Abstract
Background: The Making Every Contact Count programme (MECC) is being implemented since 209 across the Irish Health Service (including General practice) and is a key element of the Integrated care programme for the prevention and management of Chronic disease in Ireland Model of care (MoC). It aims to integrate lifestyle behaviour interventions by health professionals to patients targeting health behavioural risk factors (e.g. physical activity, diet, smoking and drug and alcohol use. The following outlines the journey to implementation of the programme across the service to date. The MECC programme was signed off as policy in 208. Roll out a standardised national blended learning training programme. Development of a standardised tool to document interventions as part of manual or digital patient record. Creation of a network of trainers and implementation champions across the country. Maintaining key strategic and policy drivers for the implementation of the programme through the inclusion in the MoC and the national health reform programme Sl intecare. Analysis of impact of MECC in general practice. Strategic research project to support upscaling, implementation and integration of brief interventions in the Irish Health Service. Evidence based Implementation strategy developed and currently being implemented.This paper will present data on the impact of the programme and the outcomes of the research to inform the ongoing implementation.
Approach: The research project consisted of three studies () a survey based on the Theoretical Domains Framework (TDF) of 357 healthcare professionals who had completed the MECC training; (2) a qualitative interview study with 36 health care professionals to further understand barriers and enablers; (3) a two-phase consensus study, with an online consultation (23 stakeholders) and a consensus meeting (7 stakeholders) to agree implementation strategies.Patient engagement was embedded in the work across the development of the programme, patient experience feedback and inclusion in the research project and the development of the implementation strategy.
Results: Implementation of the programme across General practice as part of the Chronic disease management programme in general practice has had significant impacts with a 3% reduction in smokers, 30% of patients moving from inadequate to adequate physical activity category and 58% of patients with high risk or harmful drinking now in the normal drinking pattern category.The Enablers and barriers identified through the TDF research are: environmental context, goals and intentions, knowledge, professional role, beliefs about consequences, beliefs about capabilities and skills practice. Through a consensus process, nine implementation strategies were identified and refined and using a co design approach we developed a policy brief with our recommendations to disseminate to policy makers. A consensus process identified and refined the following nine implementation strategies.. Provide dedicated time to practitioners to attend training and use MECC2. Empower and engage management/senior staff to take responsibility for MECC3. Implement a user-friendly and integrated system of recording MECC4. Develop service directories for healthcare professionals to refer patients5. Have local MECC champions to model best practice and share experiences6. Create a dedicated resource centre on the MECC website with information regarding MECC training courses and contacts7. Have a HSE national communications campaign to promote MECC8. Generate and highlight evidence for the impact of MECC on patients9. Enhance integration of MECC with undergraduate healthcare professional education.
Implications: The research is continuing to inform the implementation approach for the programme to reach full scale implementation. The outcomes of the research have also informed the approach to embed research in the implementation of the MECC programme across specific settings including maternity services, mental health settings and new integrated chronic disease services across community and acute settings.