Implementation Science: Difference between revisions
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== Introduction == | == Introduction == | ||
The need for rehabilitation services in health systems has increased with a subsequent desire to implement evidence- | The need for rehabilitation services in health systems has increased with a subsequent desire to implement [[Evidence-based Management of Pain in Refugees|evidence-based]] practices (EPB).<ref name=":0">Naccarella, L. Implementation Science Course. Physioplus. 2022</ref> Rehabilitation professionals utilise [[Evidence-based Management of Pain in Refugees|evidence-based practice]] (EBP) when making intervention decisions based on the best evidence available.<ref name=":1">Portney LG. Foundations of clinical research: applications to evidence-based practice. FA Davis; 2020 Jan 16.</ref> It is a widely held belief among healthcare care practitioners that it is critical to know why what and how an intervention works in different settings <ref name=":0" />. A key factor guiding EBP is including the patient in the decision-making process. Family norms, traditions, cultures and personal beliefs should play a role in the intervention choice. Research supports EBP has better outcomes with patient participation.<ref name=":1" /> In addition to patient involvement, practitioners need to take into account costs, resources in the community and the nature of the healthcare system.<ref name=":1" /> | ||
== '''Challenges to Implementing EBP''' == | == '''Challenges to Implementing EBP''' == | ||
Rehabilitation intervention evidence is growing every day. Principles and guidance on rehabilitation interventions are increasingly available such as: | Rehabilitation intervention evidence is growing every day. Principles and guidance on rehabilitation interventions are increasingly available such as: | ||
# | # [https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf NHS Commissioning Guidance for Rehabilitation] | ||
# | # [https://www.who.int/rehabilitation/Package-of-rehab-interventions-info-sheet.pdf World Health Organization Package of Rehabilitation Interventions Information Sheet] <ref name=":0" /> | ||
Despite the wealth of information, the uptake of this evidence into practice is a slow process, especially in lower-middle income countries. | Despite the wealth of information, the uptake of this evidence into practice is a slow process, especially in lower-middle income countries.<ref name=":0" /> The translation from clinical research to clinical practice can take anywhere between 10-20 years. <ref name=":2">Novak I, te Velde A, Hines A, Stanton E, Mc Namara M, Paton MC, Finch-Edmondson M, Morgan C. [https://www.frontiersin.org/articles/10.3389/fresc.2021.726410/full Rehabilitation Evidence-Based Decision-Making: The READ Model]. Frontiers in Rehabilitation Sciences. 2021:51.</ref>Some of the barriers causing this delay are listed below: | ||
* Patient preference for an intervention | |||
* Time demands of healthcare professionals | |||
* Patient | * Skills of practitioners | ||
* Time demands | * Confidence of practitioners | ||
* Skills | * Belief in intervention by healthcare professionals | ||
* Confidence | |||
* Belief in intervention | |||
* Clinical trials may not transfer to clinical settings | * Clinical trials may not transfer to clinical settings | ||
* Resources | * Resources of health facility | ||
* Informational overload | * Informational overload by healthcare professionals | ||
* Institutional support | * Institutional support <ref name=":2" /> <ref name=":3">Lynch EA, Chesworth BM, Connell LA. I[https://journals.sagepub.com/doi/full/10.1177/1545968318777844 mplementation—The missing link in the research translation pipeline: is it any wonder no one ever implements evidence-based practice]?. Neurorehabilitation and neural repair. 2018 Sep;32(9):751-61.</ref> | ||
In lower-middle income countries (LIMCs), the need for quality interventions is higher, however, the capacity to implement is much lower than in resource-rich countries.<ref>Yapa HM, Bärnighausen T. [https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0847-1 Implementation science in resource-poor countries and communities. Implementation] Science. 2018 Dec;13(1):1-3.</ref> Grimmer et al. (2019) <ref name=":4">Grimmer et al (2019). [https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019-0454-x A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines]. Health Research Policy and Systems;17(1):1-14.</ref> has described the challenges lower-middle income countries face to implementing EBP which are described below. | |||
* | ==== System level challenges ==== | ||
* | * Limited awareness & understanding of evidence-based rehabilitation interventions | ||
* | * Limited quantification of existing rehabilitation services, workforce & service utilisation | ||
