Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members

May combine two claims.

Positive feedback from patients and families reinforced the importance of the clinics in rural communities and contributed to team member engagement.

“Positive feedback from patients and families reinforced the importance of the clinics in the rural communities and contributed to team member engagement.”

May combine two claims.

The analysis identified 11 key factors influencing sustainability and scale-up of rural primary healthcare memory clinics: five influencing both, three sustaining, and three scaling.

“Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors.”

• Also stated in: § Results · plain

  “The analysis revealed 11 key factors, five that influenced both sustainability and scaling, three related to sustaining, and three related to scaling.”

May combine two claims.

The memory clinics filled a gap in services for individuals with memory problems in aging rural communities, going beyond diagnosis to connect patients and families with supports to enable them to continue care at home longer.

“The memory clinics filled a gap in services for individuals with memory problems in these aging rural communities, going beyond diagnosis to connect patients and families with supports to enable them to continue care at home longer.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Memory clinics are now operational in four rural communities within a 280 km radius of Team 1.

“Memory clinics are now operational in four rural communities within a 280 km radius of Team 1.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The training helped new team members not feel overwhelmed.

“and the training helped them not feel overwhelmed.”

May combine two claims.

Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring.

“Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Families feel relief at getting help and less alone and isolated; they know where to go for help.

“families feel relief at getting help and less alone and isolated; they know where to go for help”

Classified as probably not a substantial claim.

The leader must have skills in leading others through the day.

“The leader must have skills in leading others through the day”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The clinics allow families to come together to hear the same information and to make a plan.

“Another benefit is that the clinics allow families to come together “to hear the same information and to make a plan.””

Classified as probably not a substantial claim. May combine two claims.

The clinics resulted in earlier diagnosis and management, provision of supports, less stigma.

“clinics are resulting in earlier diagnosis and management, provision of supports, less stigma”

May combine two claims.

Initial orientation to assessment forms in the EMR and ongoing education sessions organized by RaDAR on dementia-related topics identified by the teams are components of the memory clinics.

“Another component of the memory clinics is the initial orientation to assessment forms in the EMR and ongoing education sessions organized by RaDAR on dementia-related topics identified by the teams.”

The quote only partly states this claim.

Positive outcomes for team members influenced sustainability of the memory clinics.

“Positive outcomes for team members”

May combine two claims.

A strong consistent leader who is passionate about the clinic inspires others to want to participate and keeps propelling it forward.

“A strong consistent leader who is passionate about the clinic inspires others to want to participate and “keeps propelling it forward” (Team 1).”

May combine two claims.

Facilitators were involved in and knowledgeable about all aspects of clinic development and implementation.

“They were involved in and knowledgeable about all aspects of clinic development and implementation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Clinics avoid travel/wait times for urban specialists.

“clinics avoid travel/wait times for urban specialists”

May combine two claims.

Memory clinic team members described family members' relief at getting help, and not being alone and isolated.

“Memory clinic team members described family members’ relief at getting help, and not being alone and isolated.”

May combine two claims.

The PHC teams involved in the study were supported by permanent health region-funded facilitators who travelled several days a week to each team and were able to incorporate memory clinic activities into their work.

“The PHC teams involved in the study were supported by permanent health region-funded facilitators who travelled several days a week to each team and were able to incorporate memory clinic activities into their work.”

May combine two claims.

Facilitators were critical to both sustaining and scaling because of their role in scheduling clinics and meetings, and keeping communication open between the teams and the researchers, and between team members.

“They were critical to both sustaining and scaling because of their role in scheduling clinics and meetings, and keeping communication open between the teams and the researchers, and between team members, who are not all co-located except on clinic days.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Patient and family are more comfortable with familiar health care team members.

“patient and family more comfortable with familiar health care team members”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Clinics provide a 'one-stop shop' with access to all services and provide 'wrap-around' support.

“clinics provide “one-stop shop” with access to all services and provide “wrap-around” support”

Classified as probably not a substantial claim. May combine two claims.

Expanding the memory clinics requires identifying potential new PHC teams that are keen to do it, and also have the capacity, in terms of personnel, time, and space.

