scholarly journals Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1451
Author(s):  
Anna M. Maw ◽  
P. Michael Ho ◽  
Megan A. Morris ◽  
Russell E. Glasgow ◽  
Amy G. Huebschmann ◽  
...  
Keyword(s):  
Health Systems ◽  
Diffusion Of Innovation ◽  
Lung Ultrasound ◽  
Implementation Strategies ◽  
The United States ◽  
Clinical Environment ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Mandated Training ◽  
Time To Learn

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of adoption within a range of clinical settings. We used the diffusion of innovation theory to guide a framework analysis of the data. Of the 27 hospitalists invited, we performed 22 interviews from four hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: (1) There are important clinical advantages to LUS despite operator dependence, (2) LUS enhances patient and clinician experience, (3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and (4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite the perceived benefits of LUS for patients, clinicians and health systems, a significant barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

scholarly journals Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments

2021 ◽  
Author(s):  
Anna M. Maw ◽  
P. Michael Ho ◽  
Megan A. Morris ◽  
Russell E. Glasgow ◽  
Amy G. Huebschmann ◽  
...  
Keyword(s):  
Health Systems ◽  
Diffusion Of Innovation ◽  
Lung Ultrasound ◽  
Implementation Strategies ◽  
Clinical Environment ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Barriers To Learning ◽  
Mandated Training ◽  
Time To Learn

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, adoption among hospitalists has been slow. We performed semi-structured interviews of hospitalists from 4 diverse health systems in the US to understand determinants of adoption within a range of clinical settings. We used the Diffusion of Innovation Theory to guide a framework analysis of the data. Of 27 hospitalists invited, we performed in-terviews of 22 from 4 hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: 1) There are important clinical advantages to LUS despite operator dependence, 2) LUS enhances patient and clinician experience, 3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and 4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite perceived benefits of LUS for patients, clinicians and health systems, an important barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

scholarly journals Considerations of Australian community pharmacists in the provision and implementation of cognitive pharmacy services: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Faith R. Yong ◽  
Su-Yin Hor ◽  
Beata V. Bajorek
Keyword(s):  
Implementation Strategies ◽  
Community Pharmacists ◽  
Evaluation Framework ◽  
Pharmacy Services ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Provider Perspectives ◽  
Australian Community ◽  
Micro Level

Abstract Background Australian federally-funded cognitive pharmacy services (CPS) (e.g. medication management and reconciliation services) have not been translated into practice consistently. These health services are purportedly accessible across all Australian community pharmacies, yet are not delivered as often as pharmacists would like. There are international indicators that pharmacists lack the complete behavioural control required to prioritise CPS, despite their desire to deliver them. This requires local investigation. Objective To explore Australian pharmacists’ perspectives [1] as CPS providers on the micro level, and [2] on associated meso and macro level CPS implementation issues. Methods Registered Australian community pharmacists were recruited via professional organisations and snowball sampling. Data were collected via an online demographic survey and semi-structured interviews until data saturation was reached. Interview transcripts were de-identified then verified by participants. Content analysis was performed to identify provider perspectives on the micro level. Framework analysis using RE-AIM was used to explore meso and macro implementation issues. Results Twenty-three participants across Australia gave perspectives on CPS provision. At the micro level, pharmacists did not agree on a single definition of CPS. However, they reported complexity in interactional work and patient considerations, and individual pharmacist factors that affected them when deciding whether to provide CPS. There was an overall deficiency in pharmacy workplace resources reported to be available for implementation and innovation. Use of an implementation evaluation framework suggested CPS implementation is lacking sufficient structural support, whilst reach into target population, service consistency and maintenance for CPS were not specifically considered by pharmacists. Conclusions This analysis of pharmacist CPS perspectives suggests slow uptake may be due to a lack of evidence-based, focused, multi-level implementation strategies that take ongoing pharmacist role transition into account. Sustained change may require external change management and implementation support, engagement of frontline clinicians in research, and the development of appropriate pharmacist practice models to support community pharmacists in their CPS roles. Trial registration This study was not a clinical intervention trial. It was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC 19–3417) on the 26th of April 2019.

