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Table 2 CENTER-IT methodology to adapt intervention components: Asthma Link case study

From: CENTER-IT: a novel methodology for adapting multi-level interventions using the Consolidated Framework for Implementation Research—a case example of a school-supervised asthma intervention

Individuals involved

Inner/outer setting

Process

Intervention adaptation

Step 1

(deliverer/recipient of interventions who identified barrier)

Step 2

(systems-level partners selected by expert consensus group to address barrier)

Step 3

(elicited solution to barrier)

Step 4

(adaptation to intervention components based on expert consensus group and multi-level input)

a. Barrier: Providers did not have time to determine if the patient was eligible, thus did not introduce program to eligible families

 Medical providers

Practice managers

Practice managers offered to systematically identify and flag eligible patients for providers

Practice trainings now ask practice managers to systematically identify and flag eligible patients for providers

b. Barrier: Family unable to pick up 2 inhalers from the pharmacy

 Families

School nurses

Medical providers

Pharmacists

Pharmacists recommend the provider’s prescription should specify to dispense two inhalers.

Practice training teaches providers to specify on the prescription to “dispense 2 inhalers, one for home and one for school”

Health insurers

Recommend establishing a Medicaid pharmacy policy to allow for 2 preventive inhalers to be dispensed at one time for Asthma Link patients

We are establishing an Asthma Link-specific policy with Medicaid pharmacy team to allow coverage of 2 inhalers for Asthma Link participants

c. Barrier: Family unable to bring the 2nd inhaler to school

 Families

School nurses

Medical providers

Pharmacists

Practice managers

Recommends using free Mail-order delivery service to send medication from pharmacy to school

Practice trainings explain how to set up select families with mail-order delivery of medication from pharmacy to school

d. Barrier: Delays with schools receiving faxed orders from practice staff

 School nurses

Practice managers

Practice managers recommend changing the workflow so orders are faxed immediately

Practice staff faxes orders as soon as phone call with school nurse is complete

e. Barrier: School nurses reported some school may not have a nurse to administer medications

 School nurses

School administrators

Recommends identifying alternate professional at school capable of administering medications

Identify alternate officials in schools who can administer medications to children (e.g. health aid, counselor

f. Barrier: School nurses reported some children did not consistently come to the nurse’s office

 School nurses

School administrators

Recommends providing a list of Asthma Link patients to principals/teachers so they can facilitate bringing child to health office

School nurse will provide principal, teacher with list of Asthma Link patients

g. Barrier: No support for daily asthma therapy during school breaks or holidays

 School nurses

Medical providers

Practice managers

School administrators

DPH

Health insurers

Recommend developing a system to aid children during school breaks

Remote Asthma Link was created for when school is not in-session: daily text message to caregiver and remote weekly school health check-in

h. Barrier: No established dissemination or sustainability protocol. At present school-supervised therapy is not widely adopted across the state or nation

 School nurses

Medical providers

Legislators

DPH

Health insurers

Recommend partnering current Asthma Link clinic/school leaders and new clinic/school leaders (targeting districts with high asthma rates) to facilitate knowledge and trust in Asthma Link

Recommended presenting data on healthcare utilization outcomes and cost reduction to support reimbursement for Asthma Link

Partner clinical/school leaders currently participating in Asthma Link with new clinical/school leaders to share their Asthma Link experiences –(disseminate to districts with high asthma rates)

Asthma Link team will present outcomes and cost savings data to payers, legislators, DPH