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American Journal of Health-system... Feb 2018The development and implementation of a centralized, comprehensive, refill authorization (CCRA) program within an academic health system are described.
PURPOSE
The development and implementation of a centralized, comprehensive, refill authorization (CCRA) program within an academic health system are described.
SUMMARY
In order to improve continuity of care for our medically complicated patients, ambulatory pharmacy services developed and implemented a highly coordinated CCRA program for multiple community clinics within the system. To implement the CCRA program, we centralized the refill-request intake process to the Pharmacy Ambulatory Clinical Care Center (PAC). PAC technicians were incorporated into the refill authorization process, and the collaborative practice agreement was updated to standardize the pharmacist refill approval process at the PAC. We successfully standardized and centralized the medication refill process from 10 community clinics with 95 family practice and internal medicine providers and 26 medical residents. We handled an average of 12,000 refill requests each month, and pharmacists documented any interventions performed with each refill request. The cost savings associated with the CCRA program were attributed to the increased efficiency of the staff reviewing refill requests. The CCRA program increased the refill approval up to 10% compared with the previous decentralized refill authorization model. With the increased approval rate, the CCRA program saved 510 hours of our providers' time annually, which created time for an additional 1,530 clinic visits. We demonstrated a faster average turnaround time for refill authorization, from an average of 72 hours before implementation to about 1 business day.
CONCLUSION
Implementation of an integrated refill authorization service standardized the method by which patients' refill requests were addressed, increased refill efficiency, and improved refill authorization turnaround time.
Topics: Academic Medical Centers; Ambulatory Care Facilities; Drug Prescriptions; Humans; Pharmacists; Pharmacy Service, Hospital; Pharmacy Technicians; Program Development
PubMed: 29371194
DOI: 10.2146/ajhp170333 -
Nursing Administration Quarterly 2020Local efforts to provide treatment for individuals with substance use disorder have had some success in addressing the continued nationwide drug epidemic. A nurse-led...
Local efforts to provide treatment for individuals with substance use disorder have had some success in addressing the continued nationwide drug epidemic. A nurse-led withdrawal and stabilization program was developed that includes an interdisciplinary team of physicians, advanced practice providers, nurses, social workers, and substance abuse counselors. Utilizing a shared vision of optimal patient care, we describe how principles of high reliability were incorporated to build a successful program within a community hospital setting from the design of the unit, development of treatment protocols, staffing, and ongoing program refinement that is based on patient and program staff feedback to final thoughts for future program changes.
Topics: Humans; Patient Care Team; Program Development; Quality Improvement; Substance-Related Disorders
PubMed: 32511177
DOI: 10.1097/NAQ.0000000000000421 -
Global Health, Science and Practice Dec 2016Implementing complex nutrition and other public health projects and tracking nutrition interventions, such as women's diet and supplementation and infant and young child...
BACKGROUND
Implementing complex nutrition and other public health projects and tracking nutrition interventions, such as women's diet and supplementation and infant and young child feeding practices, requires reliable routine data to identify potential program gaps and to monitor trends in behaviors in real time. However, current monitoring and evaluation practices generally do not create an environment for this real-time tracking. This article describes the development and application of a mobile-based nutrition and health monitoring system, which collected monitoring data on project activities, women's nutrition, and infant and young child feeding practices in real time.
PROGRAM DESCRIPTION
The Liberia Agricultural Upgrading Nutrition and Child Health (LAUNCH) project implemented a nutrition and health monitoring system between April 2012 and June 2014. The LAUNCH project analyzed project monitoring and outcome data from the system and shared selected behavioral and programmatic indicators with program managers through a short report, which later evolved into a visual data dashboard, during program-update meetings. The project designed protocols to ensure representativeness of program participants.
FINDINGS
LAUNCH made programmatic adjustments in response to findings from the monitoring system; these changes were then reflected in subsequent quarterly trends, indicating that the availability of timely data allowed for the project to react quickly to issues and adapt the program appropriately. Such issues included lack of participation in community groups and insufficient numbers of food distribution points. Likewise, the system captured trends in key outcome indicators such as breastfeeding and complementary feeding practices, linking them to project activities and external factors including seasonal changes and national health campaigns.
CONCLUSION
Digital data collection platforms can play a vital role in improving routine programmatic functions. Fixed gathering locations such as food distribution points represent an opportunity to easily access program participants and enable managers to identify strengths and weaknesses in project implementation. For programs that track individuals over time, a mobile tool combined with a strong database can greatly improve efficiency and data visibility and reduce resource leakages.
Topics: Adult; Child Health; Female; Health Status; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Liberia; Male; Pregnancy; Program Development; Smartphone; Surveys and Questionnaires
PubMed: 28031303
DOI: 10.9745/GHSP-D-16-00189 -
Patient Education and Counseling 2017To identify elements of good practice in designing and delivering alcohol education programmes in schools.
