{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T17:11:15Z","timestamp":1767978675377,"version":"3.49.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"PFIZER COMPETITIVE","award":["74261789"],"award-info":[{"award-number":["74261789"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality, particularly among older adults and individuals with chronic conditions. Early detection at the primary healthcare (PHC) level is essential to prevent unnecessary hospitalizations, ensure timely treatment, and reduce antibiotic misuse. This qualitative process evaluation examines the implementation of a collaborative quality improvement initiative aimed at enhancing early detection of ARIs in PHC settings in Mendoza, Argentina.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The intervention, which included the National Early Warning Score 2 (NEWS2), a triage system, and portable pulse oximeters, sought to recognize early clinical deterioration due to ARIs among adults with suspected or confirmed respiratory COVID-19 in PHC. Guided by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 23 healthcare professionals to explore facilitators and barriers to implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The intervention's adaptability and design quality were praised, enabling tailored implementation and structured workflows. However, leadership engagement was limited, hindering coordination and resource allocation. Available resources and organizational incentives were insufficient, leading to high workloads and low motivation. External policies lacked formal mandates, reducing perceived legitimacy. Resistance to change and self-efficacy issues limited adoption. Despite these challenges, the intervention improved clinical decision-making and team collaboration, highlighting its potential when supported by strong leadership, adequate resources, and stakeholder involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings emphasize the need for formative assessments, tailored strategies to address contextual challenges, and non-economic incentives to enhance implementation success. This study provides valuable insights for optimizing the integration of interventions in resource-constrained settings, particularly during public health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/fampra\/cmaf102","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:10:39Z","timestamp":1765458639000},"source":"Crossref","is-referenced-by-count":0,"title":["Qualitative process evaluation of a collaborative quality improvement initiative for timely detection of acute respiratory infections in primary care: insights from Argentina during the COVID-19 era"],"prefix":"10.1093","volume":"43","author":[{"given":"Juan Pedro","family":"Alonso","sequence":"first","affiliation":[{"name":"CONICET \u00a0 (CIESP), Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]},{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4285-5061","authenticated-orcid":false,"given":"Javier","family":"Roberti","sequence":"additional","affiliation":[{"name":"CONICET \u00a0 (CIESP), Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]},{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natal\u00ed","family":"Ini","sequence":"additional","affiliation":[{"name":"CONICET \u00a0 (CIESP), Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]},{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Falaschi","sequence":"additional","affiliation":[{"name":"Mendoza Government, Ministry of Health, Social Development and Sport , Av Peltier 351, CP 5500 Mendoza ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00eda","family":"Bosio","sequence":"additional","affiliation":[{"name":"Mendoza Government, Ministry of Health, Social Development and Sport , Av Peltier 351, CP 5500 Mendoza ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Guglielmino","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Negri","sequence":"additional","affiliation":[{"name":"Mendoza Government, Ministry of Health, Social Development and Sport , Av Peltier 351, CP 5500 Mendoza ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n","family":"Peralta-Roca","sequence":"additional","affiliation":[{"name":"Mendoza Government, Ministry of Health, Social Development and Sport , Av Peltier 351, CP 5500 Mendoza ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Paula","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In\u00e9s","family":"Su\u00e1rez-Anzorena","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viviana","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezequiel","family":"Garc\u00eda-Elorrio","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Facundo","family":"Jorro-Bar\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Quality, Patient Safety and Clinical Management, Institute for Clinical Effectiveness and Health Policy\u2014IECS , Ravignani 2024, CP 1414 Buenos Aires ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026010907565122000_cmaf102-B1","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1370\/afm.2386","article-title":"Predictors of adverse outcomes in uncomplicated lower respiratory tract infections","volume":"17","author":"Moore","year":"2019","journal-title":"Ann Fam Med"},{"key":"2026010907565122000_cmaf102-B2","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/s0140-6736(20)30553-5","article-title":"Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries","volume":"395","author":"Kandel","year":"2020","journal-title":"The Lancet"},{"key":"2026010907565122000_cmaf102-B3","doi-asserted-by":"publisher","first-page":"e039284","DOI":"10.1136\/bmjopen-2020-039284","article-title":"Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies","volume":"10","author":"Borek","year":"2020","journal-title":"BMJ Open"},{"key":"2026010907565122000_cmaf102-B4","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1186\/s12889-015-2254-8","article-title":"Identification of cultural determinants of antibiotic use cited in primary care in Europe: a mixed research synthesis study of integrated design \u201cCulture is all around us\u201d","volume":"15","author":"Touboul-Lundgren","year":"2015","journal-title":"BMC Public Health"},{"key":"2026010907565122000_cmaf102-B5","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1186\/s12913-022-08140-w","article-title":"COVID-19\u2014an opportunity to improve access to primary care through organizational innovations? A qualitative multiple case study in Quebec and Nova Scotia (Canada)","volume":"22","author":"Breton","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026010907565122000_cmaf102-B6","first-page":"37","article-title":"Da\u00f1o colateral de la pandemia por COVID-19 en centros privados de salud de Argentina","volume":"80","author":"Bozovich","year":"2020","journal-title":"Medicina (B Aires)"},{"key":"2026010907565122000_cmaf102-B7","doi-asserted-by":"publisher","first-page":"e88","DOI":"10.26633\/RPSP.2023.88","article-title":"COVID-19 