scholarly journals Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings

10.2196/13301 ◽  
2019 ◽  
Vol 7 (6) ◽  
pp. e13301 ◽  
Author(s):  
Andrew Quanbeck
Keyword(s):  
Primary Care ◽  
Mobile Health ◽  
Addiction Treatment ◽  
Health Intervention ◽  
Evidence Based ◽  
Stakeholder Values ◽  
Primary Care Settings

scholarly journals Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings (Preprint)

2019 ◽  
Author(s):  
Andrew Quanbeck
Keyword(s):  
Primary Care ◽  
Mobile Health ◽  
Addiction Treatment ◽  
Health Care Systems ◽  
New Technology ◽  
Face Validity ◽  
Evidence Based ◽  
Reimbursement Mechanisms ◽  
Decision Framing ◽  
Stakeholder Groups

BACKGROUND Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. OBJECTIVE The goal of this research was to describe a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP. METHODS The decision-framing model can be generally applied to EBPs, but was applied in this case to an mHealth system (Seva) for patients with addiction. The model builds from key insights in behavioral economics and game theory. The model systematically identifies, using an inductive process, the perceived gains and losses of different stakeholder groups when they consider adopting a new intervention. The model was constructed retrospectively in a parent implementation research trial that introduced Seva to 268 patients in 3 US primary care clinics. Individual and group interviews were conducted to elicit stakeholder considerations from 6 clinic managers, 17 clinicians, and 6 patients who were involved in implementing Seva. Considerations were used to construct decision frames that trade off the perceived value of adopting Seva versus maintaining the status quo from each stakeholder group’s perspective. The face validity of the decision-framing model was assessed by soliciting feedback from the stakeholders whose input was used to build it. RESULTS Primary considerations related to implementing Seva were identified for each stakeholder group. Clinic managers perceived the greatest potential gain to be better care for patients and the greatest potential loss to be cost (ie, staff time, sustainability, and opportunity cost to implement Seva). All clinical staff considered time their foremost consideration—primarily in negative terms (eg, cognitive burden associated with learning a new system) but potentially in positive terms (eg, if Seva could automate functions done manually). Patients considered safety (anonymity, privacy, and coming from a trusted source) to be paramount. Though payers were not interviewed directly, clinic managers judged cost to be most important to payers—whether Seva could reduce total care costs or had reimbursement mechanisms available. This model will be tested prospectively in a forthcoming mHealth implementation trial for its ability to predict mHealth adoption. Overall, the results suggest that implementers proactively address the cost and burden of implementation and seek to promote long-term sustainability. CONCLUSIONS This paper presents a model implementers may use to elicit stakeholders’ considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success. CLINICALTRIAL ClinicalTrials.gov NCT01963234; https://clinicaltrials.gov/ct2/show/NCT01963234 (Archived by WebCite at http://www.webcitation.org/78qXQJvVI)

Cost-effectiveness of an Evidence-Based Childhood Asthma Intervention in Real-World Primary Care Settings

2018 ◽  
Vol 41 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Avi Dor ◽  
Qian Luo ◽  
Maya Tuchman Gerstein ◽  
Floyd Malveaux ◽  
Herman Mitchell ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Real World ◽  
Childhood Asthma ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Asthma Intervention

scholarly journals Formative Evaluation Prior to Implementation of a Brief Treatment for Posttraumatic Stress Disorder in Primary Care

2021 ◽  
Author(s):  
Sarah E. Valentine ◽  
Cara Fuchs ◽  
Natalya Sarkisova ◽  
Elyse A. Olesinski ◽  
A. Rani Elwy
Keyword(s):  
Primary Care ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Formative Evaluation ◽  
Stress Disorder ◽  
Safety Net ◽  
Successful Implementation ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Evidence Based Treatments

Abstract Background Successful implementation of evidence-based treatments for posttraumatic stress disorder (PTSD) in primary care may address treatment access and quality gaps by providing care in novel and less stigmatized settings. Yet, PTSD treatments are largely unavailable safety net primary care settings. We aimed to collect data on four potential influences on implementation, including the degree of less-than-best practices, determinants of the current practice, potential barriers and facilitators of implementation, and the feasibility of a proposed strategy for implementing a brief treatment for PTSD. Methods Our mixed-methods developmental formative evaluation (Stetler et al., 2006) was guided by the Consolidated Framework for Implementation Research (CFIR), including a) surveys assessing implementation climate and attitudes towards evidence-based treatments and behavioral health integration and b) semi-structured interviews to identify barriers and facilitators to implementation and need for intervention and system augmentation. Participants were hospital employee stakeholders (N = 22), including primary care physicians, integrated behavioral health clinicians, community wellness advocates, and clinic leadership. We examined frequency and descriptive data from surveys and conducted directed content analysis of interviews. We used a concurrent mixed-methods approach, integrating survey and interview data collected simultaneously using a joint display approach to inform implementation efforts. We utilized a primary care community advisory board (CAB) comprised of employee stakeholders to refine interview guides, and apply findings to the specification of a revised implementation plan. Results Stakeholders described strong attitudinal support, yet therapist time and capacity restraints are major PTSD treatment implementation barriers. Patient engagement barriers such as stigma, mistrust, and care preferences were also noted. Recommendations based on findings included tailoring the intervention to meet existing workflows, system alignment efforts focused on improving detection, referral, and care coordination processes, protecting clinician time for training and consultation, and embedding a researcher in the practice. Conclusions Our evaluation identified key factors to be considered when preparing for implementation of PTSD treatments in safety net integrated primary care settings. Our project also demonstrated that successful implementation of EBTs for PTSD in safety net hospitals necessitates strong stakeholder engagement to identify and mitigate barriers to implementation.