“Expanding the memory clinics requires identifying potential new PHC teams that are keen to do it, and also have the capacity, in terms of personnel, time, and space.”

May combine two claims.

Being able to observe a clinic and follow one's counterpart was a powerful strategy for encouraging new team members to start a clinic, providing reassurance that they have the necessary skills, and creating excitement about their role.

“Being able to observe a clinic and follow one’s counterpart was a powerful strategy for encouraging new team members to start a clinic, providing reassurance that they have the necessary skills, and creating excitement about their role.”

May combine two claims.

While the new lead is becoming comfortable in the role, existing team members provide leadership that helps sustain the clinic.

“While the new lead is becoming comfortable in the role, existing team members provide leadership that helps sustain the clinic.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

To expand more quickly, a one-day workshop was suggested.

“To expand more quickly, a one-day workshop was suggested.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Access to needed resources may be more challenging in rural communities.

“Access to needed resources may be more challenging in rural communities.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Positive outcomes were also expected because of the focus on team-based primary healthcare.

“Positive outcomes were also expected because of the focus on team-based primary healthcare.”

May combine two claims.

In the current study, belief in the benefit of the interdisciplinary approach reinforced team member engagement and commitment, helping to counter increasing workloads, competing demands of rural practice, and the need for continuous adaptation.

“In the current study belief in the benefit of the interdisciplinary approach reinforced team member engagement and commitment, helping to counter the challenges of increasing workloads, competing demands of rural practice, and need for continuous adaptation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participation of the Alzheimer Society First Link Coordinators has benefits for everyone.

“Participation of the Alzheimer Society First Link Coordinators also has benefits for everyone.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Large-scale reorganization of the healthcare system in Saskatchewan, from 13 health regions to one region with 39 networks, began 3 years ago and was still in progress.

“Large-scale reorganization of the healthcare system in Saskatchewan, from 13 health regions to one region with 39 networks, began 3 years ago and was still in progress.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Expanding one team at a time in nearby communities facilitated shadowing and mentoring because of closer proximity.

“Expanding one team at a time in nearby communities facilitated shadowing and mentoring because of closer proximity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our findings are consistent with Yano et al. [18] who reported that champions can support scale-up by sharing their experiences and helping trouble-shoot with new teams.

“Our findings are consistent with Yano et al. [18] who reported that champions can support scale-up by sharing their experiences and helping trouble-shoot with new teams.”

• cites Yano et al. [18] Yano EM, Green LW, Glanz K, Ayanian JZ, Mittman BS, Chollette V, et al. Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum. J Natl Cancer Inst Monogr. 2012; https://doi.org/10.1093/jncimonographs/lgs004. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

When there is turnover of the lead, the experience of the other team members is critical because they are familiar with clinic operations and they know people in the community who could benefit from the clinic.

“When there is turnover of the lead, the experience of the other team members is critical because they are familiar with clinic operations and they know people in the community who could benefit from the clinic.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Coordinators can begin to establish a relationship with patients and families early on when their supports and services can make a real difference.

“The Coordinators can begin to establish a relationship with patients and families early on when their supports and services can make a real difference.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The team approach was seen as a better model of care overall.

“The team approach was seen as a better model of care overall.”

May combine two claims.

Although ideally new teams would have a full slate of disciplines involved, current members stressed that parts of the assessment could be covered by others or adapted to fit available configurations of team members and still achieve positive outcomes.

“Although ideally new teams would have a full slate of disciplines involved, current members stressed that parts of the assessment could be covered by others or adapted to fit available configurations of team members and still achieve positive outcomes.”

May combine two claims.

Of the 11 factors identified, five influenced both sustainability and scale-up, three were linked to sustainability, and three to scale-up.

“Of the 11 factors identified, five influenced both sustainability and scale-up, three were linked to sustainability, and three to scale-up.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Overall, these themes relate to team, intervention, and organizational factors.

“Overall, these themes relate to team, intervention, and organizational factors.”

May combine two claims.

Team members valued spending more time with each other and becoming more comfortable with each other and with sharing information.

“Team members valued spending more time with each other and becoming more comfortable with each other and with sharing information.”

May combine two claims.

