Improving chronic care through continuing education of interprofessional primary healthcare teams: a process evaluation

Abstract Background Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary healthcare teams to ultimately improving infant feeding practices in the Brazilian population. In primary healthcare units, continuing education in breastfeeding and complementary feeding is facilitated by EAAB tutors. A Manual to Support EAAB Tutor (the Manual) was developed following a problem-based learning methodology. This study aimed to evaluate the effectiveness of using the Manual by analyzing exclusive breastfeeding and complementary feeding indicators. Methods A before and after study was conducted at primary healthcare units in Embu das Artes, Brazil. The intervention consisted in the use of the Manual by EAAB tutors who performed some comprehensive training activities with healthcare teams, in a period of 8 months. Subjects consisted of mothers of infants under one year of age attended at primary healthcare units. 561 mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions The Manual is a continuing educational strategy that improved complementary feeding practices in primary health care. Key messages The use of a continuing education strategy grounded on a problem-based learning methodology was effective to produce improvements in complementary feeding practices in primary health care. The 'Manual to Support EAAB Tutor' consists of a tool that has the potential to be adapted for different contexts and easy to disclose to all EAAB tutors in the country.

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Patient and family views of team functioning in primary healthcare teams with nurse practitioners: a survey of patient-reported experience and outcomes

BMC Family Practice ◽

10.1186/s12875-021-01406-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kelley Kilpatrick ◽

Eric Tchouaket ◽

Nicolas Fernandez ◽

Mira Jabbour ◽

Carl-Ardy Dubois ◽

...

Keyword(s):

Urban Area ◽

Nurse Practitioners ◽

Primary Healthcare ◽

Organizational Characteristics ◽

Role Clarity ◽

Team Processes ◽

Healthcare Teams ◽

Outcomes Of Care ◽

Patient Reported ◽

Team Functioning

Abstract Background Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare team. We aimed to examine the influence of individual, team, and organizational characteristics, and role clarity on outcomes of care mediated by team processes in primary healthcare teams that include NPs. Methods A cross-sectional survey across six sites representing practices with NPs in Québec, Canada, was conducted between March 2018 and April 2019 as part of a multiple-case study. Patients and families (n = 485; response rate: 53%) completed a validated questionnaire, which included a patient-reported experience measure (PREM) and a patient-reported outcome measure (PROM) of team functioning (Cronbach alpha: 0.771 (PROM) to 0.877 (PREM)). We performed logistic regression and mediation analyses to examine relationships between the individual, team, and organizational characteristics, role clarity, and outcomes of care mediated by team processes. Results Patients and families expressed positive perceptions of team functioning (mean 4.97/6 [SD 0.68]) and outcomes of care (5.08/6 [0.74]). Also, high team processes (adjusted odds ratio [AOR] 14.92 [95% CI 8.11 to 27.44]) was a significant predictor of high outcomes of care. Role clarity (indirect effect coefficient ab = 6.48 [95% CI 3.79 to 9.56]), living in an urban area (-1.32 [-2.59 to -0.13]), patient as respondent (-1.43 [-2.80 to -0.14]), and income (1.73 [0.14 to 3.45]) were significant predictors of outcomes of care mediated by team processes. Conclusions This study provides key insights on how primary healthcare teams with NPs contribute to team functioning, using a validated instrument consistent with a conceptual framework. Results highlight that high role clarity, living in a non urban area, family as respondent, and adequate income were significant predictors of high outcomes of care mediated by high team processes. Additional research is needed to compare teams with and without NPs in different settings, to further explicate the relationships identified in our study.

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Professional nurses’ perceptions and experiences with the implementation of an integrated chronic care model at primary healthcare clinics in South Africa

Curationis ◽

10.4102/curationis.v40i1.1708 ◽

2017 ◽

Vol 40 (1) ◽

Cited By ~ 2

Author(s):

Ozayr H. Mahomed ◽

Shaidah Asmall

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Primary Healthcare ◽

Chronic Care Model ◽

Chronic Care ◽

Chronic Disease Management ◽

Management Model ◽

Care Model ◽

Professional Nurses ◽

Primary Healthcare Clinics

Background: An integrated chronic disease management model has been implemented across primary healthcare clinics in order to transform the delivery of services for patients with chronic diseases. The sustainability and rapid scale-up of the model is dependent on positive staff perceptions and experiences.Objectives: The aim of the study was to determine the perceptions and experiences of professional nurses with the integrated chronic care model that has been implemented.Method: A cross-sectional descriptive survey utilising a self-administered questionnaire was conducted amongst all professional nurses who were involved in delivering primary healthcare services at the 42 implementing facilities in September 2014. Each facility has between four and eight professional nurses providing a service daily at the facilitiesResults: A total of 264 professional nurses participated in the survey. Prior to the implementation, 34% (91) of the staff perceived the model to be an added programme, whilst 36% (96) of the staff experienced an increased workload. Staff noted an improved process of care, better level of interaction with patients, improved level of knowledge and better teamwork coupled with an improved level of satisfaction with the work environment at the clinic after implementation of the integrated chronic disease model.Conclusion: Professional nurses have a positive experience with the implementation of the integrated chronic disease management model.

