Stakeholders’ contributions to tailored implementation programs: an observational study of group interview methods

Huntink, Elke; Lieshout, Jan van; Aakhus, Eivind; Baker, Richard; Flottorp, Signe; Godycki-Cwirko, Maciek; Jäger, Cornelia; Kowalczyk, Anna; Szécsényi, Joachim; Wensing, Michel

doi:10.1186/s13012-014-0185-x

Cited by 24 publications

(21 citation statements)

References 25 publications

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“…However, little is known about how best to identify important barriers and how to select interventions to address identified barriers [ 12 , 13 ]. The TICD project conducted some ground-breaking research comparing different methods for identifying determinants of practice [ 16 ] and for linking interventions to those determinants [ 14 ]. However, our trial was limited to comparisons of tailored strategies to no intervention.…”

Section: Discussionmentioning

confidence: 99%

A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial

et al. 2015

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BackgroundElderly patients with depression are underdiagnosed, undertreated and run a high risk of a chronic course. General practitioners adhere to clinical practice guidelines to a limited degree. In the international research project Tailored Implementation for Chronic Diseases, we tested the effectiveness of tailored interventions to improve care for patients with chronic diseases. In Norway, we examined this approach to improve adherence to six guideline recommendations for elderly patients with depression targeting healthcare professionals, patients and administrators.MethodsWe conducted a cluster randomised trial in 80 Norwegian municipalities. We identified determinants of practice for six recommendations and subsequently tailored interventions to address these determinants. The interventions targeted healthcare professionals, administrators and patients and consisted of outreach visits, a website presenting the recommendations and the underlying evidence, tools to manage depression in the elderly and other web-based resources, including a continuous medical education course for general practitioners. The primary outcome was mean adherence to the recommendations. Secondary outcomes were improvement in depression symptoms as measured by patients and general practitioners. We offered outreach visits to all general practitioners and practice staff in the intervention municipalities. We used electronic software that extracted eligible patients from the general practitioners’ lists. We collected data by interviewing general practitioners or sending them a questionnaire about their practice for four patients on their list and by sending a questionnaire to the patients.ResultsOne hundred twenty-four of the 900 general practitioners (14 %) participated in the data collection, 51 in the intervention group and 73 in the control group. We interviewed 77 general practitioners, 47 general practitioners completed the questionnaire, and 134 patients responded to the questionnaire. Amongst the general practitioners who provided data, adherence to the recommendations was 1.6 percentage points higher in the intervention group than in the control group (95 % CI −6 to 9).ConclusionsThe effectiveness of our tailored intervention to implement recommendations for elderly patients with depression in primary care is uncertain, due to the low response rate in the data collection. However, it is unlikely that the effect was large. It remains uncertain how best to improve adherence to evidence-based recommendations and thereby improve the quality of care for these patients.Trial registrationClinicalTrials.gov: NCT01913236.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0397-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial

et al. 2015

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“…Each of the five countries in the TICD project selected between eight and 30 determinants for discussion in focus groups. The methods, setting, study sample and group interviews are presented in detail elsewhere [ 19 , 20 ]. Here we briefly describe how we conducted our study in Norway.…”

Section: Methodsmentioning

confidence: 99%

“…In a joint analysis of the studies to tailor interventions in the TICD project, Huntink and colleagues [ 20 ] found no relationship between the total number of suggested interventions and the number of unique suggestions (interventions only suggested by one group).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…There is a paucity of research comparing different methods of identifying determinants of practice and tailoring implementation interventions to address those. To our knowledge, the TICD project is one of the first projects that have done this [ 19 , 20 , 34 ]. We need more research to improve the methods used to tailor interventions and to understand how best to do this.…”

Section: Implications For Research and Practicementioning

confidence: 99%

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Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study