The opportunity for the healthcare providers and Coordinators to develop ongoing relationships has been rewarding and led to consultations outside of the clinic.

“The opportunity for the healthcare providers and Coordinators to develop ongoing relationships has been rewarding and led to consultations outside of the clinic.”

May combine two claims.

In the current study, turnover was a challenge because consistency of team members helped build team cohesiveness and reduced disruption to clinic operations.

“In the current study turnover was a challenge because consistency of members helped build team cohesiveness and reduced disruption to clinic operations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The interest of healthcare providers was mentioned, since their time is a resource.

“The interest of healthcare providers was mentioned, since their time is a resource.”

May combine two claims.

The informal discussions and case conferences often influence their individual and joint recommendations and increase their confidence in the quality of care they are providing.

“The informal discussions and case conferences often influence their individual and joint recommendations and increase their confidence in the quality of care they are providing.”

May combine two claims.

Despite seeing fewer patients on clinic days, the clinics were more efficient for some team members because all the players were present, streamlining assessment and planning.

“Despite seeing fewer patients on clinic days, the clinics were more efficient for some team members because all the players were present, streamlining assessment and planning.”

May combine two claims.

As a result of the interdisciplinary collaboration team members have become more comfortable with each other and developed a shared goal.

“As a result of the interdisciplinary collaboration team members have become more comfortable with each other and developed a shared goal.”

May combine two claims.

Raising awareness of the clinics in the community helps with sustaining and scaling because patients and families are more likely to ask their healthcare provider about the clinic, and awareness of its benefits may help engage new teams.

“Raising awareness of the clinics in the community helps with sustaining and scaling because patients and families are more likely to ask their healthcare provider about the clinic, and awareness of its benefits may help engage new teams.”

Probably not a substantial claim: may not pass S3 (load-bearing).

These broad categories align with those reported in other studies.

“These broad categories align with those reported in other studies (e.g., Stirman et al. [2], Fleiszer et al. [13], Côté-Boileau [40]).”

• cites Stirman et al. [2] Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013; https://doi.org/10.1186/1748-5908-8-65. sourceNot checked yet

  Not checked in the free run.

• cites Fleiszer et al. [13] Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. The sustainability of healthcare innovations: a concept analysis. J Adv Nurs. 2015; https://doi.org/10.1111/jan.12633. sourceNot checked yet

  Not checked in the free run.

• cites Côté-Boileau [40] Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst. 2019; https://doi.org/10.1186/s12961-019-0482-6. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This change created uncertainty about the impact on programs and jobs, and gaps in some leadership roles occurred while waiting for new positions to be filled.

“This change created uncertainty about the impact on programs and jobs, and gaps in some leadership roles occurred while waiting for new positions to be filled.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Inclusivity and recognition that the support staff are essential team members is important.

“Also important is inclusivity and recognition that the support staff are essential team members, communicating with patients and families, making appointments, and tracking the waitlist.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The clinic provides a unique opportunity to learn about other members' contributions to supporting individuals with dementia and their families.

“The clinic also provides a unique opportunity to learn about other members’ contributions to supporting individuals with dementia and their families.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The clinic handbook and other resources were useful to new teams.

“The clinic handbook and other resources were useful to new teams”

Probably not a substantial claim: may not pass S3 (load-bearing).

Connecting new team members with their counterpart on an established team, who could be "on call" for consultation, would also be reassuring to new team members.

“Connecting new team members with their counterpart on an established team, who could be “on call” for consultation, would also be reassuring to new team members.”

Probably not a substantial claim: may not pass S3 (load-bearing).

As in other studies, we found overlap in a number of factors related to sustainability and scale-up.

“As in other studies we found overlap in a number of factors related to sustainability and scale-up (e.g., Willis et al. [1], Laur et al. [41]).”

• cites Willis et al. [1] Willis CD, Riley BL, Stockton L, Abramowicz A, Zummach D, Wong G, et al. Scaling up complex interventions: insights from a realist synthesis. Health Res Policy Syst. 2016; https://doi.org/10.1186/s12961-016-0158-4. sourceNot checked yet

  Not checked in the free run.

