在农村初级保健站点实施技术增强精神病学协作护理模式的障碍和促进因素:一项混合方法实施案例研究。

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Ryan Kruis, Emily Johnson, Constance Guille, Candace Sprouse-McClam, Andrew Alkis, James McElligott, Jillian Harvey
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引用次数: 0

摘要

背景:精神病学协作护理管理(CoCM)有可能减轻农村社区在获得行为健康(BH)服务方面面临的挑战。然而,在农村诊所实施CoCM已被证明是困难的,并可能受益于量身定制的方法。本研究考察了在动态适应过程(DAP)指导下,在南卡罗来纳州四个农村诊所实施的远程医疗CoCM项目,特别侧重于确定支持实施的障碍、促进因素和战略。方法:本研究采用混合方法、嵌入式、时间顺序案例研究方法,整合了在实施过程中纵向收集的多个数据源。数据包括调查、焦点小组、关键信息提供者访谈和行政数据。使用编织方法对数据进行整合,以开发DAP计划实施的每个阶段(探索,准备,实施,维持)的摘要。结果:初步探索实施活动包括工作流程的制定、远程医疗平台的配置、CoCM提供者团队的组建、实施诊所间的评估等。BH资源的缺乏是农村BH治疗的主要障碍,导致CoCM试点在提供者之间的强烈预期契合。这些数据为后续阶段的活动和调整提供了信息。在准备阶段,CoCM团队接受了培训,远程护理经理进行了现场访问,以与诊所工作人员建立融洽的关系。在实施过程中,试点启动,前8个月收到296例转诊和99例患者登记。实施后的反馈显示提供者非常满意。患者的需要、患者的兴趣和提供者与护理经理的接触被确定为转诊的主要促进因素。在维持阶段,工作流程、技术和审计过程的改进与未来项目扩展的计划一起进行。结论:DAP为识别可通过适应和其他实施策略解决的情境障碍和促进因素提供了路线图,显示了针对特定农村环境量身定制CoCM实施的巨大效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study.

Background: Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation.

Methods: This study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment).

Results: Initial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion.

Conclusionl: The DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies.

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