Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
BMJ Open. 2024 Jan 31;14(1):e079234. doi: 10.1136/bmjopen-2023-079234.
Integrating a palliative approach to care into primary care is an emerging evidence-based practice. Despite the evidence, this type of care has not been widely adopted into primary care settings. The objective of this study was to examine the barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices by applying an implementation science framework.
This convergent mixed methods study analysed semistructured interviews and expression of interest forms to evaluate the implementation of a protocol, linked to implementation strategies, for a palliative approach to care called Early Palliation through Integrated Care (EPIC) in three primary care practices. This study assessed barriers to and facilitators of implementation of EPIC and was guided by the Consolidated Framework for Implementation Research (CFIR). A framework analysis approach was used during the study to determine the applicability of CFIR constructs and domains.
Primary care practices in Canada. Interviews were conducted between September 2020 and November 2021.
10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.
Overall, there were implementation barriers at multiple levels that caused some practices to struggle. However, barriers were mitigated when practices had the following facilitators: (1) a high level of intra-practice collaboration, (2) established practices with organisational structures that enhanced communications, (3) effective leveraging of EPIC project supports to transition care, (4) perceptions that EPIC was an opportunity to make a long-term change in their approach to care as opposed to a limited term project and (5) strong practice champions.
Future implementation work should consider assessing facilitators identified in our results to better gauge primary care pre-implementation readiness. In addition, providing primary care practices with support to help offset the additional work of implementing innovations and networking opportunities where they can share strategies may improve implementation success.
将姑息治疗方法融入初级保健是一种新兴的循证实践。尽管有证据表明，这种护理方式尚未在初级保健环境中广泛采用。本研究的目的是通过应用实施科学框架，检查在初级保健实践中成功实施姑息治疗方法的障碍和促进因素。
这项收敛混合方法研究分析了半结构化访谈和表达兴趣的表格，以评估实施与实施策略相关的姑息治疗方法协议的情况，该协议称为早期姑息治疗通过综合护理（EPIC），在三个初级保健实践中进行。这项研究评估了 EPIC 实施的障碍和促进因素，并由实施研究综合框架（CFIR）指导。在研究过程中使用了框架分析方法来确定 CFIR 结构和领域的适用性。
加拿大的初级保健实践。访谈于 2020 年 9 月至 2021 年 11 月进行。
参与实施 EPIC 的 10 人接受了采访。每个实践的 3 人接受了重新采访以澄清新出现的主题。
总体而言，多个层面存在实施障碍，导致一些实践面临困难。然而，当实践具备以下促进因素时，障碍会得到缓解：（1）高水平的内部实践合作；（2）具有增强沟通的组织结构的既定实践；（3）有效利用 EPIC 项目支持过渡护理；（4）认为 EPIC 是一个长期改变护理方法的机会，而不是一个有限期限的项目；（5）强大的实践拥护者。
未来的实施工作应考虑评估我们研究结果中确定的促进因素，以更好地衡量初级保健实施前的准备情况。此外，为初级保健实践提供支持，以帮助减轻实施创新的额外工作，并提供网络机会，以便他们可以分享策略，可能会提高实施的成功率。
