COVID-19 Induced Pivot to Virtual Shared Medical Appointments: Implementation Adaptations and Lessons Learned

Posted on May 7, 2021May 18, 2021 by coprhcon

RESULTS

To date, 14 practice sites were able to transition to vSMAs. Eight, belonging to 2 organizations, were swift to pivot to vSMAs. Reasons for early success in transition included support from leadership, available resources, and ability to be agile as an organization in health care delivery. Early adopting practices and practice facilitators shared successes with others and an additional six were able to implement at least one vSMA. Adapting to vSMAs introduced new technologies, expanded utilization of EHR features, including virtual study data collection and patient recruitment strategies. Adaptation challenges included locating suitable platforms and adapting to virtual delivery and interactions with patients. Practices who switched were able to have 299 patients complete 39 vSMA cohorts between March 2020 and 2021, compared to 432 patients completing 86 SMA cohorts from January 2019-March 2020. Practices who did not adopt vSMAs believed the format would not fit their patient needs, or were short staffed and overburdened, some of which had paused SMAs prior to the pandemic. Patient interviews (n=16) show that vSMAs were overall an acceptable adaptation, and while some preferred to attend in-person classes, the virtual format also allowed patients to participate who normally wouldn’t due to work schedules and stay-at-home orders during the pandemic period. At least one clinic system has decided to sustain vSMAs, stating “providers are referring and patients are participating”.

Two Pragmatic Tools for “Tracking” Implementation of the Implementation & Sustainment Facilitation Strategy

Posted on May 7, 2021May 21, 2021 by coprhcon

BACKGROUND

The Implementation & Sustainment Facilitation (ISF) Strategy has been found to be effective (Garner et al., 2020) and cost-effective (Hinde et al., 2021) for improving both implementation effectiveness (i.e., the consistency and quality of intervention implementation) and intervention effectiveness (i.e., the extent to which the intervention improves client outcomes). Beyond the importance of “specifying” implementation strategies is the importance of “tracking” implementation strategies (Bunger et al., 2017). The focus of this presentation will be on describing the development and use of two pragmatic tools for tracking the ISF Strategy. Setting: This work is intended to support broad use of the ISF Strategy as part of implementation research and practice.

METHODS

Funded by the National Institute on Drug Abuse, the SAT2HIV-II Project is a cluster-randomized type 3 hybrid trial testing the impact of the ISF Strategy on helping HIV service organizations (N = 30) and their respective staff implement a motivational interviewing-based brief intervention. Carried forward from the first SAT2HIV Project, the ISF Strategy Workbook is a pragmatic tool for tracking adherence to the ISF Strategy by “action targets” (e.g., the staff at HIV service organizations receiving the ISF Strategy; Proctor et al., 2013). The ISF Strategy Tracker was developed as part of the SAT2HIV-II Project to be a pragmatic tool for:(a) tracking ISF Strategy adherence by the “action targets” as well as (b) tracking ISF Strategy fidelity by the “actor” (e.g., the ISF Facilitator; Proctor et al., 2013).

RESULTS

The ISF Strategy Workbook and the ISF Strategy Tracker have been successfully used together in the SAT2HIV-II Project, which currently has 12 HIV service organizations participating. While some data elements overlap between the tools, using both assures quality of strategy tracking data. The tools currently show 97.14% agreement in documentation of ISF meetings for the participating organizations. For ISF meetings documented in both tools, there is 93.63% agreement in staff participation. Lack of agreement creates flags for reviewing and correcting data as appropriate. The tools have also demonstrated utility beyond assuring data quality. The ISF Strategy Workbook is a useful tool for ISF Facilitators to plan for and document their meetings as well as to reorient and guide participating staff during meetings. Alternatively, the ISF Strategy Tracker supports research efforts by automatically aggregating data across organizations and transforming them to easily link to outcomes and assess the impact of the ISF strategy.

Pragmatic Trial Evaluation of a Multilevel Intervention to Increase Human Papillomavirus Vaccination Rates

Posted on May 7, 2021May 18, 2021 by coprhcon

METHODS

We are conducting a stepped wedge cluster randomized trial with a factorial design to evaluate the independent and combined impact of parent reminder-recall letters and provider audit-and-feedback interventions on HPV vaccination rates. The audit and feedback reports sent to clinicians on a monthly basis include a web address and QR code to access a strong recommendations toolkit that teaches evidence-based methods for offering strong recommendations and addressing vaccine hesitancy. Following a 12-month baseline assessment, sites were block randomized to the interventions in three subsequent steps, each 12 months in duration to account for seasonal variation in vaccination. During the baseline period, we collected baseline vaccination rates and developed and refined our intervention materials based on feedback from focus groups involving parents of children in our target age group and clinicians who care for patients in the target age group. Throughout the trial we are conducting a process evaluation which involves mailing questionnaires to parents to evaluate their awareness of and response to the reminder-recall intervention and to assess their attitudes and beliefs about HPV vaccination. The process evaluation also includes sending electronic questionnaires to all participating healthcare providers to assess their exposure to and experience with receipt of the monthly audit-and-feedback reports. We initiated step 3 of our pragmatic trial in September of 2020; all six clinical practices are now receiving at least one of the two interventions.

CONCLUSIONS

Critical improvements were made to the intervention materials based on feedback from parents and from key stakeholders in the clinical practice. Ongoing assessment of implementation outcomes through process evaluation efforts will provide insight into intervention fidelity and individual, provider, and clinic-level factors that may be associated with observed outcomes. Results of this pragmatic trial and process evaluation will quantify the impact of these practice- and provider-level interventions on HPV vaccination rates and will provide guidance on the factors associated.