scholarly journals Evaluating the Experience of Organizations Implementing Medication Management Services Using a Variety of Implementation Strategies

2021 ◽  
Vol 12 (1) ◽  
pp. 12
Author(s):  
Deborah L. Pestka ◽  
Todd D. Sorensen
Keyword(s):  
Qualitative Interviews ◽  
Medication Management ◽  
Implementation Strategies ◽  
Structured Interviews ◽  
Learning Collaborative ◽  
Management Learning ◽  
Evaluation Approach ◽  
Key Stakeholders ◽  
Learning Collaboratives ◽  
Management Services

Purpose: The purpose of this project was to evaluate the experience of organizations who participated in a medication management learning collaborative and their perceptions of the different implementation strategies that were employed. Methods: Using a utilization-focused evaluation approach, qualitative interviews were conducted with former participants (clinicians, managers, or other key stakeholders) of medication management learning collaboratives organized and delivered by Alliance for Integrated Medication Management (AIMM). The purpose of the learning collaboratives was to provide structure and facilitation to accelerate the implementation of medication management services. One-on-one semi-structured interviews were carried out with a lead member of 11 different organizations that participated in an AIMM collaborative about their experience in the collaborative and the different implementation strategies that were used. Results: Three themes emerged: (1) perspectives on the implementation strategies, (2) external facilitators, and (3) additional benefits of being in the collaborative. Certain implementation strategies used by AIMM, such as coaching, were considered beneficial by almost everyone while other strategies, such as webinars, had mixed opinions. Participants also highlighted the importance of external facilitators, like dedicated time to work on implementation strategies, as well as the additional benefits like the professional development that comes from being in a learning collaborative and learning different implementation strategies. Conclusion: Implementation strategies may help accelerate the adoption and expansion of medication management services within and across organizations. The results of this evaluation shed light on the experiences of different organizations using select implementation strategies in their medication management implementation efforts. The perspectives of participants in this study may help other organizations in selecting and developing similar implementation strategies.

scholarly journals Collaborating to co-produce strategies for delivering adolescent sexual and reproductive health interventions: processes and experiences from an implementation research project in Nigeria

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii84-ii97
Author(s):  
Chinyere Ojiugo Mbachu ◽  
Ifunanya Clara Agu ◽  
Obinna Onwujekwe
Keyword(s):  
Reproductive Health ◽  
Sexual And Reproductive Health ◽  
Qualitative Interviews ◽  
Group Discussion ◽  
Implementation Strategies ◽  
Design Strategies ◽  
Secondary Sources ◽  
Key Stakeholders ◽  
Academic Researchers ◽  
Document Review

Abstract Implementation science embraces collaboration between academic researchers and key stakeholders/implementers for the dual purpose of capacity building and context-adaptation. Co-production ensures that knowledge created with inputs from various groups of stakeholders is more reflective of local contexts. This paper highlights the experiences of academic researchers and non-academic implementers in collaborating to design implementation strategies for improving access to sexual and reproductive information and services for adolescents. Data were collected through primary and secondary sources. Detailed review of project documents such as minutes of research meetings, reports of workshops and outputs of group work activities enabled detailed description of the processes and steps of co-designing implementation strategies. Information on experiences and perspectives of benefits of the collaborative were collected through in-depth interviews of non-academic partners and focus group discussion with academic researchers. Narrative synthesis was done for information extracted through document review. Thematic analysis of qualitative interviews was done. The process of designing implementation strategies happened in three chronological steps of setting up the collaborative, selecting intervention areas and convening partners’ meetings to design strategies. Specific activities include stakeholder engagement, situation analysis, selection of intervention areas, designing the implementation strategies and pre-testing implementation tools. The process of analysing and selecting collaborators was iterative, and facilitated by having an ‘insider’ key informant. Working with key stakeholders enabled knowledge sharing and exchange among partners. Information sharing within the collaborative facilitated shifting of mindsets about adolescent sexual and reproductive health, and contextual adaptation of names and labels given to strategies. Co-producing implementation strategies with non-academic implementers enabled stakeholder ownership of implementation strategies and set the scene for their adoption in implementation settings. Some challenges of co-production of knowledge are that it is time consuming; involves several iterations that may influence coherence of strategies; involves multiple interests and priorities and poses a threat to fidelity.