OBJECTIVE
To identify elements of good practice in designing and delivering alcohol education programmes in schools.
METHODS
Literature reviews and published programme evaluations were used to identify key elements of good practice.
RESULTS
Principles of good practive are identified and discussed. Five main issues are highlighted: choosing a universal or targetted approach, the need for theoretical frameworks, adopting a stand-alone or multi-component approach; issues of delivery and programme fidelity, and balancing programme fidelity and cultural relevance.
CONCLUSIONS
Programme objectives, programme fidelity and cultural context are important factors in designing programmes and will influence outcomes and evaluation of success.
PRACTICE IMPLICATIONS
In developing alcohol education programmes, there is a need to draw on the evidence and experience accrued from previous efforts. Programme development and implementation can draw on results from evaluated programmes to design alcohol education programmes suited to specific contexts, the availability of resources, the perceived needs of the target group and the problem to be addressed.
Topics: Alcohol Drinking; Alcohol-Related Disorders; Cultural Characteristics; Evidence-Based Medicine; Health Education; Health Promotion; Humans; Program Development; School Health Services; Schools
PubMed: 26718032
DOI: 10.1016/j.pec.2015.11.020 -
American Journal of Pharmaceutical... Oct 2014To evaluate the outcomes of alumni who were enrolled in a professional development seminar series during their doctor of pharmacy program.
OBJECTIVE
To evaluate the outcomes of alumni who were enrolled in a professional development seminar series during their doctor of pharmacy program.
DESIGN
A weekly development seminar series was administered over 5 semesters with the goal of bringing academic advisees together to help develop performance-based abilities, prepare them for entry into the profession after graduation, and provide exposure to different career opportunities.
ASSESSMENT
A survey instrument containing 39 Likert-type scale items, 2 open-ended questions, and a 10-item demographic survey was created and content-validated to assess the effect of the seminar series on alumni advisees' perceived outcomes and professional development since their graduation. The survey was electronically forwarded to advisees from the graduating classes of 2005 to 2012, and response data was collected with Qualtrics, a web-based survey service. A total of 36 percent of alumni responded to the survey. Respondents cited exposure to career alternatives and opportunities, development of presentation and communication skills, networking, and the importance of advisor/mentor relationships as benefits of the seminar series.
CONCLUSION
The professional development seminar series has demonstrated a positive impact on alumni advisees' career development and professional outcomes, most notably relating to career path exposure, communication skills, and advisor/mentor relationships.
Topics: Adult; Data Collection; Education, Pharmacy, Continuing; Female; Humans; Male; Pharmacists; Program Development; Young Adult
PubMed: 25386015
DOI: 10.5688/ajpe788150 -
Implementation Science : IS Sep 2015Implementation fidelity is critical to the internal and external validity of implementation research. Much of what is written about implementation fidelity addresses... (Review)
Review
BACKGROUND
Implementation fidelity is critical to the internal and external validity of implementation research. Much of what is written about implementation fidelity addresses fidelity of evidence-informed interventions rather than fidelity of implementation strategies. The documentation and reporting of fidelity to implementation strategies requires attention. Therefore, in this scoping review, we identify the extent and quality of documentation and reporting of fidelity of implementation strategies that were used to implement evidence-informed interventions.
METHODS
A six-stage methodological framework for scoping studies guided our work. Studies were identified from the outputs of the Effective Practice and Organization of Care (EPOC) review group within the Cochrane Database of Systematic Reviews. EPOC's primary focus, implementation strategies influencing provider behavior change, optimized our ability to identify articles for inclusion. We organized the retrieved articles from the systematic reviews by journal and selected the three journals with the largest number of retrieved articles. Using a data extraction tool, we organized retrieved article data from these three journals. In addition, we summarized implementation strategies using the EPOC categories. Data extraction pertaining to the quality of reporting the fidelity of implementation strategies was facilitated with an "Implementation Strategy Fidelity Checklist" based on definitions adapted from Dusenbury et al. We conducted inter-rater reliability checks for all of the independently scored articles. Using linear regression, we assessed the fidelity scores in relation to the publication year.
RESULTS
Seventy-two implementation articles were included in the final analysis. Researchers reported neither fidelity definitions nor conceptual frameworks for fidelity in any articles. The most frequently employed implementation strategies included distribution of education materials (n = 35), audit and feedback (n = 32), and educational meetings (n = 25). Fidelity of implementation strategies was documented in 51 (71 %) articles. Inter-rater reliability coefficients of the independent reviews for each component of fidelity were as follows: adherence = 0.85, dose = 0.89, and participant responsiveness = 0.96. The mean fidelity score was 2.6 (SD = 2.25). We noted a statistically significant decline in fidelity scores over time.
