Authors: Noura Bawab, Joanna C. Moullin, Olivier Bugnon, Clémence Perraudin
Presented by: Noura Bawab
Biography: Noura Bawab is a pharmacist and doctoral student at the Centre for Primary Care and Public Health (Unisanté) in Lausanne, Switzerland. After completing her master thesis on the development and testing of a serious game with final year pharmacy students in Switzerland and Belgium, she graduated from the Université Libre de Bruxelles. She then started her PhD thesis in 2015 while working in community pharmacy. Her research, funded by the Swiss Federal Office of Public Health, focuses on the implementation of pharmaceutical services in community pharmacies. Her current research project aims to implement an interprofessional support program for chronic patients in a primary care setting in French-speaking Switzerland, with a special focus on patients with diabetes. This project will be the result of her thesis to be presented in September 2020.
Background: The Swiss federal government promoted the evaluation of an inter-professional patient support model, including regular motivational interviews (patient-pharmacist), medication adherence and patient-reported outcomes monitoring and interactions with physicians. The aim of this 15-month study was to evaluate the implementation process of a programme tailored to patients with type 2 diabetes, taking at least one oral antidiabetic treatment.
Materials and methods: This is a prospective, multi-centric, observational, cohort study using a hybrid implementation-effectiveness design and the Framework for the Implementation of Services in Pharmacy (FISpH) . Outcomes were assessed at each stage of the implementation process using both quantitative and qualitative methods. A set of implementation measures reported on the process (number of pharmacies going through the stages), outcomes (e.g. reach, fidelity) and impact (influencing factors and implementation strategies).
Results: Two-hundred-twelve patients were included to benefit from the support programme in 27 pharmacies. The mean inclusion rate per pharmacy was 8 patients (SD 6, range: 1-29). We observed a step-by-step implementation process: 1) internal organisation: teaching and coaching of the pharmacy team, identification of eligible patients, 2) preparation of inter-professional collaboration: information and local networking with physicians; and 3) relationship building with patients. Main influencing factors were pharmacists’ skills in motivational interviewing, support from pharmacy owners, pre-existing local inter-professional networks and profitability of the programme.
Figure 1. Indicators of progress of the implementation process
Conclusions: This evaluation provided evidence regarding the implementation capacity and acceptability of the programme by pharmacy teams, patients with diabetes and physicians: a promising start for inter-professional chronic care services.
Authors: Mark Pearson, Daniele Carrieri, Karen Mattick, Chrysanthi Papoutsi, Simon Briscoe, Geoff Wong, Mark Jackson
Presented by: Mark Pearson
Biography: Mark is a social scientist focusing on knowledge mobilisation and implementation issues in health and social services. His research focuses on how social, psychological and organisational factors interact and impact on how knowledge is used in practice. Using theory-driven methods, Mark conducts research that informs both the development of interventions (the implementation and impact theories that underpin the ways in which complex interventions are proposed to work) and the evaluation of interventions (refining understanding of implementation mechanisms that are transferable across fields of practice). He is Mark is Lead for Implementation Science at the Wolfson Palliative Care Research Centre (Hull York Medical School) and a member of the National Institute for Health Research’s Health Services & Delivery Research (HSDR) Funding Committee.
Background: The impact of the work environment on the mental health of doctors is internationally recognised. However, research syntheses on interventions that provide support, advice and/or treatment to sick doctors have not fully taken account of intervention complexity and heterogeneity, the multiple dimensions of the issue, nor the challenges of implementing strategies to address mental ill-health in doctors. We: 1) conducted a realist review of interventions to improve doctors’ and medical students’ mental ill-health, engaging throughout with a diverse group of stakeholders; 2) developed recommendations to support tailoring, implementation, monitoring and evaluation of these strategies.
Method: Realist review, conducted and reported consistent with RAMESES standards. Research and policy sources identified through bibliographic database searches, purposive searches, and stakeholder engagement. Extracted data analysed using a realist lens to identify explanatory context-mechanism-outcome configurations (CMOcs) of mental ill-health in doctors and medical students.