scholarly journals A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats

2020 ◽  
Vol 2 ◽  
Author(s):  
Anna-Elisa Hein ◽  
Bernard Vrijens ◽  
Mickael Hiligsmann
Keyword(s):  
Clinical Practice ◽  
Personalized Medicine ◽  
Health Systems ◽  
Swot Analysis ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Data Generation ◽  
Structured Interviews ◽  
Personalized Management

Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective.Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis.Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations.Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.

scholarly journals Qualitative Analysis of the Implementation of a Hospital Room Service in a Large Metropolitan Hospital: Foundations for Transformation

2021 ◽  
Author(s):  
Shelley A. Wilkinson ◽  
Jack J. Bell ◽  
Bianca Neaves ◽  
Sally J. McCray ◽  
Katrina Campbell
Keyword(s):  
Public Hospital ◽  
Implementation Strategies ◽  
Service Model ◽  
Structured Interviews ◽  
Barriers And Enablers ◽  
Key Stakeholders ◽  
Metropolitan Hospital ◽  
Qualitative Descriptive ◽  
Nutrition Intake ◽  
Room Service

Abstract Background: Room Service is a hospital meal service model with demonstrated improved nutrition intake, reduced wastage and cost benefits in some settings compared with traditional models. However, uptake across public hospital settings appears low; the underlying reasons require exploration. In 2019, Room Service was introduced in a Queensland Hospital and Health Service site. The aim of this paper is to identify the barriers and enablers to implementing Room Service to provide recommendations for future implementation of this model. Methods: This qualitative descriptive study utilised semi-structured interviews with staff involved in implementation of the Room Service meal delivery model at The Prince Charles Hospital (Queensland, Australia). A purposive sample of project members and key stakeholders were recruited. Interviews explored project experiences from commencement to completion, barriers and enablers to implementation, strategies to overcome challenges and recommendations for implementation at other sites. Interviews were coded to identify themes and sub-themes. Results: Nine participants were interviewed. Key themes with associated sub-themes were (I) Foundations of transformation; (II) Navigating implementation; and (III) Embedding sustainable practices.Conclusions: This study adds rich information to understand factors that support the implementation of a room service model in a large public hospital. Future implementation of room service should not only consider measuring quantifiable outcomes, but also the importance of qualitative descriptive studies surveying project members and key stakeholders to further explore experiences, barriers and enablers to implementation and develop strategies to overcome challenges to assist further sites implement this model.

Abstract NS15: A Better Understanding of Readmission After Stroke by Including Stroke Survivor and Caregiver Perspectives

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Carole L White ◽  
Tracy L Brady ◽  
Laura L Saucedo ◽  
Deb Motz ◽  
Johanna A Sharp ◽  
...  
Keyword(s):  
Cultural Context ◽  
Recurrent Stroke ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Stroke Care ◽  
Stroke Survivor ◽  
Structured Interviews ◽  
Skilled Nursing ◽  
Swallowing Problems

