Implementation of a Hearing Loss Screening Intervention in Primary Care
Implementation of a Hearing Loss Screening Intervention in Primary Care
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DOI：
10.1370/afm.2695
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发表时间：
2021-09-01
影响因子：
4.4
通讯作者：
Zazove, Philip
中科院分区：
文献类型：
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作者：
DeJonckheere, Melissa;McKee, Michael M.;Zazove, Philip
听力损失（HL）诊断不足，往往得不到解决。最近一项使用电子提示筛查HL的研究显示，在增加后续检测的适当转诊方面有效。我们建立在这项研究的结果，使用定性透镜，探讨实施过程中，通过家庭医学临床医生的角度。方法：我们收集了临床观察和半结构化访谈的家庭医学临床医生和居民互动的HL提示。所有的数据进行了分析，采用专题，框架和混合方法集成策略。结果我们采访了27名临床医生，进行了10次观察。主题分析产生了6个主题：（1）绝大多数人认为提示简单、易用、准确;（2）临床医生认为提示是提高患者对HL的认识和对话的有效方法;（3）临床医生和工作人员的接受在实施中起着至关重要的作用;（4）临床医生在年度访视中优先考虑提示;（5）医疗助理参与即时工作流程因卫生系统、诊所和临床医生而异;（6）即时导致更多关于HL的对话，但对患者结局的影响不确定。主题是提出一起建设的正常化过程理论和干预的结果。结论HL筛查提示整合到临床实践中因临床医生的认同和对患者结局影响的信念、医疗助理的参与以及临床访视期间的优先顺序而异。需要进一步研究，以了解如何利用临床医生和工作人员的购买，以及实施新的临床提示是否对HL筛查和患者结局产生持续影响。
PURPOSE Hearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians. METHODS We collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies. RESULTS We interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes. CONCLUSION Integration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes.