis and in-centre haemodialysis’ and ‘practical issues and negotiating haemodialysis’. The lived experience of home haemodialysis was in contrast to the lived experience of in-centre haemodialysis and to the anticipated experience of home haemodialysis, highlighting patient factors that contributed to under-usage of home haemodialysis.

scholarly journals Implementation evaluation of staff support and wellbeing programmes at an academic health science centre during COVID-19: study protocol

2021 ◽  
Author(s):  
Barbora Krausova ◽  
Sam Nishanth Gnanapragasam ◽  
Len Demetriou ◽  
Alison Beck ◽  
Renata Pires-Yfantouda ◽  
...  
Keyword(s):  
Study Participant ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Evidence Base ◽  
Health Science ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Staff Support ◽  
Academic Health ◽  
Staff Wellbeing

Abstract Background Evidence from previous pandemics as well as early evidence from COVID-19 suggest risk of adverse mental health and wellbeing outcomes for healthcare workers. In response to these concerns, healthcare systems and organisations rapidly established staff support and wellbeing programmes. While there is emerging literature related to the effectiveness of such interventions, what is less well understood and evaluated is the evidence base regarding how such programmes are implemented; what supports and hinders their implementation; and how or if they are maintained following the initial acute phase of the pandemic. This study addresses this gap by studying the implementation process of COVID-19-related staff wellbeing programmes in the three UK NHS Trusts that make up one of Europe’s largest academic health sciences centres, King’s Health Partners. Methods We will conduct a prospective, cross-sectional descriptive study using qualitative research methods and non-probability purposive sampling to identify a study participant group representative of the population and implementation activity of interest. We will conduct semi-structured interviews of between 30 minutes and one hour. We will identify theory-driven elements in the dataset using the Consolidated Framework for Implementation Research (barriers and drivers), Exploration, Preparation, Implementation, Sustainment Framework (timeline/chronology/evolution of the implementation and different issues at different times) and Expert Recommendations for Implementing Change (implementation strategies). We will then identify indicators of these constructs within the dataset and report them, as well as their inter-relationships. Discussion Through this study we hope to better understand what factors hindered and enabled the implementation of three inter-linked staff support and wellbeing programmes, and how/to what extent have these programmes been sustained. We will also explore whether implementation science frameworks are applicable and beneficial in conceptualising and understanding crisis driven and rapidly implemented interventions, and in what ways, if any, they need to be adjusted when used in unprecedented circumstances such as the COVID-19 pandemic.

scholarly journals A Qualitative Study Exploring the Barriers and Facilitators Associated with the Implementation of a Closed Loop Medication System in a UK Hospital Trust

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i50-i51
Author(s):  
C L Tolley ◽  
R A Sami ◽  
S P Slight
Keyword(s):  
Health Care ◽  
Closed Loop ◽  
Implementation Process ◽  
Analytical Framework ◽  
Medication Administration ◽  
Barriers And Facilitators ◽  
Electronic Prescribing ◽  
Structured Interviews ◽  
Implementation Team ◽  
Hospital Trust

