Frontline Management Research Articles

Staff experiences working in community‐based services for people with learning disabilities who show behaviour described as challenging: The role of management support

Accessible summary We looked at staff working with people with a learning disability and challenging behaviour. We tried to find out if managers' help their staff to work better. We looked at how often staff saw their manager and if their manager tried to help their staff to work better or spent more time doing office work. We found out that when managers helped staff to work better, staff feel better about their work. Even when staff did not see their manager very often, other staff were helping them to do their work better. Organisations need to decide who will help staff to work better, and this will also help staff to feel better about their work. AbstractIntroductionResearch has shown a positive relationship between practice leadership (frontline management focused upon supporting staff to work better) and better staff experiences of working with people with learning disabilities who may show challenging behaviours. However, little is known regarding the impact of frequency and accessibility of frontline managerial support upon staff experiences, or upon the provision of practice leadership. Current policy and practice in England may lead to frontline managers being responsible for more fragmented services, thus influencing the accessibility of managerial support and practice leadership for staff. The current study investigated the impact on staff experiences of frequency of contact with service manager and of practice leadership.MethodsA single point in time survey of 144 staff measured: characteristics of service users, frequency of contact with manager, practice leadership and staff experiences, for example burnout, teamwork and job satisfaction.ResultsPractice leadership was positively associated with more frequent contact with the manager. Better staff experiences were associated with more frequent contact with the manager and practice leadership and negatively with challenging behaviours.ConclusionThe associations between practice leadership, manager contact and better staff experiences suggest further research, and organisational action is needed to provide management support for staff.

PS1376 LENALIDOMIDE MAINTENANCE POSITIVELY IMPACTS OUTCOMES IN MULTIPLE MYELOMA WITHOUT NEGATIVE IMPACTS IN RELAPSE: AN ANALYSIS OF REAL WORLD DATA FROM THE MYELOMA CANADA RESEARCH NETWORK NATIONAL DATABASE

Background:Randomized trials have demonstrated the positive impact of lenalidomide maintenance (LM) on outcomes following autologous stem cell transplant (ASCT) in multiple myeloma (MM). This finding has led to its wide‐spread adoption as a standard of care. However, data examining its effect in the real‐world setting is lacking.Aims:Using the Myeloma Canada Research Network Canadian Multiple Myeloma Database (MCRN CMM‐DB) we have examined the impact of LM at a national level.Methods:We retrospectively reviewed data from patients tracked using the MCRN CMM‐DB. This web‐based centralized platform characterizes real‐world outcomes in patients treated at 13 major Canadian academic institutionsand includes comprehensive data on >6000 patients dating back to 2007 with ongoing prospective data collection. This analysis examined patients treated with bortezomib‐based induction therapy prior to ASCT. Subjects were included up until January 2016 to ensure at least 2 years of follow‐up. The analysis was performed based on intention‐to‐treat with LM. Overall survival (OS) was defined as time from pre‐ASCT induction therapy to death or last follow‐up (F/U). Progression‐free survival (PFS) was defined as the time from induction therapy to progression, death or last F/U. We also calculated outcomes of relapsing patients in both arms, including 2nd PFS (from second‐line therapy to second relapse, death or last F/U) and PFS2 (time from induction therapy to second relapse, death or last F/U). Lastly, given regional variation in LM dosing schedules, we examined outcomes based on a 21/28 days or continuous 28/28 days dosing strategy.Results:Data from 1,256 patients across 10 Canadian centers was included (723 with LM and 533 without). Median follow‐up in the LM group was 49 months and 45 months in the non‐LM group. The median OS was not reached in the LM cohort and 98 months in the non‐LM group (p <0.0001, figure 1a). The median PFS also favoured patients treated with LM (58 months versus 35 months respectively, p <0.0001, figure 1b). Response rates were high with 98% achieving ≥PR in the LM group compared to 96% in the non‐LM group (p = 0.06). In LM patients 94% achieved ≥VGPR compared to 81% in the non‐LM group (p <0.01). At the time of analysis, 45% of LM and 63% of non‐LM patients have relapsed. Treatment for relapsed disease resulted in a similar median 2nd PFS between LM vs non‐LM patients (12 months vs 16 months respectively, p = 0.07, figure 1c). The median PFS2 remained in favour of LM compared with non‐LM (not reached vs 68 months, p < 0.01, figure 1d). Median duration of maintenance therapy was 20.5 months (0.0 ‐ 102.48+). Analysis of patients treated with a 28/28 days (n = 356) versus a 21/28 (n = 257) days LM dosing schedule showed no difference in estimated 5‐year OS (81% and 80% respectively, p = 0.66) or 5‐year PFS (47% and 52% respectively, p = 0.75).Summary/Conclusion:Using the MCRN CMM‐DB we present one of the largest real‐world cohorts demonstrating the dramatic impact on outcomes using LM following bortezomib‐based induction. Notable improvements are seen in PFS, OS and depth of response. The truncated 21/28 day dosing strategy did not negatively impact these endpoints. Importantly, LM did not demonstrate a negative effect on the outcomes with second‐line therapy, as the median 2nd PFS was similar and the PFS2 remained in favour of LM. Overall, this large real‐world cohort supports the ongoing use of LM in the frontline management of MM.image

