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系列:初级保健中的电子健康。第 4 部分:应对实施挑战。

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation.

机构信息

Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.

National eHealth Living Lab (NeLL), Leiden, the Netherlands.

出版信息

Eur J Gen Pract. 2020 Dec;26(1):140-145. doi: 10.1080/13814788.2020.1826431.

Abstract

BACKGROUND

The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability.

OBJECTIVES

We consider how evidence-based implementation strategies can be built to support eHealth implementation.

DISCUSSION

What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context.

CONCLUSION

Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.

摘要

背景

电子健康应用在初级保健中的实施仍然具有挑战性。增强对实施决定因素的认识和了解对于构建基于证据的实施策略以及优化采用和可持续性至关重要。

目的

我们考虑如何构建基于证据的实施策略来支持电子健康的实施。

讨论

要考虑哪些实施策略取决于特定情况下电子健康实施的(潜在)障碍和促进因素。因此,我们首先根据实施研究综合框架(CFIR)的五个领域讨论关键障碍和促进因素。电子健康实施的一个关键障碍是成本。隐私、安全问题以及电子健康应用缺乏公认的标准也阻碍了实施。关键利益相关者在实施过程中的参与、干预措施的实施计划以及培训和支持的提供是重要的促进因素。为了支持护理专业人员和研究人员,我们提供了一种逐步的方法来开发和应用初级保健中电子健康的基于证据的实施策略。它包括以下步骤:(1)指定电子健康应用程序,(2)定义问题,(3)指定所需的实施行为,以及(4)选择和(5)评估实施策略。为了使实施策略与环境更好地匹配,逐步方法考虑了实施过程的阶段和特定的环境。

结论

应用此处提供的方法可能有助于改善初级保健中电子健康应用的实施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0754/7580793/5cb69b928c33/IGEN_A_1826431_F0001_C.jpg

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