Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups

Abstract Background With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordin...

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Autores principales:	Rieka von der Warth, Vanessa Kaiser, Christina Reese, Boris A. Brühmann, Erik Farin-Glattacker
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Barriers Facilitators Nursing homes Focus groups Qualitative study Coordinated medical care Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/5889ebff8cc0415d878fdd7e4acbe6a4
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spelling	oai:doaj.org-article:5889ebff8cc0415d878fdd7e4acbe6a42021-11-07T12:16:19ZBarriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups10.1186/s12877-021-02579-y1471-2318https://doaj.org/article/5889ebff8cc0415d878fdd7e4acbe6a42021-11-01T00:00:00Zhttps://doi.org/10.1186/s12877-021-02579-yhttps://doaj.org/toc/1471-2318Abstract Background With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated medical care”) has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders. Methods Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP’s assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis. Results In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care. Conclusion Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself. Trial registration WHO UTN: U1111–1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23).Rieka von der WarthVanessa KaiserChristina ReeseBoris A. BrühmannErik Farin-GlattackerBMCarticleBarriersFacilitatorsNursing homesFocus groupsQualitative studyCoordinated medical careGeriatricsRC952-954.6ENBMC Geriatrics, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Barriers Facilitators Nursing homes Focus groups Qualitative study Coordinated medical care Geriatrics RC952-954.6
spellingShingle	Barriers Facilitators Nursing homes Focus groups Qualitative study Coordinated medical care Geriatrics RC952-954.6 Rieka von der Warth Vanessa Kaiser Christina Reese Boris A. Brühmann Erik Farin-Glattacker Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
description	Abstract Background With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated medical care”) has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders. Methods Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP’s assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis. Results In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care. Conclusion Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself. Trial registration WHO UTN: U1111–1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23).
format	article
author	Rieka von der Warth Vanessa Kaiser Christina Reese Boris A. Brühmann Erik Farin-Glattacker
author_facet	Rieka von der Warth Vanessa Kaiser Christina Reese Boris A. Brühmann Erik Farin-Glattacker
author_sort	Rieka von der Warth
title	Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_short	Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_full	Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_fullStr	Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_full_unstemmed	Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
title_sort	barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5889ebff8cc0415d878fdd7e4acbe6a4
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Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups

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