Eltrombopag vs Standard Front Line Management for Newly Diagnosed Immune Thrombocytopenia (ITP) in Children

Eltrombopag vs Standard Front Line Management for Newly Diagnosed Immune Thrombocytopenia (ITP) in Children

Conflict and conflict management in hospitals

PurposeHospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.Design/methodology/approachThis quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.FindingsHospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers’ personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager’s age, work experience and management experience.Practical implicationsThe nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.Originality/valueThis is the first study conducted in Iran examining the level of conflict, its types and identifying managers’ dominant conflict resolution strategies at front line, middle and top management levels.

Front-line management of non-Hodgkin lymphoma in Australia. Part 1: follicular lymphoma.

Outcomes with follicular lymphoma (FL) have improved in the modern era and median survival is now beyond 15 years. Therapeutic decisions need to consider this increased survival as well as recent clinical trial data and emerging treatments. In this context, we present here current approaches to front-line management of FL in Australia. Treatment choices depend on the disease stage, tumour burden, the patient's age, symptoms, comorbidities and preferences. Only about 10-15% of patients with FL are diagnosed with early stage disease. For patients with low-grade, early stage disease, radiotherapy (RT) is recommended. The addition of chemotherapy has been shown to increase progression-free survival (PFS) but without demonstrated overall survival advantage. For patients with low-tumour-burden, advanced-stage FL, immediate treatment may not be required and we recommend considering active monitoring. For stage III/IV disease that is symptomatic and/or with high tumour burden, established first-line treatment is chemotherapy in combination with rituximab, often followed by rituximab maintenance. The listing of bendamustine and now obinutuzumab on the Pharmaceutical Benefits Scheme has expanded the first-line treatment options in Australia to include bendamustine in combination with rituximab (without rituximab maintenance permitted) or with obinutuzumab plus 2 years obintuzumab maintenance. In the FL subgroup of the Study group indolent Lymphomas (StiL) trial, therapy with bendamustine plus rituximab significantly increased PFS compared with rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone, without rituximab maintenance. Initial tolerability may be more favourable with bendamustine in combination with anti-CD20 antibody therapy than other therapies overall, but clinical vigilance is still required because of concerns of late infectious toxicities associated with prolonged T-cell depletion.

Immune-enrichment of non-small cell lung cancer baseline biopsies for multiplex profiling define prognostic immune checkpoint combinations for patient stratification

BackgroundPermanence of front-line management of lung cancer by immunotherapies requires predictive companion diagnostics identifying immune-checkpoints at baseline, challenged by the size and heterogeneity of biopsy specimens.MethodsAn innovative, tumor heterogeneity reducing, immune-enriched tissue microarray was constructed from baseline biopsies, and multiplex immunofluorescence was used to profile 25 immune-checkpoints and immune-antigens.ResultsMultiple immune-checkpoints were ranked, correlated with antigen presenting and cytotoxic effector lymphocyte activity, and were reduced with advancing disease. Immune-checkpoint combinations on TILs were associated with a marked survival advantage. Conserved combinations validated on more than 11,000 lung, breast, gastric and ovarian cancer patients demonstrate the feasibility of pan-cancer companion diagnostics.ConclusionsIn this hypothesis-generating study, deepening our understanding of immune-checkpoint biology, comprehensive protein-protein interaction and pathway mapping revealed that redundant immune-checkpoint interactors associate with positive outcomes, providing new avenues for the deciphering of molecular mechanisms behind effects of immunotherapeutic agents targeting immune-checkpoints analyzed.

