Abstract
Background: To achieve health, sustainable habitats and integrated care, sometimes de-implementation of evidence-based low-value practices is necessary. In a Dutch GP-care region in the east of the country, not-indicated lab tests were ordered, leading to unnecessary burden for patients, the health care system (€600,000.- annually) and the environment (CO2-emissions are estimated to be 134450 CO2 annually). An intervention to reduce the number of not-indicated tests was developed, consisting of changing standard order sets and a string of educational interventions, reminders and feedback, focused on practice nurses.
Next, a tailor-made implementation plan was developed together with the target group to support the implementation of the new order sets and education, while de-implementing the not-indicated tests. In this workshop we want to discuss the tools and methods we used to develop the (de-)implementation plan. We expect to execute the plan from November 2024; preliminary results will be shared during the conference.
Audience: We would like to engage with patients, professionals and implementation researchers and facilitators. Inez van Roosmalen, recipient of the ‘Roland van Linge Implementation Award’ from the Master Integrated Care Design will share her experience.
Approach
We opt for a 90 minute workshop. With the following approach:
- Introduction – 20’ Short introduction of ourselves and the case
- Case study – 40’ In small groups: 1) discuss the case, use the Consolidated Framework for Implementation Research (CFIR) to identify and classify barriers and facilitators in the case study, 2) from barriers and facilitators to implementation strategies – draft an implementation plan
- Plenary wrap-up: what is the added value of CFIR? How did your group select (or develop) implementation strategies? What other implementation tools (Theories, Models. Frameworks) can be useful?
Outcomes: Take home message: you have to plan implementation and de-implementation, based on the knowledge of your playing field. There is a plethora of implementation TMFs that can be used for this purpose. Without proper implementation (or de-implementation) integrated care will only be theory.