Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand; and Centre for Health Systems and Technology (CHeST), Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
WellSouth Primary Health Network, Level 2, 333 Princes Street, Dunedin 9016, New Zealand.
J Prim Health Care. 2022 Jun;14(2):130-137. doi: 10.1071/HC22032.
Introduction Health systems internationally have developed new models of primary care to address health-care challenges. One such model is the Health Care Home (HCH),which has been widely adopted across New Zealand. Aim To explore the facilitators and barriers to implementation of the HCH in the southern health district (Otago and Southland). Methods Interviews with staff (n = 15) from seven general practices were undertaken. A rapid thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted using the framework method. Results A number of implementation facilitators and barriers across three CFIR domains were identified: intervention characteristics, inner setting and implementation process. The intervention - the HCH - has well-designed core components (eg clinician triage, patient portals), but the adaptable periphery also needs addressing to ensure the core components fit the local context. In the inner setting, a positive implementation climate and readiness for change (a strong need for the change, compatibility, strong leadership, availability of resources, and a clear understanding of the HCH and timely practical support) were key for successful implementation. Although the HCH practices had detailed planning and performance monitoring systems in place, a successful implementation process required having a change management plan and ensuring whole-of-practice engagement. Discussion This evaluation has identified facilitators and barriers to implementing the HCH in one health district using implementation science theory (CFIR). It is imperative to tailor the HCH model to local needs and individual general practices for successful implementation.
简介 国际卫生系统已经开发出新型的初级保健模式，以应对医疗保健挑战。其中一种模式是“医疗保健之家”（HCH），该模式已在新西兰广泛采用。 目的 探讨南部卫生区（奥塔哥和南地）实施 HCH 的促进因素和障碍。 方法 对来自七家普通诊所的 15 名工作人员进行了访谈。采用基于实施研究综合框架（CFIR）的快速主题分析方法，采用框架方法进行分析。 结果 在 CFIR 的三个领域中确定了一些实施促进因素和障碍：干预措施特征、内部环境和实施过程。干预措施——HCH——具有精心设计的核心组件（例如临床医生分诊、患者门户），但可适应的外围部分也需要解决，以确保核心组件适应当地情况。在内部环境中，积极的实施氛围和变革准备（对变革的强烈需求、兼容性、强有力的领导、资源的可用性，以及对 HCH 的清晰理解和及时的实际支持）是成功实施的关键。尽管 HCH 实践已经制定了详细的计划和绩效监测系统，但成功实施还需要有变更管理计划，并确保整个实践的参与。 讨论 本评价使用实施科学理论（CFIR），确定了在一个卫生区实施 HCH 的促进因素和障碍。根据当地需求和各个普通诊所的情况对 HCH 模型进行调整对于成功实施至关重要。