Abstract Introduction Implementation of novel digital technologies into complex hospital systems, particularly within the United Kingdom’s (UKs) National Health Service, is challenging and can result in delays to the use and evaluation of innovative systems. MedEye is a bedside tool for preventing medication administration errors used as part of a closed-loop medication administration system. Aim The aim of this study was to understand the barriers and facilitators associated with implementing MedEye for the first time in a large UK Teaching Hospital Trust. Methods We used a case study approach and conducted semi-structured interviews (n=9) with key members of the project implementation team from Pharmacy (n=3), Nursing (n=2), commercial system provider(n=2), IT (n=1) and academia (n=1) and 20 hours of field observations. We explored stakeholder’s experiences about the implementation process, barriers and facilitators and any key lessons learnt according to constructs from Sittig and Singh’s Eight Dimension Sociotechnical Model.1 We analysed the data from interviews and observations using the framework approach.2 We firstly familiarised ourselves with the data, coded interviews, guided by our analytical framework, charted and then interpreted the data. All necessary ethical and organisational approvals were obtained. Results We identified themes relating to eight sociotechnical domains. Clinical Content: the format of the medication library and process for ordering medications were different to other European sites that had implemented MedEye, posing challenges for developers. Hardware and Software Computing Infrastructure: the integration of MedEye with the electronic prescribing system was one of the “biggest challenges”(P2) and contributed to delays. Human Computer Interface: the MedEye system’s user interface was described as “clean, simple and easy to use”(P2).People: nurses and senior management “absolutely wanted this [project] to work”(P1).Communication and Workflow: it was sometimes difficult to communicate effectively because the IT team had their own “set of jargon which is very technical” and the clinical team used “lots of medical jargon”(P2), resulting in misunderstandings. Internal Organisational Policies, Procedures and Culture: the hospital recognised the potential safety benefits of MedEye. However, its implementation was different to other IT products, which would “have actually gone through the development cycle”(P7).External Rules, Regulations and Pressures: the IT and informatics team’s resources were stretched with multiple projects been implemented simultaneously. System Measurement and Monitoring: the project team conducted “a lot of testing”(P3), to refine the technology. Conclusions This study sought to understand the sociotechnical challenges when implementing a novel digital technology in a UK hospital and identified themes related to eight domains. We acknowledge that our study had a few limitations: we interviewed a small number of participants who were directly involved in the implementation process, and the study was conducted in one hospital Trust, limiting the generalisability of the findings. However, use of the eight-domain sociotechnical framework strengthened our study, allowing us to derive the specific facilitators and barriers to the implementation and deployment process. This study also emphasises the importance of working closely with IT managers who can coordinate work within an organisation to anticipate delays and mitigate against project risks. References 1. Sittig, D.F. and H. Singh, A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality & safety in health care, 2010. 19 Suppl 3(Suppl 3): p. i68-i74. 2. Pope, C., S. Ziebland, and N. Mays, Qualitative research in health care. Analysing qualitative data. BMJ (Clinical research ed.), 2000. 320(7227): p. 114–116.

scholarly journals BARRIERS AND FACILITATORS TO IMPLEMENTING COMMUNITY FIRST CHOICE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S771-S772
Author(s):  
Lisa Beauregard ◽  
Edward A Miller
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
First Choice ◽  
Health Related ◽  
Services And Supports ◽  
State Plan

Abstract Community First Choice is a program within the Affordable Care Act that encourages states to expand Medicaid home and community-based services (HCBS). Specifically, this Medicaid state plan benefit provides states with an additional 6% federal match to promote greater rebalancing of long-term services and supports. Through Community First Choice, states can offer services that assist with activities of daily living, instrumental activities of daily living, and health-related tasks. The program is optional for states, and, to date, eight states have pursued Community First Choice. The purpose of this study is to understand the barriers and facilitators to implementing Community First Choice in two states. Data was collected through semi-structured interviews with individuals involved in HCBS policy nationally and in Maryland and Texas, including government bureaucrats, consumer advocates, and provider representatives. The results suggest that communication with the Centers for Medicare and Medicaid Services, the enhanced federal match, and leveraging existing HCBS infrastructure facilitated implementation. Maryland and Texas encountered challenges implementing Community First Choice because of constraints posed by existing HCBS programs, ambitious timelines, limited staff resources, and insufficient engagement with external stakeholders. The findings suggest that implementing Community First Choice is a large undertaking, and states should ensure they have enough time and sufficient staffing for the implementation process. States should also understand how implementing Community First Choice will impact existing HCBS offerings and how leveraging HCBS infrastructure can facilitate implementation. The lessons from implementing Community First Choice can be informative to other states pursuing or contemplating this program.

scholarly journals “You’ve Got to Be Old to Go There”: Psychosocial Barriers and Facilitators to Social Eating in Older Adults

2019 ◽  
Vol 60 (4) ◽  
pp. 628-637 ◽  
Author(s):  
Anisa Saeed ◽  
Jenny Fisher ◽  
Zinnia Mitchell-Smith ◽  
Laura J E Brown
Keyword(s):  
Older Adults ◽  
Gender Differences ◽  
Barriers And Facilitators ◽  
Physical And Mental Health ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Psychosocial Barriers ◽  
Social Eating ◽  
Design And Methods

