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Background • Focus groups increasingly utilized by healthcare researchers to understand provider and patient perspectives • Advantages of focus groups: open dialogue between participants, an ability to expand on answers after hearing others’ comments, cost-effectiveness in collecting information from multiple people at once • Oklahoma’s Medicaid program overseen by the Oklahoma Health Care Authority (OHCA) and foster care program overseen by the Department of Human Services (DHS) • Children in foster care covered by Medicaid more likely prescribed psychotropic medications 1-3 • National organizations recommend states develop comprehensive psychotropic medication monitoring programs assessing efficacy and safety 4 • Potential to impact almost 10,000 children in Oklahoma foster care (OFC) program 5 Methods • Research team: Stakeholders from Pharmacy Management Consultants (PMC), OHCA, and DHS • Study Design: Qualitative focus groups consisting of participants in 5 important segments within OFC • Segments: Inpatient hospital teams, outpatient providers, child welfare staff, legal personnel, and foster families • Coverage area: Recruitment from each of the 5 DHS regions for geographical representation • Incentives: Full meal and gift card • Execution: Two research team members conducting focus groups within regions; sessions audio recorded and transcribed • Data Analysis: Transcripts uploaded into ATLAS.ti® and analyzed using the constant comparative method Focus Group Design Implications • Identification of current successes and problems in the OFC psychotropic medication use process • Improvements to quality of care for OFC children • Inform development of psychotropic medication monitoring programs References 1. Hoagwood KE, Kelleher K, Zima BT, Perrin JM, Bilder S, Crystal S. Ten-Year Trends In Treatment Services For Children With Attention Deficit Hyperactivity Disorder Enrolled In Medicaid. Health Affairs. 2016;35(7):1266-1270. 2. Crystal S, Mackie T, Fenton MC, et al. Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain. Health Affairs. 2016;35(6):974-982. 3. Zito JM, Safer DJ, Sai D, et al. Psychotropic Medication Patterns Among Youth in Foster Care. Pediatrics. 2008;121(1):e157-e163. 4. Mackie TI, Hyde J, Rodday AM, et al. Psychotropic medication oversight for youth in foster care: A national perspective on state child welfare policy and practice guidelines. Children and Youth Services Review. 2011;33(11):2213-2220. 5. Statistics. Oklahoma Fosters Initiative website. http://www.oklahomafosters.com/statistics/. Accessed March 14, 2017. 6. Tonna AP, Edwards RM. Is there a place for qualitative research methods in pharmacy practice? Eur J Hosp Pharm. 2012;0:1–3. doi:10.1136/ejhpharm-2012- 000184. 7. Creswell JW, Plano Clark V. Designing and Conducting Mixed Methods Research. 2nd ed. Thousand Oaks, CA: SAGE Publications, Inc.; 2011. Objectives • Develop a comprehensive psychiatric medication management system • Understand lived experiences of parties in the OFC program to improve communication and resource access Disclosure Statement Drs. Tidmore, Lambert, Nesser, and Shropshire have no conflicts of interest. Dr. Keast reports contractual employment with the Oklahoma Health Care Authority, an unrelated research grant from Gilead Sciences, Inc, and an unrelated research grant from Purdue Pharma. Funding for this research was received by CHIP Health Services Initiative. Implementation of Focus Groups in a Collaborative Assessment of Medication Utilization in the Foster Care System Laura Tidmore, Pharm.D., 1 Tammy Lambert, Pharm.D., Ph. D., 1,2 Shellie Keast, Pharm.D., Ph.D., 1,2 Nancy Nesser, Pharm.D, J.D., 3 Deborah Shropshire, M.D. 4 1 University of Oklahoma College of Pharmacy, 2 Pharmacy Management Consultants, 3 Oklahoma Health Care Authority 4 Oklahoma Dept. of Human Services Discussion • Not all research questions appropriately addressed through quantitative methods • Understanding lived experiences of individuals addresses complexity of healthcare problems and provides insight to improve health care delivery 5-6 • Focus groups bring together participants who share a commonality and allow researchers to study interactions between them • Advantages over surveys: collect more specific information in greater depth, minimized confusion through clarification of questions, uses participants’ own words, participants empowered to assume active role in program improvement Focus Group Segments •Inpatient Psychiatric Teams •Outpatient Providers •DHS Social Workers •Legal System Professionals •Foster Parents Groups •3 - 4 groups per segment •N = 15 - 20 groups Participants •6 - 8 participants per group •N = 90 - 160 participants Oklahoma DHS Regions

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Page 1: Implementation of Focus Groups in a Collaborative ... · Background • Focus groups increasingly utilized by healthcare researchers to understand provider and patient perspectives

Background• Focusgroupsincreasinglyutilizedbyhealthcareresearchers

tounderstandproviderandpatientperspectives• Advantagesoffocusgroups:opendialoguebetween

participants,anabilitytoexpandonanswersafterhearingothers’comments,cost-effectivenessincollectinginformationfrommultiplepeopleatonce