Background: At least 30% of stroke survivors (SSs) are readmitted in the first year after stroke. By identifying factors that lead to readmission, we can develop meaningful quality indicators for post-stroke care that target ways to improve health and support the SSs ability to manage at home. Objectives were to: i) estimate readmission rate in a cohort of older SSs at 1 and 6 months after stroke, ii) identify reasons for readmission, and iii) describe the experience of readmission from the perspective of the SS and family caregiver (CG). Methods: This mixed-methods study was undertaken utilizing electronic medical records to track readmissions and qualitative interviews were conducted with SSs and CGs. Older adults (≥ 60 years) with stroke admitted to two hospital systems were enrolled in the cohort and followed for 6 months to capture readmissions. A sample of SSs and CGs were interviewed following readmission to gain their perspective related to discharge after stroke and subsequent readmission. Results: Of the 310 included in the cohort (mean age 76 years, SD 9.8), 10% died prior to discharge. Within one month 10% were readmitted and 25% within 6 months. The main reasons for readmission were recurrent stroke/TIA (19%), pneumonia and urinary tract infection (19%), swallowing problems and dehydration (9%), and cardiac causes (7%). Discharge to a skilled nursing facility (p=.007) and higher Rankin score on discharge (p=.002) were associated with readmission. Semi-structured interviews conducted with 20 SSs and CGs revealed the following themes related to discharge and readmission: discharge preparation that includes their social and cultural context; need for anticipatory guidance on what to expect when home; support for self-management in the community; knowing when to request help; follow-up in the community that could lead to early identification of problems; complexity of medication management; and importance of social support. Conclusions: The perspective of the SS and CG is critical in identifying potential avenues for intervention, aimed at reducing preventable readmissions. Interventions aimed at the transition between hospital and skilled nursing facilities may reduce readmissions.

Moving From Interprofessional Education Toward Interprofessional Practice: Bridging the Translation Gap

2019 ◽  
Vol 4 (5) ◽  
pp. 971-976
Author(s):  
Imran Musaji ◽  
Trisha Self ◽  
Karissa Marble-Flint ◽  
Ashwini Kanade
Keyword(s):  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Evaluation Model ◽  
Implementation Strategies ◽  
Future Research ◽  
Successful Implementation ◽  
Interprofessional Practice ◽  
Translational Model ◽  
Key Stakeholders ◽  
Clear Identification

Purpose The purpose of this article was to propose the use of a translational model as a tool for identifying limitations of current interprofessional education (IPE) research. Translational models allow researchers to clearly define next-step research needed to translate IPE to interprofessional practice (IPP). Method Key principles, goals, and limitations of current IPE research are reviewed. A popular IPE evaluation model is examined through the lens of implementation research. The authors propose a new translational model that more clearly illustrates translational gaps that can be used to direct future research. Next steps for translating IPE to IPP are discussed. Conclusion Comprehensive reviews of the literature show that the implementation strategies adopted to date have fostered improved buy-in from key stakeholders, as evidenced by improved attitudes and perceptions toward interprofessional collaboration/practice. However, there is little evidence regarding successful implementation outcomes, such as changed clinician behaviors, changed organizational practices, or improved patient outcomes. The authors propose the use of an IPE to IPP translational model to facilitate clear identification of research gaps and to better identify future research targets.

scholarly journals Conservation Debates: People’s Perceptions and Values towards a Privately Protected Area in Southern Ecuador

Land ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 233
Author(s):  
Verónica Iñiguez-Gallardo ◽  
Fabián Reyes-Bueno ◽  
Olga Peñaranda
Keyword(s):  
Protected Areas ◽  
Land Tenure ◽  
Protected Area ◽  
Planning Process ◽  
Social Needs ◽  
Structured Interviews ◽  
Key Stakeholders ◽  
Southern Ecuador ◽  
Negative Perceptions ◽  
Land Tenure System

The perceptions and values that local communities have towards protected areas are of great value for the improvement of these territories’ management. Such perceptions and values are often absent in the conservation planning process, particularly in those privately protected areas that are established in areas where the land tenure system is based not only on ownership but also on customary uses. Drawing on qualitative and quantitative data obtained through semi-structured interviews with key stakeholders and members of communities surrounding a privately protected area in southern Ecuador, we identify that the level of collaboration with the managers, the distance to the protected area, the percentage of untitled land, and the dependence on the resources (customary uses) are among the variables affecting these perceptions and values. Positive perceptions towards protected areas and naturalistic values are developed among those who collaborate with the protected area managers, whereas negative perceptions, and a mix of naturalistic and biospheric values are developed among those who have a sense of a lack of attention to social needs although supporting nature conservation at the same time. The evidence presented shows the importance of matching local peoples’ expectations with conservation goals during the establishment of a protected area.