Abstract Background and Objectives Social eating is associated with a range of physical and mental health benefits for older adults. Previous research has identified some of the practical barriers that may limit social eating, such as cost and access to public transport. However, little is known about the psychosocial issues that can affect older adults’ engagement with social eating. This study examines psychosocial barriers and facilitators to attending community-based social eating opportunities for older adults. Design and Methods Forty-two older people aged between 59 and 89 years living in Manchester, UK, participated in semi-structured interviews or focus groups about their experiences and perceptions of social eating opportunities. Interview transcripts were analyzed using inductive thematic analyses. As there are known gender differences in relation to attitudes and behaviors relating to food and social activities, a framework analysis was applied to explore how these themes were differentially expressed by gender. Results Four themes were identified that related to the importance of (a) offering more than food; (b) participants’ social identity; (c) taking the first step; and (d) embarrassment and self-consciousness about physical health. Gender differences related to perceptions of the relevance and attractiveness of social eating, and the role of social support. Discussion and Implications This study improves our understanding of older adults’ social eating experiences and highlights clear strategies by which social eating opportunities could be made more attractive, accessible, and acceptable to older adults.

scholarly journals Understanding the role of hospice pharmacists: a qualitative study

2021 ◽  
Author(s):  
Zoe Edwards ◽  
Emma Chapman ◽  
Simon Pini ◽  
Michael I. Bennett
Keyword(s):  
Geographical Area ◽  
Clinical Information ◽  
Barriers And Facilitators ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Standards Of Practice ◽  
Team Working ◽  
The Hours

AbstractBackground Pharmacists are important members of multidisciplinary teams but, despite surveys of provision, the role of the hospice pharmacist is not well described. Objective To explore the role of the hospice pharmacist and identify barriers and facilitators to the role. Setting Hospices offering in-patient services caring for adults towards the end of life in one geographical area of northern England. Method Pharmacists providing services to hospices were invited to take part in qualitative semi-structured interviews asking about experience, patient contact, team working and barriers and facilitators to the role. These were recorded verbatim and data were analysed thematically using framework analysis. Main outcome measure The hospice pharmacist’s perceptions of their role and barriers and facilitators to it. Results Fifteen pharmacists took part. Two themes and ten subthemes were identified focused on tasks and communication. Practise was varied and time limited the quantity and depth of services carried out but was often spent navigating complex drug supply routes. Participants found methods of communication suited to the hours they spent in the hospice although communication of data was a barrier to effective clinical service provision. Participants identified the need for appropriate training and standards of practice for hospice pharmacists would enable better use of their skills. Conclusion Barriers to the role of hospice pharmacist include time, access to role specific training, access to clinical information and complex medicines supply chains. The role would benefit from definition to ensure that hospices are able to use hospice pharmacists to their greatest potential.

scholarly journals Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model

2021 ◽  
Vol 18 (12) ◽  
pp. 6456
Author(s):  
Selina Taylor ◽  
Alice Cairns ◽  
Beverley Glass
Keyword(s):  
Rural Communities ◽  
Community Pharmacy ◽  
Rural Community ◽  
Consumer Satisfaction ◽  
Implementation Process ◽  
Healthcare Services ◽  
Outcome Evaluation ◽  
Practice Change ◽  
Service To Others ◽  
Integrated Screening

Unaddressed hearing loss affects an estimated 466 million people worldwide, costing over $750 billion globally, with rural communities being particularly disadvantaged, due to the greater inequity in access to healthcare services. This mixed-methods study aimed to use the PRECEDE-PROCEED model to develop and pilot a rural community pharmacy-based ear health service, LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Program). The PRECEDE process involved an assessment of the predisposing, reinforcing and enabling constructs to support practice change through a scoping review, stakeholder surveys and interviews and consultation with governing bodies and regulatory authorities. The PROCEED segment structured the evaluation of the service pilot and informed planned implementation, process, impact and outcome evaluation. The pilot study conducted in February 2021 included 20 participants, with the most common ear complaints presented being pain, pressure or blockage. All these participants reported high levels of satisfaction with the service, would recommend the service to others and would attend the pharmacy first before seeing a GP for future ear complaints. The PRECEDE-PROCEED model provides a comprehensive model to guide the design of the LISTEN UP program, an innovative model, expanding services offered by rural community pharmacies, with preliminary results demonstrating high consumer satisfaction.