Responsible management on the organizational frontline: A stewardship perspective

Responsible management has become a business imperative in an era of growing governmental and public scrutiny of managerial practices and accountability. Top-down attempts at developing transparent codes of practice or agenda statements have been ineffective, especially given the difficulties of aligning responsibility needs with traditional performance indicators. Thus, we argue, there is a pertinent need to foster a sustainable sense of moral responsibility at the organizational frontline. We posit that stewardship offers a foundation for developing sustainable solutions based on aligning the interests of stakeholders and balancing longer-term and shorter-term benefits. Three principal stakeholders are involved at the organisational frontline; frontline management (FLM), frontline employees (FLE) and customers. Accordingly, we identify three key areas requiring development: stewardship-based control systems, climate and customers on the organizational frontline. We illustrate these areas with pertinent research and, hence, collate a research agenda across these areas to facilitate the development and embedding of responsible management based on a stewardship foundation.

Responsible management on the organizational frontline: a stewardship perspective

Responsible management has become a business imperative in an era of growing governmental and public scrutiny of managerial practices and accountability. Top-down attempts at developing transparent codes of practice or agenda statements have been ineffective, especially given the difficulties of aligning responsibility needs with traditional performance indicators. Thus, we argue, there is a pertinent need to foster a sustainable sense of moral responsibility at the organizational frontline. We posit that stewardship offers a foundation for developing sustainable solutions based on aligning the interests of stakeholders and balancing longer-term and shorter-term benefits. Three principal stakeholders are involved at the organisational frontline; frontline management (FLM), frontline employees (FLE) and customers. Accordingly, we identify three key areas requiring development: stewardship-based control systems, climate and customers on the organizational frontline. We illustrate these areas with pertinent research and, hence, collate a research agenda across these areas to facilitate the development and embedding of responsible management based on a stewardship foundation.

R-CHOP without radiation in frontline management of primary mediastinal B-cell lymphoma

Prior to the introduction of rituximab, primary mediastinal B-cell lymphoma (PMBCL) had high rates of treatment failure with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), prompting the use of consolidative mediastinal radiation or more intensive chemotherapy regimens. Cure rates improved dramatically with rituximab, but mediastinal radiation was still commonly employed with R-CHOP. We performed a retrospective review of patients treated with R-CHOP alone without radiation for PMBCL. Of 43 patients with PMBCL, 16 received R-CHOP alone. High-risk factors included 56% with bulky disease, 75% with elevated LDH, 25% with SVC syndrome, and 13% with stage IV disease. Three-year progression-free survival (PFS) and overall survival (OS) were 93% and 100% respectively. These results suggest that R-CHOP alone has a high cure rate in PMBCL while avoiding the side effects of mediastinal radiation.

A mapping study of employee innovation: proposing a research agenda

PurposeThe purpose of this paper is to systematically explore the current understanding of the role of non-R&D and non-managerial employees in different phases and types of innovation, and to propose avenues for future research.Design/methodology/approachBy conducting a mapping study and applying a critical discourse analysis, the phenomenon of “ordinary” employee innovation is explored across various fields, such as human resource management, psychology, economics, strategy, marketing and technology management. Proposals for future research are suggested based on the theoretical framework of dynamic capability, with the aim of further integrating employee innovation in the innovation management domain.FindingsThe findings illuminate five main themes that form the employee innovation discourse across various academic disciplines, namely, employee innovative work behavior, firm innovation performance, employee innovation processes, frontline service employees and management tools for employee innovation.Originality/valueUnlike prior studies in the field of innovation management, this study specifically focuses on the employees without innovation-specific functions in organizations, or “ordinary” employees. Concerning the methodological lens of critical discourse analysis, the authors suggest forming the employee innovation discourse in an inclusive manner. Based on the theoretical lens of dynamic capability, a research agenda is proposed in which employee innovation research makes additional use of innovation processes and types, and takes into account the interactive processes and strong empirical evidence for relevant management tools.

