Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

<p>Abstract</p> <p>Background</p> <p>Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.</p> <p>Methods</p> <p>A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.</p> <p>Results</p> <p>The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.</p> <p>Conclusion</p> <p>When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.</p

Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups

<p>Abstract</p> <p>Background</p> <p>In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.</p> <p>Methods</p> <p>Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.</p> <p>Results</p> <p>Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.</p> <p>Conclusion</p> <p>This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.</p

Asthma and COPD in primary health care, quality according to national guidelines: a cross-sectional and a retrospective study

<p>Abstract</p> <p>Background</p> <p>In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results.</p> <p>Methods</p> <p>A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included.</p> <p>Results</p> <p>All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration.</p> <p>Conclusion</p> <p>To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP.</p

Association Between Frequency of Heavy Episodic Drinking and Self-reported Consequences: A Cross-sectional Study in a Swedish Population

Aims: To describe perceived negative consequences (PNCs) of alcohol consumption related to the frequency of heavy episodic drinking (HED) in a Swedish population attending primary health care (PHC). Methods: Data from a computer-based assessment, including questions about alcohol consumption and PNC, were collected from 28 PHC centres in Sweden. The analysis included 4559 responders. Risk ratios concerning PNC for different frequencies of HED were calculated. Results: Engaging in HED once a month for women and two to three times a month for men significantly raised the proportion of individuals reporting PNC, compared with engaging in HED less than once a month. The men reported PNC of alcohol consumption to a higher degree than the women, and in general, the proportion of individuals reporting PNC was associated with the frequency of HED. Conclusion: Engaging in HED once a month for women and two to three times a month for men are critical levels regarding PNC of alcohol consumption. To identify a cut-off value for categorizing individuals as hazardous alcohol consumers due to the frequency of HED, further studies are needed.Funding Agencies|County Council of Ostergotland, Sweden||</p

SIA ”Orkla Confectionery & snacks Latvija” characterization of marketing and possibilities of perfectio.

Kvalifikācijas darba tēma- SIA”Orkla Confectionery & snacks Latvija” mārketinga raksturojums un pilnveides iespējas. Darba autors ir Guntars Ločmelis. Pētījuma mērķis ir izanalizēt esošās uzņēmuma mārketinga kampaņas un izstrādāt pilnveides iespējas. Darba izstrādē izmatotas šādas metodes: Monogrāfiskā jeb aprakstošā metode un analīzes metode, SVID analīze uzņēmumam. Analizējot uzņēmuma sasniegumus mārketingā, tika secināts, ka uzņēmumā nepieciešams pārskatīt un izvērtēt mēdiju kanālu pielietojumu konkrētām mārketinga kampaņām. Uzņēmumam ir jāspēj izcelties un veidot atšķirīgu komunikāciju no konkurentiem, uzsvērt produkcijas jaunumus un zīmola vērtības. Ļoti svarīgi būt aktīvākiem digitālajā vidē, kur ir jaunāka auditorija un nākamie produktu pircēji. Jo precīzāk tiks segmentēta potenciālā auditorija, jo vairāk sasniegti izvirzītie mārketinga mērķi. Kvalifikācijas darba apjoms ir 40 lappuses un sastāv no 3 nodaļām. Darbs satur 11 attēlus, 4 tabulas un 15 izmantotās literatūras sarakstus. Darba izstrādē izmantotas grāmatas latviešu un angļu valodā, publikācijas no interneta resursiem, uzņēmuma publicētiem un nepublicētiem datiem.The subject of Qualification Paper is the assessment of SIA”Orkla Confectionery & snacks Latvija” characterization of marketing and possibilities of perfectio. The author is Guntars Ločmelis. The objective of the paper is to perform analysis for the running marketing campaigns and identify opportunities for improvement. The following research methods had been used: monographic or descriptive method and the method of analysis; company SWOT analysis. Analysing company's marketing success, it has been concluded that the company needs to review and evaluate the use of various media channels for specific marketing campaigns. It requires marketing communication that is differentiating itself against the competition, one that is highlighting product novelty and brand values. It is also very important to be digitally savvy in order to reach the younger audience and future consumers. The more precisely the potential audience will be segmented, the more of the targeted marketing goals will be achieved. The volume of the Qualification Paper is 40 pages and it consists of 3 chapters. The study contains 11 pictures, 4 tables and a bibliography with 15 sources. References include books in Latvian and English, internet publications, as well as published and unpublished company dat