Identification Of Barriers Research Articles

Process Mapping the Lipid Management Patient Pathway in Six Health Systems for Identification of Barriers to Guideline-Directed Care

Process Mapping the Lipid Management Patient Pathway in Six Health Systems for Identification of Barriers to Guideline-Directed Care

Reproductive attitudes of youth

The article presents the results of a sociological study aimed at identifying the reproductive attitudes of young people, namely: the study of the desire and willingness of young people to have children, ideas about the ideal, desired and expected number of children in the family, the identification of barriers affecting the decision to have a child. The place of reproductive attitudes in the system of life values of young people has been determined. The factors influencing the reproductive attitudes of young people are described. The empirical basis was the results of the author's sociological research conducted by the method of Internet questionnaire in the period (n= 200), on the target sample. Respondents aged 18 to 35 were interviewed. According to the results of the study, it was found that young people mostly perceive the birth of children positively: thoughts about children and pregnancy cause pleasant feelings, and motherhood is not associated with material difficulties. At the same time, the majority of respondents share the mindset of having no more than two children, and postponing the birth of the first child until the age of 25-29. Among the factors determining the reproductive attitudes of young people are marital status, the model of the parent family and the level of education. It is particularly necessary to note the difficulties faced by young people after the birth of children: the social well-being of young parents, as well as the financial situation. Based on the results of the study, recommendations are proposed for optimizing measures of socio-demographic policy in the field of fertility and family.

Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study

BackgroundEarly initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient’s ability to receive necessary care.AimThis study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.MethodsAn initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.ResultsThe age of patients in the population of interest (n = 169) was bimodal, with a range of 15 – 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.ConclusionOur study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.

Facilitators and barriers to the implementation of the picture exchange communication system (PECS): a systematic review

Background and aimsAlthough there are several published systematic reviews and meta-analyses of the effectiveness of the Picture Exchange Communication System (PECS) protocol, no previous review has focused on factors affecting its implementation. The present review attempted to identify potential barriers and facilitators in implementing PECS, as well as examining authors’ and stakeholders’ views and experiences in terms of implementation.Methods and proceduresA total of 49 studies were identified through a systematic review search process and were included in the data extraction phase. A Content Analysis of previous researchers’ comments was also carried out.Outcome and resultsDuring the data extraction and synthesis phase, it became evident that important features of PECS interventions are not systematically reported in published literature. Thus, our primary research question remained partially unanswered. A Content Analysis of previous researchers’ comments revealed four potential implementation factors, including Contextual & Environmental Factors, PECS Training/Consultation, Supervision and Implementation Fidelity and Adherence to the Protocol.Conclusions and implicationsThe identification of potential barriers or facilitators affecting the implementation of PECS is not currently possible. The present review’s identified implementation factors were extracted from qualitative analysis of previous researchers’ anecdotal remarks or from the social validity measures. Implications in terms of previous PECS literature findings are discussed.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018099767.

Entrustable Professional Activities in Postgraduate General Surgery Training: A Scoping Review.

To provide an overview of the current use of Entrustable Professional Activities (EPAs) in postgraduate general surgery training internationally. Entrustable Professional Activities (EPAs) were introduced to connect clinical competencies and the professional activities to be entrusted to trainees on graduation. The popularity of EPAs as a framework for assessment is growing globally, including in general surgery. Anecdotally, there appears to be substantial variation in how they are implemented, yet a formal comparison of their use in postgraduate general surgery training is lacking. A scoping review was performed, based on the original five-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR). Twenty-nine published and grey literature sources were included in the review. Entrustable Professional Activity use in postgraduate general surgery training was identified in 11 unique contexts, including from North America, South America, Europe, Asia, Africa, and Australia. There were substantial differences in the scope and number of EPAs, tools used for EPA assessment, and how EPAs were sequenced through training. Despite wide variation, eight distinct EPAs were common to the majority (>80%) of countries. Several articles described findings of EPA use in postgraduate general surgery training, allowing identification of multiple barriers and facilitators to integration. This review provides guidance for certification and regulatory bodies, program directors, and institutions with ambitions to implement EPAs for assessment and curricular design. In settings where EPAs are already used, the data may facilitate refinement of programs and strategies.