• cites Laur et al. [41] Laur C, Bell J, Valaitis R, Ray S, Keller H. The sustain and spread framework: strategies for sustaining and spreading nutrition care improvements in acute care based on thematic analysis from the More-2-eat study. BMC Health Serv Res. 2018; https://doi.org/10.1186/s12913-018-3748-8. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In our study, clinic team members were able to identify strategies to improve fit of the innovation and manage threats to sustainability, but often needed support from team facilitators, managers, or researchers to follow up or help with execution due to lack of time and competing priorities.

“In our study clinic team members were able to identify strategies to improve fit of the innovation and manage threats to sustainability, but often needed support from team facilitators, managers, or researchers to follow up or help with execution due to lack of time and competing priorities.”

May combine two claims.

Key factors influencing the sustainability and scale-up of the memory clinics included the presence of a clinic champion/leader, an engaged and committed team, belief that the clinic is meeting an identified need and making a difference, consistency of team lead and members, facilitation support, and having a ready-to-use intervention model shown to be feasible and effective in a similar setting.

“Key factors included the presence of a clinic champion/leader, an engaged and committed team, belief that the clinic is meeting an identified need and making a difference, consistency of team lead and members, facilitation support, and having a ready-to-use intervention model that has been shown to be feasible and effective in a similar setting.”

• AssumptionRests on an assumption: Team members' reported perceptions accurately capture the factors that influence the sustainability and scale-up of the memory clinics.

May combine two claims.

Engaging and maintaining relationships with leaders was more time-consuming and challenging because team members were not co-located and reported to different managers, but was critical to ensuring team members felt supported to participate.

“This made engaging and maintaining relationships with leaders more time-consuming and challenging but was critical to ensuring team members felt supported to participate.”

May combine two claims.

The nurse practitioner leading Team 1 played a major role in raising awareness of the clinic and generating interest among other teams, and has been hired on a casual basis by RaDAR as a champion to support implementation in new teams.

“The nurse practitioner leading Team 1 played a major role in raising awareness of the clinic and generating interest among other teams and has been hired on a casual basis by RaDAR as a champion to support implementation in new teams.”

May combine two claims.

Identifying teams with interest, capacity, and resources was key to expanding in the rural settings because resources, especially availability of interdisciplinary team members, varied across communities.

“Identifying teams with interest, capacity, and resources was key to expanding in the rural settings because resources, especially availability of interdisciplinary team members, varied across communities.”

Classified as probably not a substantial claim. May combine two claims.

Findings related to scaling up reflect team members' views on what influenced them to participate and what was helpful (and would have been helpful) in getting started, including confidence that the clinic model is feasible and that they have the skills needed to contribute.

“Findings related to scaling up reflect team members’ views on what influenced them to participate and what was helpful (and would have been helpful) in getting started, including confidence that the clinic model is feasible and that they have the skills needed to contribute.”

• AssumptionRests on an assumption: Team members' reported perceptions accurately capture the factors that influence the sustainability and scale-up of the memory clinics.

May combine two claims.

The intermittent nature of the clinics did not justify hiring additional staff, so the clinics operated with existing personnel who needed to create time in their schedules to participate and to have manager support to do so.

“The intermittent nature of the clinics did not justify hiring additional staff thus the clinics operated with existing personnel who needed to be able to create time in their schedules to participate in the memory clinics, and to have manager support to do so.”

May combine two claims.

Participants in the current study reported that regular meetings with the RaDAR team helped with accountability and kept the clinics from getting lost amid other priorities.

“Participants in the current study reported that regular meetings with the RaDAR team helped with “accountability” and kept the clinics from getting lost amid other priorities.”

May combine two claims.

Clinic team members were not normally co-located and were from different disciplines, and therefore reported to different managers.

“Clinic team members were not normally co-located and were from different disciplines, and therefore reported to different managers.”

May combine two claims.

This holistic approach focusing on the patient and family contributed to sustainability because the clinics were meeting identified needs and team members were motivated by being able to offer meaningful support.

“This holistic approach focusing on the patient and family contributed to sustainability because the clinics were meeting identified needs and team members were motivated by being able to offer meaningful support.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Ethics approval was received from the University Behavioral Research Ethics Board and operational approval from the Saskatchewan Health Authority.

