Introducing a MAP for adherence care in the paediatric cystic fibrosis clinic: a multiple methods implementation
Bianca Richards1, Sonya R Osborne2,3, Megan Simons1,4
1Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland, 4101, Australia.
Insights
Implementing an adherence protocol in cystic fibrosis clinics showed it was acceptable but not feasible for consistent use. Further strategies are needed for successful integration into daily care.
Area of Science:
- Health Services Research
- Implementation Science
- Pediatric Healthcare
Background:
- Cystic fibrosis (CF) management requires burdensome daily treatment regimens.
- Adherence protocols can improve consistency in CF care interventions.
- This study assessed the feasibility of an adherence protocol in a pediatric CF outpatient clinic.
Purpose of the Study:
- To explore the feasibility, acceptability, and appropriateness of implementing a tailored adherence protocol in a tertiary pediatric cystic fibrosis clinic.
- To identify factors influencing the integration of adherence protocols into routine clinical practice.
Main Methods:
- A pre-post observational design utilizing mixed methods, including focus groups, interviews, and surveys.
- Implementation guided by the Replicating Effective Practice (REP) Framework and analyzed using the Consolidated Framework for Implementation Research (CFIR).
- A multicomponent protocol involving treatment plans, digital screening, and communication tools was implemented over three months.
Main Results:
- Focus groups/interviews informed protocol development with 23 participants (clinicians, parents, adolescents).
- Protocol use ranged from 44-57% of eligible consumers at three months post-implementation.
- Clinicians and consumers found the protocol acceptable and appropriate, but practice behavior changes were temporary.
Conclusions:
- Adherence protocols are not universally applicable 'off-the-shelf' solutions in hospital outpatient settings.
- Low fidelity suggests limited feasibility despite perceived acceptability and appropriateness.
- Key implementation factors and strategies are crucial for successful integration of adherence protocols in multidisciplinary CF care.
Background:
People with cystic fibrosis are required to adhere to a burdensome daily treatment regimen. Comprehensive adherence protocols can support more consistent use of adherence interventions and improve treatment adherence rates. This study aimed to explore the feasibility, acceptability, and appropriateness of implementing an adherence protocol into the outpatient cystic fibrosis clinic of a tertiary, paediatric hospital.
Methods:
This implementation study employed a pre-post observation design, using multiple methods. Focus groups and semi-structured interviews were conducted pre-implementation to understand clinician and consumer perspectives on adherence care. A multicomponent adherence protocol (including multidisciplinary written treatment plans, digital mental health screening and customised communication tools) was then implemented as standard care for a three-month implementation phase. Quantitative data was collected throughout using purpose-designed audit tools and surveys. The Replicating Effective Practice (REP) Framework guided the implementation process. Analysis was informed by The Consolidated Framework for Implementation Research (CFIR) to identify factors that support or challenge the integration of adherence protocols into standard care.
Results:
Thirteen clinicians, eight parents and two adolescents participated in focus groups or interviews that informed development of the tailored multicomponent adherence protocol for implementation. Medical chart audits demonstrated that the protocol was used with 44-57% of eligible consumers three months after introduction. Eighteen clinicians and five consumers participated in post-implementation phase questionnaires. The protocol was considered acceptable and appropriate to clinicians and consumers. Changes in clinicians' practice behaviour were short-lived peaks in response to targeted intervention strategies throughout the implementation phase, such as audit and feedback.
Conclusions:
An adherence protocol is not an "off the shelf" solution to the adherence challenge in a hospital outpatient setting. Despite the tailored adherence protocol being considered appropriate and acceptable to clinicians and consumers, low fidelity indicates limited feasibility in the outpatient clinic setting, where multi-disciplinary members are all considered responsible for adherence care interventions. Key implementation factors and strategies to consider prior to introducing an adherence protocol are described.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12619001730190 (Retrospectively registered).
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