scholarly journals “My Patients Asked Me if I Owned a Fruit Stand in Town or Something.” Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting

2021 ◽  
Vol 11 (8) ◽  
pp. 747
Author(s):  
Heather L. Rogers ◽  
Silvia Núñez Fernández ◽  
Susana Pablo Hernando ◽  
Alvaro Sanchez ◽  
Carlos Martos ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Relative Advantage ◽  
Dietary Advice ◽  
Effective Implementation ◽  
Evidence Strength ◽  
Audio Recordings ◽  
Participant Group

Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness.

scholarly journals PROVIDER PERSPECTIVES ON IMPLEMENTING A PERSON-CENTERED COMMUNICATION TOOL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S50-S50
Author(s):  
Alexandra Heppner ◽  
Nytasia Hicks ◽  
Sarina Poth ◽  
Kimberly Van Haitsma ◽  
Katherine Abbott
Keyword(s):  
A Priori ◽  
Relative Advantage ◽  
Communication Tool ◽  
Telephone Interviews ◽  
Effective Implementation ◽  
Coding Scheme ◽  
Provider Perspectives ◽  
Evidence Strength ◽  
Positive Intervention

Abstract The PAL Card QIP Project sought to understand the intervention characteristics associated with effective implementation. Telephone interviews were conducted with n=26 NH providers who completed the project. Calls were recorded, transcribed verbatim and checked for accuracy. The Consolidated Framework for Implementation Research was utilized as an a priori coding scheme to identify factors associated with effective implementation of the PAL Card project. Major themes emerging from the data related to the evidence strength and quality of the intervention as well as the relative advantage to not assessing preferences (“turns out she doesn't even like TV and we have just been having her watch TV”), adaptability (tailoring for their needs), trialability (expanding offering of intervention after initial success), and complexity of the intervention (sharing the work across departments, difficulty using unfamiliar technology). Providers reported positive intervention characteristics of the PAL cards, however, barriers remain that require additional strategies to successfully implement.

scholarly journals Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective

2012 ◽  
Vol 21 (3) ◽  
pp. 237-240 ◽  
Author(s):  
E. Aakhus ◽  
S. A. Flottorp ◽  
A. D. Oxman
Keyword(s):  
Primary Care ◽  
Implementation Strategies ◽  
The Elderly ◽  
Evidence Based ◽  
Social Changes ◽  
Scientific Publications ◽  
Effective Implementation ◽  
Tailored Implementation ◽  
Evidence Based Guidelines ◽  
Selection Of

Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called ‘Tailored Implementation for Chronic Diseases’ (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.

scholarly journals Validation of a counseling guide for adherence to antiretroviral therapy using implementation science

2020 ◽  
Vol 28 ◽  
Author(s):  
Flor Yesenia Musayón-Oblitas ◽  
Cesar Paul Cárcamo ◽  
Sarah Gimbel ◽  
Juan Ignacio Echevarria Zarate ◽  
Ana Beatriz Graña Espinoza
Keyword(s):  
Antiretroviral Therapy ◽  
Alcohol Consumption ◽  
Implementation Science ◽  
Relative Advantage ◽  
Pilot Test ◽  
Science Method ◽  
Strength Of Evidence ◽  
Evidence Strength ◽  
Different Levels

Objective: to determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science. Method: this is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling. Results: the strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92). Conclusion: the Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.

Barriers and facilitators to catch-up vaccination in migrant populations: defining effective and cost-effective implementation strategies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E De Vito
Keyword(s):  
Implementation Strategies ◽  
Cost Effective ◽  
Barriers And Facilitators ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Migrant Populations ◽  
Effective Strategies ◽  
Effective Implementation ◽  
Catch Up

Abstract In this talk, EdV will discuss barriers and facilitators to vaccination uptake in a range of diverse migrant groups in Europe, explore the role of vaccine hesitancy in vaccine uptake in migrant populations, and define effective and cost-effective strategies to improve coverage.

scholarly journals Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views (Preprint)

2020 ◽  
Author(s):  
Ingrid Titzler ◽  
Matthias Berking ◽  
Sandra Schlicker ◽  
Heleen Riper ◽  
David Daniel Ebert
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Prescribe Medication ◽  
Treatment Access ◽  
Referral Rates ◽  
Face To Face

BACKGROUND Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior. OBJECTIVE This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. METHODS Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. RESULTS GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, <i>r</i>(73)=−0.31, <i>P</i>&lt;.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. CONCLUSIONS This study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

scholarly journals Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

2020 ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Thomas Rotter ◽  
Petra Bauer ◽  
Martin Müller
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Process Evaluation ◽  
Data Extraction ◽  
Complex Interventions ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Care Pathways ◽  
Perfect Agreement

