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Research ArticleResearch

Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project

Retrospective case study

Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe and William Hogg
Canadian Family Physician January 2018; 64 (1) e23-e32;
Clare Liddy
Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute and Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario.
MD MSc CCFP FCFP
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  • For correspondence: CLiddy@bruyere.org
Margo Rowan
Principal Lead of Rowan Research and Evaluation and Assistant Professor in the Department of Family Medicine at the University of Ottawa.
PhD
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Sophie-Claire Valiquette-Tessier
Doctoral student in the School of Psychology at the University of Ottawa.
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Paul Drosinis
Research assistant at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
MPH
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Lois Crowe
Research Manager at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
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William Hogg
Professor in the Department of Family Medicine at the University of Ottawa and Senior Research Advisor at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute.
MD MSc MClSc FCFP
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Article Figures & Data

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    Figure 1.

    Inclusion of narrative reports in case study

    IDOCC—Improved Delivery of Cardiovascular Care.

  • Figure 2.
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    Figure 2.

    Number and type of barriers and facilitators for site A across the 3 program phases: Indicators are areas that require focus within the practice, and the 5 factors (coloured lines) distinguish where change can occur.

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    Figure 3.

    Number and type of barriers and facilitators for site B across the 3 program phases: Indicators are areas that require focus within the practice, and the 5 factors (coloured lines) distinguish where change can occur.

Tables

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    Table 1.

    Constructs affecting implementation of health innovations

    CONSTRUCTSDEFINITIONEXAMPLES OR SUBCONSTRUCTS
    Structural“The outer setting or external structure of the broader sociocultural context or community in which a specific organization is nested”19,22
    • Physical environment (eg, elements that pose barriers to health care access)

    • Political or social climate (eg, liberal vs conservative)

    • Public policies (eg, laws governing health care practices)

    • Economic climate (eg, funding available)

    • Infrastructure (eg, access to public transportation)

    Organizational“Aspects of the organization in which an innovation is being implemented”19
    • Leadership effectiveness

    • Culture or climate (eg, extent to which an organization values and rewards an innovation)

    • Staff satisfaction or morale

    Provider“Aspects of the [team, practice, or group of providers] who implements the innovation with a patient or client”19
    • Attitude toward evidence-based practice

    • Perceived control to implement an innovation

    Innovation“Aspects of the innovation that will be implemented”19
    • Relative advantage of using an innovation beyond current practices

    • Quality of the evidence supporting the benefit of an innovation

    Patient“Patient characteristics … that can impact implementation outcomes”19,23
    • Health-related beliefs

    • Motivation

    • Personality traits

    • Behavioural risk factors (eg, alcohol misuse)

    • Beliefs and attitudes (eg, trust or mistrust of medical practices)

    • Adapted from Chaudoir et al.19

    • View popup
    Table 2.

    Most common facilitators and barriers for sites A and B

    CONSTRUCTSCOMMON SUBTHEMES
    Structural
    • Broader community health influences (eg, outbreaks of illnesses)

    • Communication (connecting with providers outside the practice)

    • Community resources related to intervention—facilitators during the planning and sustainability phases*

    • Educational and networking resources related to IDOCC

    • Macro-level economic and political environment (eg, financial resources from government)

    Organizational
    • Change in practice model (eg, to a different type of primary care model)

    • IT and EMR (experiences or beliefs about IT and EMR)—barrier during implementation*

    • Leadership

    • Micro-level financial resources (within the organization)

    • Office efficiency (organization and management)—barrier and facilitator during planning and implementation*

    • Space (characteristics of location or work and office areas)

    • Staff mix (availability and involvement of staff)

    • Time (time available)

    Provider
    • Communication between and among staff

    • Personal and staff functioning as part of a team

    • Provider attitude toward the IDOCC intervention—barrier during implementation and sustainability phases*

    • Roles and responsibilities (clarity and scope of practice)—barrier during planning*

    Innovation
    • Awareness and insight of practice about processes needing adjusting

    • Charting, flow sheets, and template (attitude and experience)—facilitator during implementation*

    • Comprehending, complying, and agreeing with recommendations from IDOCC audit

    • Patient-physician processes (attitude and experience toward these, such as self-management)

    • PF’s capacity to spread learning from another innovation to the site—facilitator during implementation*

    • Reaction of practice to PF’s involvement and advice—facilitator during implementation*

    • Reminder system (attitude and experience)

    Patient
    • Very few patient-level barriers and no patient-level facilitators were identified

    • EMR—electronic medical record, IDOCC—Improved Delivery of Cardiovascular Care, IT—information technology, PF—practice facilitator.

    • ↵* The most common facilitators and barriers identified in ≥ 25% of a given subtheme for either case, noted by program phase.

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Canadian Family Physician: 64 (1)
Canadian Family Physician
Vol. 64, Issue 1
1 Jan 2018
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Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project
Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe, William Hogg
Canadian Family Physician Jan 2018, 64 (1) e23-e32;

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Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe, William Hogg
Canadian Family Physician Jan 2018, 64 (1) e23-e32;
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