Barriers and supportive factors in engaging cancer patients in physical activity programmes - a literature review.

Regardless of cancer type or stage of treatment, physical activity (PA) has been shown to reduce the risk of cancer recurrence and death. It is associated with a range of positive effects on patients' physical and psychological well-being, particularly in the areas of aerobic fitness, fatigue, mental health and perceived overall quality of life. However, in current oncology practice, the combination of its indication with treatment is still relatively rare. At the same time, cancer patients' participation in regular physical activity is usually very low. However, as PA is an effective method to support cancer treatment and plays an important role in prevention, it is necessary to find effective strategies to involve patients more widely in physical activities. To this end, physical activity programmes organised directly by facilities providing comprehensive cancer care appear to be very suitable. This literature review maps the main barriers and facilitators to cancer patients' participation in physical activity programmes. In particular, economic factors related to health policy, reflected in the availability of this type of supportive care for patients, the level of health literacy, the organization of PA programs, health care providers - both physicians and health care workers, social support and intrapsychic influences on the part of patients play a major role. Since the implementation of physical activity programmes into the existing cancer care system is a rather challenging process, the paper also deals with the possibilities of using the Health Belief Model. In the given context, this model allows the prediction and identification of barriers and supportive factors to patients' involvement in PA programs in order to maximize their effectiveness and adapt them to the needs of patients and, at the same time, to the capabilities of a specific medical facility.

Comprehensive sexuality education as a strategy to prevent teenage pregnancy in predominantly Indigenous communities of Chiapas, Mexico: context, scope and implementation feasibility

ABSTRACT Comprehensive sexuality education (CSE) aims to prepare adolescents for safe, healthy, and fulfilling lives. The aim of this study was to assess the perspective of key informants regarding CSE content to prevent teenage pregnancy, as well as to identify implementation barriers in predominantly indigenous communities in Chiapas, Mexico. We conducted a descriptive qualitative study using semi-structured interviews to explore three different groups’ perceptions, opinions and experiences. Adhering to grounded theory principles, we performed an inductive analysis and identified categories of interest. A total of 45 key informants (16 school staff members, 15 health personnel and 14 community leaders) were interviewed. School staff members are primarily responsible for CSE. Among all the participants, we identified a lack of training and the presence of prejudices. The information provided to adolescents by the informants was diverse and at times, incomplete. There was limited parental involvement and even opposition to sharing CSE content. Deeply rooted customs and traditions within a patriarchal context posed a significant obstacle to the implementation of CSE in the studied communities. Gaining a deeper understanding of rural and Indigenous contexts can facilitate the identification of barriers and promote the design of targeted strategies to reduce obstacles to pregnancy prevention in vulnerable populations.

Instruments used to assess gender-affirming healthcare access: A scoping review.

The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.

Identification and Analysis of Main Drivers and Barriers to the Promotion of PPAs for Green Energy

Abstract With the current climate change, decarbonization is essential to the global energy transition. In this regard many instruments have been created or developed, Power Purchase Agreements, as a direct legal contract between a power provider and a power buyer, being one of the most popular instruments to increase the use of renewable energy. But sometimes, Power Purchase Agreements get violated due to the elements that constrain and prevent its development and implementation. This situation only brings a certain insecurity to the PPA, and the result is nothing other than to compromise its true role and to distance it from the achievement of the objectives established in its contents. The main goal of this research is to identify and analyze the main drivers and barriers which constrain or prevent the development and implementation of Power Purchase Agreements as a tool for promoting green energy. For this research the comparative analysis, survey based on questionnaires, Spearman’s correlation matrix and IBM SPSS Statistics for Windows are used. The article reduces the gap among the respondents' opinion regarding the Power Purchase Agreements and their involvement in the implementation and development of these contracts, roughly establishing the level where the PPA is located in the transition to green energy. The results suggest that Power Purchase Agreements play a major role in the renewable energy market and they will have a positive impact in what it means the transition to green energy and the achievement of climate neutrality. Therefore, although Romania is a country rich in energy resources that allow the achievement of climate neutrality, it is necessary to take additional measures to attract investors, whose investments will be crucial in the development of energy from renewable energy sources, the three Power Purchase Agreements concluded up to now, regardless they represent a gratifying step, they are not enough to talk about a real Power Purchase Agreement market.