* Lack of specific government policy, strategic planning, legislation., funding for rehabilitation services across health system level (primary, secondary & acute)<ref name=":4" /> | |||
===== Health Care Provider level challenges ===== | |||
* Lack of mandate to provide evidence-based rehabilitation interventions | * Lack of mandate to provide evidence-based rehabilitation interventions | ||
* Limited rehab workforce and capacity (awareness, skills) to treat, competing priorities and heavy workloads | * Limited rehab workforce and capacity (awareness, skills) to treat, competing priorities and heavy workloads | ||
* Lack of coordination between services | * Lack of coordination between services | ||
* High re-imbursements for non-evidence-based rehabilitation interventions | * High re-imbursements for non-evidence-based rehabilitation interventions<ref name=":4" /> | ||
===== '''Patient level challenges''' ===== | |||
* Logistics of rehabilitation services | * Logistics of rehabilitation services | ||
* Affordability of rehabilitation services | * Affordability of rehabilitation services | ||
* Knowledge & attitudes to interventions | * Knowledge & attitudes to interventions | ||
* Health problem or condition specific factors | * Health problem or condition specific factors<ref name=":4" /> | ||
== Implementation Science == | == Implementation Science == | ||
Without a detailed implementation plan, it takes an average of 17 years for research evidence to be implanted into routine clinical practice. | Without a detailed implementation plan, it takes an average of 17 years for research evidence to be implanted into routine clinical practice.<ref name=":3" /> This tremendous lag time prompted the development of implementation science which studies the process used to disseminate health information and merge it into clinical practice.<ref name=":0" /><ref name=":3" /> <ref name=":5">Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. [https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-015-0089-9 An introduction to implementation science for the non-specialist]. BMC psychology. 2015 Dec;3(1):1-2.</ref><ref>Cabassa LJ, Baumann AA. [https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-8-90 A two-way street: bridging implementation science and cultural adaptations of mental health treatments]. Implementation Science. 2013 Dec;8(1):1-4.</ref> Implementation science has many different layers and the following terms will describe each component: | ||
# Implementation research: broad term referring to research by not only the provider but the organization and policy levels of healthcare | # Implementation research: broad term referring to research by not only the provider but the organization and policy levels of healthcare<ref name=":5" /> | ||
# Implementation practice: rehabilitation leaders implement evidence based research and adatpting to different contexts and settings | # Implementation practice: rehabilitation leaders implement evidence based research and adatpting to different contexts and settings<ref name=":0" /> | ||
# Implementation strategies: how to strengthen the implementation, adoption and sustainability of EBP | # Implementation strategies: how to strengthen the implementation, adoption and sustainability of EBP | ||
# Implementation Facilitation: guide rehabilitation professions regarding identifying and addressing implementation challenges and utilising positive outcomes | # Implementation Facilitation: guide rehabilitation professions regarding identifying and addressing implementation challenges and utilising positive outcomes<ref name=":0" /> | ||
# Implementation outcome: effects of adopting the new | # Implementation outcome: effects of adopting the new interventions into practice<ref name=":0" /> | ||
In summary, implementation science is concerned with the uptake and implementation of EBP. It strategically, de-implements “low-value” care while expanding effective evidence interventions. | In summary, implementation science is concerned with the uptake and implementation of EBP. It strategically, de-implements “low-value” care while expanding effective evidence interventions.<ref name=":0" /> | ||
=== Implementation Frameworks === | === Implementation Frameworks === | ||
As the implementation science field has grown, many frameworks have been developed to provide pathways for implementation. Frameworks clarify the core constructs of each step and phase providing accessibility to all involved in the implementation effort. The aim of frameworks is to blend disciplines and combine insights from different approaches. | As the implementation science field has grown, many frameworks have been developed to provide pathways for implementation. Frameworks clarify the core constructs of each step and phase providing accessibility to all involved in the implementation effort. The aim of frameworks is to blend disciplines and combine insights from different approaches. <ref>Huybrechts I, Declercq A, Verté E, Raeymaeckers P, Anthierens S. T[https://www.researchgate.net/publication/353664605_The_Building_Blocks_of_Implementation_Frameworks_and_Models_in_Primary_Care_A_Narrative_Review he building blocks of implementation frameworks and models in primary care: a narrative review]. Frontiers in Public Health. 2021;9.</ref> | ||