Tattoo-associated complications and related topics: A comprehensive review

As tattoos become more common, it is likely that practitioners will encounter adverse tattoo reactions with increasing frequency. While some tattoo-related complications (TRCs) may be nonspecific and challenging to diagnose, others present overtly and can be identified quickly by a well-informed practitioner. TRCs occur at both of these extremes, highlighting the need for better awareness and knowledge sharing regarding this heterogeneous group of morbidities. This review is a result of a compilation of the best available clinical evidence across various groupings of TRCs. The authors' intent was to provide the reader with a comprehensive overview of the topic while creating a rich repository of referenced knowledge for future investigations. From the standpoint of frontline health-care providers, effective recognition and management of TRCs require an open-mind, high degree of clinical suspicion, and nonjudgmental approach to a mainstream phenomenon that is still considered by many to be a taboo. The following core competencies are addressed in this article: Medical knowledge, Patient care, and Systems-based practice.

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study.

BackgroundTelemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability.ObjectiveThe objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations.MethodsSemistructured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the telemonitoring program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on (1) potential impact for sustainability and scalability, (2) feasibility, and (3) perceived risks to negatively impacting the program’s ability to yield desired health outcomes.ResultsA total of 5 themes representing opportunities for cost reduction were discussed, including (1) Bring Your Own Device (BYOD), (2) technical support, (3) clinician role, (4) duration of enrollment, and (5) intensity of monitoring. The hardware used for the telemonitoring system and the modalities of providing technical support were found to be highly adaptable, which supported the decision to implement a BYOD model, whereby patients used their own smartphone, weight scale, and blood pressure cuff. Changes also included the development of a website aimed at reducing the burden on a technical support telehealth analyst. In addition, the interviews suggested that although it is important to have a clinician who is part of a patient’s circle of care monitoring telemonitoring alerts, the skill level and experience were moderately adaptable. Thus, a registered nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of telemonitoring alerts and take over the technical support role from a telehealth analyst.ConclusionsThis study provides a user-centered example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of telemonitoring programs. In addition, the findings offer insights into what components of a telemonitoring program can be safely adapted to ensure its integration in various clinical settings.

Outcomes of Follicular Lymphoma Patients Treated with Frontline Bendamustine and Rituximab: Impact of Histologic Grade and Early Progression on Overall Survival

Outcomes of Follicular Lymphoma Patients Treated with Frontline Bendamustine and Rituximab: Impact of Histologic Grade and Early Progression on Overall Survival

Crash, bang, wallop: The school nurse's role in the management of dental trauma

Initial management of dental trauma has a huge impact on the long-term prognosis of any teeth involved, therefore school nurses play an import role in implementing appropriate first aid. Good management can mean less initial and long-term treatment is required, less time off school and less psychological impact on the child. The International Association of Dental Traumatology (IADT) have created guidelines for trauma management, however, these are targeted to dentists, who are rarely involved in the crucial immediate management stage of dental trauma. This article aims to translate elements of these guidelines to make them more accessible and to support school nurses who are more often involved in the frontline management of dental injuries.

Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study.

Musculoskeletal pain is a societal epidemic because it is highly prevalent and a leading contributor to disability; however, physical therapists are still challenged when predicting which patients are at high risk for persistent symptoms. The objectives of this study were to identify patient characteristics predictive of persistent musculoskeletal pain 12 months following physical therapist care and to determine the influence of anatomical region. The design included a secondary analysis of a cohort study. Participants ranged in age from 18 to 65 years, had a primary report of knee, shoulder, back, or neck pain, were receiving physical therapy, and were enrolled in the Orthopedic Physical Therapy Investigative Network (OPT-IN) Optimal Screening for Prediction of Referral and Outcome (OSPRO) validation cohort study. Candidate predictor variables included demographic and clinical characteristics, comorbidities, and OSPRO Review of Systems (OSPRO-ROS) and OSPRO Yellow Flag (OSPRO-YF) tool scores. Persistent musculoskeletal pain was assessed by self-report responses to questions on the duration of pain and activity limitation. Logistic regression was used for completed cases to identify predictors of persistent pain at 12 months in full and parsimonious models. Follow-up assessment at 12 months was performed for 63.4% of participants (279/440). Participants with persistent pain at 12 months (n=101; 36.2%) had more comorbidities, higher numerical pain rating scale scores, and higher OSPRO-ROS and OSPRO-YF tool scores at baseline than those without persistent pain, and the findings were independent of anatomical region. The number of comorbidities (odds ratio [OR] range=0.30-0.46), numerical pain rating scale scores (OR at baseline=1.44-1.75; OR at 4 weeks=1.37-1.39), and OSPRO-ROS (plus additional items) scores (OR=1.33-1.54) were predictors in full and parsimonious models. Convenience sampling was used, with a follow-up rate at 12 months (63.4%) that was lower than anticipated, and an operational definition for chronic low back pain was applied to persistent musculoskeletal pain in other body regions. The OSPRO-ROS tool may be used to improve the prediction of persistent musculoskeletal pain at 12 months in conjunction with comorbidities and pain intensity (baseline and 4 weeks). These are potentially important findings because persistent pain was not commonly evaluated in previous screening studies; however, it is a relevant outcome in an era of front-line nonpharmacological pain management.

