SEARCH · PubMed Health

Results for “Implementation challenges”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,135 records · Page 63Linked to original sources

PubMed2005

Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon.

OBJECTIVE: To review the key issues related to the design and implementation of an electronic health record (EHR) system in urban primary health care (PHC) practice in Cameroon. METHODOLOGY: The goal of the project was to assess EHR as a tool to improve providers' performance, quality and continuity of care, and the availability of data in PHC practice in Cameroon. A locally designed EHR system called MEDCAB was developed. The system was based on the International Classification for Primary Care (ICPC) and was designed taking into consideration the PHC practice environment in Cameroon. An original cohort of 14 users was involved in the experiment. RESULTS: Users generally showed good acceptance of the system. Monitoring the use of the system at the early stages of implementation was important to ensure immediate response to users' comments and requests. Some of the key issues identified during the development and implementation of the system were: user involvement, the choice of an appropriate terminology, pre-existing data collection culture and leadership issues. Some positive achievements brought about by the system included promotion of good medical practice and routine availability of consultation data. CONCLUSION: Strengthening the medical record in general, and the EHR in particular, could contribute to its position as a valuable source of information for healthcare delivery, public health and policy making in Cameroon. Challenges to adoption are huge and successful implementation for any specific setting will require a comprehensive modelling of the local medical practice, the choice of an appropriate terminology and a co-ordinated approach involving all stakeholders.

Africa South of the Sahara↗

PubMed2005

Changing nursing practice: evaluating the usefulness of a best-practice guideline implementation toolkit.

PURPOSE: This pilot study describes the evaluation of an 88-page Toolkit that was developed to guide nursing leaders, including advanced practice nurses, managers and steering committees, who were responsible for coordinating implementation of selected best-practice guidelines (BPG) in their respective agencies. METHODS: The self-administered questionnaire was mailed to all clinical resource nurses and steering committee members involved in implementing best-practice guidelines. The questionnaire evaluated the usefulness of the content of five chapters (and the case scenarios and worksheets included with each chapter). RESULTS: Sixty-eight percent of respondents returned the questionnaire. More than 85% of them found the Toolkit helpful during the implementation process; 83% reported using it, 80% said they would use it again. The Toolkit was used primarily to identify, analyze and engage stakehoLders, and to assess environmental readiness. Fifty-seven percent of respondents said they used the Toolkit to plan the implementation strategy. CONCLUSIONS: The Toolkit assessed in this evaluation shows promise as a useful guide for those charged with BPG implementation. Like other guidelines that are based on evidence, the Toolkit will require occasional updates to ensure that the strategies proposed reflect current evidence. Nursing leaders have a responsibility to keep up to date and to provide efficient and effective healthcare services. Best-practice guidelines or clinical practice guidelines are useful tools that synthesize the latest evidence and provide recommendations for care providers aiming to improve the quality of patient care (Grol 2001). Many leaders are challenged to know how and when to implement the increasing numbers of practice guidelines. The purpose of this article is to describe a pilot study to evaluate a Toolkit that was developed to guide nursing leaders in implementing selected best-practice guidelines (BPGs) in their respective agencies.

Benchmarking↗

PubMed2003

Abortion: developments and impact in South Africa.

The article seeks to clarify the context of the Choice on Termination of Pregnancy Act, 1996 (Act No.92 of 1996), the factors that led to its adoption and implementation including the role of research in support of policy development, the expanded utilization of professional nurses, and the respect and promotion of women's right to life and well-being. The challenges that cropped up on the road to implementation and sustenance are also spelt out. It is important to evaluate the programme because this will assist South Africa to improve on the performance of service delivery. It will also assist other countries, both poor and rich, to progressively realize the promotion of human rights. Lastly, the article also seeks to identify areas that will lead to the improvement of women's lives, and ultimately societal development and health.

Abortion, Legal↗

PubMed2000

Integrated Resource Management: Moving from Rhetoric to Practice in Australian Agriculture.

