From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy.

Abstract:

OBJECTIVE:Formative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescription and medication review process. METHODS/SETTING:Twenty-seven general practitioners (GPs) were included in the study in the two groups of the C-RCT, the intervention, and the wait list control group. Behavior-related outcomes were investigated using three-step data analysis (content analytic approach, documentary method, and design of a model of implementation pathways). RESULTS:Content analysis showed that physicians were more intensely aware of polypharmacy-related risks, described positive learning effects of the digital technology on their prescribing behavior, and perceived a change in communication with patients and pharmacists. Conversely, they felt uncertain about their own responsibility when prescribing. Three main dimensions were discovered which influenced adoption behavior: (1) the physicians' interpretation of the relevance of pharmaceutical knowledge provided by the intervention in changing decision-making situations in polypharmacy; (2) their medical code of ethics for clinical decision making in the context of progressing digitalization; and (3) their concepts of evidence-based medicine on the basis of professional experiences with polypharmacy in primary care settings. In our sample, both simple and complex pathways from sensitization to adoption were observed. The resulting model on adoption behavior includes a paradigmatic description of different pathways and a visualization of different observed levels and applied methodological approaches. We assumed that the GP habitus can weaken or strengthen interventional effects towards intervention uptake. This formative evaluation strategy is beneficial for the identification of behavior-related implementation barriers and facilitators. CONCLUSION:Our analyses of the adoption behavior of a digitally supported intervention in polypharmacy revealed both simple and complex pathways from awareness to adoption, which may impact the implementation of the intervention and therefore, its effectiveness. Future consideration of adoption behavior in the planning and evaluation of digitally supported interventions may enhance uptake and support the interpretation of effects. TRIAL REGISTRATION:NCT03430336 , 12 February 2018.

journal_name

Implement Sci

authors

Söling S,Köberlein-Neu J,Müller BS,Dinh TS,Muth C,Pfaff H,Karbach U,AdAM Study Group.

doi

10.1186/s13012-020-01043-6

subject

Has Abstract

pub_date

2020-09-21 00:00:00

pages

82

issue

1

issn

1748-5908

pii

10.1186/s13012-020-01043-6

journal_volume

15

pub_type

杂志文章
  • Learning from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series.

    abstract::As the recent collection of papers from the Quality Enhancement Research Initiative (QUERI) Series indicates, knowledge is leading to considerable action in the United States (U.S.) Department of Veterans Affairs (VA). The QUERI Series offers clinical researchers, implementation scientists, health systems, and health ...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-4-13

    authors: Graham ID,Tetroe J

    更新日期:2009-03-06 00:00:00

  • E-learning interventions are comparable to user's manual in a randomized trial of training strategies for the AGREE II.

    abstract:BACKGROUND:Practice guidelines (PGs) are systematically developed statements intended to assist in patient and practitioner decisions. The AGREE II is the revised tool for PG development, reporting, and evaluation, comprised of 23 items, two global rating scores, and a new User's Manual. In this study, we sought to dev...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/1748-5908-6-81

    authors: Brouwers MC,Makarski J,Durocher LD,Levinson AJ

    更新日期:2011-07-26 00:00:00

  • Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

    abstract:BACKGROUND:One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-016-0426-2

    authors: Handley MA,Harleman E,Gonzalez-Mendez E,Stotland NE,Althavale P,Fisher L,Martinez D,Ko J,Sausjord I,Rios C

    更新日期:2016-05-18 00:00:00

  • A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study.

    abstract:BACKGROUND:The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake in...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-014-0090-3

    authors: Connell LA,McMahon NE,Harris JE,Watkins CL,Eng JJ

    更新日期:2014-08-12 00:00:00

  • Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration.

    abstract:BACKGROUND:Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other inte...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-1-23

    authors: Stetler CB,Legro MW,Rycroft-Malone J,Bowman C,Curran G,Guihan M,Hagedorn H,Pineros S,Wallace CM

    更新日期:2006-10-18 00:00:00

  • Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents.

    abstract:BACKGROUND:The last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining reso...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-014-0148-2

    authors: Langton JM,Srasuebkul P,Reeve R,Parkinson B,Gu Y,Buckley NA,Haas M,Viney R,Pearson SA,End-of-Life in Cancer Care (EoL-CC) Investigators.

