The role of a remote knowledge broker from an academic setting using an adaptive approach to implement evidence-based practice in primary care settings: A case study of integrating mood management interventions for treatment seeking tobacco users.

2020 ◽  
Author(s):  
Nadia Minian ◽  
Sheleza Ahad ◽  
Laurie Zawertailo ◽  
Arun Ravindran ◽  
Claire de Oliveira ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Providers ◽  
Family Health ◽  
Practice Change ◽  
Knowledge Broker ◽  
Local Context ◽  
Knowledge Brokering ◽  
Mood Management ◽  
Management Interventions

Abstract Background: Knowledge brokering is an emerging knowledge translation strategy used within healthcare to bridge the gap between evidence and practice. Reported studies indicate that the day-to-day role of a knowledge broker often involves in-person communication with frontline workers and decision makers. However, travelling to primary care sites can be cost- and resource-intensive and thus not feasible. In this paper, we describe the role and experience of a remote knowledge broker (rKB) working in an academic health sciences centre, delivering tailored one-on-one support to end-users using phone and email communications. Methods: A rKB was hired to support (n = 62) English-speaking Family Health Teams (FHTs) across Ontario with implementing mood management interventions as part of an existing smoking cessation program, the Smoking Treatment for Ontario Patients (STOP) program. We describe the eight categories of tasks performed by the rKB over a 12-month period, as well as their experience communicating via technology to develop relationships with healthcare providers (HCPs). Results: Sixty-one of the 62 FHTs (n = 73 HCPs) were provided rKB services. The total number of successful phone and email communications with the rKB ranged from 3-98 interactions over 12 months. Common barriers to implementation reported by FHTs were associated with the Inner and Outer Setting domains of the Consolidated Framework for Implementation Research (CFIR) and included lack of time, resources, and patient engagement. Conclusions: The role of the rKB involved building relationships with HCPs, identifying and helping to problem solve barriers, and building capacity in the field. Similar to traditional knowledge brokering, this analysis shows that developing a meaningful relationship between a remotely situated KB and HCPs could take anywhere between 1-6 months. Using implementation frameworks such as CFIR can help the rKB identify barriers and be ready to address them. In addition, hiring a rKB with previous engagements and knowledge of the local context may facilitate clinical practice change. Our future work will evaluate the cost-effectiveness of rKBs to inform its potential to be scaled up.

scholarly journals Tailored Versus Generic Knowledge Brokering to Integrate Mood Management Into Smoking Cessation Interventions in Primary Care Settings: Protocol for a Cluster Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Nadia Minian ◽  
Aliya Noormohamed ◽  
Dolly Baliunas ◽  
Laurie Zawertailo ◽  
Carol Mulder ◽  
...  
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Knowledge Translation ◽  
Controlled Trial ◽  
Family Health ◽  
Knowledge Broker ◽  
Mood Management ◽  
Primary Care Settings ◽  
Management Interventions ◽  
Cluster Randomized

BACKGROUND Both tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients. OBJECTIVE The objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions. METHODS The study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients. RESULTS Recruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020. CONCLUSIONS This study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings. CLINICALTRIAL ClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)

scholarly journals A Universal Early Parenting Education Intervention in Community-Based Primary Care Settings: Development and Installation Challenges

2018 ◽  
Vol 8 (4) ◽  
pp. 178 ◽  
Author(s):  
Grainne Hickey ◽  
Sinead McGilloway ◽  
Yvonne Leckey ◽  
Ann Stokes
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Service Providers ◽  
Practice Change ◽  
Parenting Education ◽  
Local Context ◽  
Programme Implementation ◽  
Community Based ◽  
Early Parenting ◽  
The Impact

Prevention and early intervention programmes, which aim to educate and support parents and young children in the earliest stages of the family lifecycle, have become an increasingly popular policy strategy for tackling intergenerational disadvantage and developmental inequality. Evidence-based, joined-up services are recommended as best practice for achieving optimal outcomes for parents and their children; however, there are persistent challenges to the development, adoption and installation of these kinds of initiatives in community-based primary health care settings. In this paper, we present a description of the design and installation of a multi-stakeholder early parenting education and intervention service model called the Parent and Infant (PIN) programme. This new programme is delivered collaboratively on a universal, area-wide basis through routine primary care services and combines standardised parent-training with other group-based supports designed to educate parents, strengthen parenting skills and wellbeing and enhance developmental outcomes in children aged 0–2 years. The programme design was informed by local needs analysis and piloting to establish an in-depth understanding of the local context. The findings demonstrate that a hospitable environment is central to establishing interagency parenting education and supports. Partnership, relationship-building and strategic leadership are vital to building commitment and buy-in for this kind of innovation and programme implementation. A graduated approach to implementation which provides training/education and coaching as well as organisational and administrative supports for practice change, are also important in creating an environment conducive to collaboration. Further research into the impact, implementation and cost-effectiveness of the PIN programme will help to build an understanding of what works for parents and infants, as well as identifying lessons for the development and implementation of other similar complex prevention and intervention programmes elsewhere. This kind of research coupled with the establishment of effective partnerships involving service providers, parents, researchers and policy makers, is necessary to meeting the challenge of improving family education and enhancing the capacity of family services to help promote positive outcomes for children.