“Ethics approval was received from the University Behavioral Research Ethics Board and operational approval from the Saskatchewan Health Authority.”

May combine two claims.

The gap between evidence and practice is particularly acute with respect to dementia care, exacerbated by the challenges of delivering dementia services in rural settings.

“The gap between evidence and practice is particularly acute with respect to dementia care [3, 4], exacerbated by the challenges of delivering dementia services in rural settings [5–7].”

• cites [3] Feldman HH, Estabrooks CA. The Canadian dementia challenge: ensuring optimal care and services for those at risk or with dementia throughout the country. Can J Public Health. 2017; https://doi.org/10.17269/CJPH.108.5852. sourceNot checked yet

  Not checked in the free run.

• cites [4] Lourida I, Abbott RA, Rogers M, Lang IA, Stein K, Kent B, et al. Dissemination and implementation research in dementia care: a systematic scoping review and evidence map. BMC Geriatr. 2017; https://doi.org/10.1186/s12877-017-0528-y. sourceNot checked yet

  Not checked in the free run.

• cites [5] Auer S, Ratajczak P, Span E, Höfler M. Timely diagnosis of dementia in rural areas of Austria: the dementia service Centre model. In: Innes A, Farmer J, Morgan D, editors. Rural and remote dementia care: policy, research, and practice. Bristol: Policy Press; 2020. p. 103–26.Not checked yet

  Not checked in the free run.

• cites [6] Innes A, Morgan D, Kosteniuk J. Dementia care in rural and remote settings: a systematic review of informal/family caregiving. Maturitas. 2011; https://doi.org/10.1016/j.maturitas.2010.10.002. sourceNot checked yet

  Not checked in the free run.

• cites [7] Morgan D, Innes A, Kosteniuk J. Dementia care in rural and remote settings: a systematic review of formal or paid care. Maturitas. 2011; https://doi.org/10.1016/j.maturitas.2010.09.008. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The focus groups were the primary data source; workgroup data provided additional contextual data that were used to verify, refine, and add to the themes.

“The focus groups were the primary data source; workgroup data provided additional contextual data that were used to verify, refine, and add to the themes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All study methods were performed in accordance with the relevant guidelines and regulations.

“All study methods were performed in accordance with the relevant guidelines and regulations.”

May combine two claims.

Primary healthcare plays a critical role in rural dementia care due to lack of specialists and the importance of care coordination post-diagnosis.

“Primary healthcare plays a critical role in rural dementia care due to lack of specialists and the importance of care coordination post-diagnosis [24, 25], thus effective models of primary healthcare for dementia in rural settings are needed [26], along with strategies for translating these into practice and ensuring sustainability.”

• cites [24] Prince MJ. World Alzheimer report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. [internet]. London: Alzheimer’s Disease International; 2015. Available from: https://www.alzint.org/resource/world-alzheimer-report-2015/. Accessed 01 Feb 2021Not checked yet

  Not checked in the free run.

• cites [25] Spenceley SM, Sedgwick N, Keenan J. Dementia care in the context of primary care reform: an integrative review. Aging Ment Health. 2015; https://doi.org/10.1080/13607863.2014.920301. sourceNot checked yet

  Not checked in the free run.

• cites [26] Froehlich Chow A, Morgan D, Bayly M, Kosteniuk J, Elliot V. Collaborative approaches to team-based primary health Care for Individuals with dementia in rural/remote settings. Can J Aging. 2019; https://doi.org/10.1017/S0714980818000727. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Initial coding and theme development was conducted by DM. JK, MB, VE, and CC independently reviewed transcripts and draft themes to refine the analysis.

“Initial coding and theme development was conducted by DM. JK, MB, VE, and CC independently reviewed transcripts and draft themes to refine the analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The focus groups and workgroups were audio recorded, transcribed, and checked for accuracy.

“The focus groups and workgroups were audio recorded, transcribed, and checked for accuracy.”

May combine two claims.

There is limited research on effective models for dementia care in rural primary healthcare, or evidence on sustaining and scaling them.

“Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them.”