Analysing the Barriers of Strategic Entrepreneurship: A DEMATEL Approach

Entrepreneurship research has developed in the last twenty years and now the focus is on Strategic Entrepreneurship (SE). SE can provide the sustainable growth of an organisation and increase its competitiveness globally. Despite these advantages, developing countries cannot reap the benefits of SE due to various barriers. Therefore, this study aims to identify and model the barriers of SE to the development of organisational management. Initially, the barriers of SE are identified through a literature review and further validated with a domain expert. The causal relationship among the barriers is modelled using the decision-making trial and evaluation laboratory (DEMATEL) method. The result suggests that low awareness of SE, risk aversion, and low financial support are the major barriers in the development of SE that need to be mitigated. Further, this analysis also categorises these barriers into a cause-and-effect group. Six barriers belong to the cause group and the remaining four are part of the effect group. Knowledge of the barriers is helpful for policymakers to design development strategies and helps business development managers in the successive planning of the organisation. The understanding of the interrelationship among the barriers will help the organisation to remove these barriers in an optimal manner. The findings of the study will be helpful for top management and strategic planners to advance design thinking and strategic planning. The contribution of this research lies in the identification of barriers to SE and their causal relationships, which have been scarcely examined in the existing literature.

Integrating smart cities and tourism systems: a critical review

PurposeThis study explores the relationship between Tourism Systems and Smart Cities, aiming to identify what prevents public managers from including these systems in Smart City strategies. This separation neglects that increasing tourism attractiveness may also impact city resources, infrastructures and inhabitants.Design/methodology/approachTo this end, we developed a critical literature review consulting three databases: Scopus, Web of Science and EBSCOhost. A total of 73 articles were selected and analyzed through thematic analysis.FindingsThrough this critical review, we develop a framework of barriers to integrating a tourism system in Smart City strategies composed of four main barrier themes and 11 barrier factors. Findings show the need for innovative research and public managers to go beyond considerations related to technological challenges and instead focus on other barriers hindering integration, such as the lack of participatory governance and knowledge of tourism systems' current and future impact.Originality/valueThis study offers a critical identification of barriers impeding the inclusion of tourism systems in Smart City strategies, providing a useful guideline for public managers aiming to follow an innovative approach to smart development where tourism can still be a tool to enhance the attractiveness of the territory while considering its current and future impact on the city.

Challenges of Access to Treatments: The Case Of Laron Syndrome and the Fight For Social Inclusion

Objective: To identify and disseminate the challenges faced by patients with Laron syndrome in accessing Mecasermin treatment in Ecuador. Theoretical Framework: Laron syndrome is a rare genetic disease characterised by metabolic disorders such as hypoglycemia and severe growth retardation. Treatment with Mecasermin improves growth and thus quality of life for those affected. Ecuador has the largest Laron syndrome population in the world, extensively studied contributing to understanding the peculiarities and needs of these patients. Method: Official documents, letters, news articles from national and international press, and legal and medical databases were reviewed. Legal and medical advice was sought for this study. Results and Discussion: Over approximately ten years, a group of parents pursued national and international legal action to provide their children with the only scientifically validated treatment for this syndrome. However, authorities denied these requests without justification. It was only after the Inter-American Commission on Human Rights report the admissibility of this case that Ecuador began administering medication to children with Laron syndrome. Research Implications: Increase public awareness of this rare disease and barriers faced by those affected, fostering empathy, and understanding of patients' needs. Originality/Value: Identification of specific barriers to accessing treatment, while the quality of life of patients and their families is affected.

GBS vaccines in the UK: a round table discussion.