Results: 179 sources were included, 45% of which were from the USA and 74% of which were published in 2009 or later. The synthesis produced 19 CMOcs (processes, relationality, balance, and implementation) explaining how mental ill-health develops in the workplace and how strategies can be implemented to reduce mental ill-health. Trust was identified as highly important in explaining the interplay between implementation strategy, intervention development, and the broader workplace context.
Conclusion: Interventions to improve doctors’ and medical students’ mental ill-health should take account of the complexity of the issue and its implementation by operating at multiple levels and engaging diverse stakeholders. Refining existing complex interventions, informed by the CMOcs in this review, is likely to be more efficient and ultimately more effective than developing new interventions. This review has demonstrated the importance of Realist review in critically synthesising diverse evidence about complex health service issues so that implementable multi-level strategies can be developed.
Acknowledgements: This project is funded by the by the National Institute for Health Research (NIHR) HS&DR (project number 16/53/12) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Systematic review registration PROSPERO CRD42017069870
Authors: Mike Hurley, Sally Irwin, Jo Erwin, Fay Sibley, Amber Gibney, Andrea Carter
Presented by: Mike Hurley
Biography: Mike Hurley qualified as a physiotherapist at Kings’ College Hospital in 1985. After completing his PhD at University College London he was Lecturer, Reader and Professor at Kings’ College London between 1990-2010. In 2010 he became Research Lead in the School of Rehabilitation Sciences at St George’s University of London, and in 2013 was appointed Clinical Director for the Musculoskeletal Programme of the Health Innovation Network.
Professor Hurley has been a Clinical Advisor to Arthritis Research UK (2002-2008), Chair of Chartered Society of Physiotherapy’s Research and Clinical Effectiveness (2001-2004), has contributed to several national working groups, clinical guideline committee and conferences. He has authored more than 80 papers.
A major part of his work was the development of ESCAPE-pain – a rehabilitation programme to help people with knee, hip and back pain that is now being delivered in nearly 300 clinical and community venues across the UK.
Background: NICE recommend people with knee, hip and/or back pain receive self-management and lifestyle advice, emphasising the importance of physical activity and maintaining healthy weight. Unfortunately, delivering NICE advice to the millions of people requiring help is prevented by limitations in time, facilities and expertise. Moreover, using healthcare facilities and professionals medicalises a problem most people see as a natural part of living and ageing. Joint Pain Advice (JPA) can deliver NICE advice in a variety of health and community settings, using a range healthcare and non-healthcare professionals (1,2). Here we extend JPA delivery into workplace settings using local health champions.
Method: In workplaces, 2-3 people were trained to deliver JPA. This involved an initial assessment of participant’s pain (using VAS), musculoskeletal health and function (MSK-HQ), activity level (number of days/week active for >30mins). Participants were taught simple self-management strategies, encouraged to adopt healthier lifestyle using motivational interviewing, goal-setting action/coping planning and personalised care plans constructed. Participants were reviewed 3 times over 6-months, baseline outcomes reassessed, progress highlighted, health messages reinforced and plans and care plans revised if necessary. Results presented as mean change (95% CI)
Results: Twelve large public organisations or small/medium private enterprises delivered JPA to 417 people. Participants attendance was 75%, suggesting they found JPA acceptable, valued advice tailored to their individual needs and experienced tangible benefits. Overall the MSK-HQ improved by 8 points (CI 6.6 to 9.2), pain 1 (-1.33 to -0.88), activity for >30mins by 1.5 (1.1 to 1.8), self-reported physical function by 1.5 (1.1 to 1.8).
Conclusion: Delivering NICE advice for management of chronic joint pain through JPA in workplace settings using local health champions is practicable, beneficial and valued. This can avoid medicalising the problem and “prevent turning people into patients”. JPA could benefit small medium or large employers across the UK.
