Aplicando a estrutura conceitual consolidada para pesquisa de implementação em um programa da doença de Parkinson

Ana Amália de Sá, Brenda Nazaré Gomes Andriolo, Cauã Leal, Adriano Massuda

Resumo


Introdução: A transformação da prestação de serviços de saúde para lidar com as doenças crónicas constitui um desafio significativo para os sistemas de saúde. Objetivo: A presente pesquisa teve como objetivo identificar barreiras e facilitadores para implementação do Programa Multidisciplinar e Multidimensional para Doença de Parkinson em uma instituição de saúde da região Amazônica brasileira. Métodos: A metodologia qualitativa e o Quadro Consolidado para Pesquisa de Implementação (CFIR) foram utilizados para descrever e aprender as etapas na formulação e implementação do programa de referência. Para a coleta de dados da pesquisa foram utilizados documentos oficiais da instituição, entrevistas semiestruturadas aplicadas a gestores e profissionais assistenciais e registros do pesquisador. Os resultados seguiram uma análise de 34 construtos do CFIR. Por fim, os construtores foram alocados em uma matriz de domínio pelo grau de prova de barreiras e facilitadores. Resultados: A análise revelou predominância de construtos muito evidentes vinculados ao domínio “características da intervenção” como fatores determinantes para implementação. Por outro lado, verificaram-se barreiras relacionadas ao domínio dos “processos”. Conclusão: Com base na análise foram apresentadas propostas que buscam maior sustentabilidade para o programa na instituição.

Palavras-chave: Ciência da implementação; Doença de Parkinson; Modelos de saúde.

 

ABSTRACT

Applying the consolidated conceptual framework for implementation research in a Parkinson’s disease program

Introduction: The transformation in health service delivery to deal with chronic diseases is a significant challenge for health systems. Objective: The present research aimed to identify barriers and facilitators of implementing the Multidisciplinary and Multidimensional Program for Parkinson’s Disease in a health institution in Brazil’s Amazon region. Methods: Qualitative methodology and the Consolidated Framework for Implementation Research (CFIR) were used to describe and learn steps in formulating and implementing the reference program. To collect research data, official documents from the institution, semi-structured interviews applied to managers and care professionals, and the researcher’s records were used. Results: The results followed an analysis of 34 CFIR constructs. Ultimately, the constructors were allocated in a domain matrix by the degree of proof of barriers and facilitators. An analysis revealed a predominance of very evident constructs linked to the domain “intervention characteristics” as determining factors for implementation. On the other hand, barriers related to the domain of “processes” were verified. Conclusion: Based on the analysis, proposals were presented that seek greater sustainability for the program at the institution.

Keywords: implementation science; Parkinson disease; healthcare models.


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Referências


Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018; 8:S3–S8.

Bloem BR, Okun MS, Klein C. Parkinson's disease. Lancet. 2021; 397: 2284–2303.

Vaugha CP, Prizer LP, Vandenberg AE, Goldstein FC, Trotti LM, et al. A Comprehensive Approach to Care in Parkinson's Disease Adds Quality to the Current Gold Standard. Mov Disord Clin Pract. 2017; 4:743–749.

Rajan R, Brennan L, Bloem BR, Dahodwala N, Gardner J et al. Integrated care in parkinson's disease: a systematic review and meta-analysis. Mov Disord. 2020; 35:1509–1531.

van der Marck MA, Bloem BR. How to organize multispecialty care for patients with Parkinson's disease. Parkinsonism Relat Disord. 2014; 20 Suppl 1:S167–S173.

Radder DLM, Nonnekes J, van Nimwegen M, Eggers C, Abbruzzese G, Alves G, et al. Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease. J Parkinsons Dis. 2020; 10:1087–1098.

Llibre-Guerra JJ, Prina M, Sosa AL, Acosta D, Jimenez-Velazquez IZ, et al. Prevalence of parkinsonism and Parkinson disease in urban and rural populations from Latin America: A community based study. Lancet Reg Health Am. 2022; 7:100136.

Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci. 2016; 11:72.

Goldani MZ, Mosca PRF, Portela AK, Silveira PP, Silva CH. The impact demographic and epidemiological transition in the health of children and adolescents in Brazil. Clin Biomed Res. 2012; 32:49-57.

Holmes JA, Logan P, Morris R, Radford K. Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review. Syst Rev. 2020; 9:1-17.

Peters D, Tran NT, Adam T. Implementation research in health: a practical guide [Internet]. Geneva: World Health Organization. 2013.

Damschroder LJ, Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. 2011; 25:194-205.

Damschroder LJ. Clarity out of chaos: Use of theory in implementation research. Psychiatry Research. 2020; 283:112461.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009; 4. https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50.

World Health Organization. World report on ageing and health. Geneva: World Health Organization. 2015.

Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implementation Science. 2013; 8:8-51.

Fernandez ME, Walker TJ, Weiner BJ, Calo WA, Liang S, Risendal, B. et al. Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research. Implementation Science. 2018; 13 https://pubmed.ncbi.nlm.nih.gov/29587804/.

Means AR, Kemp CG, Gwayi-Chore MC, Gimbel S, Soi C, Sherr K, et al. Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implementation Science. 2020; 15. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-0977-0

Hinde J, Bray J, Kaiser D, Mallonee, E. The influence of state-level policy environments on the activation of the Medicaid SBIRT reimbursement codes. Addiction. 2017; 112:82–91. https://pubmed.ncbi.nlm.nih.gov/28074562/

Gold HT, McDermott C, Hoomans T, Wagner TH. Cost data in implementation science: categories and approaches to costing. Implementation Science. 2022; 17. https://pubmed.ncbi.nlm.nih.gov/35090508/

Counte MA, Howard SW, Chang L, Aaronson W. Global Advances in Value-Based Payment and Their Implications for Global Health Management Education, Development, and Practice. Frontiers in Public Health. 2019; 6. https://www.frontiersin.org/articles/10.3389/fpubh.2018.00379/full




DOI: http://dx.doi.org/10.23973/ras.97.399

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Revista de Administração em Saúde
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