Laura-Mae Baldwin, MD, MPH; Leah Tuzzio, MPH; Allison M. Cole, MD, MPH; Erika Holden, BA; Jennifer A. Powell, MPH, MBA; Michael L. Parchman, MD, MPH
Corresponding Author: Laura-Mae Baldwin, MD, MPH; Department of Family Medicine - University of Washington
Contact Email: lmb@uw.edu
Section: Original Research
Ahead of Print: | HTML | | PDF | Final Publication: | HTML | | PDF |
BACKGROUND: When implementing interventions in primary care, tailoring implementation strategies to practice barriers can be effective, but additional work is needed to understand how to best select these strategies. This study sought to identify clinicians’ contributions to the process of tailoring implementation strategies to barriers in clinical settings.
METHODS: We conducted a modified nominal group exercise involving eight implementation scientists and 26 primary care clinicians in the WWAMI region Practice and Research Network. Each group identified implementation strategies it felt would best address barriers to using a cardiovascular disease (CVD) risk calculator previously identified across 44 primary care clinics from the Healthy Hearts Northwest pragmatic trial (2015- 2018). These barriers had been mapped beforehand to the Consolidated Framework for Implementation Research (CFIR) domains. We examined similarities and differences in the strategies that 30% or more of each group identified (agreed-upon strategies) for each barrier and for barriers in each CFIR domain. We used the results to demonstrate how strategies might be tailored to individual clinics.
RESULTS: Clinicians selected 23 implementation strategies to address one or more of the 13 barriers; implementation scientists selected 35. The two groups agreed on at least one strategy for barriers in each CFIR domain – Inner Setting, Outer Setting, Intervention Abstract Characteristics, Characteristics of Individuals, and Process. Conducting local needs assessment and assessing for readiness/identifying barriers and facilitators were the two most common implementation strategies chosen only by clinicians.
CONCLUSIONS: Clinician stakeholders identified implementation strategies that augmented those chosen by implementation scientists, suggesting that co-design of implementation processes between implementation scientists and clinicians may strengthen the process of tailoring strategies to overcome implementation barriers.