    更新日期:2015-02-26 00:00:00

  • Specifying and reporting complex behaviour change interventions: the need for a scientific method.

    abstract::Complex behaviour change interventions are not well described; when they are described, the terminology used is inconsistent. This constrains scientific replication, and limits the subsequent introduction of successful interventions. Implementation Science is introducing a policy of initially encouraging and subsequen...

    journal_title:Implementation science : IS

    pub_type: 社论

    doi:10.1186/1748-5908-4-40

    authors: Michie S,Fixsen D,Grimshaw JM,Eccles MP

    更新日期:2009-07-16 00:00:00

  • Knowledge translation in Uganda: a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework.

    abstract:BACKGROUND:A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful t...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-7-117

    authors: Bergström A,Peterson S,Namusoko S,Waiswa P,Wallin L

    更新日期:2012-12-03 00:00:00

  • A randomised controlled trial of performance review and facilitated feedback to increase implementation of healthy eating and physical activity-promoting policies and practices in centre-based childcare.

    abstract:BACKGROUND:While it is recommended that childcare services implement policies and practices to support obesity prevention, there remains limited evidence to inform policy and practice. The aim of this study is to examine the effectiveness of performance review and facilitated feedback in increasing the implementation o...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1186/s13012-019-0865-7

    authors: Finch M,Stacey F,Jones J,Yoong SL,Grady A,Wolfenden L

    更新日期:2019-02-18 00:00:00

  • The use of tacit and explicit knowledge in public health: a qualitative study.

    abstract:BACKGROUND:Planning a public health initiative is both a science and an art. Public health practitioners work in a complex, often time-constrained environment, where formal research literature can be unavailable or uncertain. Consequently, public health practitioners often draw upon other forms of knowledge. METHODS:T...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-7-20

    authors: Kothari A,Rudman D,Dobbins M,Rouse M,Sibbald S,Edwards N

    更新日期:2012-03-20 00:00:00

  • Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

    abstract:BACKGROUND:A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implement...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s13012-017-0661-1

    authors: Naidoo K,Gengiah S,Yende-Zuma N,Padayatchi N,Barker P,Nunn A,Subrayen P,Abdool Karim SS

    更新日期:2017-11-13 00:00:00

  • Refining a taxonomy for guideline implementation: results of an exercise in abstract classification.

    abstract:BACKGROUND:To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strat...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-8-32

    authors: Mazza D,Bairstow P,Buchan H,Chakraborty SP,Van Hecke O,Grech C,Kunnamo I

    更新日期:2013-03-15 00:00:00

  • GRAIDs: a framework for closing the gap in the availability of health promotion programs and interventions for people with disabilities.

    abstract:BACKGROUND:Evidence-based health promotion programs developed and tested in the general population typically exclude people with disabilities. To address this gap, a set of methods and criteria were created to adapt evidence-based health promotion programs for people with disabilities. In this first study, we describe ...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-014-0100-5

    authors: Rimmer JH,Vanderbom KA,Bandini LG,Drum CE,Luken K,Suarez-Balcazar Y,Graham ID

    更新日期:2014-08-14 00:00:00

  • Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial.

    abstract:BACKGROUND:Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavil...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s13012-017-0544-5

    authors: Wiltsey Stirman S,Finley EP,Shields N,Cook J,Haine-Schlagel R,Burgess JF Jr,Dimeff L,Koerner K,Suvak M,Gutner CA,Gagnon D,Masina T,Beristianos M,Mallard K,Ramirez V,Monson C

    更新日期:2017-03-06 00:00:00

  • Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change.

    abstract:BACKGROUND:Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to in...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-8-119

    authors: Schierhout G,Hains J,Si D,Kennedy C,Cox R,Kwedza R,O'Donoghue L,Fittock M,Brands J,Lonergan K,Dowden M,Bailie R

    更新日期:2013-10-08 00:00:00

  • Contextual influences on health worker motivation in district hospitals in Kenya.

    abstract:BACKGROUND:Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-4-43

    authors: Mbindyo P,Gilson L,Blaauw D,English M

    更新日期:2009-07-23 00:00:00

  • Implementation of case management to reduce cardiovascular disease risk in the Stanford and San Mateo Heart to Heart randomized controlled trial: study protocol and baseline characteristics.

    abstract:BACKGROUND:Case management has emerged as a promising alternative approach to supplement traditional one-on-one sessions between patients and doctors for improving the quality of care in chronic diseases such as coronary heart disease (CHD). However, data are lacking in terms of its efficacy and cost-effectiveness when...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-1-21

    authors: Ma J,Lee KV,Berra K,Stafford RS

    更新日期:2006-09-27 00:00:00

  • Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' - an emergent approach.

