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Barriers in the implementation of interprofessional continuing education programs--a qualitative study from Germany.

ABSTRACT: BACKGROUND:Insufficient communication and coordination is one of the most problematic issues in German health care delivery leading to detrimental effects on health care outcomes. As a consequence interprofessional continuing education (CIPE) is gathering momentum in German health policy and health care practice aiming to enhance service quality and patient safety. Nevertheless, there is limited evidence on the course of implementation and the perceived effectiveness/acceptance of CIPE in German health care. This paper describes the objectives and formal characteristics of CIPE trainings and maps important determinants influencing the success of CIPE implementation from the perspective of providers offering CIPE trainings for German health care professionals. METHODS:Forty-nine training institutions offering CIPE for health care professionals were identified by a structured web search including the websites of German medical education associations and public/private training institutions. Directors and managers of the identified institutions were invited to participate in a semi-structured interview. The interview guideline was developed using the SPSS method by Helferich and colleges. Interviews were analyzed using the summarizing content analysis developed by Mayring resulting in a paradigm that contextualizes hindering factors regarding the implementation of CIPE in the German health care system. RESULTS:Overall, 19 of the identified institutions agreed to participate with one director/manager per institution resulting in a response rate of almost 38.8%. The included institutions offer n?=?85 CIPE trainings for health care professionals. Trainings offered mainly address the enhancement of domain, social and personal competencies of the participating health care professionals and follow three main objectives comprising better care of severely ill patients, improvement of patient safety by sustained risk management as well as a more patient centered care. Implementation of CIPE in Germany is influenced by various hindering factors mostly coming from systemic (missing incentives), behavioral (hierarchy problems) and methodological (limited quality assurance) factors. CONCLUSION:CIPE is an evolving concept in the German health care system. There are various difficulties that impede a successful implementation of CIPE and might be mitigated by specific health policy interventions such as mandatory CIPE participation of health care professionals and comprehensive pre-license interprofessional education.

SUBMITTER: Altin SV

PROVIDER: S-EPMC4288664 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Barriers in the implementation of interprofessional continuing education programs--a qualitative study from Germany.

Altin Sibel V SV Tebest Ralf R Kautz-Freimuth Sibylle S Redaelli Marcus M Stock Stephanie S

BMC medical education 20141021

<h4>Background</h4>Insufficient communication and coordination is one of the most problematic issues in German health care delivery leading to detrimental effects on health care outcomes. As a consequence interprofessional continuing education (CIPE) is gathering momentum in German health policy and health care practice aiming to enhance service quality and patient safety. Nevertheless, there is limited evidence on the course of implementation and the perceived effectiveness/acceptance of CIPE i ...[more]

PMID: 25335560

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Project description:BackgroundPrimary healthcare in Sweden and worldwide has a diverse structure with many kinds of healthcare units involved. This is a challenge for collaboration between different professions in primary healthcare, as the different healthcare professions often work in silos. Interprofessional education (IPE) in the context of primary healthcare is less studied than IPE at hospitals and most of the studies in primary healthcare have focused on collaboration between general practitioners and nurses. The aim of this study was to describe how healthcare students perceived conditions for IPE in primary healthcare.MethodsQualitative group interviews were used and a total of 26 students, recruited on a voluntary basis participated in four group interviews with students mixed from study programmes in nursing, physiotherapy, occupational therapy and medicine. Students from the study programme in medicine were in their second to eleventh semesters of 11 semesters in total, whilst students from the occupational therapist, physiotherapist and nursing programmes were in their fourth to sixth of six semesters in total.ResultsOur findings indicated one theme: Students perceived a need for support and awareness of IPE from both study programmes and clinical placements. Five categories were found to belong to the theme. Students' tunnel-vision focus on their own profession may have affected their ability to collaborate with students from other professions. The nature of the patients' healthcare problems decided if they were perceived as suitable for IPE. Clinical supervisors' support for and attitude towards IPE were important. The hierarchy between different professions was perceived as a hindrance for seeking help from the other professions. The students asked for more collaboration between different study programmes, in order to gain knowledge about the roles and responsibilities of the other professions.ConclusionsIn conclusion, students in this study considered it essential for different study programmes and clinical placements to be more aware of the opportunities for and importance of IPE. The study identified conditions that were required for IPE in primary healthcare that may be helpful for healthcare teachers and clinical supervisors to better understand how students perceive IPE in primary healthcare, thus facilitating the planning of IPE.