scholarly journals Using qualitative and participatory methods to refine implementation strategies: universal family psychosocial screening in pediatric cancer

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Janet A. Deatrick ◽  
Anne E. Kazak ◽  
Rebecca E. Madden ◽  
Glynnis A. McDonnell ◽  
Katherine Okonak ◽  
...  
Keyword(s):  
Health Equity ◽  
Pediatric Cancer ◽  
Universal Screening ◽  
Implementation Strategies ◽  
Interactive Systems ◽  
Psychosocial Risk ◽  
Care Providers ◽  
Psychosocial Screening ◽  
Universal Family ◽  
Key Stakeholders

Abstract Background Children with cancer and their families are at risk for short- and long-term psychosocial difficulties. Screening for psychosocial risk remains inconsistent, leading to inequitable access to psychosocial services. The Psychosocial Assessment Tool (PAT) is an evidence-based caregiver report screener of family psychosocial risk ready for implementation in a nationwide cluster randomized trial that will test two implementation strategies across 18 pediatric cancer centers. The current study, conducted in preparation for the trial, solicited the perspectives of key stakeholders about two proposed implementation strategies identified during previous research which focus on health equity and screening of all families (universal screening). Results were used to refine the implementation strategies for testing in the subsequent trial. Methods Semi-structured interviews with 19 key stakeholders (parents, health care providers, pediatric oncology organizations, and pediatric healthcare leaders) were conducted regarding the two implementation strategies. Strategy I is a training webinar; Strategy II is training + implementation enhanced resources, which includes a champion at each site and monthly peer support consultation calls. Data were analyzed using directed content analysis with deductively derived codes based on the Interactive Systems Framework and inductive codes based on emerging data. Results Stakeholder interviews provided rich data to rigorously modify the proposed implementation strategies. Implementation strategies were modified in consistent with these recommendations: engaging providers by framing family psychosocial screening as an opportunity for more efficient and effective practice; setting clear expectations about the importance of screening 100% of children and their families to achieve the goal of universal screening, equity of care, and reduction of disparities; and adapting successful strategies for systematic implementation of screening to ensure optimal engagement with children and their families throughout their care. Conclusions Stakeholder input strengthened implementation strategies by suggesting modifications that emphasized health equity and reduction in health disparities. Using implementation science methods to build on a long-standing program of research provided practical insights about immediate needs of families and historical insights regarding structural inequities such as language differences and access to services. Resulting strategies address all levels of the social ecology for children’s cancer care, including the patient, family, provider, healthcare system, and community. Trial registration NCT04446728 June 23, 2020

Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management

2021 ◽  
Vol 10 (1) ◽  
pp. 304-308
Author(s):  
Kenneth A. Blocker ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
Medication Adherence ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Illness Representation ◽  
Effective Management ◽  
Structured Interviews ◽  
Antihypertensive Medications ◽  
Hypertension Knowledge ◽  
Management Behaviors

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.

scholarly journals Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson’s

2021 ◽  
pp. 089198872098890
Author(s):  
Angeliki Bogosian ◽  
Catherine S. Hurt ◽  
John V. Hindle ◽  
Lance M. McCracken ◽  
Debora A. Vasconcelos e Sa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Qualitative Interviews ◽  
Quality Adjusted Life Year ◽  
Secondary Outcome ◽  
Structured Interviews ◽  
Potential Cost ◽  
Mindfulness Intervention ◽  
Related Quality

Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson’s. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson’s. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson’s found the sessions acceptable and helpful.

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