Changing practice in cystic fibrosis: Implementing objective medication adherence data at every consultation, a learning health system and quality improvement collaborative

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems Pub Date : 2024-09-14 DOI:10.1002/lrh2.10453

Carla Girling, India Davids, Nikki Totton, Madelynne A. Arden, Daniel Hind, Martin J. Wildman

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Abstract

Background

Medication adherence data are an important quality indicator in cystic fibrosis (CF) care, yet real-time objective data are not routinely available. An online application (CFHealthHub) has been designed to deliver these data to people with CF and their clinical team. Adoption of this innovation is the focus of an National Health Service England-funded learning health system and Quality Improvement Collaborative (QIC). This study applies the capability, opportunity, and motivation model of behavior change to assess whether the QIC had supported healthcare professionals' uptake of accessing patient adherence data.

Method

This was a mixed-method study, treating each multidisciplinary team as an individual case. Click analytic data from CFHealthHub were collected between January 1, 2018, and September 22, 2019. Thirteen healthcare practitioners participated in semi-structured interviews, before and after establishing the QIC. Qualitative data were analyzed using the behavior change model.

Results

The cases showed varied improvement trajectories. While two cases reported reduced barriers, one faced persistent challenges. Participation in the QIC led to enhanced confidence in the platform's utility. Reduced capability, opportunity, and motivation barriers correlated with increased uptake, demonstrating value in integrating behavior change theory into QICs.

Conclusion

QICs can successfully reduce barriers and enable uptake of e-health innovations such as adherence monitoring technology. However, ongoing multi-level strategies are needed to embed changes. Further research should explore sustainability mechanisms and their impact on patient outcomes.

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改变囊性纤维化的实践：在每次咨询中实施客观的药物依从性数据，学习卫生系统和质量改进协作

药物依从性数据是囊性纤维化（CF）治疗的重要质量指标，但实时客观数据通常无法获得。一个在线应用程序（CFHealthHub）已被设计用于将这些数据传递给CF患者及其临床团队。采用这种创新是英国国家卫生服务资助的学习卫生系统和质量改进协作（QIC）的重点。本研究应用行为改变的能力、机会和动机模型来评估QIC是否支持医疗保健专业人员获取患者依从性数据。方法采用混合方法，将每个多学科小组作为个案进行研究。CFHealthHub的点击分析数据收集于2018年1月1日至2019年9月22日。在建立QIC之前和之后，13名医疗保健从业人员参加了半结构化访谈。使用行为改变模型对定性数据进行分析。结果各病例表现出不同的改善轨迹。虽然有两个案例的障碍有所减少，但有一个案例面临着持续的挑战。参与QIC增强了对平台效用的信心。减少的能力、机会和动机障碍与增加的吸收相关，证明了将行为改变理论整合到QICs中的价值。结论质量保证中心可以成功地减少障碍，促进电子卫生创新，如依从性监测技术的采用。然而，需要持续的多层次策略来嵌入变化。进一步的研究应探讨可持续性机制及其对患者预后的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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