Acknowledgements: This work was funded by the Department of Work and Pensions Work and Health Unit Challenge Fund Trial Registration Not applicable Consent to publish Not applicable References 1. Hurley M V., Semple A, Sibley F, Walker A. Evaluation of a health trainer–led service for people with knee, hip and back pain. Perspectives in Public Health [Internet]. 2019;139(6):308–15. Available from: https://doi.org/10.1177/1757913919833721 2. Innovation Network Joint Pain Advice (JAP) information https://healthinnovationnetwork.com/projects/joint-pain-advisor-exploring-a-new-model-of-care-for-chronic-joint-pain/Health
Authors: Seward N, Hanlon C, Colbourn T, Murdoch J, Prince M, Venkatapuram S, Sevdalis N
Presented by: Nadine Seward
Biography: Nadine Seward is a Lecturer in Global Implementation, based within the Centre for Implementation Science. Nadine holds a BSC (Hons Life Science) from Queen’s University in Canada, an MSC (Epidemiology) from LSHTM and a PhD (Epidemiology) from UCL.
Prior to starting at KCL in August 2018, Nadine worked at LSHTM on community trials aimed at improving maternal and newborn health outcomes as well as trials trying to better educational outcomes. Her interests were focused on using causal mediation analyses and other techniques to evaluate the “how and why” behind the effectiveness of different complex interventions. Before LSHTM, Nadine worked at UCL, Institute of Global Health on community trials that involved women’s groups using participatory learning and action, to improve maternal and newborn health outcomes.
Nadine is currently working with the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa (ASSET) to improve the quality of integrated primary health care, surgical and maternal and newborn care. As a Lecturer in Global Implementation Science, Nadine is interested in brining interventions that are known to be effective, to scale through the application of appropriate models, frameworks and theories. Nadine will be working with the different ASSET partners and across the different care platforms to use implementation science methodology to evaluate practical ways to improve the quality and coverage of care.
Nadine is also interested in developing implementation science methodologies as well as applying and adapting causal inference techniques to evaluate the effectiveness of different implementation programmes in low- and- middle- income countries.
Background: The call for universal health coverage within low-and middle-income countries, requires the implementation and scale-up of interventions that are known to be effective.1 Achieving universal health coverage requires robust implementation research (IR) that evaluates the influence of context on the effectiveness of interventions to deliver evidence-based care.(1) However, where IR uses a randomised controlled trial (RCT) to test the effectiveness of interventions to deliver care that is known to be effective, clinical equipoise may no longer be relevant.(2)
IR is fundamentally about evaluating the influence of context on the effectiveness of interventions to deliver evidence-based care. (3) However, the process of conceptualising whether there is sufficient evidence about context to generalise findings from previous research to a new setting is rarely reported, leaving uncertainty as to whether an RCT is justified. This raises important ethical concerns surrounding participants in the control arm of an RCT being exposed to unnecessary harms associated with denying individuals access to care that is known or can be expected to be effective, in the local context.(2)
Proposed methods to address ethical concerns: To address this ethical concern, we propose a complementary approach to clinical equipoise for IR, known as “contextual equipoise.” We further propose that IR that uses an RCT needs to clearly articulate the grounds for contextual equipoise. However, the process of understanding contextual equipoise raises ontological and epistemological challenges for assessing the certainty of evidence. We discuss these challenges and argue that a guiding principle should be uncertainty amongst key stakeholders, as to the influence of context on the delivery evidence-based care.
Conclusions: To guide researchers, we describe how theory-driven methods can be applied to help understand if contextual equipoise is justified. We hope our approach helps researchers to better understand and ensure the ethical principle of beneficence is upheld in the real-world contexts of IR in low-resource settings.
