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Can implementation failure or intervention failure explain the result of the 3D multimorbidity trial in general
Cindy Mann1, Ali R G Shaw2, Bruce Guthrie3
1Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, UK cindy.mann@bristol.ac.uk.
BMJ Open
|November 9, 2019
Summary
Implementation fidelity issues in the 3D study, a multimorbidity intervention, impacted trial outcomes. Addressing modifiable barriers is crucial for future intervention success.
Area of Science:
- Health Services Research
- General Practice
- Multimorbidity Care
Background:
- The 3D study evaluated a multimorbidity intervention focused on continuity of care and biennial reviews.
- Understanding implementation fidelity is key to interpreting trial outcomes and guiding future interventions.
Purpose of the Study:
- To examine implementation fidelity of the 3D intervention.
- To identify factors influencing fidelity and inform future implementation strategies.
Main Methods:
- A mixed-methods process evaluation was conducted using data from a cluster randomized trial.
- The evaluation included thematic analysis of interviews, focus groups, and observations, integrated with quantitative implementation data.
- Analysis was blinded to trial outcomes and focused on context, adoption, reach, maintenance, and review delivery.
Main Results:
- Implementation fidelity was influenced by staff turnover, practice size, and administrative strategies.
- Fewer reviews were delivered than planned; however, completed reviews largely included intended components.
- Variations in review delivery style were observed, with some patients reporting increased patient-centeredness despite identified barriers like inadequate training.
Conclusions:
- Implementation and intervention design failures contributed to the 3D intervention's lack of impact on quality of life.
- Identifying and addressing modifiable implementation barriers is essential for improving the effectiveness of redesigned interventions.
Keywords:
implementation failureimplementation fidelityintervention failuremultimorbiditynull trialpatient-centredprimary careprocess evaluationMore Related Videos
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