1
|
Zafošnik U, Cerovečki V, Stojnić N, Belec AP, Klemenc-Ketiš Z. Developing a competency framework for training with simulations in healthcare: a qualitative study. BMC Med Educ 2024; 24:180. [PMID: 38395862 PMCID: PMC10893594 DOI: 10.1186/s12909-024-05139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Simulation is a technique used to create an experience without going through the real event. Competency-based medical education focuses on outcomes and ensures professionals have the necessary knowledge, skills, and attitudes. The purpose of this study was to develop a set of competencies for the instructors providing basic and advanced levels of simulation-based training in healthcare. METHODS We conducted a qualitative study in three steps, with each next step building on and influenced by the previous one. First, we conducted a literature review, then a consensus development panel, and finally a three-step Delphi process. The participants were experts in the fields of healthcare, education, and simulations. RESULTS The six main competencies identified for the instructor providing simulation-based training at the basic level in healthcare include knowledge of simulation training, education/training development, education/training performance, human factors, ethics in simulation, and assessment. An instructor providing simulation-based training at an advanced level in healthcare should also possess the following five competencies: policies and procedures, organisation and coordination, research, quality improvement, and crisis management. CONCLUSION The identified competencies can serve as a valuable resource for simulation educators and organisations involved in simulation education, to plan curriculum and implement a continuous train-the-trainers programme.
Collapse
Affiliation(s)
- Uroš Zafošnik
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - Venija Cerovečki
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000, Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000, Zagreb, Croatia
| | - Nataša Stojnić
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - Anja Poženel Belec
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia.
- Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000, Maribor, Slovenia.
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| |
Collapse
|
2
|
Zavrnik Č, Stojnić N, Lukančič MM, Martens M, Danhieux K, Chham S, Mihevc M, Virtič Potočnik T, Ketiš ZK, van Olmen J, Susič AP. Development of a Qualitative Data Analysis Codebook for Arterial Hypertension and Type-2-Diabetes Integrated Care Evaluation. Int J Integr Care 2024; 24:20. [PMID: 38525482 PMCID: PMC10959140 DOI: 10.5334/ijic.7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Non-communicable diseases, such as arterial hypertension (HTN) and type-2 diabetes (T2D), pose a global public health problem. Integrated care with focus on person-centred principles aims to enhance healthcare quality and access. Previous qualitative research has identified facilitators and barriers for scaling-up integrated care, however the lack of standardized terms and measures hinder cross-country comparisons. This paper addresses these gaps by presenting a generic codebook for qualitative research on integrated care implementation for HTN and T2D. Description The codebook serves as a tool for deductive or deductive-inductive qualitative analysis, organizing concepts and themes from qualitative data. It consists of nine first level and 39 second level themes. First level codes cover core issues; and second level codes provide detailed insights into facilitators and barriers. Discussion This codebook is more widely applicable than previously developed tools because it includes a broader scope of stakeholders across micro, meso, and macro levels, and the themes being derived from highly diverse health systems across high- and low-income countries. Conclusion The codebook is a useful tool for implementation research on integrated care for HTN and T2D at global scale. It facilitates cross-country learning, contributing to improved implementation, scale-up and outcomes.
Collapse
Affiliation(s)
- Črt Zavrnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| | - Nataša Stojnić
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
| | - Majda Mori Lukančič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
| | - Monika Martens
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, BE-2000 Antwerp, Belgium
| | - Katrien Danhieux
- University of Antwerp, Department of Family Medicine and Population Health, Prinsstraat 6, BE-2000 Antwerp, Belgium
| | - Savina Chham
- National Institute of Public Health, Cambodia, Boeung Kok 2 quarter, KH-120408 Phnom Penh, Cambodia
| | - Matic Mihevc
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
- Primary Healthcare Centre Trebnje, Goliev trg 3, SI-8210 Trebnje, Slovenia
| | - Tina Virtič Potočnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Primary Healthcare Centre Slovenj Gradec, Partizanska pot 16, SI-2380 Slovenj Gradec, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Zalika Klemenc Ketiš
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Josefien van Olmen
- University of Antwerp, Department of Family Medicine and Population Health, Prinsstraat 6, BE-2000 Antwerp, Belgium
| | - Antonija Poplas Susič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| |
Collapse
|
3
|
Stojnić N, Klemenc-Ketiš Z, Mori Lukančič M, Zavrnik Č, Poplas Susič A. Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study. BMC Health Serv Res 2023; 23:362. [PMID: 37046293 PMCID: PMC10091568 DOI: 10.1186/s12913-023-09353-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. METHODS Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. RESULTS We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. CONCLUSION Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.
Collapse
Affiliation(s)
| | - Zalika Klemenc-Ketiš
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | | | - Črt Zavrnik
- Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Antonija Poplas Susič
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
4
|
Martens M, Wouters E, van Olmen J, Klemenc Ketiš Z, Chhim S, Chham S, Buffel V, Danhieux K, Stojnić N, Zavrnik Č, Poplas Susič A, Van Damme W, Ir P, Remmen R, Ku GMV, Klipstein-Grobusch K, Boateng D. Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project): a study protocol. BMJ Open 2022; 12:e062151. [PMID: 36581422 PMCID: PMC9806029 DOI: 10.1136/bmjopen-2022-062151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The 'SCale-Up diaBetes and hYpertension care' (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up. METHODS AND ANALYSIS A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools-including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping-were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities.
Collapse
Affiliation(s)
- Monika Martens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Zalika Klemenc Ketiš
- Community Health Center Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Srean Chhim
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Savina Chham
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Veerle Buffel
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Črt Zavrnik
- Community Health Center Ljubljana, Ljubljana, Slovenia
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Gerontology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Roy Remmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Grace Marie V Ku
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| |
Collapse
|
5
|
Klemenc-Ketis Z, Stojnić N, Zavrnik Č, Ružić Gorenjec N, Danhieux K, Lukančič MM, Susič AP. Implementation of Integrated Primary Care for Patients with Diabetes and Hypertension: A Case from Slovenia. Int J Integr Care 2021; 21:15. [PMID: 34690619 PMCID: PMC8485865 DOI: 10.5334/ijic.5637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. METHODS This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. RESULTS The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. DISCUSSION The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. CONCLUSION Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.
Collapse
Affiliation(s)
- Zalika Klemenc-Ketis
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
| | - Nataša Stojnić
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Črt Zavrnik
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Nina Ružić Gorenjec
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Katrien Danhieux
- Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Belgium
| | | | - Antonija Poplas Susič
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| |
Collapse
|