Background
Methods and results
Step 1: Preparation
Methods step 1
Identifying existing evidence and theory
Exploring the health care providers´ perspective
Individual interviews with health professionals
Group interviews with health professionals
Study design, recruitment, data collection and analysis
Exploring the health care consumers´ perspective
Individual interviews with patients
Study design, recruitment, data collection and analysis
Characteristics of the interviewers
Results step 1
Results of systematic reviews
Results of the individual and focus group interviews with health professionals
Characteristics of the interviewees
GPs
(n = 7) |
PTs
(n = 6) |
Nurses
(n = 5) | |
---|---|---|---|
Age (Mean ± SD (Range)) | 58.7 ± 7.87 (42 – 66) | 42.0 ± 10.71 (28 – 58) | 43.2 ± 11.05 (31 – 55) |
Sex (female / %) | 3 / 43% | 5 / 71% | 3 / 60% |
Years of current occupation (Mean ± SD (Range)) | 30.0 ± 8.04 (14 – 37) | 18.3 ± 10.39 (6—36) | 20 ± 5.87 (15 – 30) |
As community nurse (Mean ± SD (Range)) | n.a | n.a | 12.8 ± 10.85 (1 – 27) |
Weekly hours with patients (Mean ± SD (Range)) | n.a | 34.8 ± 8.21 (6 – 36) | 30 ± 21.11 (1 – 60) |
FG 1
|
FG 2
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|
GP
(n = 1) |
PT
(n = 1) |
Nurse
(n = 1) |
GP
(n = 1) |
PT
(n = 1) |
Nurse
(n = 1) | |||||
Age (years) | 68 | 50 | 55 | 66 | 27 | 31 | ||||
Sex (m / f) | m | m | f | m | f | f | ||||
Years of current occupation (years) | 40 | 25 | 25 | 41 | 8 | 7 | ||||
As CN (years) | n.a | n.a | n.s | n.a | n.a | 4 | ||||
Working hours per week (%) | 110 | 100 | 70 | 130 | 100 | 100 |
GP perspective
PT perspective
“I think they (the GPs) are hardly informed about what they can assign to what kind of patients (…) I can remember only one patient (…) coming with this (…) indication key (…). All other (patients are assigned concerning) cervical spine.” (PT, interviewee 4).
“For certain things sometimes there exists very clear and beautiful guidelines, like a catalogue where you choose (…) I have a tree (…) something like a decision tree, exactly.” (PT, interviewee 2)
Nurses´ perspective
“They should document or record everything. Either that or have a kind of online portal; that would of course be the easiest. That means, where you can exchange information about the patient and (.) where everyone can write something there or in the documentation folders on site. In the end, it takes just a minute that you write in there.” (Nurse, interviewee 14).
Multidisciplinary perspective
“I think the online portal is the one thing that could best be realized. (…) time is relatively tight (…) and you do not have to sit down together, you can actually do it online. In addition, maybe just write to me. So I find that feasible now.” (Nurse, interviewee 1)“So, I think team meetings are less feasible because the different times can never be brought together (…) it is of course also unpaid time. (…) the basis could be an electronic document (…) and 80% can then be resolved (…) and the rest, you are (…) on the phone. (GP, interviewee 1)
Results of the individual interviews with patients
Characteristics of the interviewees
Patients
(n = 11) | |
---|---|
Age (Mean ± SD (Range)) | 75.5 ± 6.9 (65 – 89) |
Sex (female / %) | 7 / 64% |
Symptoms (n / %): | |
Dizziness | 9 / 82% |
Balance disorder | 4 / 36% |
Gait instability | 10 / 91% |
Fall history | 8 / 73% |
Other additional symptoms | 6 / 55% |
Patient perspective
Step 2: Modelling
Methods step 2
Modelling the first version of the CPW and implementation strategies
Expert workshop
Study design, recruitment, data collection and analysis
Methods of the workshop
Subsequent modelling of the CPW, intervention components and educational training materials
Modelling process of CPW design in a specific expert group
Modelling behaviour change
Developing a Logic Model
Results Step 2
Results of the expert workshop
Characteristics of the experts
First version of the CPW
Implementation strategy
Potential barriers and facilitators
CFIR | ERIC | |||
---|---|---|---|---|
Priority
|
Construct
|
Barrier
|
Priority
|
Strategy
|
1 | Intervention characteristics | Cost | 1 | Identify and prepare champions |
2 | Inner setting | Organizational Incentives & Rewards | 2 | Alter incentive/allowance structures |
3 | Characteristics of individuals | Knowledge & Beliefs about the Intervention | 3 | Assess for readiness and identify barriers and facilitators |
4 | Processes | Reflecting and evaluating | 4 | Conduct local consensus discussions |
5 | Inner setting | Implementation climate | 5 | Inform local opinion leaders |
6 | Inner setting | Available resources | 6 | Conduct educational meetings |
7 | Processes | Planning | 7 | Access new funding |
8 | Intervention characteristics | Evidence strength & quality | 8 | Capture and share local knowledge |
9 | Outer setting | External policy & incentives | 9 | Conduct local needs assessment |
10 | Characteristics of individuals | Individual stage of change | 10 | Develop a formal implementation blueprint |
11 | Intervention characteristics | Relative advantage | 11 | Audit and provide feedback |
12 | Inner setting | Tension for Change | 12 | Build a coalition |
13 | Inner setting | Goals and Feedback | 13 | Develop and implement tools for quality monitoring |
14 | Inner setting | Leadership Engagement | 14 | Identify early adopters |
15 | Involve executive boards |
Implementation strategies
Milestones and implementation plan
Steps of the CPW | Milestones |
---|---|
Access: | |
- Immediately | → Reaching of the pre-defined number of participating GPs and patients |
- Direct | |
- Involvement of relatives | |
Assessment: | |
- Central role of GP | → Development of a screening tool |
- Checklist | → Accompanied previous educational training of GPs |
- Educational training of GPs | |
Assignment: | |
- Prompt | |
- Physical therapy as favoured intervention | |
- Organized in a network | |
- Case managers | |
Intervention: | |
- Capacity of providers | → Recruitment of collaboration partners |
- Treatment duration | → Educational training of PTs |
- Involvement of additional potential actors | |
- Extended offer of providers (e.g., clubs, community college) | |
Evaluation: | |
- Feedback to all involved actors | |
- Follow-up appointments in checklist |