Nora Jacobson 1 , Roberta Johnson 2 , Bri Deyo 2 , Esra Alagoz 3 , Andrew Quanbeck 4 Show Affiliations »
Abstract
BACKGROUND: In order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system. OBJECTIVES: To describe (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care. METHODS: A team of investigators conducted observations (n=24), focus groups (n=4) and interviews (n=2). The team; kept contact logs documenting all interactions with the intervention clinics and preserved all work products resulting from the intervention. Initial analysis was concurrent with data collection and findings were used to modify the intervention in real time. At the conclusion of the pilot test, a pragmatic descriptive analysis of all data was performed to explore key modifications. RESULTS: Time constraints, entrenched hierarchical structures and a lack of quality improvement skills among clinical staff were the main barriers to implementing systems consultation. Modifications made to address these conditions included creating a consulting team, giving change teams more direction, revising process improvement tools, supporting the use of electronic health record (EHR) functionalities and providing opportunities for shared learning among clinics. DISCUSSION AND CONCLUSION: With the lessons of this research in mind, our goal in future iterations of systems consultation is to give clinics a combination of clinical, organisational change and EHR expertise optimised according to their needs. We believe a streamlined process for assessing the key characteristics identified in this study can be used to develop a plan for this kind of optimisation, or tailoring, and we will be developing such a process as part of an upcoming clinical trial. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
BACKGROUND: In order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system. OBJECTIVES: To describe (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care. METHODS: A team of investigators conducted observations (n=24), focus groups (n=4) and interviews (n=2). The team; kept contact logs documenting all interactions with the intervention clinics and preserved all work products resulting from the intervention. Initial analysis was concurrent with data collection and findings were used to modify the intervention in real time. At the conclusion of the pilot test, a pragmatic descriptive analysis of all data was performed to explore key modifications. RESULTS: Time constraints, entrenched hierarchical structures and a lack of quality improvement skills among clinical staff were the main barriers to implementing systems consultation. Modifications made to address these conditions included creating a consulting team, giving change teams more direction, revising process improvement tools, supporting the use of electronic health record (EHR) functionalities and providing opportunities for shared learning among clinics. DISCUSSION AND CONCLUSION: With the lessons of this research in mind, our goal in future iterations of systems consultation is to give clinics a combination of clinical, organisational change and EHR expertise optimised according to their needs. We believe a streamlined process for assessing the key characteristics identified in this study can be used to develop a plan for this kind of optimisation, or tailoring, and we will be developing such a process as part of an upcoming clinical trial. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
clinical practice guidelines; evidence-based medicine; implementation science; primary care; qualitative research
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Year: 2018
PMID： 30381332 DOI： 10.1136/bmjqs-2018-008160
Source DB: PubMed Journal: BMJ Qual Saf ISSN： 2044-5415 Impact factor: 7.035