The role of remote facilitation within the IMP2ART study- a potentially useful tool for implementation within Primary Care?

Problem

Supported self-management is the cornerstone of asthma care yet its implementation within primary care continues to face challenges. Implementation science theory (iPARIHS) recommends that skilled facilitators can be an important catalyst for change. This approach was used in the IMP2ART whole systems implementation trial, where skilled respiratory nurses supported implementation of supported self-management through remote facilitation in an introductory one hour workshop and follow-up contacts over 12 months. Understanding what facilitation activities were practiced, and possible, through remote only facilitation is important to understand the extent IMP2ART was implemented as planned and to inform future use of facilitation in primary care. This was the primary aim of this study.

Approach

IMP2ART recruited 144 primary care practices to a cluster randomized implementation trial with half randomized as implementation practices. Four respiratory nurses with prior experience of facilitation were identified, trained and supervised. To assess facilitation a bespoke tool the FACE (Facilitators Activities and Competencies Evaluation) was developed based on identified competencies in the literature. A 10% sample of implementation practices, stratified so at least one practice per facilitator was selected, underwent coding which was conducted independently by two members of the research team.

Findings

Stage one of coding looked at delivery of seven initial workshops. Preliminary findings suggest that in all practices’ facilitators were able to deliver core activities such as communicate the importance of team working and setting a team plan. Some activities however were more challenging, such as facilitating the team to interpret audit and feedback results and ensuring equal participation by all members of the practice. These activities may have been made more complicated by limited visibility of participants due to the remote nature of facilitation and technical difficulties such as only one microphone shared between many.

Consequences

Online facilitation has significant potential to support implementation of initiatives within primary care. It is also likely to be a cost-effective and efficient implementation strategy. The IMP2ART trial has shown that this is feasible, however it is possible that this mode of facilitation may limit delivery of some facilitation activities. This has implications for the set up and design of online facilitation which should be considered at the outset of implementation design.