Interventions to promote the evidence-based care of children with ADHD in primary-care settings

2009 ◽  
Vol 9 (4) ◽  
pp. 477-487 ◽  
Author(s):  
Joshua M Langberg ◽  
William B Brinkman ◽  
Philip K Lichtenstein ◽  
Jeffery N Epstein
Keyword(s):  
Primary Care ◽  
Evidence Based ◽  
Children With Adhd ◽  
Primary Care Settings ◽  
Evidence Based Care

Successful transfer of stable patients on opioid agonist therapies from specialty addiction treatment to primary care settings in Ukraine: A pilot study

2021 ◽  
pp. 108619
Author(s):  
Anna Meteliuk ◽  
Samy Galvez ◽  
Tetiana Fomenko ◽  
Hela Kalandiia ◽  
Volodymyr Iaryi ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Addiction Treatment ◽  
Opioid Agonist ◽  
Primary Care Settings ◽  
Successful Transfer

scholarly journals Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

2018 ◽  
Vol 68 (675) ◽  
pp. e663-e672 ◽  
Author(s):  
Sioe Lie Thio ◽  
Joana Nam ◽  
Mieke L van Driel ◽  
Thomas Dirven ◽  
Jeanet W Blom
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Chronic Medication ◽  
Primary Care Settings ◽  
Number Of Patients ◽  
The Mean ◽  
Randomised Controlled

BackgroundPolypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%.ConclusionOnly a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.

Developing theeCPP: Adapting an Evidence-Based Parent Training Program for Digital Delivery in Primary Care Settings

2015 ◽  
Vol 12 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Susan M. Breitenstein ◽  
James Shane ◽  
Wrenetha Julion ◽  
Deborah Gross
Keyword(s):  
Primary Care ◽  
Parent Training ◽  
Training Program ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Parent Training Program ◽  
Digital Delivery

scholarly journals Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (SINEMA): A cluster-randomized controlled trial

PLoS Medicine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. e1003582
Author(s):  
Lijing L. Yan ◽  
Enying Gong ◽  
Wanbing Gu ◽  
Elizabeth L. Turner ◽  
John A. Gallis ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile Health ◽  
Rural China ◽  
Controlled Trial ◽  
Health Intervention ◽  
Activity Level ◽  
Timed Up And Go ◽  
And Performance ◽  
Cluster Randomized

Background Managing noncommunicable diseases through primary healthcare has been identified as the key strategy to achieve universal health coverage but is challenging in most low- and middle-income countries. Stroke is the leading cause of death and disability in rural China. This study aims to determine whether a primary care-based integrated mobile health intervention (SINEMA intervention) could improve stroke management in rural China. Methods and findings Based on extensive barrier analyses, contextual research, and feasibility studies, we conducted a community-based, two-arm cluster-randomized controlled trial with blinded outcome assessment in Hebei Province, rural Northern China including 1,299 stroke patients (mean age: 65.7 [SD:8.2], 42.6% females, 71.2% received education below primary school) recruited from 50 villages between June 23 and July 21, 2017. Villages were randomly assigned (1:1) to either the intervention or control arm (usual care). In the intervention arm, village doctors who were government-sponsored primary healthcare providers received training, conducted monthly follow-up visits supported by an Android-based mobile application, and received performance-based payments. Participants received monthly doctor visits and automatically dispatched daily voice messages. The primary outcome was the 12-month change in systolic blood pressure (BP). Secondary outcomes were predefined, including diastolic BP, health-related quality of life, physical activity level, self-reported medication adherence (antiplatelet, statin, and antihypertensive), and performance in “timed up and go” test. Analyses were conducted in the intention-to-treat framework at the individual level with clusters and stratified design accounted for by following the prepublished statistical analysis plan. All villages completed the 12-month follow-up, and 611 (intervention) and 615 (control) patients were successfully followed (3.4% lost to follow-up among survivors). The program was implemented with high fidelity, and the annual program delivery cost per capita was US$24.3. There was a significant reduction in systolic BP in the intervention as compared with the control group with an adjusted mean difference: −2.8 mm Hg (95% CI −4.8, −0.9; p = 0.005). The intervention was significantly associated with improvements in 6 out of 7 secondary outcomes in diastolic BP reduction (p < 0.001), health-related quality of life (p = 0.008), physical activity level (p < 0.001), adherence in statin (p = 0.003) and antihypertensive medicines (p = 0.039), and performance in “timed up and go” test (p = 0.022). We observed reductions in all exploratory outcomes, including stroke recurrence (4.4% versus 9.3%; risk ratio [RR] = 0.46, 95% CI 0.32, 0.66; risk difference [RD] = 4.9 percentage points [pp]), hospitalization (4.4% versus 9.3%; RR = 0.45, 95% CI 0.32, 0.62; RD = 4.9 pp), disability (20.9% versus 30.2%; RR = 0.65, 95% CI 0.53, 0.79; RD = 9.3 pp), and death (1.8% versus 3.1%; RR = 0.52, 95% CI 0.28, 0.96; RD = 1.3 pp). Limitations include the relatively short study duration of only 1 year and the generalizability of our findings beyond the study setting. Conclusions In this study, a primary care-based mobile health intervention integrating provider-centered and patient-facing technology was effective in reducing BP and improving stroke secondary prevention in a resource-limited rural setting in China. Trial registration The SINEMA trial is registered at ClinicalTrials.gov NCT03185858.

Evidence-Based Care Models for Recognizing and Treating Alcohol Problems in Primary Care Settings: Part I

2001 ◽  
Author(s):  
Katherine E. Watkins ◽  
Harold Alan Pincus ◽  
Terri L. Tanielian
Keyword(s):  
Primary Care ◽  
Alcohol Problems ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Care Models ◽  
Evidence Based Care
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