scholarly journals Evaluation of a school-based participatory intervention to improve school environments using the Consolidated Framework for Implementation Research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
April K. Wilhelm ◽  
Maria Schwedhelm ◽  
Martha Bigelow ◽  
Nicole Bates ◽  
Mikow Hang ◽  
...  
Keyword(s):  
Participatory Research ◽  
Implementation Research ◽  
Implementation Process ◽  
Intervention Implementation ◽  
Structured Interviews ◽  
Institutional Goals ◽  
School Based ◽  
Case Comparison ◽  
The Individual ◽  
Participatory Intervention

Abstract Background Participatory research offers a promising approach to addressing health inequities and improving the social determinants of health for diverse populations of adolescents. However, little research has systematically explored factors influencing the implementation of participatory health interventions targeting health disparities. Objective This study examined the utility of the Consolidated Framework for Implementation Research (CFIR) in identifying and comparing barriers and facilitators influencing implementation of participatory research trials by employing an adaptation of the CFIR to assess the implementation of a multi-component, urban public school-based participatory health intervention. Methods We collected qualitative data over a one-year period through weekly team meeting observational field notes and regular semi-structured interviews with five community-based participatory researchers, one school-based partner, and four school principals involved in implementing a participatory intervention in five schools. Adapted CFIR constructs guided our largely deductive approach to thematic data analysis. We ranked each of the three intervention components as high or low implementation to create an overall implementation effectiveness score for all five schools. Cross-case comparison of constructs across high and low implementation schools identified constructs that most strongly influenced implementation. Results Ten of 30 assessed constructs consistently distinguished between high and low implementation schools in this participatory intervention, with five strongly distinguishing. Three additional constructs played influential, though non-distinguishing, roles within this participatory intervention implementation. Influential constructs spanned all five domains and fit within three broad themes: 1) leadership engagement, 2) alignment between the intervention and institutional goals, priorities, demographics, and existing systems, and 3) tensions between adaptability and complexity within participatory interventions. However, the dynamic and collaborative nature of participatory intervention implementation underscores the artificial distinction between inner and outer settings in participatory research and the individual behavior change focus does not consider how relationships between stakeholders at multiple levels of participatory interventions shape the implementation process. Conclusions The CFIR is a useful framework for the assessment of participatory research trial implementation. Our findings underscore how the framework can be readily adapted to further strengthen its fit as a tool to examine project implementation in this context.

Networks and efficient policy implementation: Insights from cohesion policy

Evaluation ◽  
2019 ◽  
Vol 25 (4) ◽  
pp. 411-429
Author(s):  
Dorine Boumans ◽  
Martin Ferry
Keyword(s):  
Policy Implementation ◽  
Negative Impact ◽  
Implementation Process ◽  
Evidence Base ◽  
Network Governance ◽  
Efficient Implementation ◽  
Cohesion Policy ◽  
Structured Interviews ◽  
Potential Benefits

Network-based arrangements are increasingly used for policy implementation. Arguments are made for the potential benefits of this approach, but evidence of their efficiency is inconclusive. Recent methodological innovations, incorporating social network analysis, are building the evidence base. This article contributes to a growing area of study by exploring the relationship between the efficient implementation of European Union cohesion policy projects, and the characteristics of the networks involved in the implementation process. The research combined quantitative analysis of implementation of projects in Scotland in 2007–2013 and semi-structured interviews. The research finds that the involvement of many partners can have a negative impact on implementation. Rather, the strategic position of key actors in the network is important for efficient implementation. The results stress the importance of network governance and the role of key agents as nodes that bridge structural gaps and facilitate exchange of knowledge and resources.

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