Aakhus

Granlund

Oxman

et al. 2015

Int J Ment Health Syst

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BackgroundTo improve adherence to evidence-based recommendations, it is logical to identify determinants of practice and tailor interventions to address these. We have previously prioritised six recommendations to improve treatment of elderly patients with depression, and identified determinants of adherence to these recommendations. The aim of this article is to describe how we tailored interventions to address the determinants for the implementation of the recommendations.MethodsWe drafted an intervention plan, based on the determinants we had identified in a previous study. We conducted six group interviews with representatives of health professionals (GPs and nurses), implementation researchers, quality improvement officers, professional and voluntary organisations and relatives of elderly patients with depression. We informed about the gap between evidence and practice for elderly patients with depression and presented the prioritised determinants that applied to each recommendation. Participants brainstormed individually and then in groups, suggesting interventions to address the determinants. We then presented evidence on the effectiveness of strategies for implementing depression guidelines. We asked the groups to prioritise the suggested interventions considering the perceived impact of determinants and of interventions, the research evidence underlying the interventions, feasibility and cost. We audiotaped and transcribed the interviews and applied a five step framework for our analysis. We created a logic model with links between the determinants, the interventions, and the targeted improvements in adherence.ResultsSix groups with 29 individuals provided 379 suggestions for interventions. Most suggestions could be fit within the drafted plan, but the groups provided important amendments or additions. We sorted the interventions into six categories: resources for municipalities to develop a collaborative care plan, resources for health professionals, resources for patients and their relatives, outreach visits, educational and web-based tools. Some interventions addressed one determinant, while other interventions addressed several determinants.ConclusionsIt was feasible and helpful to use group interviews and combine open and structured approaches to identify interventions that addressed prioritised determinants to adherence to the recommendations. This approach generated a large number of suggested interventions. We had to prioritise to tailor the interventions strategies.

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“…The international project tailored intervention for chronic diseases (TICD) focused on the development and evaluation of a tailored implementation programme [8]. We followed subsequent steps starting with identifying barriers and enablers (so-called determinants) of current practice of CVRM care in general practice in the Netherlands and strategies to address these [9–11]. Next, we developed a tailored intervention programme, comprising of the prioritised strategies.…”

Section: Introductionmentioning

confidence: 99%

Process evaluation of a tailored intervention programme of cardiovascular risk management in general practices

et al. 2016

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BackgroundA tailored implementation programme to improve cardiovascular risk management (CVRM) in general practice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on counselling skills and CVRM knowledge of practice nurses, (2) their use of the various components of the intervention programme and adoption of recommended practices and (3) patients’ perceptions of counselling for CVRM.MethodsA mixed-methods process evaluation was conducted. We assessed practice nurses’ motivational interviewing skills on audio-taped consultations using Motivational Interviewing Treatment Integrity (MITI). They also completed a clinical knowledge test. Both practice nurses and patients reported on their experiences in a written questionnaire and interviews. A multilevel regression analysis and an independent sample t test were used to examine motivational interviewing skills and CVRM knowledge. Framework analysis was applied to analyse qualitative data.ResultsData from 34 general practices were available, 19 intervention practices and 14 control practices. No improvements were measured on motivational interviewing skills in both groups. There appeared to be better knowledge of CVRM in the control group. On average half of the practice nurses indicated that they adopted the recommended interventions, but stated that they did not necessarily record this in patients’ medical files. The tailored programme was perceived as too large. Time, follow-up support and reminders were felt to be lacking. About 20% of patients in the intervention group visited the general practice during the intervention period, yet only a small number of these patients were referred to recommended options.ConclusionsThe tailored programme was only partly used by practice nurses and had little impact on either their clinical knowledge and communication skills or on patient reported healthcare. If the assumed logical model of change is valid, a more intensive programme is needed to have an impact on CVRM in general practice at all.

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Stakeholders’ contributions to tailored implementation programs: an observational study of group interview methods

Cited by 24 publications

References 25 publications

A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial

A tailored intervention to implement guideline recommendations for elderly patients with depression in primary care: a pragmatic cluster randomised trial

Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study

Process evaluation of a tailored intervention programme of cardiovascular risk management in general practices

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