Authors: Shalini Ahuja*, Nathan Peiffer-Smadja, Kimberly Peven, Michelle White, Andrew Leather, Sanjeev Singh, Marc Mendelson, Alison Holmes, Gabriel Birgand, and Nick Sevdalis*, ASPIRES study co-investigators
Presented by: Shalini Ahuja
Biography: Shalini is an implementation science researcher and a physiotherapist by training. She has a PhD in public mental health research from King’s College London and a master’s in health management, planning and policy from University of Leeds, UK.
Her research work includes design and implementation of behaviour change interventions addressing various public health challenges including chronic malnutrition, mental health treatment gap, Antimicrobial Resistance, infection-prevention and control, all in the context of low and middle income countries mainly India, Nepal, Ghana, South Africa and Ethiopia.
Background: Surgical site infection (SSI) prevention is a major issue, particularly in the era of antimicrobial resistance. Reducing SSI rates will require, among other priorities, optimisation of antibiotic usage which may be enhanced by feedback1. Within the area of surgery, it remains unclear how feedback can best be used to reduce SSIs and improve antibiotic usage. Therefore, this study aims to understand how data from surveillance and audit are utilised in routine surgical practice.
Method: A systematic scoping review was conducted. Two electronic health-oriented databases and the bibliographies of relevant articles were searched. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively. The results of included studies were synthesised using a narrative synthesis approach underpinning thematic analysis principles. Implementation strategies were grouped into 73 discrete strategies as suggested by the ERIC implementation science research group2. The quality of the individual studies was assessed using Integrated Quality Criteria for Systematic Review of Multiple Study Designs.
Results: We identified 21 studies: 17 focused on SSI outcomes and 8 described antibiotic usage in surgery in relation to SSI. These 21 studies described several interventions, mostly multimodal with feedback as a component. Among studies reporting antibiotic usage in surgery most (71%,) discussed compliance with surgical antibiotic prophylaxis. Fifty-five percent of the studies on SSI outcomes reported significant reduction in infection rates. Feedback was often provided in written format (62%), either individualised (38%) or in group (48%). In 65% of the studies, between one and five of 73 ERIC implementation strategies were used while only one study reported using more than 15 implementation strategies.
Conclusion: Our study summarises the efficacy of auditing and surveillance outputs by analysing implementation strategies and highlights the need for feedback to all levels of health care professionals involved in perioperative care of surgical patients.
Authors: Jackie Dwane, Dr. Sean Redmond, Eoin O’Meara Daly, Caitlin Lewis
Presented by: Jackie Dwane
Biography: Jackie joined the Research into Evidence Policy, Programme and Practice (REPPP) team in University of Limerick in 2019. Her role on the Action Research Project involves working with Garda (Police) Youth Diversion Projects (GYDP) to identify and disseminate best practice in working with young people at risk. Jackie graduated from University College Cork (UCC) (BA Hons) in 1998 and completed her MSocSc in Youth and Community Work in UCC in 2001. For twelve years Jackie worked in the Limerick and Clare Education and Training Board as a Youth Officer where her role included trialling a new framework with youth projects involved in a reform process with the Department of Children and Youth Affairs. Jackie’s previous career history includes working as Coordinator of a GYDP in Limerick city, as a youth worker and as a residential care worker with young people in secure care settings. Jackie is an experienced trainer and facilitator of Restorative Practice.
Background: There are 105 youth diversion projects across Ireland targeting young people in trouble with the law. It is estimated that 60 percent of professionals’ time spent in these projects relates to building professional relationships with young people. This relationship effort accounts for approximately €8 million taxpayer’s investment each year. The objective of the relationship is to motivate young people towards pro-social trajectories. However, the practice is largely uncodified or sufficiently described in terms of highlighting and incentivising approaches which are informed by the available evidence.