• Also stated in: § Introduction · plain

  “A scoping review [4] identified limited research on dissemination, implementation, and sustainment of evidence-based practices in dementia care, with a particular gap in primary care settings where there is increasing demand to provide care for people with dementia and their caregivers.”

• Also stated in: § Introduction · plain

  “There is also a paucity of evidence on sustaining and scaling dementia care innovations in rural settings [20].”

• cites [4] Lourida I, Abbott RA, Rogers M, Lang IA, Stein K, Kent B, et al. Dissemination and implementation research in dementia care: a systematic scoping review and evidence map. BMC Geriatr. 2017; https://doi.org/10.1186/s12877-017-0528-y. sourceNot checked yet

  Not checked in the free run.

• cites [20] Russell DJ, Humphreys JS. Meeting the primary healthcare needs of small rural communities: Lessons for health service planners. [Internet]. Rural and Remote Health. 2016. Available from: https://www.rrh.org.au/journal/article/3695. Accessed 05 Jan 2021. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Reported influences on sustainability include characteristics of the innovation and the individuals involved, leadership, capacity, processes, and context.

“Reported influences on sustainability include characteristics of the innovation and the individuals involved, leadership, capacity, processes, and context [2, 9, 13, 14].”

• cites [2] Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013; https://doi.org/10.1186/1748-5908-8-65. sourceNot checked yet

  Not checked in the free run.

• cites [9] Hailemariam M, Bustos T, Montgomery B, Barajas R, Evans LB, Drahota A. Evidence-based intervention sustainability strategies: a systematic review. Implement Sci. 2019; https://doi.org/10.1186/s13012-019-0910-6. sourceNot checked yet

  Not checked in the free run.

• cites [13] Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. The sustainability of healthcare innovations: a concept analysis. J Adv Nurs. 2015; https://doi.org/10.1111/jan.12633. sourceNot checked yet

  Not checked in the free run.

• cites [14] Lennox L, Maher L, Reed J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci. 2018; https://doi.org/10.1186/s13012-017-0707-4. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This study highlighted how the rural context elevates the importance of specific factors that influence sustainability and scale-up, several of which have not been previously identified.

“However, this study highlighted how the rural context elevates the importance of specific factors that influence sustainability and scale-up, several of which have not been previously identified.”

May combine two claims.

The fact that all but one of the teams were led by nurse practitioners reflects their relative stability in their communities and greater flexibility in their practice.

“The fact that all but one of the teams were led by nurse practitioners reflects their relative stability in their communities and greater flexibility in their practice.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Engaging physicians was a challenge perhaps because they were uncertain about how long they would stay in the community.

“perhaps because they were uncertain about how long they would stay in the community.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants' belief that they are equipped and able to contribute to the program is key to maintaining motivation.

“The importance of capacity-building is reinforced by Coté-Boileau et al. [40] who found that participants’ belief that they are equipped and able to contribute to the program is key to maintaining motivation.”

• cites [40] Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst. 2019; https://doi.org/10.1186/s12961-019-0482-6. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Team 1 has been sustained since 2017 and Team 2 since 2018, longer than the 2 years suggested as a minimum for defining a sustained program.

“Team 1 has been sustained since 2017 and Team 2 since 2018, longer than the 2 years suggested as a minimum for defining a sustained program [47, 56]”

• cites [47] Hodge LM, Turner KM. Sustained implementation of evidence-based programs in disadvantaged communities: a conceptual framework of supporting factors. Am J Community Psychol. 2016; https://doi.org/10.1002/ajcp.12082. sourceNot checked yet

  Not checked in the free run.

• cites [56] Shelton RC, Cooper BR, Stirman SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health. 2018; https://doi.org/10.1146/annurev-publhealth-040617-014731. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Development of strategies for regular communication among team members is necessary for collaborative team-based primary healthcare for dementia in rural settings.

“A review of approaches to team-based primary healthcare for dementia in rural settings [26] found that development of strategies for regular communication among team members was necessary for collaborative care.”