• Oklahoma’sMedicaidprogramoverseenbytheOklahomaHealthCareAuthority(OHCA)andfostercareprogramoverseenbytheDepartmentofHumanServices(DHS)

• ChildreninfostercarecoveredbyMedicaidmorelikelyprescribedpsychotropicmedications1-3

• Nationalorganizationsrecommendstatesdevelopcomprehensivepsychotropicmedicationmonitoringprogramsassessingefficacyandsafety4

• Potentialtoimpactalmost10,000childreninOklahomafostercare(OFC)program5

Methods• Researchteam:StakeholdersfromPharmacyManagement

Consultants(PMC),OHCA,andDHS• StudyDesign:Qualitativefocusgroupsconsistingof

participantsin5importantsegmentswithinOFC• Segments:Inpatienthospitalteams,outpatientproviders,

childwelfarestaff,legalpersonnel,andfosterfamilies• Coveragearea:Recruitmentfromeachofthe5DHSregions

forgeographicalrepresentation• Incentives:Fullmealandgiftcard• Execution: Tworesearchteammembersconductingfocus

groupswithinregions;sessionsaudiorecordedandtranscribed

• DataAnalysis:TranscriptsuploadedintoATLAS.ti®andanalyzedusingtheconstantcomparativemethod

FocusGroupDesign

Implications• IdentificationofcurrentsuccessesandproblemsintheOFCpsychotropicmedicationuseprocess

• ImprovementstoqualityofcareforOFCchildren• Informdevelopmentofpsychotropicmedicationmonitoringprograms

References1. Hoagwood KE,KelleherK,ZimaBT,PerrinJM,Bilder S,CrystalS.Ten-YearTrends

InTreatmentServicesForChildrenWithAttentionDeficitHyperactivityDisorderEnrolledInMedicaid.HealthAffairs.2016;35(7):1266-1270.

2. CrystalS,MackieT,FentonMC,etal.RapidGrowthOfAntipsychoticPrescriptionsForChildrenWhoArePubliclyInsuredHasCeased,ButConcernsRemain.HealthAffairs.2016;35(6):974-982.

3. Zito JM,SaferDJ,SaiD,etal.PsychotropicMedicationPatternsAmongYouthinFosterCare.Pediatrics.2008;121(1):e157-e163.

4. MackieTI,HydeJ,Rodday AM,etal.Psychotropicmedicationoversightforyouthinfostercare:Anationalperspectiveonstatechildwelfarepolicyandpracticeguidelines.ChildrenandYouthServicesReview.2011;33(11):2213-2220.

5. Statistics.OklahomaFostersInitiativewebsite.http://www.oklahomafosters.com/statistics/.AccessedMarch14,2017.

6. Tonna AP,EdwardsRM.Isthereaplaceforqualitativeresearchmethodsinpharmacypractice?Eur JHospPharm.2012;0:1–3.doi:10.1136/ejhpharm-2012-000184.

7. CreswellJW,PlanoClarkV.DesigningandConductingMixedMethodsResearch.2nded.ThousandOaks,CA:SAGEPublications,Inc.;2011.

Objectives• Developacomprehensivepsychiatricmedication

managementsystem• UnderstandlivedexperiencesofpartiesintheOFCprogram

toimprovecommunicationandresourceaccess

DisclosureStatementDrs.Tidmore,Lambert,Nesser,andShropshire havenoconflictsofinterest.Dr.Keast reportscontractualemploymentwiththeOklahomaHealthCareAuthority,anunrelatedresearchgrantfromGileadSciences,Inc,andanunrelatedresearchgrantfromPurduePharma.FundingforthisresearchwasreceivedbyCHIPHealthServicesInitiative.

Implementation of Focus Groups in a Collaborative Assessment of Medication Utilization in the Foster Care System

Laura Tidmore, Pharm.D.,1 Tammy Lambert, Pharm.D., Ph. D.,1,2 Shellie Keast, Pharm.D., Ph.D.,1,2

Nancy Nesser, Pharm.D, J.D.,3 Deborah Shropshire, M.D.41University of Oklahoma College of Pharmacy, 2Pharmacy Management Consultants, 3Oklahoma Health Care Authority 4Oklahoma Dept. of Human Services

Discussion• Notallresearchquestionsappropriatelyaddressedthroughquantitativemethods

• Understandinglivedexperiencesofindividualsaddressescomplexityofhealthcareproblemsandprovidesinsighttoimprovehealthcaredelivery5-6

• Focusgroupsbringtogetherparticipantswhoshareacommonalityandallowresearcherstostudyinteractionsbetweenthem

• Advantagesoversurveys:collectmorespecificinformationingreaterdepth,minimizedconfusionthroughclarificationofquestions,usesparticipants’ownwords,participantsempoweredtoassumeactiveroleinprogramimprovement

FocusGroupSegments

•InpatientPsychiatricTeams•OutpatientProviders•DHSSocialWorkers•LegalSystemProfessionals•FosterParents

Groups

•3- 4groupspersegment•N=15- 20groups

Participants

•6- 8participantspergroup•N=90- 160participants

OklahomaDHSRegions

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