Food Therapy in Sinosphere Asia.

Traditional Chinese Food Therapy has long been an integral part of dietary practices in Sinosphere Asia. This therapy is defined by the classification of foods into cooling (Yin) and heaty (Yang) and the manipulation of dietary intake of these foods as a therapeutic strategy for chronic diseases. Both functional dyspepsia (FD) and irritable bowel syndrome (IBS) are chronic, functional gut disorders widely prevalent in Sinosphere Asia. Diet is increasingly recognized as a symptom trigger in FD and IBS, and the evidence suggesting the utility of diet therapies as front-line management is growing, particularly in the West. Specifically, a diet low in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols is an efficacious therapy for patients with IBS. In contrast, a proportion of patients with IBS in Sinosphere Asia utilize Chinese Food Therapy for symptom management. Chinese Food Therapy provides an attractive target for integration with evidence-based Western dietary therapies as a management strategy in FD and IBS. However, significant gaps in research exist with the utility of Chinese Food Therapy that first need to be addressed. This includes a lack of standardization for heaty and cooling classification, limited mechanistic rationale or clinical studies supporting its efficacy in FD and IBS, and the lack of an ideal practitioner for implementation of Chinese Food Therapy. Hence, the review provides a summary of the role of diet and nutrition in Sinosphere Asia with an emphasis on FD and IBS, and an examination of how modern dietary practices may be able to be integrated into practices in this region.

Key stakeholders\u2019 experiences of respite services for people with dementia and their perspectives on respite service development: a qualitative systematic review

BackgroundRespite services provide a break in the caregiving relationship for people with dementia and their carers, however they are often under-used and service acceptability can be low. This study aims to understand key stakeholders’ experiences of respite services for people with dementia, with a view to informing respite service development.MethodsA systematic search was conducted of the Pubmed/MedLine, Embase, Cinahl, PsychInfo, Scopus, Web of Science, and Cochrane databases (1980–2016, English) with fixed search terms relating to ‘respite’ and ‘dementia’, following PRISMA guidelines. Noblit and Hare’s approach to meta-ethnography was employed. Key concepts were identified across the papers and reciprocal and refutational translation techniques were applied to primary studies; findings were synthesized into third order interpretations and finally, a ‘line-of-argument’ was developed.ResultsIn total 23 papers were reviewed, which described 20 independent samples across 12 countries. The views of 889 participants were synthesized (13 people with dementia, 690 carers, 44 ‘service providers’, 52 frontline staff, 70 managers, 12 volunteers, six academic/policy-makers, and two independent consultants). Five key concepts were identified and outlined i.e. 1) the transition to service use 2) expanding organizational capacity 3) dementia care quality 4) building a collaborative care partnership and 5) dyad restoration. There was broad agreement around the key areas for service development across the range of stakeholders (flexible and responsive person-centred care, meaningful activity for people with dementia, enhanced client-service communication and informational support). However, there was clear divergence in stakeholder perspectives around the barriers to implementation of such developments. Organizational tension was evident between frontline staff and management in respite services, hindering the cultural change necessary to facilitate service development in line with dyad’s needs and preferences.ConclusionRespite services must surmount internal organizational barriers to change, and cultivate a collaborative solution-focused care culture, which acknowledges the centrality of the dyad and their care preferences. Future research should explore the development of alternative/modified community respite service models, which have greater capacity to be responsive to the needs of each individual dyad. The perspectives of people with dementia must be included in research in this area going forward.Trial registrationPROSPERO Registration Number: CRD42016050191.

Advances in Diagnosis and Management of Diffuse Large B-cell Lymphoma.

