Identifying the challenges and facilitators of implementing a COPD care bundle

Lennox, Laura; Green, Stuart; Howe, Cathy; Musgrave, Hannah; Bell, Derek; Elkin, Sarah

doi:10.1136/bmjresp-2014-000035

Cited by 29 publications

(48 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While community and primary health care providers saw education and training as a more vital contributor to uptake, they did not describe lack of time as a barrier. Contrary to our findings, Lennox et al [36] found lack of time ("staff too busy") as the most prominent barrier to bundle implementation in their study on implementation of a COPD care bundle in hospitals in London (UK). However, similar to our study results, they recognized staff shortages, staff engagement, and added workload among the top four barriers to bundle implementation, barriers that the most robust implementation plan would be challenged with.…”

Section: Discussioncontrasting

confidence: 99%

Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

Michas

Deuchar

Leigh

et al. 2020

Implement Sci Commun

View full text Add to dashboard Cite

Background: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and morbidity in high-income countries. In addition to the high costs of initial hospitalization, COPD patients frequently return to the emergency department (ED) and are readmitted to hospital within 30 days of discharge. A COPD acute care discharge care bundle focused on optimizing care for patients with an acute exacerbation of COPD has been shown to reduce ED revisits and hospital readmissions. The aim of this study was to explore and understand factors influencing implementation and uptake of COPD discharge care bundle items in acute care facilities from the perspective of health care providers and patients. Methods: Qualitative methodology was adopted. Nine focus groups were conducted using a semi-structured guide: seven with acute and primary/community health care providers and two with patients/family members. Focus groups were audiotaped, transcribed verbatim, and coded and analyzed using a thematic approach. Results: Forty-six health care providers and 14 patients/family members participated in the focus groups. Health care providers and patients identified four factors that can challenge the implementation of COPD discharge care bundles: process of care complexities, human capacity in care settings, communication and engagement, and attitudes and perceptions towards change. Both health care providers and patients recognized process of care complexity as the most important determinant of the COPD discharge bundle uptake. Processes of care complexity include patient activities in seeking and receiving care, as well as practitioner activities in making a diagnosis and recommending or implementing treatment. Important issues linked to human capacity in care settings included time constraints, high patient volume, and limited staffing. Communication during transitions in care across settings and patient engagement were also broadly discussed. Other important issues were linked to patients', providers', and system attitudes towards change and level of involvement in COPD discharge bundle implementation.

show abstract

Section: Discussioncontrasting

confidence: 99%

Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

Michas

Deuchar

Leigh

et al. 2020

Implement Sci Commun

View full text Add to dashboard Cite

show abstract

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk to implementation in a systematic way. Lennox et al, 42 working as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for Northwest London, interviewed staff members involved in a multihospital QI project implementing COPD care bundles. They identified 28 challenges that impacted negatively on bundle implementation across five themes, including staffing, infrastructure, process, use of improvement methodology and patient and public involvement.…”

Section: Literature Reviewmentioning

confidence: 99%

Care bundles to reduce re-admissions for patients with chronic obstructive pulmonary disease: a mixed-methods study