Project description:BACKGROUND:An interprofessional medication adherence program (IMAP) for chronic patients was developed and successfully implemented in the community pharmacy of the Department of ambulatory care and community medicine (Lausanne, Switzerland). This study assesses the capacity of a physician and a nurse at the infectious diseases service of a public hospital and of community pharmacists in the Neuchâtel area (Switzerland) to implement the IMAP in their practice. METHODS:Mixed method, prospective, observational study. Quantitative and qualitative analyses of the implementation process were conducted following the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). RESULTS:Implementation started in November 2014. One physician, one nurse, and five pharmacists agreed to participate. Healthcare professionals perceived the benefits of the program and were motivated to implement it in their practice (adoption). Seventeen patients were included in the program; 13 refused to participate. The inclusion of naïve HIV patients was easier than the inclusion of experienced patients with difficult psychosocial issues (reach). Pharmacists were engaged in reinforcing patient medication adherence in 25% of interviews (effectiveness). Key facilitators expressed by healthcare professionals were patient inclusion by the physician and the nurse instead of the pharmacist and the organisation of regular meetings between all stakeholders. In contrast, the encountered barriers were the lack of time and resources, the lack of team uptake, and the lack of adoption by senior managers (implementation). Interviewed patients were all satisfied with this new program, encouraging healthcare professionals to scale it up. Structural changes allowed the hospital and one pharmacy to enter the maintenance stage (maintenance). CONCLUSION:The research team and collaboration between all professionals involved played an important role in this implementation. However, the dissemination of such a program to a larger scale and for the long term requires financial and structural resources as well as transitional external support.

Project description:BACKGROUND:Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy. METHODS:We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers. RESULTS:The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system). CONCLUSION:Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration number is CRD42018098604.

Project description:ObjectiveContinuing medical education (CME) is a vital component of health systems. Setting up a CME system is a complex task, requiring involvement of stakeholders including educators, learners, institutions and policy makers. The aim of the study was to conduct qualitative research involving multiple stakeholders to explore the perceived effectiveness and shortcomings of the CME system in Georgia, its place in the health system and potential means of improving it.DesignThis is a qualitative study. All data were collected using semistructured individual interviews. The questions were derived from the relevant literature. Data analysis was conducted using comparative strategy.ParticipantsWe interviewed individuals from CME providers, medical establishments, the professional development board (PDB), and the Regulatory Agency for Medical and Pharmaceutical Activities. We thus interviewed 23 people (11 people from CME providers, 8 people from medical establishments, 3 PDB members and 1 person from Legal Entity under Public Law Regulatory Agency for Medical and Pharmaceutical Activities).ResultsGeorgia has had experience of mandatory CME in the past, which had been criticised for its poor quality and bureaucratic processes. CME is viewed as an essential developmental process for medical professionals, the outcome of which is to deliver high-quality medical care. Our interviewees identified a clear need for high-quality CME courses. However, significant challenges that need to be overcome include financial barriers, doctors' attitudes to CME, a lack of CME courses in all medical specialties and relatively weak professional associations.ConclusionCME is widely recognised as an essential pillar in providing quality medical care. Establishing high-quality CME requires a strategic and holistic approach. In order to ensure the sustainable and effective implementation of the CME process, we need to take into account stakeholders' interests and expectations, the socioeconomic status and development of the country, and past experiences of all relevant individuals and organisations.

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Barriers in the implementation of interprofessional continuing education programs--a qualitative study from Germany.

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Barriers in the implementation of interprofessional continuing education programs--a qualitative study from Germany.

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