CONCLUSIONS
In addition to identifying the under-reporting of fidelity of implementation strategies in the health literature, we developed and tested a simple checklist to assess the reporting of fidelity of implementation strategies. More research is indicated to assess the definitions and scoring schema of this checklist. Careful reporting of details about fidelity of implementation strategies will make an important contribution to implementation science.
Topics: Documentation; Evidence-Based Medicine; Humans; Observer Variation; Program Development
PubMed: 26345357
DOI: 10.1186/s13012-015-0320-3 -
International Journal of Adolescent... Feb 2017Based on the data collected from the Tier 1 Program of a community-based positive youth development program (Project P.A.T.H.S.) in 2013, the current study explored the...
Based on the data collected from the Tier 1 Program of a community-based positive youth development program (Project P.A.T.H.S.) in 2013, the current study explored the perspectives of 634 program implementers who implemented the Tier 1 Program in Hong Kong. Upon the completion of the program, the program implementers responded to a validated client satisfaction scale (Form B). The results showed that the program implementers perceived the program, implementers and benefits of the program in a positive manner. However, there were no differences among perceived program content, implementers and effectiveness across the three grades. Consistent with previous studies, perceived program predicted effectiveness of the program. Nevertheless, program implementers did not predict program effectiveness. Once again, the present findings indicated that the Tier 1 Program was well received by the program implementers.
Topics: Adolescent; Adolescent Behavior; Adolescent Development; Community-Based Participatory Research; Female; Health Plan Implementation; Hong Kong; Humans; Male; Outcome Assessment, Health Care; Program Development; Program Evaluation; School Health Services
PubMed: 27299202
DOI: 10.1515/ijamh-2017-3003 -
International Journal of Medical... Apr 2018
Topics: Curriculum; Humans; Leadership; Program Development; Program Evaluation; Schools, Medical
PubMed: 29669927
DOI: 10.5116/ijme.5abe.12d2 -
Journal of Human Lactation : Official... May 2017Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are...
BACKGROUND
Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are exclusively breastfeeding at 3 and 6 months, respectively. Research aim: The Centers for Disease Control and Prevention provides guidance and funding to state health departments to support strategies to improve breastfeeding policies and practices in the hospital, community, and worksite settings. In 2010, the Hawaii State Department of Health received support from the Centers for Disease Control and Prevention to launch the Baby-Friendly Hawaii Project (BFHP) to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay.
METHODS
For this article, we examined the BFHP's final evaluation report and Hawaii breastfeeding and maternity care data to identify the role of the BFHP in facilitating improvements in maternity care practices and breastfeeding rates.
RESULTS
Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii's overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014.
CONCLUSION
Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.
Topics: Breast Feeding; Hawaii; Humans; Infant; Infant Health; Infant, Newborn; Mothers; Program Development; Program Evaluation; Public Health
PubMed: 28135119
DOI: 10.1177/0890334416683675 -
Nursing Leadership (Toronto, Ont.) Jun 2019Purpose of the paper: To describe the development of a testable conceptual model that examines the relationship between implementation leadership characteristics and...
PURPOSE
Purpose of the paper: To describe the development of a testable conceptual model that examines the relationship between implementation leadership characteristics and nurses' use of mobile health technologies (mHealth) as part of their nursing practice. The model is currently being tested in the pan-Canadian context.
CONCEPTS
Primary concepts and issues to be addressed: The 2014 and 2017 Canada-wide surveys of nurses' use of technologies reported seemingly low rates of mobile technology use: 3% in 2014 and 7% in 2017(Canada Health Infoway 2014, 2017). The agenda to increase the use of mHealth by nurses persists, though understanding of nurses' use of mHealth remains underexplored. Nurses' usage of mHealth has primarily been examined using technology acceptance models, which are limited in their ability to account for unique aspects of nursing practice. The Nurse LEADership for Implementing Technologies (Nurse LEAD-IT) - mHealth (Nurse LEAD-IT - mHealth) model draws concepts from implementation science, computer science, organizational behaviour, information science and nursing to develop a testable conceptual model. The model facilitates examination of the relationship between nurses' use of mHealth and leaders' implementation characteristics (proactivity, knowledge, support and perseverance) and technology acceptance (perceived usefulness and perceived ease of use), while controlling for factors that influence technology use (previous experience and voluntariness of use) and nurses' acceptance of evidence-based practice (age, gender and education).
SIGNIFICANCE
Significance and/or implications for nurse leaders: The Nurse LEAD-IT model can aid in delineating the pragmatic skills and knowledge necessary for nursing leaders to successfully implement mHealth initiatives in nursing practice settings. Use of mHealth in Canadian nursing settings remain in the emergent stages; results from the testing of this conceptual model will be timely and important in informing current and future strategies by nursing leaders to best situate the development and implementation of mHealth for successful uptake and usage in nursing.
Topics: Biomedical Technology; Diffusion of Innovation; Humans; Leadership; Program Development; Telemedicine
PubMed: 31613215
DOI: 10.12927/cjnl.2019.25960