Model Of Care For Patients Research Articles

Models of care for patients with knee osteoarthritis in primary healthcare: a scoping review protocol

IntroductionKnee osteoarthritis (OA) is a prevalent condition with associated high disability and healthcare costs. Evidence of major gaps in the implementation of evidence-based interventions in people with knee OA led...

Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience.

Japan is a super-aging society, the geriatric care system establishment for hip fractures is at an urgent task. This report described our concept of multidisciplinary care model for geriatric hip fractures and 5-year outcomes at the Toyama City Hospital, Japan. In this retrospective cohort study, a multidisciplinary treatment approach was applied for elderly patients with hip fracture since 2014. These patients (n = 678, males: n = 143, mean age: 84.6 ± 7.5years), were treated per the multidisciplinary care model. Time to surgery, length of hospital stays, complications, osteoporosis treatment, mortality, and medical costs were evaluated. The mean time to surgery was 1.7days. Overall, 78.0% patients underwent surgery within 2days. The mean duration of hospital stay was 21.0 ± 12.4days. The most frequent complication was deep venous thrombosis (19.0%) followed by dysuria (14.5%). Severe complications were pneumonia 3.4%, heart failure 0.8% and pulmonary embolism 0.4%. The in-hospital mortality rate was 1.2%. The 90-day, 6-month, and 1-year mortality rates were 2.5%, 6.7%, and 12.6%, respectively. The pharmacotherapy rate for osteoporosis at discharge was 90.7%, and the continuation pharmacotherapy rate was 84.7% at 1-year follow-up. The total hospitalization medical cost per person was lower than about 400 other hospitals' average costs every year, totaled 14% less during the 5-year study period. We have organized a multidisciplinary team approach for geriatric hip fracture. This approach resulted in a shorter time to surgery and hospital stay than the national average. The incidence of severe complications and mortality was low. The multidisciplinary treatment has maintained a high rate of osteoporosis treatment after discharge and at follow-up. Furthermore, the total medical cost per person was less than the national average. Thus, the multidisciplinary treatment approach for geriatric hip fractures was effective and feasible to conduct in Japan.

Models of care for chronic myeloid leukemia patients during the COVID-19 pandemic in the United Kingdom: Changes in patient attitudes to remote consultations and future implications.

The ongoing COVID‐19 pandemic has presented numerous challenges to the provision of patient care within hematology. We undertook a questionnaire‐based study investigating the experiences and opinions of patients with chronic myeloid leukemia (CML) in the UK in relation to the different models of follow‐up care received during the pandemic. One hundred fifty‐four patients completed the online questionnaire. Only 19% of patients had experienced remote clinics prior to the pandemic compared with 91% afterward. After having experience of remote clinics, the proportion of patients who were positive about the remote clinic concept increased from 34% to 52% (P < .05). However, when asked to compare their experiences with face to face versus remote clinics, 48% preferred face‐to‐face clinics compared with 17% preferring remote clinics (35% expressed no preference). During the pandemic, frequency of blood tests was unchanged for 71% of patients, although they were performed in a number of different locations. The majority of patients (57%) had medication delivered to their home, with a small number (8%) having difficulty obtaining their medication. In terms of future models of care, 72% of patients were in favor of building remote appointments into the clinic model with 61% expressing a preference for a mixture of remote and face‐to‐face appointments. There was also interest in greater utilization of primary care for blood testing. Our findings should help optimize future models of care for CML patients.

Improving Primary Care Delivery for Patients Receiving Maintenance Hemodialysis

The beneficial impact of primary care, focused on all aspects of a patient's health (rather than a disease-specific focus) is well established. Recognized benefits include greater receipt of preventive care and counseling, lower use of emergency care and hospitalization for ambulatory care-sensitive conditions, and decreased early mortality. Although the importance of primary care and care coordination at the primary care/specialty interface is well recognized, the role of primary care within traditional and emerging care models for patients receiving in-center maintenance hemodialysis remains ill-defined. In this perspective article, we will describe: (1) the role of primary care for patients receiving maintenance hemodialysis and the current evidence regarding the receipt of primary care among these patients; (2) the key challenges to delivery of primary care in these complex cases, including suboptimal care coordination between nephrology and primary care providers, the intensity of dialysis care, and the limited capacity of nephrologists and primary care providers to meet the broad health needs of hemodialysis patients; (3) potential strategies for improving the delivery of primary care for patients receiving hemodialysis; and (4) future research requirements to improve primary care delivery for this high-risk population.

Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis

BackgroundThe elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients.MethodWe searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis.ResultsEleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low.ConclusionsThe geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes.Trial registrationPROSPERO registration number - CRD42020181779.