scholarly journals Pharmacogenomics for Primary Care: An Overview

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1337 ◽  
Author(s):  
Victoria Rollinson ◽  
Richard Turner ◽  
Munir Pirmohamed
Keyword(s):  
Primary Care ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Academic Hospital ◽  
Direct To Consumer ◽  
Gradual Introduction ◽  
Barriers To Implementation ◽  
Primary Healthcare Providers ◽  
Future Practice

Most of the prescribing and dispensing of medicines happens in primary care. Pharmacogenomics (PGx) is the study and clinical application of the role of genetic variation on drug response. Mounting evidence suggests PGx can improve the safety and/or efficacy of several medications commonly prescribed in primary care. However, implementation of PGx has generally been limited to a relatively few academic hospital centres, with little adoption in primary care. Despite this, many primary healthcare providers are optimistic about the role of PGx in their future practice. The increasing prevalence of direct-to-consumer genetic testing and primary care PGx studies herald the plausible gradual introduction of PGx into primary care and highlight the changes needed for optimal translation. In this article, the potential utility of PGx in primary care will be explored and on-going barriers to implementation discussed. The evidence base of several drug-gene pairs relevant to primary care will be outlined with a focus on antidepressants, codeine and tramadol, statins, clopidogrel, warfarin, metoprolol and allopurinol. This review is intended to provide both a general introduction to PGx with a more in-depth overview of elements relevant to primary care.

School Nurses on the Front Lines of Medicine: When You Don’t Need to “STOP AT AN ER STAT!”—The Role of Urgent Care Centers in the Management of Students With Nonemergent Chief Complaints

2019 ◽  
Vol 35 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Rachel Rothstein ◽  
Kevin Zhen ◽  
Robert P. Olympia
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Healthcare Providers ◽  
School Nurses ◽  
Chief Complaint ◽  
Urgent Care ◽  
Chief Complaints ◽  
Pediatric Services ◽  
Urgent Care Centers

In the midst of our nation’s growing primary care provider shortage and subsequent overutilization of the emergency room (ER), urgent care centers represent an accessible, convenient, and affordable alternative for the management of “urgencies” or nonemergent illnesses and injuries. Despite the presence of competent healthcare providers and a wide array of services at urgent care centers, patients continue to pursue care in the ER for urgencies. School nurses may utilize urgent care centers for the evaluation and management of students with nonemergent medical or traumatic chief complaints. This article discusses the field of urgent care medicine, describes the pediatric services provided at urgent care centers, and summarizes the capabilities of centers to deal with potential urgencies versus emergencies in children and adolescents based on their chief complaint.

scholarly journals Primary care nurses' approach to cases of violence against children

2013 ◽  
Vol 21 (spe) ◽  
pp. 172-179 ◽  
Author(s):  
Ailton de Souza Aragão ◽  
Maria das Graças Carvalho Ferriani ◽  
Telma Sanchez Vendruscollo ◽  
Sinara de Lima Souza ◽  
Romeu Gomes
Keyword(s):  
Primary Care ◽  
Family Health ◽  
Structured Interviews ◽  
Face To Face ◽  
Violence Against Children ◽  
The Family ◽  
Primary Care Nurses ◽  
The Face ◽  
The City

In Primary Care, the field of nursing comes face-to-face with the complexity of violence, leading these professionals to constantly re-evaluate their habitus. OBJECTIVE: to analyze how cases of violence against children and adolescents are approached by primary care nurses, identifying limits and possibilities for dealing with these cases. METHOD: a qualitative study, undertaken in 2011, through semi-structured interviews with 8 out of 48 nurses in the Family Health teams in the city of Uberaba in the state of Minas Gerais, the analysis of which followed the interpretation of meanings, based in dialectical hermeneutics. RESULTS: the following stand out: non-identification of violence as a problem for the nurses; denunciations and notifications as a role of the nurses; and the limits found in the face of violence. CONCLUSION: it is determined that the habitus of nursing directed at health promotion and prevention of violence must be restructured, overcoming the biomedical paradigm and involving intersectorial and multidisciplinary actions.