• cites [26] Froehlich Chow A, Morgan D, Bayly M, Kosteniuk J, Elliot V. Collaborative approaches to team-based primary health Care for Individuals with dementia in rural/remote settings. Can J Aging. 2019; https://doi.org/10.1017/S0714980818000727. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A primary healthcare intervention for dementia is feasible in a sparsely populated rural area and can be sustained if the right conditions and supports are maintained, including team, organizational, and intervention-based factors.

“our research shows that a PHC intervention for dementia is feasible in a sparsely populated rural area and can be sustained if the right conditions and supports are maintained, including team, organizational, and intervention-based factors.”

• cites [12] Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013; https://doi.org/10.1186/1748-5908-8-117. sourceNot checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: The conditions and supports that sustained the memory clinics in the study teams are attainable in other rural primary healthcare settings, so the intervention can be sustained more widely.

May combine two claims.

The study included a small number of teams but included both cross-sectional and longitudinal data, and perspectives from both newer and more established teams.

“The study included a small number of teams but included both cross-sectional and longitudinal data, and perspectives from both newer and more established teams.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The longitudinal analysis was completed over a relatively brief timeframe, and longer-term data are needed.

“nevertheless, the longitudinal analysis has been completed over a relatively brief timeframe, and longer-term data are needed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Staff mobility and turnover were identified as barriers to innovation sustainability in low-resource communities, barriers not mentioned in earlier reviews.

“The importance of continuity of team members was reported in a review of innovation sustainability in low-resource communities, where staff mobility and turnover were identified as barriers not mentioned in earlier reviews [47].”

• cites [47] Hodge LM, Turner KM. Sustained implementation of evidence-based programs in disadvantaged communities: a conceptual framework of supporting factors. Am J Community Psychol. 2016; https://doi.org/10.1002/ajcp.12082. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It is crucial that those involved believe the innovation improves the quality of care, because their efforts to support the innovation are motivated by the added value they want to achieve.

“A review of sustaining and scaling healthcare innovations [40] noted that it is crucial that those involved believe that the innovation improves the quality of care, as their efforts to support the innovation are motivated by the added value they want to achieve.”

• cites [40] Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst. 2019; https://doi.org/10.1186/s12961-019-0482-6. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In disadvantaged communities, process factors including technical assistance and ongoing support from program developers are important to promote local problem-solving efforts and motivate providers.

“A finding from disadvantaged communities [47] was the importance of process factors, including technical assistance and ongoing support from program developers to promote local problem-solving efforts and motivate providers.”

• cites [47] Hodge LM, Turner KM. Sustained implementation of evidence-based programs in disadvantaged communities: a conceptual framework of supporting factors. Am J Community Psychol. 2016; https://doi.org/10.1002/ajcp.12082. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

This study focused on team member perceptions, so the findings do not include the wider views of managers, directors, and other organizational leaders.

“This study focused on team member perceptions thus findings do not include wider views of managers, directors, and other organizational leaders.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The study communities were relatively homogenous in terms of ethnicity at the time of the study.

“The study communities were relatively homogenous in terms of ethnicity at the time of the study.”

May combine two claims.

Interprofessional primary care teams that allocate more time for planning and discussion are better able to tailor implementation and adapt to a changing context, resolve issues, and improve collaboration.

“Studies of factors affecting interprofessional primary care team function, including in rural areas, found that teams allocating more time for planning and discussion were better able to tailor the implementation and adapt to a changing context [49], resolve issues [48], and improve collaboration [26].”

• cites [49] Sibbald SL, Ziegler BR, Maskell R, Schouten K. Implementation of interprofessional team-based care: a cross-case analysis. J Interprof Care. 2020; https://doi.org/10.1080/13561820.2020.1803228. sourceNot checked yet

  Not checked in the free run.

• cites [48] Misfeldt R, Suter E, Mallinson S, Boakye O, Wong S, Nasmith L. Exploring context and the factors shaping team-based primary healthcare policies in three Canadian provinces: a comparative analysis. Healthc Policy. 2017; https://doi.org/10.12927/hcpol.2017.25190. sourceNot checked yet

  Not checked in the free run.

