PDF(Pubmed)
Abstract：
BACKGROUND: The Assessment of Burden of Chronic Conditions (ABCC-)tool is developed to facilitate a personalized approach to care in the patient-healthcare provider (HCP) conversation based on shared decision-making and individualized care plans. An effectiveness study highlighted its effect on the perceived quality of care and patient activation. Successful implementation of novel interventions necessitates an understanding of the user\'s actual application, user experiences and an evaluation of implementation outcomes. This study aims to evaluate the implementation of the ABCC-tool by HCPs in Dutch primary care.
METHODS: This study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll\'s framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework.
RESULTS: Seventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2-6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support.
CONCLUSIONS: HCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.
METHODS: This study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll\'s framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework.
RESULTS: Seventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2-6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support.
CONCLUSIONS: HCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.
摘要：
背景：开发了慢性病负担评估（ABCC-）工具，以促进基于共享决策和个性化护理计划的患者-医疗保健提供者（HCP）对话中的个性化护理方法。一项有效性研究强调了其对感知的护理质量和患者激活的影响。成功实施新颖的干预措施需要了解用户的实际应用，用户体验和实施结果评估。这项研究旨在评估HCP在荷兰初级保健中实施ABCC工具的情况。
方法：本研究是对较大的1型有效性-实施混合试验的过程评估。与HCPs的半结构化访谈，他们是混合试验的干预主义者，在他们开始使用ABCC工具后的三个月和十二个月举行。使用到达-有效性-采用-实施-维护（RE-AIM）框架来评估实施结果。通过使用Carroll的框架对实施保真度进行评估，进一步加强了实施领域。在RE-AIM框架内，采用归纳编码和主题分析来确定相关的参与者经验和实施成果。
结果：十七个HCP（1名全科医生，16名执业护士)参加了这项研究，代表39%的潜在合格参与者。大多数HCP在完成自己的例程后应用了该工具，而不是打算如何使用该工具，即从协商开始。HCPs达到2-6名患者。最初采用了ABCC工具，但由于与COVID-19相关的咨询取消，12个HCP停止使用该工具。应用问卷和可视化发现了高保真度。低保真度用于应用共享决策，制定护理目标和监测进展。HCP指出，ABCC工具的维护取决于随附的培训和实施支持。
结论：HCP应用的ABCC工具与预期的截然不同，可能会降低其优势和易用性。该评估强调需要制定量身定制的实施计划，其中包括有关如何以及何时使用ABCC工具的更详细培训和指导。
方法：本研究是对较大的1型有效性-实施混合试验的过程评估。与HCPs的半结构化访谈，他们是混合试验的干预主义者，在他们开始使用ABCC工具后的三个月和十二个月举行。使用到达-有效性-采用-实施-维护（RE-AIM）框架来评估实施结果。通过使用Carroll的框架对实施保真度进行评估，进一步加强了实施领域。在RE-AIM框架内，采用归纳编码和主题分析来确定相关的参与者经验和实施成果。
结果：十七个HCP（1名全科医生，16名执业护士)参加了这项研究，代表39%的潜在合格参与者。大多数HCP在完成自己的例程后应用了该工具，而不是打算如何使用该工具，即从协商开始。HCPs达到2-6名患者。最初采用了ABCC工具，但由于与COVID-19相关的咨询取消，12个HCP停止使用该工具。应用问卷和可视化发现了高保真度。低保真度用于应用共享决策，制定护理目标和监测进展。HCP指出，ABCC工具的维护取决于随附的培训和实施支持。
结论：HCP应用的ABCC工具与预期的截然不同，可能会降低其优势和易用性。该评估强调需要制定量身定制的实施计划，其中包括有关如何以及何时使用ABCC工具的更详细培训和指导。
