Are primary care providers ready to implement goal-oriented care? An explorative study using the Normalization Process Theory

Dagje Boeykens, Ine Huybrechts, Agnes Grudniewicz, Carolyn Steele Gray, An De Sutter, Peter Pype, Dominique Van De Velde, Pauline Boeckxstaens, Sibyl Anthierens

Keywords: Goal-oriented care, person-centered care, chronic care, multimorbidity, primary care providers

GOC is a possible approach to more coordinated and integrated care and tailors care to patients’ personal life goals. The concept has gained interest among policy makers and researchers but the main drivers for successful implementation are the Primary Care Professionals (PHCPs) who need to see added value of GOC in order to embed it into their daily practice. Normalization Process Theory (NPT), developed to understand the processes of implementing new ways of organizing care, offers a useful lens to understand adoption of GOC in primary care practice.

Research questions:
Are primary care providers ready to implement goal-oriented care?

PHCPs (n=131) who participated in a 2-hour community meeting on GOC were asked to complete the Normalization MeAsure Development survey (NoMAD) survey. This 23-item survey is based on NPT and describes participants’ views about how an intervention would impact their work, their expectations about it, and whether it could become a routine part of their work.

The NPT-constructs coherence (sense-making work) and cognitive participation (relational work) showed positive tendency towards implementation of GOC. The participants had an initial understanding on GOC and their was much interest in supporting and start working with this approach. The other constructs collective action (operational work) and reflexive monitoring (appraisal work) will need further efforts to trigger implementation. A common ground is needed to integrate GOC as a common practice which can be achieved by intensive interprofessional collaboration.

PHCPs seemed to welcome GOC as an innovation and there was willingness to adopt it in daily practice. Further specification of GOC into a concrete intervention with specific guidelines on how to provide is needed to enable a deeper understanding of the concept and how to put it into practice.

Points for discussion: