Ross Jamie, Stevenson Fiona, Dack Charlotte, Pal Kingshuk, May Carl, Michie Susan, Barnard Maria, Murray Elizabeth
Research Department of Primary Care and Population Health, UCL, Upper 3rd floor, Royal Free hospital, Rowland Hill St, London, NW32PF, UK.
Department of Psychology, University of Bath, Bath, UK.
BMC Health Serv Res. 2018 Oct 19;18(1):794. doi: 10.1186/s12913-018-3615-7.
Evidence on how to implement new interventions into complex healthcare environments is often poorly reported and indexed, reducing its potential to inform initiatives to improve healthcare services. Using the implementation of a digital intervention within routine National Health Service (NHS) practice, we provide an example of how to develop a theoretically based implementation plan and how to report it transparently. In doing so we also highlight some of the challenges to implementation in routine healthcare.
The implemented intervention was HeLP-Diabetes, a digital self-management programme for people with Type 2 Diabetes, which was effective in improving diabetes control. The target setting for the implementation was an inner city London Clinical Commissioning Group in the NHS comprised of 34 general practices. HeLP-Diabetes was designed to be offered to patients as part of routine diabetes care across England. Evidence synthesis, engagement of local stakeholders, a theory of implementation (Normalization Process Theory), feedback, qualitative interviews and usage data were used to develop an implementation plan.
A new implementation plan was developed to implement HeLP-Diabetes within routine practice. Individual component strategies were selected and developed informed by Normalization Process Theory. These strategies included: engagement of local opinion leaders, provision of educational materials, educational visits, educational meetings, audit and feedback and reminders. Additional strategies were introduced iteratively to address barriers that arose during the implementation. Barriers largely related to difficulties in allocating resources to implement the intervention within routine care.
This paper provides a worked example of implementing a digital health intervention. The learning from this work can inform others undertaking the work of planning and executing implementation activities in routine healthcare. Of particular importance is: the selection of appropriate theory to guide the implementation process and selection of strategies; ensuring that enough attention is paid to planning implementation; and a flexible approach that allows response to emerging barriers.
关于如何在复杂的医疗环境中实施新干预措施的证据往往报道和索引不佳，降低了其为改善医疗服务举措提供信息的潜力。通过在国民保健服务体系（NHS）常规实践中实施一项数字干预措施，我们提供了一个如何制定基于理论的实施计划以及如何透明报告该计划的示例。在此过程中，我们还强调了常规医疗实施过程中的一些挑战。
实施的干预措施是HeLP-Diabetes，这是一项针对2型糖尿病患者的数字自我管理计划，对改善糖尿病控制有效。实施的目标是NHS中一个位于伦敦市中心的临床委托小组，该小组由34家全科诊所组成。HeLP-Diabetes旨在作为全英格兰常规糖尿病护理的一部分提供给患者。通过证据综合、当地利益相关者的参与、实施理论（规范化过程理论）、反馈、定性访谈和使用数据来制定实施计划。
制定了一项新的实施计划，以便在常规实践中实施HeLP-Diabetes。根据规范化过程理论选择并制定了各个组成部分的策略。这些策略包括：当地意见领袖的参与、提供教育材料、教育访问、教育会议、审核与反馈以及提醒。迭代引入了其他策略以应对实施过程中出现的障碍。障碍主要与在常规护理中分配资源以实施干预措施的困难有关。
本文提供了一个实施数字健康干预措施的实例。从这项工作中获得的经验教训可为其他在常规医疗中规划和执行实施活动的人提供参考。特别重要的是：选择合适的理论来指导实施过程和策略选择；确保对实施规划给予足够关注；以及采用灵活的方法以应对新出现的障碍。
