ABSTRACT
OBJECTIVES: This study evaluated the scale-up of a remote monitoring (RM) service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. METHODS: A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. RESULTS: The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritisation of staff needs was emphasised. CONCLUSION: Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling RM interventions for patients with RA in routine care settings.
ABSTRACT
BACKGROUND: Evidence from previous pandemics as well as early evidence from COVID-19 suggests risk of adverse mental health and wellbeing outcomes for healthcare workers. In response to these concerns, healthcare systems and organisations rapidly established staff support and wellbeing programmes. While there is emerging literature related to the effectiveness of such interventions, what is less well understood and evaluated is the evidence base regarding how such programmes are implemented; what supports and hinders their implementation; and how or if they are maintained following the initial acute phase of the pandemic. This study addresses this gap by studying the implementation process of COVID-19-related staff wellbeing programmes in the three UK NHS Trusts that make up one of Europe's largest academic health sciences centres, King's Health Partners. METHODS: We will conduct a prospective, cross-sectional descriptive study using qualitative research methods and non-probability purposive sampling to identify a study participant group representative of the population and implementation activity of interest. We will conduct semi-structured interviews of between 30 min and 1 h. We will identify theory-driven elements in the dataset using the Consolidated Framework for Implementation Research (barriers and drivers), Exploration, Preparation, Implementation, Sustainment Framework (timeline/chronology/evolution of the implementation and different issues at different times) and Expert Recommendations for Implementing Change (implementation strategies). We will then identify indicators of these constructs within the dataset and report them, as well as their inter-relationships. DISCUSSION: Through this study, we hope to better understand what factors hindered and enabled the implementation of three inter-linked staff support and wellbeing programmes and how/to what extent have these programmes been sustained. We will also explore whether implementation science frameworks are applicable and beneficial in conceptualising and understanding crisis driven and rapidly implemented interventions and in what ways, if any, they need to be adjusted when used in unprecedented circumstances such as the COVID-19 pandemic.