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Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9

BMC Public Health ◽

10.1186/s12889-019-7569-4 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Sara Farnbach ◽

◽

Graham Gee ◽

Anne-Marie Eades ◽

John Robert Evans ◽

...

Keyword(s):

Indigenous People ◽

Process Evaluation ◽

Study Protocol ◽

Primary Healthcare ◽

Screening Tool ◽

Trial Registration ◽

Free Text ◽

Healthcare Staff ◽

Clinical Trial Registry ◽

Culturally Adapted

Abstract Background The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Methods Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Results Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Conclusion Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Trial registration Australian New Zealand Clinical Trial Registry ANZCTR12614000705684, 03/07/2014.

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Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

BMC Medical Informatics and Decision Making ◽

10.1186/1472-6947-12-85 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 7

Author(s):

Anik Giguere ◽

Michel Labrecque ◽

Roland Grad ◽

Michel Cauchon ◽

Matthew Greenway ◽

...

Keyword(s):

Study Protocol ◽

Primary Healthcare ◽

Barriers And Facilitators ◽

Healthcare Teams

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Introducing a quality improvement programme to primary healthcare teams

BMJ Quality & Safety ◽

10.1136/qshc.7.4.200 ◽

1998 ◽

Vol 7 (4) ◽

pp. 200-208 ◽

Cited By ~ 12

Author(s):

H. Hearnshaw ◽

S. Reddish ◽

D. Carlyle ◽

R. Baker ◽

N. Robertson

Keyword(s):

Quality Improvement ◽

Primary Healthcare ◽

Quality Improvement Programme ◽

Healthcare Teams ◽

Improvement Programme

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Process evaluation of a primary healthcare validation study of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people: study protocol

BMJ Open ◽

10.1136/bmjopen-2017-017612 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017612 ◽

Cited By ~ 3

Author(s):

Sara Farnbach ◽

John Evans ◽

Anne-Marie Eades ◽

Graham Gee ◽

Jamie Fernando ◽

...

Keyword(s):

Process Evaluation ◽

Primary Healthcare ◽

Torres Strait Islander ◽

Screening Tool ◽

Depression Screening ◽

Healthcare Staff ◽

Torres Strait Islander People ◽

Research Project ◽

Culturally Adapted ◽

Torres Strait

IntroductionProcess evaluations are conducted alongside research projects to identify the context, impact and consequences of research, determine whether it was conducted per protocol and to understand how, why and for whom an intervention is effective. We present a process evaluation protocol for the Getting it Right research project, which aims to determine validity of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people. In this process evaluation, we aim to: (1) explore the context, impact and consequences of conducting Getting It Right, (2) explore primary healthcare staff and community representatives’ experiences with the research project, (3) determine if it was conducted per protocol and (4) explore experiences with the depression screening tool, including perceptions about how it could be implemented into practice (if found to be valid). We also describe the partnerships established to conduct this process evaluation and how the nationalValues and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Researchis met.Methods and analysisRealist and grounded theory approaches are used. Qualitative data include semistructured interviews with primary healthcare staff and community representatives involved with Getting it Right. Iterative data collection and analysis will inform a coding framework. Interviews will continue until saturation of themes is reached, or all participants are considered. Data will be triangulated against administrative data and patient feedback. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Researchers will be blinded from validation data outcomes for as long as is feasible.Ethics and disseminationThe University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. Findings will be submitted to academic journals and presented at conferences.Trial registration numberACTRN12614000705684.

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Continuing education on child development for primary healthcare professionals: a prospective before-and-after study

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2014.1324665 ◽

2014 ◽

Vol 132 (4) ◽

pp. 211-218 ◽

Cited By ~ 2

Author(s):

Amira Consuêlo Melo Figueiras ◽

Rosana Fiorini Puccini ◽

Edina Mariko Koga Silva

Keyword(s):

Child Development ◽

Continuing Education ◽

Education Program ◽

Primary Healthcare ◽

Healthcare Professionals ◽

Before And After ◽

The Impact ◽

Children's Development ◽

Before And After Study ◽

Children’S Development

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

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