Morton

Sanderson²,

Dixon³

et al. 2019

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Chronic obstructive pulmonary disease (COPD) is the commonest respiratory disease in the UK, accounting for 10% of emergency hospital admissions annually. Nearly one-third of patients are re-admitted within 28 days of discharge. Objectives The study aimed to evaluate the effectiveness of introducing standardised packages of care (i.e. care bundles) as a means of improving hospital care and reducing re-admissions for COPD. Design A mixed-methods evaluation with a controlled before-and-after design. Participants Adults admitted to hospital with an acute exacerbation of COPD in England and Wales. Intervention COPD care bundles. Main outcome measures The primary outcome was re-admission to hospital within 28 days of discharge. The study investigated secondary outcomes including length of stay, total number of bed-days, in-hospital mortality, 90-day mortality, context, process and costs of care, and staff, patient and carer experience. Data sources Routine NHS data, including numbers of COPD admissions and re-admissions, in-hospital mortality and length of stay data, were provided by 31 sites for 12 months before and after the intervention roll-out. Detailed pseudo-anonymised data on care during admission were collected from a subset of 14 sites, in addition to information about delivery of individual components of care collected from random samples of medical records at each location. Six case study sites provided data from interviews, observation and documentary review to explore implementation, engagement and perceived impact on delivery of care. Results There is no evidence that care bundles reduced 28-day re-admission rates for COPD. All-cause re-admission rates, in-hospital mortality, length of stay, total number of bed-days, and re-admission and mortality rates in the 90 days following discharge were similar at implementation and comparator sites, as were resource utilisation, NHS secondary care costs and cost-effectiveness of care. However, the rate of emergency department (ED) attendances decreased more in implementation sites than in comparator sites {implementation: incidence rate ratio (IRR) 0.63 [95% confidence interval (CI) 0.56 to 0.70]; comparator: IRR 1.14 (95% CI 1.04 to 1.26) interaction p < 0.001}. Admission bundles appear to be more complex to implement than discharge bundles, with 3.7% of comparator patients receiving all five admission bundle elements, compared with 7.6% of patients in implementation sites, and 28.3% of patients in implementation sites receiving all five discharge bundle elements, compared with 0.8% of patients in the comparator sites. Although patients and carers were unaware that care was bundled, staff view bundles positively, as they help to standardise working practices, support a clear care pathway for patients, facilitate communication between clinicians and identify post-discharge support. Limitations The observational nature of the study design means that secular trends and residual confounding cannot be discounted as potential sources of any observed between-site differences. The availability of data from some sites was suboptimal. Conclusions Care bundles are valued by health-care professionals, but were challenging to implement and there was a blurring of the distinction between the implementation and comparator groups, which may have contributed to the lack of effect on re-admissions and mortality. Care bundles do appear to be associated with a reduced number of subsequent ED attendances, but care bundles are unlikely to be cost-effective for COPD. Future work A longitudinal study using implementation science methodology could provide more in-depth insights into the implementation of care bundles. Trial registration Current Controlled Trials ISRCTN13022442. Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 21. See the NIHR Journals Library website for further project information.

show abstract

“…on whether or not to implement guidelines. This barrier has been pointed out in several studies carried out in various settings [9][10][11][12][13][14][15][16][17][18][19][20][21][22] . Moreover, Chapman et al has observed that if a team practice is tailored according to the team head, the choice of which CPG to adopt might change if a new team head is appointed [19] .…”

Section: Table 1: Demographics Of Participantsmentioning

confidence: 99%

“…It can be argued that the physicians in this study perceived their lack of awareness of the guideline and a lack of knowledge as a barrier to implementation. This has been one of the most reported barriers across studies in this topic [20][21][22]24] . This lack of knowledge could be divided into two types; first, the lack of knowledge about the guideline itself which has been labeled as awareness in some studies [23,25] , and second, lack of knowledge in the usage or application of the guidelines, which has been labeled as skills in other studies [22,24] .…”

Section: Table 1: Demographics Of Participantsmentioning

confidence: 99%

A Study of Barriers and Facilitators of Clinical Practice Guidelines Implementation among Physicians

Alnaim¹,

Almazrou²

2017

pharmaceutical-sciences

View full text Add to dashboard Cite

Alnaim and Almazrou.: Barriers and Facilitators of Clinical Practice GuidelinesThere is a gap in understanding the barriers and facilitators related to guideline implementation in Saudi Arabia. A descriptive cross sectional study was conducted to identify the factors that may act as barriers or facilitators of clinical practice guidelines used by physicians working in Riyadh, Saudi Arabia. A survey was distributed to 215 physicians working at universities and government hospitals in Riyadh city. The survey was pilot-tested on a small group of physicians to improve the clarity and limit response bias. A total of 157 physicians completed the questionnaire. About 88.5% of the physicians indicated that they did implement clinical practice guidelines in their practice while 9.6% declared that they did not implement any guidelines. Clinical practice guideline implementation was not affected by the physician role, years of experience or nationality. There were less female physicians that opted for clinical practice guidelines (P<0.5). Eighty four percent of the physicians chose them because they are evidence-based while only 40.1% incorporated them because it was part of their institutions' regulation. There was a weak positive relation between the total scores of barriers and facilitators assessment tool and the nationality of the physician. The reasons for choosing specific guidelines were not determined by the physician role, years of experience, nationality or gender. Most agreed that clinical practice guidelines served as a good foundation for self-study and still provide space for them to come to their own conclusions, but at the same time, they would like to know more about them before they decide to apply it. The implementation of guidelines was obstructed by three barriers, which were lack of support by the leadership, lack of awareness and lack of knowledge. On the other hand, the ease of access and autonomy has driven the implementation of clinical practice guidelines. Nonetheless, the barriers and facilitators experienced by the physicians may differ depending on their ethnicity and gender.

show abstract

Identifying the challenges and facilitators of implementing a COPD care bundle

Cited by 29 publications

References 24 publications

Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

Care bundles to reduce re-admissions for patients with chronic obstructive pulmonary disease: a mixed-methods study

A Study of Barriers and Facilitators of Clinical Practice Guidelines Implementation among Physicians

Contact Info

Product

Resources

About