Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.

INTRODUCTION: The use of mobile delivery to deliver parent training can address barriers to access and improve the translation of interventions in existing settings like pediatric primary care. Studying implementation provides critical information to identify and address barriers and facilitators and inform sustainability efforts. METHOD: This study was a descriptive evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as part of a Hybrid Type I Effectiveness-Implementation trial of the ezParent Program within 4 pediatric primary care clinics. We collected data before, during, and after implementation to evaluate provider implementation and their perspectives on program benefits and barriers to implementation. RESULTS: On average, 14% of eligible parents were introduced to the study. Of these parents, 78% expressed interest in participating and 37% enrolled in the study. Seventy-eight percent of staff providers (n = 36) implemented the procedures at least once, and among those who implemented 3 or more times (n = 24), 79% maintained implementation for 6 months. Barriers to implementation include limited time, lack of information, and full practice buy-in and engagement. DISCUSSION: Implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the ezParent program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Advanced practice nursing students in the patient-centered medical home: preparing for a new reality.

Driven by reimbursement incentives for increased access, improved quality and reduced cost, the patient-centered medical home model of health care delivery is being adopted in primary care practices across the nation. The transition from traditional primary care models to patient-centered medical homes presents many challenges, including the assembly of a well-prepared, interprofessional provider team to achieve effective, well-coordinated care. In turn, advanced practice nursing education programs are challenged to prepare graduates who are qualified for practice in the new reality of health care reform. This article reviews the patient-centered medical home model and describes how one college of nursing joined 7 primary care physician practices to prepare advanced practice nursing students for the new realities of health care reform while supporting each practice in its transition to the patient-centered medical home.