Method: An Action Research Project (ARP) on behalf of the Department of Justice and Equality is underway to identify the most potent mechanisms within the best relationships. The study involves 16 projects. Initially a Systematic Evidence Review of high quality youth programmes examined underlying relationship ‘mechanisms’. The project then involved academics and practitioners co-designing new evidence informed guidance on relationship-building to improve the effectiveness of everyday practice. An implementation study will complement a realist evaluation of the ARP. The researchers are routinely collecting data through a series of reflective conversations with practitioners over several months to track the experiences of each project implementing the new guidance, time stamped to document key internal and external events. Focused workshops with the wider teams will further interrogate this experience. The researchers are using the Proctor implementation outcomes framework (Proctor et al. 2011) to shape their analysis of the data collected from across the 16 projects.
Results: The implementation study charts the projects’ experience of co-design and transforming guidance into practice. Projects have responded to phase one of the co-design process with enthusiasm and we can report initial ‘buy-in’ and motivation is high.
Conclusion: This presentation will outline the implementation study so far in terms of the methodological design, interim implementation findings, next steps and our reflections on a complex co-design process. Acknowledgements This study is presented on behalf of Research Evidence into Policy, Programme and Practice (REPPP). The Action Research Project is funded and supported by the Department of Justice and Equality. Special thank you goes to the participating Garda Youth Diversion Projects and the Department of Justice and Equality.
References: Proctor, E., Silmere, H., Raghavan, R. et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health 38, 65–76 (2011).
Authors: Julia E. Moore and Sobia Khan
Presented by: Julia Moore
Biography: Dr. Julia E. Moore is the Senior Director for the Center for Implementation. Dr. Moore has a PhD from Penn State in Human Development, where she was trained as an implementation scientist, researching the best ways to implement evidence-based programs. She has worked on over 100 implementation projects. Dr. Moore is known internationally for her ability to communicate complex implementation science concepts in a clear and practical ways. Dr. Moore developed the online mini-course, Inspiring Change: creating impact with evidence-based implementation, which has been completed by over 4000 professionals from around the world. She is an invited keynote speaker at implementation and healthcare conferences and events. Dr. Moore is most passionate about supporting professionals how to use implementation science; she has delivered dozens workshops to thousands of participants.
Background: While the field of implementation science has advanced in recent years, this has coincided with a growing divide between the science and practice of implementation. One strategy to bridge this gap is training implementation practitioners to apply implementation science to their initiatives in a thoughtful and proactive way. Effective implementation capacity building should be based on core competencies – the knowledge, skills, attitudes, and behaviours needed to apply implementation science. There is a growing body of literature on core competencies for implementation scientists, but the same progress has not been made for core competencies for implementation practitioners. Building applied implementation science capacity at the practitioner level can foster better implementation and overall improved population-level impacts; therefore, understanding the core competencies for applying implementation science at the front line is paramount. The goal of this project was to extrapolate and synthesize core competencies for implementation practitioners.
Method: We scanned the published and grey literature to identify core competencies for implementation practice. Six documents outlining (or including components of) core competencies for implementation practice were retrieved. Two analysts reviewed each document using a content analysis approach. Competencies relevant to implementation practice were extracted into an abstraction form and consolidated into a list of common competencies. The refined list of competencies was then grouped thematically into overarching implementation “activities” (e.g., understanding the problem, facilitating implementation).
Results: We identified 37 core competencies which we categorized into 10 implementation activities: Inspiring Stakeholders and Developing Relationships; Building Implementation Teams; Understanding the Problem; Using Evidence to Inform all Aspects of KT; Assessing the Context; Facilitating Implementation; Evaluation; Planning for Sustainability; Brokering Knowledge; and Disseminating Evidence. Additionally, we identified 5 values or guiding principles for implementation practice, which emerged from the document review.
Conclusion: The competencies can be used as a guide to prioritize capacity building efforts. Acknowledgements Support and funding from Health Canada for this project.