The management of diffuse large B-cell lymphoma (DLBCL) has been gradually evolving since the discovery of its 2 major forms, the germinal center B-like (GCB) and activated B-cell (ABC) types. Although the reference standard for the identification of these cell types is considered gene expression profiling (GEP), currently the only method commercially available is immunohistochemistry (IHC). The application of various IHC-based algorithms and their correlation with GEP and clinical outcome are discussed. Because of the adverse prognostic implications of the non-GCB type and its potential effects on treatment selection, the recently revised World Health Organization classification has included these biologic cell types. The management of double hit lymphomas, which almost exclusively fall under the GCB category, is discussed, together with the double expresser phenotype, which is usually grouped under the non-GCB type. The role of lenalidomide and ibrutinib in the management of the non-GCB type is examined. We also discuss the front-line management of primary mediastinal large cell lymphoma using the EPOCH (etoposide, prednisolone, Oncovin [vincristine], cyclophosphamide, hydroxydaunorubicin [doxorubicin]) regimen and examine new salvage data on immune checkpoint inhibitors for this clinical subtype. The prognosis, clinical features, and management of de novo CD5+ DLBCL are discussed, and newer and promising developments in the management of primary central nervous system lymphomas are presented in detail. The most popular salvage regimens and the application of high-dose chemotherapy with stem cell transplantation are assessed in detail. Finally, data on new treatment tactics such as CART (chimeric antigen receptor T-cell) cells and promising new drugs, including blinatumomab and venetoclax, are presented.

Using Information Communication Technology in Models of Integrated Community-Based Primary Health Care: Exploring ICT in the iCOACH Study

Introduction: Information and communication technology (ICT) is a promising enabler to support delivery of integrated care by inter-disciplinary teams by supporting information sharing across professional and organizational boundaries; arguably a crucial aspect of successful models of integrated care. The literature suggests that there are core components of ICT functionality such as interoperability between systems, supported chronic disease management functions and patient and caregiver access to ICT, are required to support the delivery of integrated models of care. While suggestions on what ICT for integrated care should look like abound in the literature, few studies have explored how ICT is used in practice in the implementation of integrated community-based primary health care. Theory and Methods: We draw on data from interviews with front-line staff and management collected from 2 cases in Canada (one in Ontario and one in Quebec) and 3 case studies in New Zealand collected as part of the iCOACH project. Interview data was thematically coded around three core themes: 1) types of ICT systems adopted; 2) the role ICT plays in the model of care with regard to central activities of integrated care, and 3) perceived value of systems from the perspective of health care providers and organizational managers and leaders. Results: All case sites had some form of ICT system in place (most often electronic medical records), however variation occurs within and across jurisdictions in terms of which integrated care activities were supported by ICT, the level of adoption, and the sophistication of systems. Most models faced significant challenges with regard to between-system interoperability to allow for effective information sharing. There was additional diversity in terms of healthcare provider use and acceptance of available technology. Where systems were lacking, sites would use workarounds, for example co-locating providers who could access multiple systems at a single site. Discussion: Preliminary analyses of case study data suggest that ICT was used to support a range of integrated care activities. Interoperability remains an important, and often elusive, requirement. Front-line providers and organizations showed the ability to creatively work around limitations of ICT, but did not see these as sustainable solutions. Conclusion: ICT systems across the cases varied in terms of maturity and functionality. There was a consensus across sites regarding the importance of ICT to support integrated care, however many cases did without robust systems. Providers and leaders identified the need to adopt ICT systems that supported information sharing across teams to sustain and grow programs. Lessons Learned: Adoption of ICT systems into models of integrated care can occur at different stages of implementation, with many models reaching a point at which integrated ICT systems are required to support effective sustainable growth. Limitations: Case study findings offer unique and in-depth perspective on the adoption of ICT in 9 different models of integrated care. Findings may not be generalizable to all of models of integrated care. Suggestions for future research: Further exploration is required to determine at exactly which point in the implementation process (early vs. sustained adoption) ICT is required.

The role of electronic records in disability support

ABSTRACTThe aim of this study was to explore how disability support organisations and people who work in these organisations understand electronic records within the context of their daily work. Interviews were carried out with 16 front-line support management staff from a consortium of organisations that were introducing a shared electronic record; a software firm representative; and a project manager. Interviews were analysed thematically. Participants lacked consistency in how they described and anticipated the electronic record. They were unclear about who would use and benefit from the record. The role of third parties in the use of the record, such as medical professionals, was also unclear. Clarity about the way in which electronic records might change the work of support organisations could address larger challenges related to the concepts of “choice and control” and “person-centred” support. Without a consistent understanding of electronic records in disability support, there is a risk that future implementations of such records will fail.