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A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery
BACKGROUND: Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been sh...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955512/ https://www.ncbi.nlm.nih.gov/pubmed/29768430 http://dx.doi.org/10.1371/journal.pone.0196105 |
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author | Tuepker, Anaïs Elnitsky, Christine Newell, Summer Zaugg, Tara Henry, James A. |
author_facet | Tuepker, Anaïs Elnitsky, Christine Newell, Summer Zaugg, Tara Henry, James A. |
author_sort | Tuepker, Anaïs |
collection | PubMed |
description | BACKGROUND: Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. METHODS: Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. RESULTS: PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider’s own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider’s skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. CONCLUSIONS: Existing adaptations highlight the need to better understand mechanisms underlying PTM’s effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities. |
format | Online Article Text |
id | pubmed-5955512 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-59555122018-05-25 A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery Tuepker, Anaïs Elnitsky, Christine Newell, Summer Zaugg, Tara Henry, James A. PLoS One Research Article BACKGROUND: Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. METHODS: Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. RESULTS: PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider’s own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider’s skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. CONCLUSIONS: Existing adaptations highlight the need to better understand mechanisms underlying PTM’s effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities. Public Library of Science 2018-05-16 /pmc/articles/PMC5955512/ /pubmed/29768430 http://dx.doi.org/10.1371/journal.pone.0196105 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Tuepker, Anaïs Elnitsky, Christine Newell, Summer Zaugg, Tara Henry, James A. A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title | A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title_full | A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title_fullStr | A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title_full_unstemmed | A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title_short | A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery |
title_sort | qualitative study of implementation and adaptations to progressive tinnitus management (ptm) delivery |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955512/ https://www.ncbi.nlm.nih.gov/pubmed/29768430 http://dx.doi.org/10.1371/journal.pone.0196105 |
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