Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study

Stefan Paciocco,Shannon L Sibbald,Anita Kothari,Christopher J Licskai,Madonna Ferrone

doi:10.1186/s12913-021-06636-5

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada’s annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used.MethodsA qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site.ResultsEleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead.ConclusionsThis study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.

Highlights

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada’s annual healthcare spending
This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program
It demonstrates the potential of using a peer-to-peer implementation strategy

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada’s annual healthcare spending. COPD is a debilitating chronic respiratory disease that accounts for the greatest number of chronic illness-related hospital admissions in Canada [4]. The use of team-based primary care has been explored to manage and combat the rise of chronic illnesses [5]. Using primary care to manage chronic diseases has become a successful part of comprehensive care, resulting in these models becoming a standard for chronic disease management and care around the world [9]. There is limited literature describing how best to engage primary care in the management of COPD utilizing an integrated disease management approach. In Canada and other jurisdictions the management of COPD falls below guideline standards, is reactive, not proactive, and in this way distinct from other conditions such as diabetes, where the obverse is true [10,11,12,13,14]

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