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Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups

BACKGROUND: With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated med...

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Autores principales: von der Warth, Rieka, Kaiser, Vanessa, Reese, Christina, Brühmann, Boris A., Farin-Glattacker, Erik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567636/
https://www.ncbi.nlm.nih.gov/pubmed/34736421
http://dx.doi.org/10.1186/s12877-021-02579-y
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author von der Warth, Rieka
Kaiser, Vanessa
Reese, Christina
Brühmann, Boris A.
Farin-Glattacker, Erik
author_facet von der Warth, Rieka
Kaiser, Vanessa
Reese, Christina
Brühmann, Boris A.
Farin-Glattacker, Erik
author_sort von der Warth, Rieka
collection PubMed
description BACKGROUND: With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated medical care”) has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders. METHODS: Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP’s assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis. RESULTS: In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care. CONCLUSION: Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself. TRIAL REGISTRATION: WHO UTN: U1111–1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02579-y.
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spelling pubmed-85676362021-11-04 Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups von der Warth, Rieka Kaiser, Vanessa Reese, Christina Brühmann, Boris A. Farin-Glattacker, Erik BMC Geriatr Research Article BACKGROUND: With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated medical care”) has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders. METHODS: Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP’s assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis. RESULTS: In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care. CONCLUSION: Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself. TRIAL REGISTRATION: WHO UTN: U1111–1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02579-y. BioMed Central 2021-11-04 /pmc/articles/PMC8567636/ /pubmed/34736421 http://dx.doi.org/10.1186/s12877-021-02579-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
von der Warth, Rieka
Kaiser, Vanessa
Reese, Christina
Brühmann, Boris A.
Farin-Glattacker, Erik
Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_full Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_fullStr Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_full_unstemmed Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_short Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_sort barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567636/
https://www.ncbi.nlm.nih.gov/pubmed/34736421
http://dx.doi.org/10.1186/s12877-021-02579-y
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