Below are a sampling of various implementation frameworks and their links categorized based on their target goal: | Below are a sampling of various implementation frameworks and their links categorized based on their target goal: | ||
| Line 66: | Line 58: | ||
Frameworks focused on what differences would there to implementing a new EB intervention | Frameworks focused on what differences would there to implementing a new EB intervention | ||
# | # [https://cfirguide.org/ Consolidated Framework for Implementation Research (CFIR)] | ||
# | # Theoretical Domains Framework | ||
# '''Integrating Promoting Action on Research Implementation in Health Services (I=PARIHS)''' | # '''Integrating Promoting Action on Research Implementation in Health Services (I=PARIHS)''' | ||
Revision as of 16:35, 3 February 2022
Introduction[edit | edit source]
The need for rehabilitation services in health systems has increased with a subsequent desire to implement evidence-based practices (EPB).[1] Rehabilitation professionals utilise evidence-based practice (EBP) when making intervention decisions based on the best evidence available.[2] It is a widely held belief among healthcare care practitioners that it is critical to know why what and how an intervention works in different settings [1]. A key factor guiding EBP is including the patient in the decision-making process. Family norms, traditions, cultures and personal beliefs should play a role in the intervention choice. Research supports EBP has better outcomes with patient participation.[2] In addition to patient involvement, practitioners need to take into account costs, resources in the community and the nature of the healthcare system.[2]
Challenges to Implementing EBP[edit | edit source]
Rehabilitation intervention evidence is growing every day. Principles and guidance on rehabilitation interventions are increasingly available such as:
- NHS Commissioning Guidance for Rehabilitation
- World Health Organization Package of Rehabilitation Interventions Information Sheet [1]
Despite the wealth of information, the uptake of this evidence into practice is a slow process, especially in lower-middle income countries.[1] The translation from clinical research to clinical practice can take anywhere between 10-20 years. [3]Some of the barriers causing this delay are listed below:
- Patient preference for an intervention
- Time demands of healthcare professionals
- Skills of practitioners
- Confidence of practitioners
- Belief in intervention by healthcare professionals
- Clinical trials may not transfer to clinical settings
- Resources of health facility
- Informational overload by healthcare professionals
- Institutional support [3] [4]
In lower-middle income countries (LIMCs), the need for quality interventions is higher, however, the capacity to implement is much lower than in resource-rich countries.[5] Grimmer et al. (2019) [6] has described the challenges lower-middle income countries face to implementing EBP which are described below.
System level challenges[edit | edit source]
- Limited awareness & understanding of evidence-based rehabilitation interventions
- Limited quantification of existing rehabilitation services, workforce & service utilisation
- Lack of specific government policy, strategic planning, legislation., funding for rehabilitation services across health system level (primary, secondary & acute)[6]
Health Care Provider level challenges[edit | edit source]
- Lack of mandate to provide evidence-based rehabilitation interventions
- Limited rehab workforce and capacity (awareness, skills) to treat, competing priorities and heavy workloads
- Lack of coordination between services
- High re-imbursements for non-evidence-based rehabilitation interventions[6]
Patient level challenges[edit | edit source]
- Logistics of rehabilitation services
- Affordability of rehabilitation services
- Knowledge & attitudes to interventions
- Health problem or condition specific factors[6]
Implementation Science[edit | edit source]
Without a detailed implementation plan, it takes an average of 17 years for research evidence to be implanted into routine clinical practice.[4] This tremendous lag time prompted the development of implementation science which studies the process used to disseminate health information and merge it into clinical practice.[1][4] [7][8] Implementation science has many different layers and the following terms will describe each component:
