Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research
BACKGROUND: Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this resear...
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| Lenguaje: | inglés |
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2023
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| _version_ | 1881508853818851328 |
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| author | Stephanie N. Wilson Helen E. Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey N. LaGrone |
| author_browse | David Ortega Checa Gabriela Zavala Wong Helen E. Noble Kirsten Senturia Lacey N. LaGrone Manuel J Rodríguez Maria Warne Stephanie N. Wilson Willy Jesús Neumann Ordoñez |
| author_facet | Stephanie N. Wilson Helen E. Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey N. LaGrone |
| author_sort | Stephanie N. Wilson |
| collection | Producción científica |
| description | BACKGROUND: Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. METHODS: Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. RESULTS: Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. CONCLUSIONS: Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/1368 |
| institution | UPeU |
| language | English |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| record_format | dspace |
| spelling | oai:cris.upeu.edu.pe:20.500.15037/13682026-10-30T16:15:40ZImplementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation ResearchStephanie N. WilsonHelen E. NobleWilly Jesús Neumann OrdoñezGabriela Zavala WongManuel J RodríguezDavid Ortega ChecaMaria WarneKirsten SenturiaLacey N. LaGronePsychological interventionIntervention (counseling)Implementation researchSpecialtyQualitative researchAdaptation (eye)Medical educationSeniorityHealth careMedicineNursingPsychologyPolitical scienceFamily medicineSociologyNeuroscienceLawSocial sciencePsychological interventionIntervention (counseling)Implementation researchSpecialtyQualitative researchAdaptation (eye)Medical educationSeniorityHealth careMedicineNursingPsychologyPolitical scienceFamily medicineSociologyHealth Sciences Health Professions General Health Professions Health Policy Implementation ScienceHealth Sciences Health Professions Health Information Management Electronic Health Records SystemsHealth Sciences Medicine Public Health, Environmental and Occupational Health Global Health and SurgeryBACKGROUND: Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. METHODS: Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. RESULTS: Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. CONCLUSIONS: Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site.Articlehttps://pubmed.ncbi.nlm.nih.gov/37024984https://implementationsciencecomms.biomedcentral.com/counter/pdf/10.1186/s43058-023-00397-4https://doi.org/10.1186/s43058-023-00397-410.1186/s43058-023-00397-4https://hdl.handle.net/20.500.15037/1368W4362671039enImplementation Science Communications2662-22112023-04-062026-06-13T09:55:44Z2026-06-13T09:55:44Z |
| spellingShingle | Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Neuroscience Law Social science Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Health Sciences Health Professions General Health Professions Health Policy Implementation Science Health Sciences Health Professions Health Information Management Electronic Health Records Systems Health Sciences Medicine Public Health, Environmental and Occupational Health Global Health and Surgery Stephanie N. Wilson Helen E. Noble Willy Jesús Neumann Ordoñez Gabriela Zavala Wong Manuel J Rodríguez David Ortega Checa Maria Warne Kirsten Senturia Lacey N. LaGrone Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_full | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_fullStr | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_full_unstemmed | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_short | Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research |
| title_sort | implementing point of care medical information systems into trauma and general surgeon practice in a middle income country a qualitative study utilizing the consolidated framework for implementation research |
| topic | Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Neuroscience Law Social science Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Health Sciences Health Professions General Health Professions Health Policy Implementation Science Health Sciences Health Professions Health Information Management Electronic Health Records Systems Health Sciences Medicine Public Health, Environmental and Occupational Health Global Health and Surgery |
| topic_facet | Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Neuroscience Law Social science Psychological intervention Intervention (counseling) Implementation research Specialty Qualitative research Adaptation (eye) Medical education Seniority Health care Medicine Nursing Psychology Political science Family medicine Sociology Health Sciences Health Professions General Health Professions Health Policy Implementation Science Health Sciences Health Professions Health Information Management Electronic Health Records Systems Health Sciences Medicine Public Health, Environmental and Occupational Health Global Health and Surgery |
| url | https://pubmed.ncbi.nlm.nih.gov/37024984 https://implementationsciencecomms.biomedcentral.com/counter/pdf/10.1186/s43058-023-00397-4 https://doi.org/10.1186/s43058-023-00397-4 https://hdl.handle.net/20.500.15037/1368 |
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