Authors: Dennis H. Li, Nanette Benbow, J. D. Smith, Juan Villamar, Brennan Keiser, Melissa Mongrella, Thomas Remble, Brian Mustanski
Presented by: Dennis H. Li
Biography: Dennis H. Li (he/him) is an assistant professor in the Department of Psychiatry and Behavioral Sciences and the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) at Northwestern University. He holds an MPH and PhD from The University of Texas Health Science Center at Houston School of Public Health. His research centers on the development and implementation of technology-enabled sexual health promotion programs for young people, particularly sexual and gender minority youth. A primary focus is on accelerating the scale-out of eHealth evidence-based HIV prevention interventions into public health practice in order to improve reach to marginalized populations. He is a co-investigator on two national (US) implementation–effectiveness hybrid trials of web-based HIV interventions. He also leads the online community of practice for the Implementation Science Coordination, Consultation, and Collaboration Initiative (ISC3I), the research coordination and technical assistance center for the USA’s Ending the HIV Epidemic plan.
Background: The first year of the USA’s Ending the HIV Epidemic (EHE) strategy funded 65 planning projects in 46 high-priority jurisdictions to begin studying implementation of evidence-based HIV interventions in local healthcare and public health systems. To maximize the value of implementation science (IS) in these projects, we established the Implementation Science Coordination, Consultation, and Collaboration Initiative (ISC3I) with two goals: (1) support high-quality IS through expert technical assistance and (2) create opportunities to develop generalizable knowledge from local knowledge through cross-project information sharing, measure harmonization, and data synthesis. This presentation describes the first year of this innovative approach to coordinating HIV implementation research nationally.
Methods: To launch ISC3I, we invited project leads, their primary implementation partners, and federal health agencies to a two-day summit that focused on applying IS concepts to HIV contexts, facilitated researchers and partners’ co-development of an implementation research logic model, and fostered cross-project dialogue. We created an online community of practice (COP) as a clearinghouse for IS resources and ISC3I training and collaboration activities (e.g., webinars, expert coaching, videoconference discussions). We also established infrastructure to collect data from the projects, which we are using to inform coordinated IS measures and constructs to put forth for recommended use across future EHE-related projects.
Results: Because most project leads had limited prior IS training or experience, and most projects are in the formative stage, ongoing coordination challenges include differentiating interventions from implementation strategies and identifying appropriate implementation outcomes. However, many teams have engaged with ISC3I activities and reported them to be helpful. Additional lessons learned will be discussed.
Conclusions: ISC3I represents an unprecedented opportunity to expand IS capacity and develop generalizable knowledge for HIV prevention and treatment in the US. We aim to further codify our measure harmonization efforts as we move into the next year of EHE.
Authors: Dr Logan Manikam, Shereen Allaham, Dr Michelle Heys, Dr Clare Llewellyn, Dr Neha Batura, Prof Andrew Hayward, Yasmin Bou Karim, Jenny Gilmour, Kelley Webb-Martin, Carol Irish, Chanel Edwards, Prof Monica Lakhanpaul
Presented by: Shereen Al Laham
Biography: Shereen Al Laham holds Doctor of Pharmacy degree and Master of Public Health in Management and Leadership from the University of Sheffield. She has previous experience working in clinical settings and with Local authorities. She is particularly interested in epidemiological studies, and the analysis of health data to strengthen the healthcare system and its influences on policies. Currently working at the University College London (UCL) as part of the Research team on NIHR funded Nurture Early for Optimal Nutrition (NEON) Project (intervention development & Pilot Randomised Controlled Trial), that aims to optimise feeding, care and dental hygiene practices in South Asian children <2 in East London, using participatory learning and action (PLA) cycles facilitated by a multi-lingual community facilitator. She also works on other research projects at Aceso Global Health Consultants Limited and Public Health England.
Background: The first 1,000 days of a child’s life are an important period for growth and cognitive development. Exposures during pregnancy and infancy may alter lifetime risk of overall development and dental health1. The Participatory Learning and Action (PLA) is a low-cost bottom-up approach that mobilises communities to identify, prioritise, implement, and evaluate their needs and solutions through culturally-sensitive group discussions2. Recognising PLA has been successful in LMICs and the importance of community engagement, the NEON study aimed at improving infant feeding, care, and dental hygiene practices of South Asians (SA) in two deprived East London boroughs (Tower Hamlets & Newham) by reverse innovating the WHO-recommended PLA approach from LMICs.