Prevalence of comorbidity in chronic HCV‑infection

The effect of the comorbid background on the course of the infectious process in chronic HCV infection requires study due to the existence of a risk of progression of liver fibrosis even after the eradication of the virus against the background of concomitant diseases.Material and methods. The article analyzes the prevalence of various comorbid conditions in 700 patients with chronic HCV infection, who were observed in the hospital of the Botkin in St. Petersburg, an assessment of the mutual influence of the comorbid background and the progression of liver fibrosis in HCV infection was given. To determine the contribution of comorbidity to the course of HCV infection, the odds ratio (OR) parameters were calculated.Results. HCV-infected individuals have higher prevalence of comorbidity (63 %) and multimorbidity (50 %). In patients with severe fibrosis or cirrhosis, the presence of the comorbidity factor increased to 85 %. In the examined group of patients, diseases of the biliary tract and pancreas prevailed (30.0 %), occult Hepatitis B Infection was revealed in 19.0 %, in 15.4 % – cardiovascular diseases, in 13.7 % – diseases of the upper gastrointestinal tract. Diabetes mellitus was found in 4.6 % of patients, and obesity – in 5.9 %, kidney disease – 3.0 %. The remaining concomitant diseases occurred in less than 2.0 % of the observed patients. It has been established that diseases of the biliary tract and pancreas, gastrointestinal tract, diabetes mellitus, obesity, cardiovascular diseases are risk factors for the development of liver fibrosis in chronic HCV infection.Conclusions. The data obtained indicate the need for a more personalized approach to monitoring patients and the need to create integrated models of medical care for patients with chronic hepatitis C.

Quality of life in patients with the first-episode psychosis

IntroductionThe use of a modern biopsychosocial model of care for patients with schizophrenia dictates the need for a dynamic assessment of the quality of life of patients at different stages of the disease to identify targets for treatment and rehabilitation measures. It is especially important to determine the available targets in the early stages of the disease in order to select effective complex therapy and improve the clinical and social prognosis.ObjectivesTo determine the socio-biological and clinical factors that have a significant impact on the quality of life of patients with first-episode psychosis.MethodsThe sample consisted of patients diagnosed with schizophrenia (n=58). The following research methods were used: 1) clinical-psychopathological; 2) quality of life assessment; 3) clinical-laboratory and functional research methods; 4) statistical. The QL-100 questionnaire was used as a tool for studying the quality of life. The PANSS scale was used to assess the severity of positive and negative syndromes.ResultsThe most significant adverse impact on the quality of life indicators are the absence of family, lack of work, low material wealth, active consumption of psychoactive substances, the predominance of negative symptoms and the presence of concomitant somatic disease in the acute phase.ConclusionsEarly identification of problematic aspects of the quality of life in patients with the first-episode psychosis allows us to conduct effective treatment and rehabilitation measures for these patients.

Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study

ObjectivesDiabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of...

Improved coordination of care after acute myocardial infarction in Poland since 2017: Promising early results

A new model of complex patient care after acute myocardial infarction (AMI) has been in operation in Poland since late 2017, comprising invasive treatment, cardiac rehabilitation and scheduled outpatient follow-up. Its stated objectives are to improve secondary prevention measures, quality of care and long-term health outcomes in AMI-patients. The model implements all key aspects of post-MI care recommended by the European Society of Cardiology (ESC), representing the first nation-wide model of structured and comprehensive post-MI care that closely follows ESC guidelines. The aim of this paper is to describe the background of this reform, its content and implementation as well as to assess its results. Early outcomes seem promising, with significantly lower mortality rate and lower risk of serious cardiological events in patients participating in the new model of care compared to patients who were not included. A comprehensive assessment of the reform will require further clinical data, covering a larger population and a longer period of time, as well as a holistic analysis of the programme in its wider context, taking into account potential benefits and cost-effectiveness of improved primary prevention implemented outside of this model.

Integrated oral care contributes positively to the course of treatment of oncopediatric patients.

The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.

What about health representation in healthcare professionals toward immigrant chronic patients: a new tool for discourse analysis

In a multicultural diverse society, healthcare professionals (HPs) should adopt a personalized approach with adequate attitudes and behaviors to respond promptly to the needs of patients with different cultural backgrounds who become regular users of the health service. This study aimed to explore the health representations of HPs taking charge of immigrant chronic patients in Italy. Semi-structured interviews were conducted, recorded, and transcribed on a sample of 54 HPs. Mixed quali-quantitative analysis was applied, including the method of discourse analysis. Results underlined the prevalence of specific recurring topics and words that highlight positive aspects but also weaknesses in chronic care models for immigrant patients, stressing what needs to be done. Keystones are the relational experience between HPs and patients and new specific training opportunities for HPs. To conclude, a new semi-structured interview schedule is proposed, able to obtain in-depth information on the representation of HPs toward immigrant chronic patients.

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review.

Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.

Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients.