Abstract Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. Trial registration : PROSPERO 2018 CRD42018087689

scholarly journals Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029760 ◽  
Author(s):  
H. Hofstede ◽  
H.A.M. van der Burg ◽  
B.C. Mulder ◽  
A.M. Bohnen ◽  
P.J.E. Bindels ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
General Practice ◽  
Qualitative Study ◽  
General Practitioners ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Care Practice ◽  
Registration Number ◽  
Test Ordering

ObjectiveThere has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12laboratory tests ordered.Design and settingThis qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.ParticipantsTwenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.ResultsThe most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs’ knowledge about test indications and their awareness of their own testing behaviour.ConclusionTo achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.Trial registration numberWAG/mb/16/039555.

scholarly journals Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views

10.2196/18642 ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. e18642
Author(s):  
Ingrid Titzler ◽  
Matthias Berking ◽  
Sandra Schlicker ◽  
Heleen Riper ◽  
David Daniel Ebert
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Prescribe Medication ◽  
Treatment Access ◽  
Referral Rates ◽  
Face To Face

Background Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior. Objective This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. Methods Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. Results GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, r(73)=−0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. Conclusions This study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

scholarly journals Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022594 ◽  
Author(s):  
Yao Liu ◽  
Nicholas J Zupan ◽  
Rebecca Swearingen ◽  
Nora Jacobson ◽  
Julia N Carlson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Referral Process ◽  
Provider Education ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Eye Screening ◽  
Diabetic Eye Screening

ObjectiveTeleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. We sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use.DesignWe conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use. The Chronic Care Model was used as a framework for the development of the interview guide and for categorising implementation strategies to increase teleophthalmology use.SettingA rural, US multipayer primary care clinic with an established teleophthalmology programme for diabetic eye screening.ParticipantsWe conducted interviews with 29 participants (20 patients with diabetes and 9 PCPs).ResultsMajor patient barriers to teleophthalmology use included being unfamiliar with teleophthalmology, misconceptions about diabetic eye screening and logistical challenges. Major patient facilitators included a recommendation from the patient’s PCP and factors related to convenience. Major PCP barriers to referring patients for teleophthalmology included difficulty identifying when patients are due for diabetic eye screening and being unfamiliar with teleophthalmology. Major PCP facilitators included the ease of the referral process and the communication of screening results. Based on our results, we developed a model that maps where these key patient and PCP barriers occur in the teleophthalmology referral process. Patients and PCPs also identified implementation strategies to directly address barriers and facilitators to teleophthalmology use.ConclusionsPatients and PCPs have limited familiarity with teleophthalmology for diabetic eye screening. PCPs were expected to initiate teleophthalmology referrals, but reported significant difficulty identifying when patients are due for diabetic eye screening. System-based implementation strategies primarily targeting PCP barriers in conjunction with improved patient and provider education may increase teleophthalmology use in rural, US multipayer primary care clinics.

scholarly journals Role of primary care in supporting older adults who self-harm: a qualitative study in England

2019 ◽  
Vol 69 (688) ◽  
pp. e740-e751 ◽  
Author(s):  
M Isabela Troya ◽  
Carolyn A Chew-Graham ◽  
Opeyemi Babatunde ◽  
Bernadette Bartlam ◽  
Faraz Mughal ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Help Seeking ◽  
Public Involvement ◽  
Barriers And Facilitators ◽  
Complex Nature ◽  
Design Data ◽  
Frequent Contact ◽  
Self Harm

BackgroundSelf-harm and suicide are major public health concerns. Self-harm is the strongest risk factor for suicide, with the highest suicide rates reported in older populations. Little is known about how older adults access care following self-harm, but they are in frequent contact with primary care.AimTo identify and explore barriers and facilitators to accessing care within primary care for older adults who self-harm.Design and settingAn exploratory qualitative methods study using semi-structured interviews with older adults and third-sector workers in England. Older adults were invited to participate in one follow-up interview.MethodInterviews occurred between September 2017 and September 2018. These were audio-recorded, transcribed verbatim, and data analysed thematically. A patient and public involvement and engagement group contributed to the study design, data analysis, and interpretation.ResultsA total of 24 interviews with nine older adults and seven support workers, including eight follow-up interviews with older adults, were conducted. Three themes emerged: help-seeking decision factors; sources of support; and barriers and facilitators to accessing primary care.ConclusionDespite older adults’ frequent contact with GPs, barriers to primary care existed, which included stigma, previous negative experiences, and practical barriers such as mobility restrictions. Older adults’ help-seeking behaviour was facilitated by previous positive experiences. Primary care is a potential avenue for delivering effective self-harm support, management, and suicide prevention in older adults. Given the complex nature of self-harm, there is a need for primary care to work with other sectors to provide comprehensive support to older adults who self-harm.

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