scholarly journals Cognitive Aids for Operating Room Crises – A Thematic Analysis of Implementer Experiences

2020 ◽  
Author(s):  
Natalie Henrich ◽  
Emily Benotti ◽  
William Berry ◽  
Alexander Hannenberg ◽  
David Hepner ◽  
...  
Keyword(s):  
Operating Room ◽  
Thematic Analysis ◽  
Implementation Strategies ◽  
The United States ◽  
Barriers And Facilitators ◽  
World Health ◽  
Local Context ◽  
Substantial Variation ◽  
Structured Interviews ◽  
Cognitive Aids

AbstractBackgroundStrategies for the implementation of evidence-based interventions have proliferated, but it remains unclear how these strategies are operationalized for different types of interventions and contexts. Here, we examine seven implementation strategies--initially developed for implementing the World Health Organization (WHO) Surgical Safety Checklist (SSC)--for implementing cognitive aids for operating room (OR) crises.MethodsWe conducted semi-structured interviews with implementers of these aids exploring the use of each of the strategies previously studied with WHO SSC implementation as well as barriers and facilitators to implementation. We conducted a thematic analysis to identify and describe the use of the strategies. We mapped barriers and factors helping facilitate (facilitators) onto corresponding constructs from the Consolidated Framework for Implementation Research.ResultsWe conducted interviews with 37 implementers across the United States. Most interviewees identified similar strategies in their implementation process, and none offered additional strategies that fell outside existing categories. There was substantial variation among implementers in how the strategies were deployed. Many of the barriers and facilitators were common across implementations.ConclusionInterviewees used a core set of strategies to implement cognitive aids for OR crises, but there was substantial variation in how implementers used these strategies, suggesting the flexibility of the strategies and the value of deliberately adapting strategies to local context. The transferability of implementation strategies from the WHO SSC to other OR-based cognitive aids demonstrates the utility of informing novel implementations with prior successful ones that share similar attributes with respect to intervention and/or context.

scholarly journals Choice Under Uncertainty: The Settlement Decisions of Serbian Self-Initiated Expatriates in the United States

2019 ◽  
Vol 11 (1) ◽  
pp. 47-79
Author(s):  
Kristijan Civljak
Keyword(s):  
United States ◽  
Value Added ◽  
Well Being ◽  
The United States ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Social Service Agencies ◽  
Acculturation Orientation ◽  
Self Worth ◽  
Qualitative Phenomenological

Abstract Objective: This study explores the settlement decisions of Serbian self-initiated expatriates (SIEs) in the United States. Methodology: Using qualitative phenomenological inquiry, semi-structured interviews were conducted with 10 Serbian SIEs, and the data were analyzed through the framework analysis method. This explorative study focused on individual preferences and processes, social interactions, and socio-economic environment through the concepts of decision theory, acculturation orientation, and transnational attachment. Findings: Serbian SIEs were motivated to migrate to the United States for career opportunities, self-worth validation, departure from social norms placed by the Serbian society, and normal, happy lives. Their decisions to stay were deeply influenced by their family members, possible repatriation or further journey dependent on favorable opportunities at home, potential boredom with a current lifestyle, and intention to start a family. Serbian SIEs navigated the macro system based on knowledge gained through exploration and transnational networks. They chose the path of individualism and integration in terms of their acculturation orientation, which put them in balanced position for their own well-being. Serbian SIEs deliberately chose metropolitan areas, in which transnational attachments were fostered, and more opportunities arose. Value added: Living in a culturally plural society has become a reality, leading to acculturation among migrants. If policy makers, hiring organizations, social service agencies, immigration officials, and law enforcement agencies understand why people choose to permanently relocate, they can also provide appropriate and relevant help in their adjustment challenges. Recommendations: The research on migration and SIEs’ decisions shows strong evidence that it relates to economic and professional gain as well as social networks and family ties; however, economic and social factors are not the only ones influencing migration decisions. Studies that call for both person- and institutional level are needed for deeper understanding of migration and settlement decisions as parameters exploring the consequences of immigration, crucial for the development of the intercultural management field. This way, both micro- and macro-level aspects would be equally highlighted, while meso-level information would serve for providing the connection between the two.