    abstract::In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A develop...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-3-46

    authors: Soper B,Buxton M,Hanney S,Oortwijn W,Scoggins A,Steel N,Ling T

    更新日期:2008-10-30 00:00:00

  • Collaborative planning approach to inform the implementation of a healthcare manager intervention for Hispanics with serious mental illness: a study protocol.

    abstract:BACKGROUND:This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified i...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-6-80

    authors: Cabassa LJ,Druss B,Wang Y,Lewis-Fernández R

    更新日期:2011-07-26 00:00:00

  • How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals.

    abstract:BACKGROUND:Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectat...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-016-0435-1

    authors: Lambooij MS,Koster F

    更新日期:2016-05-20 00:00:00

  • Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach.

    abstract:BACKGROUND:This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Pe...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,评审

    doi:10.1186/s13012-017-0553-4

    authors: Band R,Bradbury K,Morton K,May C,Michie S,Mair FS,Murray E,McManus RJ,Little P,Yardley L

    更新日期:2017-02-23 00:00:00

  • Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol.

    abstract:BACKGROUND:Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to s...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s13012-017-0562-3

    authors: Aarons GA,Ehrhart MG,Moullin JC,Torres EM,Green AE

    更新日期:2017-03-03 00:00:00

  • Pilot study evaluating the effects of an intervention to enhance culturally appropriate hypertension education among healthcare providers in a primary care setting.

    abstract:BACKGROUND:To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-5-35

    authors: Beune EJ,Bindels PJ,Mohrs J,Stronks K,Haafkens JA

    更新日期:2010-05-14 00:00:00

  • A patient-centered network approach to multidisciplinary-guideline development: a process evaluation.

    abstract:BACKGROUND:Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in f...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-9-68

    authors: Den Breejen EM,Hilbink MA,Nelen WL,Wiersma TJ,Burgers JS,Kremer JA,Hermens RP

    更新日期:2014-06-04 00:00:00

  • Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol.

    abstract:BACKGROUND:Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens. METHODS/DESIGN:This randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-re...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/1748-5908-6-114

    authors: Petersen LA,Urech T,Simpson K,Pietz K,Hysong SJ,Profit J,Conrad D,Dudley RA,Lutschg MZ,Petzel R,Woodard LD

    更新日期:2011-10-03 00:00:00

  • Evidence-informed health policy 4 - case descriptions of organizations that support the use of research evidence.

    abstract:BACKGROUND:Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case ...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-3-56

    authors: Lavis JN,Moynihan R,Oxman AD,Paulsen EJ

    更新日期:2008-12-17 00:00:00

  • Understanding effective care management implementation in primary care: a macrocognition perspective analysis.

    abstract:BACKGROUND:Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care r...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/s13012-015-0316-z

    authors: Holtrop JS,Potworowski G,Fitzpatrick L,Kowalk A,Green LA

    更新日期:2015-08-21 00:00:00

  • Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study.

    abstract:BACKGROUND:Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the Unit...

    journal_title:Implementation science : IS

    pub_type: 杂志文章

    doi:10.1186/1748-5908-4-59

    authors: Akl EA,Mustafa R,Wilson MC,Symons A,Moheet A,Rosenthal T,Guyatt GH,Schünemann HJ

    更新日期:2009-09-21 00:00:00

  • Implementation of the uterine fibroids Option Grid patient decision aids across five organizational settings: a randomized stepped-wedge study protocol.

    abstract:BACKGROUND:Uterine fibroids are non-cancerous overgrowths of the smooth muscle in the uterus. As they grow, some cause problems such as heavy menstrual bleeding, pelvic pain, discomfort during sexual intercourse, and rarely pregnancy complications or difficulty becoming pregnant. Multiple treatment options are availabl...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s13012-019-0933-z

    authors: Scalia P,Durand MA,Forcino RC,Schubbe D,Barr PJ,O'Brien N,O'Malley AJ,Foster T,Politi MC,Laughlin-Tommaso S,Banks E,Madden T,Anchan RM,Aarts JWM,Velentgas P,Balls-Berry J,Bacon C,Adams-Foster M,Mulligan CC,Venable S

    更新日期:2019-09-02 00:00:00

  • Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial.

    abstract:BACKGROUND:Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is...

    journal_title:Implementation science : IS

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/1748-5908-8-124

    authors: Riis A,Jensen CE,Bro F,Maindal HT,Petersen KD,Jensen MB

    更新日期:2013-10-20 00:00:00