- Implementation research: broad term referring to research by not only the provider but the organization and policy levels of healthcare[7]
- Implementation practice: rehabilitation leaders implement evidence based research and adatpting to different contexts and settings[1]
- Implementation strategies: how to strengthen the implementation, adoption and sustainability of EBP
- Implementation Facilitation: guide rehabilitation professions regarding identifying and addressing implementation challenges and utilising positive outcomes[1]
- Implementation outcome: effects of adopting the new interventions into practice[1]
In summary, implementation science is concerned with the uptake and implementation of EBP. It strategically, de-implements “low-value” care while expanding effective evidence interventions.[1]
Implementation Frameworks[edit | edit source]
As the implementation science field has grown, many frameworks have been developed to provide pathways for implementation. Frameworks clarify the core constructs of each step and phase providing accessibility to all involved in the implementation effort. The aim of frameworks is to blend disciplines and combine insights from different approaches. [9]
Below are a sampling of various implementation frameworks and their links categorized based on their target goal:
Frameworks focused on what differences would there to implementing a new EB intervention
- Consolidated Framework for Implementation Research (CFIR)
- Theoretical Domains Framework
- Integrating Promoting Action on Research Implementation in Health Services (I=PARIHS)
Many of these various frameworks are not used in isolation as they often are used together.(SPEAKER)
Implementation Facilitation Mindset[edit | edit source]
Implementation facilitation is a multi-stage process that encompasses pre-implementation, implementation and sustainment. Facilitators implementing EBP adhere to three key factors:
- Intervention: , program or practice they want to adopt, scale up or spread
Questions they consider:
- Is there strong evidence for the intervention?
- Does this intervention have an advantage?
- Context the setting that will either enable or hinder the implementation.
Questions they consider:
- Is there a readiness and openness for change to implement this new intervention?
- Will this new intervention receive support from senior management and organisational leadership?
- Stakeholders: who are key implementation players for the intervention (policymakers, organisational managers, or frontline rehabilitation professionals).
Questions they consider:
- What knowledge, skills, and beliefs exist with stakeholders?
- What resources and time are available amongst the stakeholders?
In summary, implementation facilitation describes how to administer implementation science while identifying barriers and creating solutions to have a supportive sustainable evidence-based clinical practice or programs.
Resources[edit | edit source]
- Evidence Based Practice(EBP) in Physiotherapy
- https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf
- https://www.who.int/rehabilitation/Package-of-rehab-interventions-info-sheet.pdf
- https://episframework.com/
- https://implementationscience-gacd.org/implementation-science-overview/
- https://impsciuw.org/implementation-science/learn/implementation-science-overview/
- https://cfirguide.org/
- https://machaustralia.org/news/implementation-science-series/
- https://globalimplementation.org/ bulleted list
- x
or
- numbered list
- x
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Naccarella, L. Implementation Science Course. Physioplus. 2022
- ↑ 2.0 2.1 2.2 Portney LG. Foundations of clinical research: applications to evidence-based practice. FA Davis; 2020 Jan 16.
- ↑ 3.0 3.1 Novak I, te Velde A, Hines A, Stanton E, Mc Namara M, Paton MC, Finch-Edmondson M, Morgan C. Rehabilitation Evidence-Based Decision-Making: The READ Model. Frontiers in Rehabilitation Sciences. 2021:51.
- ↑ 4.0 4.1 4.2 Lynch EA, Chesworth BM, Connell LA. Implementation—The missing link in the research translation pipeline: is it any wonder no one ever implements evidence-based practice?. Neurorehabilitation and neural repair. 2018 Sep;32(9):751-61.
- ↑ Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implementation Science. 2018 Dec;13(1):1-3.
- ↑ 6.0 6.1 6.2 6.3 Grimmer et al (2019). A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines. Health Research Policy and Systems;17(1):1-14.
- ↑ 7.0 7.1 Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC psychology. 2015 Dec;3(1):1-2.
- ↑ Cabassa LJ, Baumann AA. A two-way street: bridging implementation science and cultural adaptations of mental health treatments. Implementation Science. 2013 Dec;8(1):1-4.
- ↑ Huybrechts I, Declercq A, Verté E, Raeymaeckers P, Anthierens S. The building blocks of implementation frameworks and models in primary care: a narrative review. Frontiers in Public Health. 2021;9.