Telemedicine for Patients with Inflammatory Bowel Disease (TELE-IBD) Clinical Trial: Qualitative Assessment of Participants’ Perceptions of the TELE-IBD Intervention (Preprint)

2019 ◽  
Author(s):  
Charlene C Quinn ◽  
Sarah Chard ◽  
Erin G Roth ◽  
J. Kevin Eckert ◽  
Katharine M Russman ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Disease Activity ◽  
Remote Monitoring ◽  
Standard Care ◽  
Disease Process ◽  
The United States ◽  
Qualitative Assessment ◽  
Structured Interviews ◽  
Treatment Groups ◽  
Inflammatory Bowel

BACKGROUND Inflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, affects 1 to 3 million people in the United States. Telemedicine has shown promise in IBD. The objective of the parent study, TELE-IBD, was to compare disease activity and quality of life (QoL) in a one-year randomized clinical trial of IBD patients receiving telemedicine versus standard care. Treatment groups experienced improvements in disease activity and QoL but there was not significant differences between groups. Study adherence to the text-based intervention was less than the 80% of the targeted goal. OBJECTIVE To understand adherence to remote monitoring, the goal of this qualitative assessment was to obtain TELE-IBD trial participants’ perceptions of the TELE-IBD system, including their recommendations for future TELE-IBD monitoring. METHODS In the parent study, patients attending three tertiary referral centers with worsening IBD symptoms in the previous two years were eligible for randomization to remote monitoring via texts every other week (EOW), weekly (W) or standard care. Participants (n=348) were evenly enrolled in the treatment groups and 259 (74.4%) completed the study. For this study, a purposive sample of adherent (N=15) and non-adherent (N=14) patients was drawn from the TELE-IBD trial population. Adherence was defined as the completion of 80% or more of the W or EOW self-assessments. Semi-structured interviews conducted by phone surveyed 1) the strengths and benefits of TELE-IBD; 2) challenges associated with using TELE-IBD; and 3) how to improve the TELE-IBD intervention. Interviews were recorded, professionally transcribed, and coded based on a priori concepts and emergent themes with the aid of ATLAS.ti qualitative data analysis software. RESULTS Participants' discussions centered on three elements of the intervention: 1) self-assessment questions, 2) action plans, and 3) educational messages. Participants also commented on: text-based platform, depression and adherence, TELE-IBD system in place of office visit, and their recommendations for future TELE-IBD systems. Adherent and non-adherent participants prefer a flexible system that is personalized, including targeted education messages, and they perceive TELE-IBD as effective in facilitating IBD self-management. CONCLUSIONS Participants identified clear benefits to the TELE-IBD system, including obtaining a better understanding of the disease process, monitoring their symptoms, and feeling connected to their health care provider. Participants' perceptions obtained in this qualitative study will assist in improving the TELE-IBD system to be more responsive to patients with IBD. CLINICALTRIAL NCT01692743

scholarly journals The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Daniel Hind ◽  
Kate Allsopp ◽  
Prathiba Chitsabesan ◽  
Paul French
Keyword(s):  
Young People ◽  
Process Evaluation ◽  
Terrorist Attack ◽  
Health Sector ◽  
Routine Data ◽  
Recovery Phase ◽  
Normalisation Process Theory ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Response Phase

Abstract Background A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, ‘The Resilience Hub’, to screen and refer those affected. We present a process evaluation conducted after 1 year. Methods Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May’s Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers. Results Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester. Conclusions The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.

scholarly journals Male autistic youth experiences of belonging in integrated physical education