Objectives:Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care.Methods:A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically.Results:Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned.Conclusion:This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.

Spiritual Support in Advanced Heart Failure

Heart failure is a complex, progressive disease with an uncertain trajectory. Those with advanced heart failure (AHF) experience substantial spiritual needs. Spiritual interventions may enhance quality of life and reduce anxiety and depression, but studies are limited and none have focused exclusively on the AHF patient population. This is the first feasibility randomized controlled trial (RCT) to ascertain the clinical and cost effectiveness of a spiritual intervention (spiritual support) in AHF patients. A total of 47 AHF patients were randomized to control (standard care, n = 25) or intervention (standard care plus spiritual support, n = 22) groups. Spiritual support consisted of a one-hour discussion facilitated by trained volunteers using a “Spiritual Enquiry Tool” at two-monthly intervals over six months. Participants completed validated measures of spiritual well-being, depression/anxiety, and health-related quality of life (QoL). Purpose-designed questionnaires gathered information on demographics, NHS resource use, confounding factors, and satisfaction with spiritual support. The new information was to help researchers design an RCT to determine the clinical and cost effectiveness of spiritual support within a holistic model of care for AHF patients. Future trends worthy of further investigation include (i) the possible positive effect of spiritual support on QoL and anxiety, and (ii) possible lower NHS resource use and cost savings in patients receiving spiritual support. Overall, the key message of this study is that researchers must evaluate whether the cost of running a well-designed trial of this nature is justified in the current economic climate, where funding bodies are looking for value for money.

Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP &lt;90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP &lt; 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

Editor's Letter: West Virginian Physicians: Role Models of Optimal Patient Care

Editor's Letter: West Virginian Physicians: Role Models of Optimal Patient Care

P0480 / #1216: THE ACCESS OF INFORMATION BY THE FAMILY OF NEWBORNS AT NEONATAL INTENSIVE CARE UNIT

Aims & Objectives: The information regarding newborn´s clinical health conditions is one of the needs of families at NICU. According to patient and Family Care Model, shared information is an essential support for families. Therefore, it is imperative to measure how the family perceive the access of information to evaluate their participation and the quality of care. Objectives: To measure the perception of shared information access by families at NICU. Methods: Survey conducted with 43 family members of newborns admitted at a neonatal intensive care unit in the city of Sao Paulo, Brazil. Data collection included the appliance of a sociodemographic questionnaire and the Access to Shared Information Instrument after the approval by the university ethics committee. Data were analyzed descriptively and analytically. Results: The majority of participants were mothers; median of age 32,3; and prematurity was the most prevalent diagnosis of infants on admission. The average of overall score of access to shared information was 3,2 (almost always). The highest scores were: “the information helps me to take care of my child” (3,93); “I receive information about the care of my child at different moments at his hospitalization”(3,86). The lowest score was: “I receive detailed and written information about my child (1,79). Conclusions: The study highlights the importance of the access of information for the newborn´s family at NICU. Families validated the information as a support for them to care for the infant. More investment on innovative ways to share information with families on this context of care is necessary

COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates.

PurposeTo evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities.Patients and MethodsForty “host” pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two “consultant” pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient’s general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student’s t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data.ResultsNine “host” pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the “consultant” pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership.ConclusionIn this pilot study, the specialized pharmacy-based COPD care model delivered by “consultant” pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model’s effectiveness in a larger population as well as when measured against standard care.

Lessons learned from inadequate implementation planning of team-based chronic disease management: implementation evaluation

BackgroundThis study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program’s goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in 2018. After a 10-month implementation period, the program was unable to enroll a sufficient number of patients to examine if there was an improvement in patient outcomes.MethodsA retrospective case-study design using multiple data sources was used to gather feedback from participants involved in CDMI. Data collection occurred throughout planning and implementation and continued into early 2019. Semi-structured interviews were conducted, and transcripts were analyzed using NVivo 10 software. This was followed by content analysis.ResultsAnalysis revealed four key themes as barriers to CDMI’s implementation: 1) lack of a needs assessment with key stakeholders; 2) lack of buy-in from medical staff; 3) inadequate patient engagement and; 4) contextual barriers. Planners did not conduct a proper needs assessment, nor include patients in the study design. In addition, there was insufficient consideration for how CDMI should be integrated into the usual COPD care plan, leading to confusion in roles and responsibilities. Poor communication between the implementation team and healthcare providers implementing the program, led to a lack of buy-in and engagement.ConclusionThe key themes resonate with what is already known in the literature. This study supports the importance of using a theoretically grounded plan for implementation. Using a model only in the planning stages is insufficient even when an intervention is based on evidence to support higher quality care. It is imperative to consider practical and contextual factors of program implementation and their interactions. By detailing the ‘failed implementation’ of this intervention, we hope to share important lessons about the need to plan implementation processes early in program planning.