/ Implementing the concept of sustainability through integrated approaches to natural resource management poses enormous challenges for both the rural communities and government agencies concerned. This paper reviews the underlying rhetoric of sustainable agricultural systems and the integrated resource management paradigm and identifies some of the challenges being experienced in translating this rhetoric into practice. A relatively recently implemented community-based integrated catchment management (ICM) process in a rural community in northeast Australia is examined in terms of some of the lessons learned that may be relevant to other similar integrated resource management (IRM) processes. It reveals a pragmatic, opportunistic, and evolving implementation process based on adaptive learning rather than a more traditional "rational" planning approach. Some essential characteristics of a community-based IRM process are identified, including fostering communication; providing a structure that fosters cooperation and facilities coordination among community, industry, and government agencies; the integration of IRM principles into local government planning schemes; and an emergent strategic approach to IRM program implementation. We conclude by identifying some essential characteristics of an IRM process that can assist a community to adapt to, and manage change for, sustainable resource use.

Journal Article↗

PubMed2025

Global considerations for lifelong management and therapeutic development for phenylketonuria.

Phenylketonuria (PKU) is an inherited metabolic disorder characterized by the accumulation of toxic phenylalanine levels in the brain that can lead to neurocognitive impairment if untreated. This review evaluates unmet needs in PKU, the importance of newborn screening (NBS), and considerations for chronic treatment options. An international group of experts reviewed the available literature across ethnicities and geographies to identify unmet needs of individuals with PKU. Treatment was assessed in a global context to address patient benefit. Reflecting challenges to the worldwide PKU community, some countries have been unable to implement NBS programs and/or do not apply a treatment-for-life approach. Ongoing challenges for individuals with PKU include maintaining adherence to treatment guidelines for patient- and practice-specific reasons, such as inadequate access to low-cost treatment, insufficient social support, limited clinical staffing, and disease burden. Dietary interventions may not adequately address all symptoms, and some of the current pharmacotherapies may be associated with limited efficacy or adverse events. Several new therapies are being evaluated for the treatment of PKU, offering the potential to address unmet needs. Global availability of NBS programs, access to treatments, and a tenacious commitment to treatment-for-life are expected to improve outcomes for individuals with PKU across geographic regions.

Humans↗

PubMed2005

A framework based on Web service orchestration for bioinformatics workflow management.

Bioinformatics activities are growing all over the world, with proliferation of data and tools. This brings new challenges: how to understand and organize these resources and how to provide interoperability among tools to achieve a given goal. We defined and implemented a framework to help meet some of these challenges. Four issues were considered: the use of Web services as a basic unit, the notion of a Semantic Web to improve interoperability at the syntactic and semantic levels, and the use of scientific workflows to coordinate services to be executed, including their interdependencies and service orchestration.

Algorithms↗

PubMed2001

Training and support program for pharmacists in rural Victoria.

The 'Rural Pharmacist Training and Support Program' was a pilot project that was conducted by the Monash University Centre for Rural Health. It examined the implementation of Pharmacy Board of Victoria Guidelines to Residential Care Facilities in the Loddon Mallee region of Victoria. Through a series of workshops, pharmacists were encouraged to discuss and address difficulties that were impeding implementation of the guidelines. These included upskilling in clinical pharmacy and ways to overcome the shortage of pharmacists in rural areas. Furthermore, the project was a catalyst for eight additional outcomes. This project highlighted the challenges facing rural pharmacists as they seek to implement the guidelines and resulted in a number of recommendations that addressed workforce issues, training and continuing education, Pharmacy Board requirements, improved communication with other health professionals and undergraduate training.

Education, Pharmacy, Continuing↗

PubMed2003

A method for subdividing clinical guidelines into process modules with associated triggers and objectives to facilitate implementation.

Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for sub-dividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described.

Decision Support Systems, Clinical↗

PubMed2004

Implementing telemedicine technology: lessons from India.

Information and communications technologies have universally helped to bridge the digital divide. As an application of ICT, telemedicine is an efficient pathway for enabling health care delivery. Developing countries, too, have started reaping the benefits of this evolutionary technology, but realisation of such dreams has not been swift. The implementation of a pilot scheme in telemedicine in India has been confounded with challenges right from the very start. One of the prime lessons to be learnt from the implementation of a pilot project in a developing country is to keep the objectives of the project in small modules and to keep the deliverables within sight. An account of some of the challenges faced while developing telemedicine technology in India serves as a useful example for upcoming telemedicine programmes in Third World countries.

Benchmarking↗

PubMed1995

Implementing a directly observed therapy program in an urban community hospital.