Group B streptococcus (GBS) remains a leading cause of infant sepsis, meningitis and death despite intrapartum antibiotic prophylaxis. A vaccine is urgently required, and two candidates are in advanced clinical trials. For successful GBS vaccine implementation, especially if a vaccine is licensed based on an immunological threshold, there must be cross-sector engagement, effective advocacy, robust plans for phase IV studies and equitable access. A round-table discussion, held at St George's University of London, reviewed the current position of GBS vaccines in the UK context, focusing on phase IV plans, convening a diverse group of stakeholders from across the UK, with a role in GBS vaccine licensure, advocacy, implementation or effectiveness evaluation.Presentations outlined the latest UK epidemiology, noting the rising infant invasive GBS (iGBS) infection rates from 1996 to 2021 for both early and late onset disease, with the highest disease rates in Black infants (1.1/1000 livebirths vs white infants (0.81/1000 livebirths). Potential coverage of the candidate vaccines was high (>95%). Regulatory input suggested that EU regulators would consider waiving the need for a pre-licensure efficacy study if a putative correlate of protection could be adequately justified. Phase IV study methodologies for a GBS vaccine were considered, largely based on previous UK maternal vaccine assessments, such as a nationwide cohort study design using a vaccine register and a maternal services dataset. Other strategies were also discussed such as a cluster or stepped-wedge randomised trial to evaluate implementation outcomes. Opportunities for advocacy, education and engagement with additional key partners were discussed and identified. With an approved GBS vaccine a near possibility, planning of phase IV studies and identification of critical barriers to implementation are urgently needed. Cross-sector engagement is essential and will facilitate a successful pathway.

Have we reached a technological plateau? A situational awareness approach to overcome the barriers limiting the development of BIM-based plugins

Purpose The construction industry has embraced building information modelling (BIM) as a practical methodology towards digitalisation. However, critics believe BIM has reached a plateau in addressing distinctive construction challenges. As a result, literature has seen an increase in the development and use of BIM-based plugins. Overall, the plugins have been critical in delivering custom-built solutions to longstanding construction challenges. The purpose of this study is to empirically investigate this trend and the potential barriers undermining the wider development of BIM plugins, by that contributing to a stimulating research topic and a growing knowledge gap. Design/methodology/approach Methodologically, this study used a quantitative approach to collect data through a carefully designed questionnaire. This study achieved a sample size of 39 experts who have been involved in developing, experimenting and publishing BIM-based plugins for specific construction activities. Findings The findings led to the identification of the key barriers to using BIM-based plugins and the identification of the key strategies to overcome them across the three situational awareness (SA) phases. Results also suggest that the development and use of plugins are destined to increase, and the research community can now rely on the insights of this paper as a departure point to address the technological plateau in BIM-related research. Originality/value To the best of the authors’ knowledge, this is the first study to empirically identify and assess the barriers undermining the wider development of BIM-based plugins. This study contributes to theory by building on SA, by challenging existing wisdom and fostering new knowledge around strategies to overcome the evaluated barriers.

Co-designing Entrustable Professional Activities in General Practitioner’s training: a participatory research study

BackgroundIn medical education, Entrustable Professional Activities (EPAs) have been gaining momentum for the last decade. Such novel educational interventions necessitate accommodating competing needs, those of curriculum designers, and those of users in practice, in order to be successfully implemented.MethodsWe employed a participatory research design, engaging diverse stakeholders in designing an EPA framework. This iterative approach allowed for continuous refinement, shaping a comprehensive blueprint comprising 60 EPAs. Our approach involved two iterative cycles. In the first cycle, we utilized a modified-Delphi methodology with clinical competence committee (CCC) members, asking them whether each EPA should be included. In the second cycle, we used semi-structured interviews with General Practitioner (GP) trainers and trainees to explore their perceptions about the framework and refine it accordingly.ResultsDuring the first cycle, 14 CCC members agreed that all the 60 EPAs should be included in the framework. Regarding the formulation of each EPAs, 20 comments were given and 16 adaptations were made to enhance clarity. In the second cycle, the semi-structured interviews with trainers and trainees echoed the same findings, emphasizing the need of the EPA framework for improving workplace-based assessment, and its relevance to real-world clinical scenarios. However, trainees and trainers expressed concerns regarding implementation challenges, such as the large number of EPAs to be assessed, and perception of EPAs as potentially high-stakes.ConclusionAccommodating competing stakeholders’ needs during the design process can significantly enhance the EPA implementation. Recognizing users as experts in their own experiences empowers them, enabling a priori identification of implementation barriers and potential pitfalls. By embracing a collaborative approach, wherein diverse stakeholders contribute their unique viewpoints, we can only create effective educational interventions to complex assessment challenges.