in Latin America: inequalities and response capacity of health systems to health emergencies COVID-19 en America Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud","volume":"47","author":"Dos Santos","year":"2023","journal-title":"Rev Panam Salud Publica"},{"key":"2026010907565122000_cmaf102-B8","doi-asserted-by":"publisher","first-page":"e2400208","DOI":"10.9745\/GHSP-D-24-00208","article-title":"Service delivery redesign for noncommunicable disease management: assessment of needs and solutions through a co-creation process in Argentina","volume":"12","author":"Mazzoni","year":"2024","journal-title":"Glob Health Sci Pract"},{"key":"2026010907565122000_cmaf102-B9","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1177\/17423953251318614","article-title":"Exploring the burden of treatment in patients\u2019 experiences of chronic condition management: a mixed-method study in Mendoza, Argentina","volume":"21","author":"Roberti","year":"2025","journal-title":"Chronic Illn"},{"key":"2026010907565122000_cmaf102-B10","doi-asserted-by":"publisher","first-page":"e022528","DOI":"10.1136\/bmjopen-2018-022528","article-title":"Using the national early warning score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England","volume":"8","author":"Brangan","year":"2018","journal-title":"BMJ Open"},{"key":"2026010907565122000_cmaf102-B11","doi-asserted-by":"publisher","first-page":"i3","DOI":"10.1093\/fampra\/cmab016","article-title":"NEWS2 to assess suspected COVID-19 in the community: a service evaluation of a primary care assessment centre","volume":"38","author":"Zaman","year":"2021","journal-title":"Fam Pract"},{"key":"2026010907565122000_cmaf102-B12","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12916-020-01893-3","article-title":"Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study","volume":"19","author":"Carr","year":"2021","journal-title":"BMC Med"},{"key":"2026010907565122000_cmaf102-B13","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1136\/bmjqs-2017-006926","article-title":"Are quality improvement collaboratives effective? A systematic review","volume":"27","author":"Wells","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"2026010907565122000_cmaf102-B14","doi-asserted-by":"publisher","first-page":"e003390","DOI":"10.1136\/bmjoq-2025-003390","article-title":"Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative","volume":"14","author":"Jorro Baron","year":"2025","journal-title":"BMJ Open Qual"},{"key":"2026010907565122000_cmaf102-B15","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement Sci"},{"key":"2026010907565122000_cmaf102-B16","volume-title":"Plan Provincial de Salud 2024\u20132030","author":"Ministry of Health and Sports of Mendoza","year":"2024"},{"key":"2026010907565122000_cmaf102-B17","doi-asserted-by":"publisher","first-page":"58","DOI":"10.48162\/rev.42.072","article-title":"Enfermedades cr\u00f3nicas en Mendoza antes y despu\u00e9s de la pandemia de COVID-19. Unan\u00e1lisis de datos de panel","volume":"9","author":"Lara","year":"2025","journal-title":"Cuyonomics Investigaciones en Econom\u00eda Regional"},{"key":"2026010907565122000_cmaf102-B18","doi-asserted-by":"publisher","first-page":"e062111","DOI":"10.1136\/bmjopen-2022-062111","article-title":"Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care","volume":"12","author":"Sirimsi","year":"2022","journal-title":"BMJ Open"},{"key":"2026010907565122000_cmaf102-B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/1062860620954273","article-title":"Practical tips for ambulatory care in COVID-19: lessons learned in a New York health system","volume":"36","author":"Sagar","year":"2021","journal-title":"Am J Med Qual"},{"key":"2026010907565122000_cmaf102-B20","doi-asserted-by":"publisher","first-page":"e045469","DOI":"10.1136\/bmjopen-2020-045469","article-title":"Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study","volume":"11","author":"Stocker","year":"2021","journal-title":"BMJ Open"},{"key":"2026010907565122000_cmaf102-B21","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s43058-021-00150-9","article-title":"Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening","volume":"2","author":"Lam","year":"2021","journal-title":"Implement Sci Commun"},{"key":"2026010907565122000_cmaf102-B22","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.1017\/S1463423623000063","article-title":"Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR","volume":"24","author":"Aerts","year":"2023","journal-title":"Prim Health Care Res Dev"},{"key":"2026010907565122000_cmaf102-B23","doi-asserted-by":"publisher","first-page":"23333936211015660","DOI":"10.1177\/23333936211015660","article-title":"Theory-driven, rapid formative research on quality improvement intervention for critical care of patients with COVID-19 in Argentina","volume":"8","author":"Roberti","year":"2021","journal-title":"Glob Qual Nurs Res"},{"key":"2026010907565122000_cmaf102-B24","doi-asserted-by":"publisher","first-page":"agaf003","DOI":"10.1093\/alcalc\/agaf003","article-title":"A qualitative exploration of the barriers and facilitators to the implementation of the alcohol assertive outreach model","volume":"60","author":"Scoles","year":"2025","journal-title":"Alcohol Alcohol"},{"key":"2026010907565122000_cmaf102-B25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13012-015-0242-0","article-title":"Making sense of implementation theories, models and frameworks","volume":"10","author":"Nilsen","year":"2015","journal-title":"Implement Sci"},{"key":"2026010907565122000_cmaf102-B26","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s12913-020-4999-8","article-title":"Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses","volume":"20","author":"Nilsen","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026010907565122000_cmaf102-B27","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1177\/14034948231199804","article-title":"Implementation of an integrated community approach in deprived neighbourhoods: a theory-based process evaluation using the Consolidated Framework for Implementation Research (CFIR)","volume":"52","author":"Grootjans","year":"2024","journal-title":"Scand J Public Health"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/1\/cmaf102\/66152858\/cmaf102.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/43\/1\/cmaf102\/66152858\/cmaf102.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T12:57:00Z","timestamp":1767963420000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/article\/doi\/10.1093\/fampra\/cmaf102\/8407251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12,9]]}},"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmaf102","relation":{},"ISSN":["0263-2136","1460-2229"],"issn-type":[{"value":"0263-2136","type":"print"},{"value":"1460-2229","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,12,9]]},"article-number":"cmaf102"}}