Method: Our approach was developed through a series of workshops with community and local stakeholders facilitated by experts in PLA. Adaptation is supported by multilingual community facilitators (CFs) and the local health and social care systems. We are currently co-developing the PLA intervention toolkit consisted of; (i) PLA group facilitator manual, (ii) picture cards, (iii) healthy food recipes & (iv) community asset map by undertaking monthly development meetings with SA CFs (n=10) and refinement workshops with a larger audience of SA residents (n=50). Initially done face-to-face, we are now utilising blended-approach of online meetings due to COVID-19.
Results: The PLA approach was highly acceptable to participants. However, the feasibility of undertaking 12-session PLA cycle was questioned. We have since adapted the model to shorter cycles (7&6 session). Strong community ownership presented with CFs engaged in developing culturally-tailored PLA intervention content including a digitally shareable asset map consisting of local resources and services.
Conclusion: NEON is an exemplar of how to adapt tailored culturally-sensitive community-based intervention from LMICs to urban high-income setting. The PLA is an acceptable and feasible approach to address public health issues in marginalised poorly-resourced and ethnically-diverse community.
Authors: Michael Sykes*, Richard Thomson, Niina Kolehmainen, Louise Allan, Tracy Finch, and the co-design group
Presented by: Michael Skyes
Biography: I am a nurse with experience of leading improvements across health sectors in NHS England and Scotland, including leading national improvement work. My research interest is in implementing enhancements to existing quality improvement interventions. I am an NIHR Doctoral Research Fellow leading a study to describe and enhance the effectiveness of audit and feedback.
Background: Patients with dementia do not always get best care . Hospitals use audit and feedback to improve dementia care. Audit and feedback is variably effective at improving care . There have been calls to test potential enhancements to national audit . Both evidence and theory describe practices that might affect the effectiveness of audit and feedback [2,4]. We aimed to describe the content and delivery of the national audit of dementia, identify potential enhancements and develop a strategy to implement the enhancements.
Method: We purposively sampled six hospitals, semi-structured interview participants (n=32), observations (n=36) and documentary analysis (n=39). We used framework analysis. Interim analysis was iteratively presented to stakeholders during co-design workshops (n=9; 18 hours) for challenge and to integrate findings, until a stable description was developed. The co-design group specified potential enhancements (3 workshops; 6 hours). Further co-design workshops (n=2; 4 hours) used the normalisation process theory toolkit  to identify mechanisms affecting implementation. This analysis informed a specified  implementation strategy.
Results: Hospital actions were not informed by a robust analysis of performance, were selected from a narrow range of implementation strategies  and were not presented in a way to gain organisational commitment . We co-designed a training intervention to hospital dementia leads and clinical governance leads that aims to improve the development and agreement of hospital-level actions. The intervention trains the leads to present information which supports governance committee sense-making in relation to implementation capability (by targeting low baseline, analysing barriers and linking barriers to actions) and change commitment (by addressing trust and credibility, linking to priorities, presenting comparators and considering existing work) [2,3,7,8].
Conclusion: Training clinical leads to analyse performance, investigate barriers, select strategies and present specific information designed to gain organisational commitment may enhance the effectiveness of the national audit of dementia.
Authors: S. Hogervorst, M.C. Adriaanse, H.E. Brandt, M. Vervloet, L. van Dijk, J.G. Hugtenburg
Presented by: Stijn Hogervorst
Biography: Stijn Hogervorst is a PhD student at the department of Health Sciences at the VU University, Amsterdam. He has a background in Public Administration and Health Sciences. From 2017-2019 he was the main researcher in the support for diabetes project. Currently, he is working as a researcher in the Dutch Make-It consortium. This is a group of Dutch experts on medication adherence funded by The Netherlands Organisation for Health Research and Development (ZonMw). They strive to combine their knowledge to stimulate sustainable implementation of medication adherence interventions in the Dutch primary care.
