PRP037: Barriers and facilitators to the implementation of an intervention for people with multimorbidity in primary care

Patrice Ngangue, MD, PhD, MSc; Tu Nguyen, MD, PhD; Maxime Sasseville, PhD, RN; Martin Fortin, MD, MSc, CCFP; Judith Brown, PhD; Catherine Forgues, RD; Mohamed Ali Ag Ahmed, MD, PhD, MPH


A patient-centered interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of the Province of Quebec, Canada.
This embedded study aimed to identify the barriers and facilitators to the implementation.
Study Design and Analysis
A descriptive qualitative study conducted from October 2016 to September 2017 using semi-structured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, data analysis, and reporting of findings.
Population studied
Ten managers and 19 healthcare professionals (HCP) including family physicians, nurses, kinesiologists, nutritionists, and respiratory therapist were interviewed.
Seven Family Medicine Groups (FMGs) in one region (Saguenay-Lac-saint-Jean) of the Province of Quebec, Canada
The main barriers of implementation included: (1) the intervention complexity (difficulties distinguishing between intervention services and pre-existing services, understanding procedures related to recruitment, and explaining the intervention adequately to patients); (2) organizational culture (difficulty integrating the relocated HCPs into clinic work routines), implementation climate (delays in accessing some HCPs because they worked part-time and there was a lack of administrative support which complicated and increased their work); (3) process (health system reform, union deadlines and lack of human and physical resources contributed to slowing down the relocation of healthcare professionals). The main facilitators of implementation included: (1) intervention source (funded program, expertise in chronic diseases of the research team) ; (2) relative advantage (colocation of HPC allowed the proximity of HCP and services for patients); (3) patient needs and resources (HCP training on how to meet the needs of patients such as patient-centered care, motivational interviewing, self-management support) ; (4) collaboration and teamwork (the managers' involvement in the HCP training and the provision of reminders to family physicians during the referral phase)
Applying the CFIR as an analysis lens allows comparisons with other contexts and setting, and may be useful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programs for people with multiple chronic conditions in primary care.

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Edmond Ramly, PhD 11/24/2020

Nice depiction of CFIR constructs highlighting facilitators, not just barriers. Curious about differences you found between B/Fs reported by managers and ones reported by HCPs

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