Shifting Implementation Science Theory to Empower Primary Care Practices

Miller, William L.; Rubinstein, Ellen B.; Howard, Jenna; Crabtree, Benjamin F.

doi:10.1370/afm.2353

Cited by 22 publications

(17 citation statements)

References 43 publications

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“…Organizations may also want to consider building flexibility into ongoing telemedicine support plans. 29 As our study has shown, PCPs have had to adapt their practice approaches as well as their surroundings to make telemedicine work, and these findings should be considered as organizations continue to assess what adjustments are needed to support the ongoing use of telemedicine.…”

Section: Discussionmentioning

confidence: 92%

Making It Work: Physicians' Perspectives on the Rapid Transition to Telemedicine

DePuccio

Gaughan

McAlearney

2021

Telemedicine Reports

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Background: Telemedicine is a major pillar in the health care system's response to the coronavirus disease 2019 (COVID-19) pandemic. However, the rapid implementation of telemedicine is not without its challenges. We examined the strategies primary care physicians (PCPs) used to make the transition to telemedicine during the pandemic. Methods: A qualitative study was conducted to explore the perspectives of PCPs working at a Midwestern Academic Medical Center (AMC) who used telemedicine during the COVID-19 pandemic. Semistructured interviews with 20 PCPs were conducted 3 months following the rapid increase in the use of telemedicine across the AMC. Interview questions asked about physicians' challenges using telemedicine, the changes they had to make to use telemedicine, and what had helped them deliver care through telemedicine. All interviews were recorded, transcribed, coded, and rigorously analyzed using deductive thematic analysis. Results: According to PCPs, a successful transition to telemedicine involved three key elements: (1) maintaining flexibility in the context of constant change; (2) recognizing the need to upgrade their home office spaces; and(3) seeking opportunities to continue collaborating and sharing knowledge with peers. These strategies enabled physicians to rapidly pivot to deliver care through telemedicine when stay-at-home orders took effect. Physicians also described how frequent leadership communication and the rapid dissemination of telemedicine training supported their use of this care modality. Conclusions: Successful adoption of telemedicine requires that physicians adapt their care delivery practices. Considering these facilitators of telemedicine use can help both physicians and health care organizations with this important transition.

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Section: Discussionmentioning

confidence: 92%

Making It Work: Physicians' Perspectives on the Rapid Transition to Telemedicine

DePuccio

Gaughan

McAlearney

2021

Telemedicine Reports

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“…Stakeholder engagement is an integral component of implementation [25,26]. Growing calls are being made for [27] and examples of embedded research models, such as practice-based research networks, learning health systems, and implementation laboratories [28], that foster collaborations between researchers, implementers, and policy-makers integrated within a healthcare system to conduct research.…”

Section: Establish and Maintain Community Stakeholder Engagement And mentioning

confidence: 99%

“…Further, an implementation framework can inform clarity. Stakeholders can be engaged in the application of an implementation framework by, for example, having them involved in defining the local health system needs and selecting EBP(s) and/ or implementation strategies in the EPIS implementation phase, as these are important to enhance their collaboration and ownership of the implementation effort [26].…”

Section: Establish and Maintain Community Stakeholder Engagement And mentioning

confidence: 99%

Ten recommendations for using implementation frameworks in research and practice

Moullin

Dickson

Stadnick

et al. 2020

Implement Sci Commun

226

175

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Background: Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion: Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary: The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.

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“…Fortunately, primary care scholars are generating new family medicine practice-based evidence across the implementation and dissemination research continuum. 9 Research on practice change draws explicitly on theory and measurement. Implementation science uses learning health systems and other real-world "collaboratories" 10 to "bake-in" external validity from the beginning.…”

mentioning

confidence: 99%

Thank You, Reviewers and E-Letter Contributors!

2021

Ann Fam Med

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Shifting Implementation Science Theory to Empower Primary Care Practices

Cited by 22 publications

References 43 publications

Making It Work: Physicians' Perspectives on the Rapid Transition to Telemedicine

Making It Work: Physicians' Perspectives on the Rapid Transition to Telemedicine

Ten recommendations for using implementation frameworks in research and practice

Thank You, Reviewers and E-Letter Contributors!

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