Autism ◽  
2021 ◽  
pp. 136236132110186
Author(s):  
Justin A Haegele ◽  
Anthony J Maher
Keyword(s):  
Physical Education ◽  
Peer Relationships ◽  
Peer Interactions ◽  
Physical Space ◽  
The United States ◽  
Educational Needs ◽  
Subjective Experiences ◽  
Structured Interviews ◽  
Autistic People ◽  
Locker Room

The study examined the subjective experiences of autistic youth regarding the role of peer interactions and relationships in feelings of belonging in integrated physical education classes. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. Eight autistic youth (all male, aged 13–18 years) who had received most of their physical education in integrated classes acted as participants. Semi-structured interviews were used to generate qualitative data, which were analyzed using a reflexive thematic approach. Findings are presented in three themes: (a) bullying can lead to self-harm and self-isolation, (b) peer interactions and relationships in the locker room, and (c) peer relationships are based on shared interests and take time to develop. Even though autistic students were educated in the same spaces as their non-autistic peers, feelings of belonging were largely unavailable to them. Lay abstract Recent years have seen calls to amplify the voices of autistic people in research about their subjective experiences. Despite this, we know little about how autistic youth experience integrated physical education, particularly in the United States. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. In this study, we sought to explore the perspectives of autistic youth toward their experiences in integrated physical education, and the roles of social interactions and relationships with peers in those experiences. Findings noted that several factors influenced the ways and extent to which our participants interacted with their peers during physical education. Unfortunately, most of our participants recalled experiencing bullying, and that physical education offered an environment where bullying was most frequent and comparatively unique compared to other contexts throughout the school day. The locker room, a space linked to physical education, was of particular concern because of a lack of teacher presence. Despite the negative views of and experiences in physical education, there was evidence of participants actively pursuing to connect with peers in this context. However, most instances where participants recalled pursuing friendship were not welcomed from others, which stunted their sense of belonging in this space. Given the role that belonging plays in what it means “to be included,” our research supports emerging ideas that even though autistic students were educated in the same physical spaces as their non-autistic peers, feelings of inclusion were largely absent.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

2021 ◽  
Author(s):  
Kyle Wilhelm ◽  
Lindsey Wilhelm
Keyword(s):  
Music Therapy ◽  
Private Practice ◽  
Phenomenological Study ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
The United States ◽  
Business Owners ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Music Therapists

Abstract As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs’ lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Responsibility for chemical exposures: perspectives from small beauty salons and auto shops in southern metropolitan Tucson

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda A. Lee ◽  
Maia Ingram ◽  
Carolina Quijada ◽  
Andres Yubeta ◽  
Imelda Cortez ◽  
...  
Keyword(s):  
Small Businesses ◽  
Chemical Exposure ◽  
The United States ◽  
Power Structures ◽  
Structured Interviews ◽  
Chemical Exposures ◽  
Study Partner ◽  
Chemical Products ◽  
Beauty Salons ◽  
Exposure Risks

Abstract Background Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of ‘responsibilization’ in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses. Methods We conducted semi-structured interviews with a total of 22 workers and owners in auto repair shops and beauty salons – two high-risk industries – in Southern Metropolitan Tucson. Participants were asked about their insights into workplace chemical exposures and health. A qualitative analysis team with representation from all study partner organizations collectively coded and reviewed the interview data in QSR International’s NVivo 11 and identified overarching themes across the interviews. Results We identified three primary themes: 1) ambivalence toward risks in the workplace; 2) shifting responsibilities for exposure protection at work; and 3) reflections on the system behind chemical exposure risks. Participants discussed the complexities that small businesses face in reducing chemical exposures. Conclusions Through our analysis of the interviews, we examine how neoliberal occupational and environmental policies funnel responsibility for controlling chemical exposures down to individuals in small businesses with limited resources, obscuring the power structures that maintain environmental health injustices. We conclude with a call for upstream policy changes that more effectively regulate and hold accountable the manufacturers of chemical products used daily by small business workers.

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