Grandes Gonzalo, Sanchez Alvaro, Cortada Josep M, Pombo Haizea, Martinez Catalina, Balagué Laura, Corrales Mary Helen, de la Peña Enrique, Mugica Justo, Gorostiza Esther
Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain.
Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain.
BMC Res Notes. 2017 Dec 6;10(1):699. doi: 10.1186/s13104-017-3040-8.
Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care.
Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A's evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records.
Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.
如果从业者与研究人员合作制定实施策略，循证干预措施更有可能被采用。本文描述了规划和执行一项策略的步骤，包括为在初级和社区护理中实施已证实的健康促进干预措施所需的结构和支持的开发。
在四个积极性很高的初级卫生保健中心举行了10至13次讨论和共识会议，涉及80%的初级护理人员和21个社区组织。所有四个中心都选择解决身体活动、饮食和吸烟问题。他们选择了基于证据的5A临床干预措施，以适应健康中心的背景。计划的实施策略在多个层面发挥作用：自下而上的初级护理组织变革、管理者的自上而下支持、社区参与以及创新的电子健康信息和通信工具的开发。共同决策和实践促进被视为协作建模过程中最积极的方面，该过程比预期花费的时间更多，尤其是集成到电子健康记录中的新电子健康工具的开发。
在积极性高的中心，对将健康促进整合到初级和社区护理中的实施策略进行协作建模是可行的。然而，如果受到初级护理繁重工作量的阻碍，并且产生自下而上决策过程固有的不确定性，这将是困难的。从这一经验中吸取的教训可能在不同环境和其他临床干预中有用。两篇配套论文报告了其可行性评估，并对实施过程进行了定量和定性评估。