St. Clare's Health and Hospital Center has implemented a directly observed therapy (DOT) program for a challenging urban population of largely HIV+ patients in response to a need for the prevention of the spread of multidrug-resistant tuberculosis in the population. Identified treatment barriers are needs of patient subgroups within the population. Issues in the implementation include: patient compliance, effectiveness of patient identification and follow-up, and continuity of care. Challenges to continuity of care include patients signing out of the hospital against medical advice and missed clinic appointments. Patient identification and follow-up is enhanced by coordinating DOT treatment with the methadone maintenance treatment program.

AIDS-Related Opportunistic Infections↗

PubMed2003

How to implement change in clinical practice.

Changing clinical practice is a major challenge. It is not acceptable simply to send out a new clinical guideline or care pathway and expect there to be a change in practice. This paper addresses the problems associated with the development of a clinical guideline and sets out a clear strategy for dissemination, implementation and evaluation in a way that should promote the successful change of practice. The first section examines the development of the guideline. National or international guidelines may well exist but local adaptation and refinement of those guidelines are required, along with a local summary document. Valid, reproducible, evidence-based, clear, logical, easily accessible guidelines need to be available after widespread local, multi-professional consultation. Second, prior to dissemination, there needs to be promotion among all the health professionals and families involved with the change in practice. Appropriate educational and multi-disciplinary interventions, highlighting and informing in workshops and preparing people for the changes are recommended. Recognising the barriers to implementation and change and addressing these locally is important. Once the guideline has been disseminated and implemented and the change in practice has occurred, full evaluation and ongoing audit of the changes in practice are required to sustain the changes.

Guideline Adherence↗

PubMed1998

Use of noncontingent reinforcement in the treatment of challenging behavior. A review and clinical guide.

Recently, noncontingent reinforcement (NCR) has been used to reduce challenging behavior in persons with developmental disabilities. In this context, NCR involves reinforcement on a fixed-time schedule irrespective of behavior. The present article reviews studies involving NCR for the treatment of challenging behavior. Based on this review, a clinical guide for the implementation of NCR is delineated. NCR appears to depend on ensuring that reinforcement matches the function of the challenging behavior. Initially, noncontingent reinforcement should be provided on a continuous basis. The schedule can then be faded from continuous reinforcement to a more appropriate level in a number of ways. NCR can also be combined with additional educationally oriented interventions to promote skill development. Given its ease of implementation and other potential advantages, NCR would appear particularly relevant for applied settings. The clinical guide may offer some assistance to practitioners.

Adult↗

PubMed2001

Minority health risk behaviors: an introduction to research on sexually transmitted diseases, violence, pregnancy prevention and substance use.

AIMS: The goal of this article is to introduce the Research on Sexually Transmitted Diseases, Violence, and Pregnancy Prevention Project (RSVPP), which represents one response of the National Institutes of Health to reduce health disparities in racial and ethnic populations. METHODS: As part of this effort, seven independent projects were funded to design, implement, and evaluate community-based intervention strategies aimed at reducing risk behaviors among minority youth. The interventions and research designs varied across the sites; however, all sites included a common set of questions in their questionnaires. This study focuses on the lessons learned about community-based research across all sites. RESULTS: Sites learned many lessons regarding community-based research, including: the value of building trust, the dynamic nature of communities, the intensive time and resources necessary for success, dissimilarities between researcher and community goals, the value of clear communication, the importance of recognizing the contribution of community members and expressing gratitude for their efforts; the difficulty of disseminating findings regarding sensitive topics, and the need for continuation of interventions. CONCLUSION: Community involvement posed challenges, but enhanced the quality of the implementation and the evaluation of the interventions. This special issue includes findings from the RSVPP sites.

Adolescent↗

PubMed1984

The role of utilization management under PPS.

Under PPS an effective utilization management system is essential and the implementation of such systems presents a new challenge for hospital managers. An effective utilization management system must have the following characteristics: a process for establishing expected resource levels for each DRG; the ability to assign a working DRG at admission; a review schedule for each DRG; a method of identifying consistent patterns of high utilization; a focused review plan which targets selected DRG and physicians; a method of predicting the clinical treatment requirements of each patient; a review process which evaluates the need for continued hospitalization and identifies the reasons for any misutilization, and a feedback process which modifies the focused review plan on an ongoing basis. By operating a utilization management system with these attributes on a concurrent basis, a hospital will achieve the monitoring and control over its resources so critical under PPS. Hospitals that are able to successfully implement a utilization management system will have accomplished one of the essential components necessary to respond to PPS.

Ancillary Services, Hospital↗

PubMed2002

Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP).

