Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.
Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care.
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DOI：
10.1186/s13012-016-0525-0
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发表时间：
2016-12-01
期刊：
影响因子：
--
通讯作者：
Manca DP
中科院分区：
文献类型：
--
作者：
Sopcak N;Aguilar C;O'Brien MA;Nykiforuk C;Aubrey-Bassler K;Cullen R;Grunfeld E;Manca DP
BETTER（Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care）是一项基于患者的干预措施，旨在改善40至65岁患者的心血管疾病、糖尿病、癌症和相关生活方式因素的慢性病预防和筛查（CDPS）。BETTER的关键组成部分是预防从业人员（PP），这是一名具有CDPS专业技能的医疗保健专业人员，他与患者会面，使用BETTER工具包和简短行动计划制定个性化的预防处方。本定性研究的目的是了解促进者和障碍的实施更好的2程序之间的临床医生，患者和利益相关者在三个（城市，农村和偏远）的初级保健设置在纽芬兰和拉布拉多，加拿大。我们收集并分析了20个关键线人访谈和5个焦点小组的回应，以及备忘录和现场笔记。使用Nvivo 10软件组织数据，并使用常数比较方法编码。然后，我们采用了实施研究的综合框架（CFIR），将我们的分析集中在与计划实施最相关的领域。在五个CFIR领域内，以下关键因素被确定为影响BETTER 2的实施：（1）干预特征-干预的复杂性和成本;（2）外部环境-对适合性的感知，包括缺乏报酬、缺乏资源和重复服务，以及医生和患者感知的患者需求;（3）预防咨询师的特征--对预防的兴趣以及支持和激励患者的能力;（4）内部设置--当地支持者的可用性以及团队合作与团队合作;以及（5）过程规划和参与、协作和团队合作。在新的初级保健环境中实施新的CDPS计划是一个复杂的多层次过程。这项研究确定了在纽芬兰和拉布拉多的三个初级保健机构中阻碍或促进实施更好方法的关键因素。采用CFIR作为一个总体类型学允许与其他背景和设置进行比较，并可能是有用的做法，研究人员和政策制定者有兴趣在实施CDPS计划。
BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics—complexity and cost of the intervention; (2) outer setting—perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients’ needs as perceived by physicians and patients; (3) characteristics of prevention practitioners—interest in prevention and ability to support and motivate patients; (4) inner setting—the availability of a local champion and working in a team versus working as a team; and (5) process—planning and engaging, collaboration, and teamwork. The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.
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影响因子：
2.9
作者：
Kadu MK;Stolee P
通讯作者：
Stolee P
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.7
作者：
Rubio-Valera M;Pons-Vigués M;Martínez-Andrés M;Moreno-Peral P;Berenguera A;Fernández A
通讯作者：
Fernández A
影响因子：
2.9
作者：
Grunfeld E;Manca D;Moineddin R;Thorpe KE;Hoch JS;Campbell-Scherer D;Meaney C;Rogers J;Beca J;Krueger P;Mamdani M;BETTER Trial Investigators
通讯作者：
BETTER Trial Investigators
DOI：
10.9778/cmajo.20130040
发表时间：
2014-01-01
期刊：
CMAJ open
影响因子：
--
作者：
Campbell-Scherer, Denise;Rogers, Jess;Grunfeld, Eva
通讯作者：
Grunfeld, Eva