Development and Validation of Perception of Wisdom Exploratory Rating Scale: An Instrument to Examine Teachers’ Perceptions of Wisdom

The purpose of this study was to develop and validate the Perception of Wisdom Exploratory Rating Scale based on the Polyhedron Model of Wisdom (PMW). A total number of 585 responses from in-service and preservice teachers was collected. In the EFA, the items fit a seven-factor structure, producing the following subscales: knowledge management, self-regulation, moral maturity, openness, tolerance, sound judgment, and creative thinking. CFA was performed to test the construct validity of the scale. The model produced a good fit to the data (χ2/df = 1.67, CFI = 0.92, TLI = 0.91, RMSEA = 0.049, and SRMR = 0.06). With continued testing and revisions, this instrument could be useful for the cross-cultural comparison of perceptions of wisdom and identification of barriers to promoting wisdom instruction.

Coastal emergency managers’ risk perception and decision making for the Tonga distant tsunami

On January 15, 2022, the Hunga-Tonga-Hunga-Ha'apai (Tonga) volcano erupted and triggered a tsunami forecasted to reach North America. This event provided a unique opportunity to investigate risk perception and communication among coastal emergency managers and emergency program coordinators (EMs). In response, this research explores 1) how risk can be communicated most effectively and 2) how risk perceptions associated with “distant” tsunami alerts and warnings affect EMs' willingness to issue emergency alerts. A purposive sample of coastal EMs (n = 21) in the U.S. Pacific Northwest participated in semi-structured interviews. Participants represented Tribal, county, state, and federal agencies in Washington, Oregon, and California. Interview transcripts were deductively coded and thematically analyzed. Participants perceived low risk from the Tonga tsunami but took precautionary measures and alerted the public. Participants described how their actions were driven by community characteristics and the anticipated reactions to messaging among residents. Many reported the need to balance notifying the public and avoiding the negative impacts of their messaging (e.g., “crying wolf,” panic, curiosity). The unique nature of the event led to identification of unanticipated facilitators and barriers to decision-making among participants. These findings can inform distant tsunami risk communication and preparedness for coastal communities.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. http://links.lww.com/IJEBH/A210.

The status of ultrasound imaging education in Doctor of Physical Therapy program curricula: results of a national survey

BackgroundThis investigation evaluated the state of ultrasound imaging (USI) education in entry-level Doctor of Physical Therapy (DPT) program curricula in the USA, including faculty perceptions and qualifications regarding USI and identification of potential barriers to inclusion or expansion of USI education. A review of published literature reveals that the inclusion of USI education in entry-level DPT program curricula has not been systematically investigated and is largely unknown.MethodsInvestigators created an online survey developed in QualtricsXM and distributed through email an electronic link to the program chair/director at all 258 accredited entry-level DPT programs in the USA with instructions to complete and or share with faculty.ResultsThe overall response rate was 24% (65/269) and represented 54 programs from 28 of the 50 states; 70% reported including USI education in their program’s curriculum, with 91% spending < 10 h on instruction throughout their curriculum; 44% reported plans to expand USI education in their curriculum, with 85% citing expanding scope of practice and curriculum as primary reasons; 79% cited the lack of qualified instructors, lack of knowledge/training, and equipment cost as the largest barriers to the inclusion of USI education in their program’s curriculum. Whether USI is an entry-level skill was evenly split among respondents.ConclusionsRespondents from a representative sample of entry-level DPT programs across the USA provided survey responses. Despite most respondents being knowledgeable about USI, most do not use this point-of-care imaging modality in clinical practice. Based on the results of this survey, overcoming perceived barriers is necessary to expand USI education in entry-level DPT program curricula, namely, lack of qualified instructors, lack of knowledge/training, and cost of equipment. This national survey provides original data that may stimulate discussion about innovative ways to include USI education in entry-level DPT program curricula to meet the emerging needs of our profession.

Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study.

Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers. TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63-78), 29% were female, and median ejection fraction was 35% (IQR 25-40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF. This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.