Background: Despite the existence of many effective adherence interventions, they are rarely used in routine care. This gap between research and practice calls for more emphasis on the implementation of adherence interventions. This pilot project aims to implement an existing adherence intervention (HOUVAST 2.0) in the Dutch primary care.
Method: A qualitative process evaluation was conducted as part of a medication adherence pilot project (HOUVAST 2.0). Data were collected through a focus group and four interviews with ten allied GP and pharmacy staff members. Interviews and focus groups were semi-structured using topic lists based on the RE-AIM implementation framework. Interviews were audiotaped and transcribed verbatim. Atlas.ti 8.0 software was used for coding and structuring of themes. A thematic analysis of the data was performed.
Results: Main themes that emerged were ‘Training and preparation’, ‘Appreciation for the intervention’ ‘Technical barriers to implementation‘ and ‘social barriers to implementation’.
The intervention HOUVAST 2.0 proved engaging for clinicians that used the intervention, but also proved difficult to implement. The main barriers were a suboptimal selection process based on pharmacy refill data, a difficult target population, nurse practitioners’ difficulties addressing adherence with patients and the project did not align with goals of GPs.
Conclusion: Implementation of the HOUVAST 2.0 intervention in the Dutch primary care proved challenging. A good established collaboration between GPs and pharmacies, better ICT applications for selecting patients and a training more aimed towards practical communication techniques are important improvements needed for further implementation.
Authors: Susan Calnan, Caragh Flannery, Sheena McHugh
Presented by: Susan Calnan
Biography: Dr Susan Calnan is a post-doctoral researcher at the School of Public Health in University College Cork (UCC). She is currently working on a number of Health Research Board (HRB) funded projects within the School, involving research in implementation science and knowledge translation. Susan completed her PhD in 2019 in the area of alcohol research, including evaluation of an alcohol prevention programme for college students. Prior to this, she worked for 10 years in research publishing and has also worked as a freelance health journalist. Susan also holds a Masters of Social Science in Social Policy. Her research interests include implementation science, knowledge translation, policy analysis, ageing and alcohol-related research.
Background: Falls are considered one of the most serious and common threats to older people’s ability to maintain their independence. In Ireland, a new integrated falls prevention pathway for older people was introduced in 2015, including multidisciplinary falls risk assessment clinics in primary care. The aim of this study is to identify the factors that influenced the acceptability, appropriateness and feasibility of implementation among those delivering the clinics.
Methods: Methods involved one-to-one interviews with healthcare professionals (physiotherapists, occupational therapists and nurses) delivering falls risk assessment clinics across five implementation sites. Interviews were conducted prior to implementation and six months after implementation had commenced, in 2016 and 2017. Data were analysed deductively and inductively using a combination of the Consolidated Framework for Implementation Research (CFIR) and Proctor’s implementation outcomes taxonomy.
Results: The study identifies particular aspects of the implementation, as defined by CFIR, that influenced its acceptability, appropriateness and feasibility. Intervention characteristics, such as the relative advantages perceived and low complexity of the assessment clinics, positively influenced its perceived acceptability among service providers. Both outer setting (patient need for falls services) and inner setting (networks and communications) factors influenced its perceived appropriateness. Readiness for implementation, in particular the lack of available resources, strongly influenced the perceived feasibility of the service.
Conclusion: This study highlights the complex interplay between implementation outcomes. While an intervention may be deemed acceptable by service providers, for example, its perceived feasibility may be negatively impacted by practical constraints of the implementation setting. Results from this study will be used to improve future implementation of this complex health intervention and to inform the implementation of other falls prevention services for older people internationally.