Primary care physician perspectives on using team care in clinical practice

Evaluating Patient and Provider Experiences of Enrolling in a Remote Cardiovascular Health Program: A Qualitative Interview Study

BACKGROUND

Remote health management programs utilizing evidence-based algorithm-driven virtual care solutions for chronic disease management offer a novel approach to addressing implementation gaps for conditions such as hypertension. However, little is known about how to optimize patient enrollment.

METHODS

Through structured interviews, we conducted a qualitative analysis of patient and primary care physician attitudes toward enrollment in a remote hypertension management program at Mass General Brigham (Boston, MA). We selectively recruited a sampling of patients who had enrolled, declined, or were eligible for Mass General Brigham's remote hypertension management program, which utilized interdisciplinary teams to implement clinical guideline-based algorithmic management of hypertension. We analyzed the data using thematic analysis to identify common themes related to enrollment and engagement.

RESULTS

Between July and August 2022, we performed 20 patient interviews and 6 provider interviews. Most patient participants were male (n=12) and identified their race and ethnicity as White (n=15). Most provider participants were female (n=4), and all were medical doctors. Six themes related to hypertension care and remote hypertension management programs were identified: (1) strong connections between patients and care teams drive engagement; (2) there is widespread comfort with hybrid care delivery; (3) provider guidance facilitates home blood pressure monitoring; (4) the decision to enroll hinges on provider endorsement; (5) a clearly articulated program structure; and (6) working with trained nonlicensed navigators is an acceptable element of remote hypertension management programs.

CONCLUSIONS

Enrollment in remote hypertension management programs depends on several key factors. As in traditional care settings, providers significantly influence patient engagement with remote hypertension programs. Key challenges include nonlicensed navigator training and communication clarity about program structure. Building upon facilitators and addressing core challenges are essential for expansion of innovative hypertension care delivery programs to improve patient outcomes at scale.

The Role of Care Coordination: A Qualitative Study of Care Coordinator Perceptions

BACKGROUND

Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective.

PURPOSE

To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination.

METHODS

Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis.

RESULTS

Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills.

CONCLUSIONS

Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness.

Reach in a pragmatic hypertension trial: A critical RE-AIM component

BACKGROUND

Hypertension control is falling in the US yet efficacious interventions exist. Poor patient reach has limited the ability of pragmatic trials to demonstrate effectiveness. This paper uses quantitative and qualitative data to understand factors influencing reach in Hyperlink 3, a pragmatic hypertension trial testing an efficacious pharmacist-led Telehealth Care intervention in comparison to a physician-led Clinic-based Care intervention. Referrals to both interventions were ordered by physicians.

METHODS

A sequential-explanatory mixed methods approach was used to understand barriers and facilitators to reach. Reach was assessed quantitatively using EHR data, defined as the proportion of eligible patients attending intended follow-up hypertension care and qualitatively, via semi-structured interviews with patients who were and were not reached. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative data were analyzed via combined deductive and inductive content analysis.

RESULTS

Of those eligible, 27% of Clinic-based (n = 532/1945) and 21% of Telehealth patients (n = 385/1849) were reached. In both arms, the largest drop was between physician-signed orders and patients attending initial intended follow-up care. Qualitative analyses uncovered patient barriers related to motivation, capability, and opportunity to attend follow-up care.

CONCLUSIONS

Although the proportion of eligible patients with signed orders was high in both arms, the proportion ultimately reached was lower. Patients described barriers related to the influence of one's own personal beliefs or priorities, decision making processes, logistics, and patient perceptions on physician involvement on reach. Addressing these barriers in the design of pragmatic interventions is critical for future effectiveness.

TRIAL REGISTRATION

NCT02996565.