Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health Promotion

Supervisor

Sibbald, Shannon L.

Abstract

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage. Interprofessional teams are effective at providing chronic disease management and care that meets the needs of patients. As part of an ongoing spread, an interprofessional primary care COPD management program was implemented at a family health team in Ontario. A qualitative case study was performed to determine the supporting or hindering factors to the implementation of the program. Data collected was deductively analyzed using the Consolidated Framework for Implementation Research. Eleven constructs were determined to meaningfully affect implementation. Cosmopolitanism, networks and communication, engaging, design quality and packaging, and reflecting and evaluating were identified as the most influential. This study provides a clearer understanding of the factors related to program implementation. These factors will be useful in informing the continued spread of the program as well as the implementation of future chronic care programs.

Summary for Lay Audience

Chronic obstructive pulmonary disease (COPD) is a common chronic disease. COPD patient care accounts for a significant portion of Canada’s annual healthcare spending. Because of the complexity of the disease, it often requires coordinated approaches to manage. Teams, specifically involving the coordination of multiple fields of healthcare providers, are effective at providing care that meets the needs of patients with COPD. In Ontario, these types of teams are typically referred to as family health teams (FHT). A new model of primary care for COPD management based in FHTs was successful in one Ontario region, resulting in spread and implementation in another region. The objectives of this research were to determine the site-specific implementation factors supporting or impeding implementation of this program in a new setting while evaluating the implementation strategy used. This study involved the use of interviews, focus groups, and observations with providers at the FHT along with patients receiving care within the program. An analysis of documents relevant to program implementation was also performed. The Consolidated Framework for Implementation Research (CFIR), a framework comprised of different factors proven to affect program implementation, was used as an evaluation guide. Data analysis using CFIR assisted in assessing the extent to which each of its factors affected the implementation at this FHT. Data collected revealed that 11 CFIR factors meaningfully affected this program’s implementation. Five factors stood out as the most influential including: the FHT’s partnerships with other organizations, networks and communication amongst program providers, engaging key individuals to participate in program implementation, the design quality and packaging of the program, and reflecting and evaluating throughout the implementation process. This study provides a clearer understanding of the various factors positively and negatively influencing the implementation of the COPD management program. Our research will be useful in informing the continued spread of the program as well as the implementation of other chronic care programs.

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