Ike Brooke, Baldwin Laura-Mae, Sutton Sarah, Van Borkulo Nicole, Packer Christine, Parchman Michael L
From the Department of Family Medicine, University of Washington, Seattle, WA (BI, LMB, SS); Shift Results, Seattle, WA (NVB); Clearwater Valley Hospital and Clinics, Orofino, ID (CP); Kaiser Permanente Washington Health Research Institute, Seattle, WA (MP).
J Am Board Fam Med. 2019 Sep-Oct;32(5):715-723. doi: 10.3122/jabfm.2019.05.190027.
The Six Building Blocks Program is an evidence-based approach to primary care redesign for opioid management among patients with chronic pain. This analysis assesses the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff.
Six rural and rural-serving primary care organizations with 20 clinic locations implemented the Six Building Blocks with support from a practice facilitator, clinical experts, and an informatics specialist. After 15 months of support, interviews and focus groups were conducted with staff and clinicians in each organization to stimulate reflection on the process and outcomes of implementing the Six Building Blocks Program. Transcripts of interviews and focus groups were coded and analyzed using template analysis. Once a set of themes was agreed on, the primary qualitative analyst revisited the source data to confirm that they accurately reflected the data.
Overall, implementing the Six Building Blocks improved provider and staff work-life experience. Reported improvements to work-life included increased confidence and comfort in care provided to patients with long-term opioid therapy, increased collaboration among clinicians and staff, improved ability to respond to external administrative requests, improved relationships with patients using long-term opioid therapy, and an overall decrease in stress.
Clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management. Further research is needed on patient experiences specific to practice redesign programs.
“六个模块计划”是一种基于证据的方法,用于重新设计初级医疗保健,以管理慢性疼痛患者的阿片类药物使用。本分析评估了实施“六个模块”对初级医疗保健提供者和工作人员工作生活的影响。
六个拥有20个诊所地点的农村及服务农村的初级医疗保健组织在实践促进者、临床专家和信息学专家的支持下实施了“六个模块”。在获得15个月的支持后,对每个组织的工作人员和临床医生进行了访谈和焦点小组讨论,以促使他们反思实施“六个模块计划”的过程和结果。访谈和焦点小组的记录使用模板分析法进行编码和分析。一旦确定了一组主题,主要定性分析师会重新审视源数据,以确认它们准确反映了数据。
总体而言,实施“六个模块”改善了提供者和工作人员的工作生活体验。报告的工作生活改善包括对长期接受阿片类药物治疗的患者提供护理时信心和舒适度增加、临床医生和工作人员之间的协作增加、应对外部行政要求的能力提高、与长期接受阿片类药物治疗的患者的关系改善以及压力总体减轻。
临床医生和工作人员报告称,在实施“六个模块计划”以改善阿片类药物管理后,他们的工作生活得到了改善。需要对实践重新设计计划所特有的患者体验进行进一步研究。