Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study
Objective 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 impl...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/1/e079234.full |
| _version_ | 1797295781550489600 |
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| author | Robin Urquhart Grace Warner Jodi Langley Cheryl Tschupruk Erin Christian |
| author_facet | Robin Urquhart Grace Warner Jodi Langley Cheryl Tschupruk Erin Christian |
| author_sort | Robin Urquhart |
| collection | DOAJ |
| description | Objective 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.Design 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.Setting Primary care practices in Canada. Interviews were conducted between September 2020 and November 2021.Participants 10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.Results 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.Conclusions 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. |
| first_indexed | 2024-03-07T21:53:54Z |
| format | Article |
| id | doaj.art-0affe0dcf711402281662ebc1abf41e3 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-07T21:53:54Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-0affe0dcf711402281662ebc1abf41e32024-02-24T22:50:08ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-079234Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods studyRobin Urquhart0Grace Warner1Jodi Langley2Cheryl Tschupruk3Erin Christian4Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, CanadaDepartment of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, CanadaFaculty of Health, Dalhousie University, Halifax, Nova Scotia, CanadaPalliative Health Network, Nova Scotia Health Authority, Halifax, Nova Scotia, CanadaPrimary Health Care and Chronic Disease Management Network, Nova Scotia Health Authority, Halifax, Nova Scotia, CanadaObjective 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.Design 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.Setting Primary care practices in Canada. Interviews were conducted between September 2020 and November 2021.Participants 10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.Results 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.Conclusions 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.https://bmjopen.bmj.com/content/14/1/e079234.full |
| spellingShingle | Robin Urquhart Grace Warner Jodi Langley Cheryl Tschupruk Erin Christian Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study BMJ Open |
| title | Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study |
| title_full | Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study |
| title_fullStr | Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study |
| title_full_unstemmed | Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study |
| title_short | Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study |
| title_sort | barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices a mixed methods study |
| url | https://bmjopen.bmj.com/content/14/1/e079234.full |
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