CONTEXT: The evaluation of competence in the health professions is of great importance to the public and professionals alike. Recent efforts to design dependable and accurate systems of assessment for demanding clinical roles are increasingly attempting to focus on all-round competence of practitioners. Many challenges are faced in this field as a balance between robust assessment methodology and feasibility in practice is crucial to implementation and adoption. OBJECTIVES: The authors discuss some of the challenges faced by educators and clinicians involved in the development of systems of assessment for the health professions, and describe a method which aims to address these issues in the assessment of postgraduate dental training in Scotland. DISCUSSION: Three of the major challenges facing educators and clinicians involved in the design of competency-based systems of assessment are considered: the requirement for evaluation in different areas of competence; the importance of association of assessment with the training objectives, and the types and focus of the assessment introduced. Issues around the use of formative and summative assessment, and the perception that these must always remain completely separate, are discussed in detail. SOLUTIONS: A proposal is made for the introduction of a method of assessment which has been designed keeping these challenges in mind. The rationale behind this assessment method is described.

Clinical Competence↗

PubMedDate not supplied

Communication skills workshops in learning disability nursing.

This article investigates the effects of a combination of direct speech, language therapy and staff training on the communication skills of nursing and support staff working with people who have a severe learning disability and challenging behaviour. The approach aimed to help staff choose, prioritize and implement changes in communication. The input was effective in increasing the knowledge of the staff group with regard to challenging behaviour and communication breakdown, and in changing the communicative behaviour of staff. The changes measured were those of longer interactions occurring between staff and service users, and the use of non-verbal communication to support interactions. The implementation of the communication strategies is being audited.

Clinical Competence↗

PubMed1992

Pharmacoeconomic consequences of measurement and modification of hospital drug use.

Patterns of drug usage affect hospital-based delivery of healthcare in a variety of ways. Adverse reactions to drugs (ADR) precipitate some 5% of admissions and prejudice the care of some 20% of patients who are in hospital, while inadequate drug therapy prejudices outcomes and prolongs hospital stay. Conversely, appropriate application of drugs can promote recovery and increase the quality of care. Well documented examples include prevention of deep vein thrombosis and postoperative wound infections. Accordingly, optimisation of drug use represents a major quality assurance issue in addition to determining cost-efficiency of healthcare delivery. Drug utilisation review (DUR) requires all elements of the quality assurance process. In practice, therapeutically meaningful and cost-efficient exercises can only be mounted if there is knowledge of the linkage between patterns of drug use and clinical outcomes. These processes of measurement are currently rate-limiting in quality assurance. There are various ways that hospital drug usage can be measured. These range from readily available and relatively cheap quantitative methods to methods requiring the availability of expert staff. There is a sequence of methods involving increasing costs and increasing resource demands yielding increasing detail of information obtained. This sequence commences with pharmacy purchases, followed by pharmacy issues to particular clinical areas, prescription or treatment sheet survey, clinical record review, and finally the reports of trained investigators working in the clinical area. The simpler methods can provide useful information and an efficient basis for choosing and planning definitive studies. Once a category of drug use is appropriately targeted for intervention, drug use can be modified by planned intervention with improvement in clinical outcomes and reduced economic costs in many instances. The intervention strategies to modify drug usage may be classed as re-educative, persuasive, facilitative and power strategies. Other models for implementing behavioural change have been considered, including the impact of trained investigators and the use of online computer prescribing with interactive software with appropriate guidelines. The challenge is to achieve sustained change when interventions are implemented. Cost-efficient quality assurance of drug use is possible with modest resources if outcome-orientated activities are prioritised.

Drug Prescriptions↗

PubMed2006

The health-e-AME faith-based physical activity initiative: Description and baseline findings.

This article provides an overview of the development, implementation, and baseline findings from a statewide faith-based physical activity (PA) initiative. The 3-year program is training African Methodist Episcopal volunteers across South Carolina to implement programs to increase PA in their congregations. To date, 98 churches have been trained. Interviews done with a random sample (n = 39) indicated that 54% are implementing at least one PA program. The baseline telephone survey (N = 571) estimates that 27.8% of the population is regularly active, 54.9% underactive, and 17.3% sedentary. Baseline rates of regular PA were higher in those who were younger, healthier, and nonsmokers. Challenges to date have included obtaining rosters and implementing a large-scale program with limited resources. Interest in the program has been strong and supported by church leaders. Current efforts are on training additional churches and working with those already trained to support sustainability.

Adolescent↗