Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research
Abstract Background Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, thi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Implementation Science Communications |
| Online Access: | https://doi.org/10.1186/s43058-023-00397-4 |
| _version_ | 1797850050573893632 |
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| author | Stephanie N. Wilson Helen Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J. Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey Nicole LaGrone |
| author_facet | Stephanie N. Wilson Helen Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J. Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey Nicole LaGrone |
| author_sort | Stephanie N. Wilson |
| collection | DOAJ |
| description | Abstract Background Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. Methods Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. Results Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. Conclusions Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site. |
| first_indexed | 2024-04-09T18:54:06Z |
| format | Article |
| id | doaj.art-aacb8e7b88e64413a864a61af012f748 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-04-09T18:54:06Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-aacb8e7b88e64413a864a61af012f7482023-04-09T11:17:39ZengBMCImplementation Science Communications2662-22112023-04-01411710.1186/s43058-023-00397-4Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation ResearchStephanie N. Wilson0Helen Noble1Willy Jesús Neumann Ordoñez2Gabriela Zavala Wong3Manuel J. Rodríguez4David Ortega Checa5Maria Warne6Kirsten Senturia7Lacey Nicole LaGrone8Applied WorldwideNorthern Pacific Global Health Fogarty International Program, University of WashingtonSociedad de Cirujanos Generales del PerúMedical School, Universidad Peruana Cayetano HerediaDepartment of Surgery, Universidad Peruana Cayetano HerediaDepartment of Surgery, Hospital RebagliatiUniversity of Colorado HealthUniversity of WashingtonDepartment of Surgery, Medical Center of the Rockies, University of Colorado HealthAbstract Background Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. Methods Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. Results Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. Conclusions Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site.https://doi.org/10.1186/s43058-023-00397-4 |
| spellingShingle | Stephanie N. Wilson Helen Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J. Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey Nicole LaGrone Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research Implementation Science Communications |
| title | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_full | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_fullStr | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_full_unstemmed | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_short | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_sort | implementing point of care medical information systems into trauma and general surgeon practice in a middle income country a qualitative study utilizing the consolidated framework for implementation research |
| url | https://doi.org/10.1186/s43058-023-00397-4 |
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