scholarly journals The role of the Family Health Program in the organization of primary care in municipal health systems

2009 ◽  
Vol 25 (5) ◽  
pp. 1153-1167 ◽  
Author(s):  
Maria Guadalupe Medina ◽  
Zulmira Maria de Araújo Hartz
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Health Program ◽  
Family Health ◽  
Family Health Program ◽  
The Family ◽  
Institutional Contexts ◽  
Definition Of ◽  
Municipal Health

The contribution of primary care to population health and health systems organization has been well documented, but some authors have highlighted that in Third World countries it has gained more ground in discourse than in facts and practices, with different possible configurations. The objectives of the current study were to evaluate and correlate organizational and local contextual characteristics to the degree of implementation of primary care in two municipalities (counties) in the State of Bahia State, Brazil, that had adopted the Family Health Program (FHP) as the system's central thrust. The research was based on two case studies with interwoven levels of analysis, using as the point of departure the underlying goal-image of primary care in the definition of criteria and standards for degree of implementation. The total scores for Municipalities A and B were 66 and 81, respectively (maximum total score = 100), while differences were observed between the urban and rural teams. The political and institutional contexts helped explain differences in the degree of implementation of primary care, but regardless of the municipal context, the study showed the emergence of organizational innovations closely related to the FHP.

scholarly journals Living with severe asthma: the role of perceived competence and goal achievement

2019 ◽  
pp. 174239531988410
Author(s):  
Daniela Eassey ◽  
Helen K Reddel ◽  
Kath Ryan ◽  
Lorraine Smith
Keyword(s):  
Severe Asthma ◽  
Healthcare Providers ◽  
Perceived Competence ◽  
Goal Achievement ◽  
Self Management ◽  
Future Research ◽  
Face To Face ◽  
Management Interventions ◽  
Semistructured Interviews

Objective The overall aim of this study was to examine, among individuals living with severe asthma, the role of perceived competence in achieving their goals. Methods Qualitative research methods were used to conduct in-depth semistructured interviews. Interviews were video and/or audio recorded, transcribed and analyzed inductively and deductively, informed by the self-determination theory construct of perceived competence. Thirty-six face-to-face interviews, lasting 1.5–4 h, were conducted across Australia. Results Feeling competent to achieve asthma goals played a role in participants’ ability to achieve broader goals. Their desire to achieve their broader goals was strongly driven by their perceived ability to master managing their condition, which at times required more than medical strategies. Two main themes were discerned from the analysis: (1) learning how to look after yourself: self-care is important and (2) reaching an agreement with severe asthma: being at one with the illness. Discussion This study highlighted the influence of perceived competence on self-management and goal achievement in severe asthma. Healthcare providers could explore patients’ perceived competence to set and achieve goals, as a self-management strategy. Future research should consider these findings when developing and implementing patient-driven, self-management interventions for those living with severe asthma.

scholarly journals Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory - Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nur Zahirah Balqis-Ali ◽  
Pui San Saw ◽  
Anis Syakira Jailani ◽  
Weng Hong Fun ◽  
Noridah Mohd Saleh ◽  
...  
Keyword(s):  
Primary Care ◽  
Factor Analysis ◽  
Exploratory Factor Analysis ◽  
Internal Consistency ◽  
Healthcare Providers ◽  
Local Context ◽  
Care Practice ◽  
Underlying Structure ◽  
Expert Committee ◽  
Local Practice

Abstract Background The Person-centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers’ perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia. Methods The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis. Results Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of the subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was high (Cronbach’s alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs. Conclusion The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well as interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.

scholarly journals Cross-Cultural Adaptation and Exploratory Factor Analysis of The Person-Centred Practice Inventory-Staff (PCPI-S) Questionnaire Among Malaysian Primary Healthcare Providers

2020 ◽  
Author(s):  
Nur Zahirah Balqis-Ali ◽  
Pui San Saw ◽  
Anis Syakira Jailani ◽  
Weng Hong Fun ◽  
Noridah Mohd Saleh ◽  
...  
Keyword(s):  
Primary Care ◽  
Factor Analysis ◽  
Exploratory Factor Analysis ◽  
Internal Consistency ◽  
Healthcare Providers ◽  
Local Context ◽  
Care Practice ◽  
Underlying Structure ◽  
Expert Committee ◽  
Local Practice

Abstract Background: The Person-Centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers’ perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia.Methods: The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis.Results: Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was found to be high (Cronbach’s alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs. Conclusion: The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.Trial registration: NMRR-18-309-40447

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