Table 2.
Steps to Implementation and Supporting Qualitative Data
| Steps to implementation | Supporting qualitative data |
|---|---|
| Step 1. Cofacilitators agree to implement the program and attend the IMGV training. | Cofacilitators agreed to implement the program and attended the IMGV training before interviews. |
| Step 2. Clinical staff/stakeholders demonstrate a thorough understanding of the IMGV. | “Education for our staff as a clinic—for them to know and understand what the program is going to be offering so that they can better talk to patients about it or better know what's happening. If they don't understand it, they're not going to be as well equipped to support it.” – Administrator_1 |
| “Sharing the information and creating an awareness to providers that this program exists so that we can pass that information on to patients who we think would be appropriate.” – Administrator_2 | |
| “The more education we can do, the more marketing and the more research you can share behind some of these visits, the better… just to get them to understand, to know more about how this can help their patients.” – Administrator_3 | |
| Step 3. Clinicians/information technology professionals identify the electronic referral process. | “Do you know if this would be set up in EPIC [electronic health record] where we would order a referral, or how logistically it would happen?… Yeah, I think the fewer steps you can get it to be the better.” – Clinician_8 |
| Step 4. Clinicians refer patients to IMGV. | “…the physicians who are actually going to make the referrals. So that's going to be me and [another physician] as the two who see the most chronic pain people. That's also going to be [other physicians]. They should be able to send you a lot of patients, too.” – Clinician_1 |
| “It depends on how open people are to referring people and advertising and getting people to come to the program. I think it depends on the provider.” – Clinician_2 | |
| Step 5. Clinical facilitator determines eligibility for IMGV. | “Some people just don't do well in groups or there's personality conflicts that could happen.” – Clinician_3 |
| “From the patient's point of view, I think there is a strong need but only if we can find the patients who can take advantage of what they are going to learn and have the time and resources to do so.” – Clinician_1 | |
| “It's going to be entirely dependent on whether the patient is extroverted enough to do it or not… I think patients are going to have a difficult time finding the time for it. So that's going to be one barrier. I think if they can make it to every session, they would be potentially well rewarded from it.” – Staff_1 | |
| “You are going to have to be selective in who you choose… some folks may absolutely not do well in a group setting.” – Clinician_5 | |
| Step 6. Cofacilitators review the manual and prepare to lead IMGV (having future cofacilitators sit in). | “I think it would have to be more fined tuned. Like what my role would be and what I would talk about… I'm assuming that each of the visits is going to have maybe one overarching theme.” – Clinician_5 |
| “I don't really know what goes on in integrative group visits. I would be interested in participating in it and maybe observing some of them initially.” – Clinician_6 | |
| Step 7. Cofacilitators secure and reserve space/telehealth platform. | “One of the struggles I was having the last time we talked about this program was nailing it down to a day and a time where we were actually going to be able to get the conference room reserved.” – Administrator_1 |
| “In the last nine weeks it has been crazy the strides we have seen as far as some of the [telehealth] platforms we are using.” – Staff_1 | |
| “If things can't be run out of the conference room—it's really understanding of what type of space is really needed for these group visits.” –Administrator_3 | |
| Step 8. (Telehealth only) Cofacilitators conduct a practice session with participants to introduce the telehealth platform. | “So hopefully these are folks who have already had a virtual visit which is nice so they'll know how to do it.” – Clinician_3 |
| “…making sure you feel comfortable navigating the [video conference platform] and that type of thing. So maybe running a session or so of how it will be done.” – Staff_1 | |
| “You may want to train people with how to interact online, and not just in a group setting. You put out the basic rules of the room: everyone takes turns, listens to the other person, you may have to have some virtual need for some virtual rules as well.” –Administrator_4 | |
| Step 9. Cofacilitators reserve time in the clinical schedule for group visits. | “I do think the scheduling piece may be tricky… I'll be surprised if I can have six patients scheduled at six o'clock. I'm guessing they'll have to spread them out a little bit.” – Clinician_3 |
| Step 10. Scheduling staff open the clinic schedule for up to 10 patients. | “For the front desk staff to even be willing to assist with scheduling took some time, but it did eventually happen.” – Clinician_7 |
| “If everyone is coming in at once and getting checked in at once, I see that being a concern from the front desk and any sort of additional clinical aid…the same thing could happen at check out if they don't have all of their visits scheduled ahead of time or over the phone. If ten people get up and all walk out to check out at the front desk… again, that's a bottleneck there so I guess that's probably my biggest concern: getting patients in and out.” – Clinician_6 | |
| Step 11. Nursing staff implements the IMGV check-in process. | “Be concise on what you want…Just knowing what days and hours and what is expected of us. That's all we ask. Basically, tell us what you want to happen, and let's do it.” – Staff_2 |
| “Well, not other than if it was just a massive check-in or if I was havin’ to do blood pressures and we're still on one person. As long as they could do it, then that would be—or one of you guys could do it as they come in.” – Staff_3 | |
| Step 12. Cofacilitators communicate regularly with stakeholders. | “Well, for it to succeed is just for everybody to be on the same page. All of you guys be on the same page and then the people that's comin’ into it on the same page.” – Staff_3 |
| “If there's enough information that's changing or updates, on a weekly basis would be great, having a weekly summary, but if that's too often, I think biweekly updates would be helpful, just to keep us in a loop of what's going on, ways we can help, things we need to look at as well. We like to share updates within our staff meeting and just ways to continue to keep our clinic staff in the loop as well, what's going on, what's working, what's not working.” – Administrator_3 |
Steps to implementation are specified based on qualitative data from semistructured interviews with key stakeholders.
IMGV, Integrative Medical Group Visit.