• cites [26] Froehlich Chow A, Morgan D, Bayly M, Kosteniuk J, Elliot V. Collaborative approaches to team-based primary health Care for Individuals with dementia in rural/remote settings. Can J Aging. 2019; https://doi.org/10.1017/S0714980818000727. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Our experiences collaborating with rural primary healthcare teams to develop and implement the memory clinics highlighted the complex nature of the rural healthcare context and are consistent with the view of innovation as an unpredictable journey and a process of managing and supporting continuous improvement and adaptation.

“Our experiences in collaborating with rural PHC teams to develop and implement the memory clinics have highlighted the complex nature of the rural healthcare context [51] and are consistent with the view of innovation as an unpredictable journey, and a process of managing and supporting continuous improvement and adaptation [40].”

• cites [51] Buykx P, Humphreys JS, Tham R, Kinsman L, Wakerman J, Asaid A, et al. How do small rural primary health care services sustain themselves in a constantly changing health system environment? BMC Health Serv Res. 2012; https://doi.org/10.1186/1472-6963-12-81. sourceNot checked yet

  Not checked in the free run.

• cites [40] Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst. 2019; https://doi.org/10.1186/s12961-019-0482-6. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

There is a need for facilitation focused on helping staff translate knowledge into practice change at the bedside.

“McGilton et al. [50] found a need for facilitation, but it was focused on helping staff translate knowledge into practice change at the bedside.”

• cites [50] McGilton KS, Cumal A, Corsi D, Gingrich S, Zheng N, Escrig-Pinol A. Context matters when implement-ing patient centred rehabilitation models for persons with cognitive impairment: a case study. BMC Health Serv Res. 2021; https://doi.org/10.1186/s12913-021-06206-9. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The role of sex and gender of the healthcare providers in sustainability and scale-up was not explored in this study because the challenges of bringing teams together restricted the time available for the focus groups.

“Because the challenges of bringing teams together restricted the time available for the focus groups, the role of sex and gender of the healthcare providers in sustainability and scale-up was not explored in this study.”

Classified as probably not a substantial claim. May combine two claims.

Scale-up is facilitated by considering local context and readiness, and by being responsive to opportunities.

“The Spread and Sustain framework [41] is based on a study that found scale-up was facilitated by considering local context and readiness, and being responsive to opportunities.”

• cites [41] Laur C, Bell J, Valaitis R, Ray S, Keller H. The sustain and spread framework: strategies for sustaining and spreading nutrition care improvements in acute care based on thematic analysis from the More-2-eat study. BMC Health Serv Res. 2018; https://doi.org/10.1186/s12913-018-3748-8. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Program familiarity and perceived competence in delivering the program are particularly important in low-resource communities, underlining the need to engage providers early and provide continued training.

“Program familiarity and perceived competence in delivering the program were identified as particularly important in low-resource communities and underlined the need to engage with providers early and to provide continued training [47].”

• cites [47] Hodge LM, Turner KM. Sustained implementation of evidence-based programs in disadvantaged communities: a conceptual framework of supporting factors. Am J Community Psychol. 2016; https://doi.org/10.1002/ajcp.12082. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Sustainability requires ongoing effort, so it is essential to build local capacity to adapt to constant change.

“Given that sustainability requires ongoing effort, it is essential to build local capacity to adapt to constant change [14, 54].”

• cites [14] Lennox L, Maher L, Reed J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci. 2018; https://doi.org/10.1186/s13012-017-0707-4. sourceNot checked yet

  Not checked in the free run.

• cites [54] Greenhalgh T, Papoutsi C. Spreading and scaling up innovation and improvement. BMJ. 2019; https://doi.org/10.1136/bmj.l2068. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Even after innovations become part of routine practice, effort is still required for maintaining the routine.

“Laur et al., who developed the Sustain and Spread Framework [41], found that even after innovations were becoming part of routine practice, effort was still required for “maintaining the routine” [p. 4].”

• cites [41] Laur C, Bell J, Valaitis R, Ray S, Keller H. The sustain and spread framework: strategies for sustaining and spreading nutrition care improvements in acute care based on thematic analysis from the More-2-eat study. BMC Health Serv Res. 2018; https://doi.org/10.1186/s12913-018-3748-8. sourceNot checked yet

  Not checked in the free run.