• Jennifer Shuldiner, Huda Shah, Stacey Bar-Ziv, Joe Mauti, David Kaplan, Mina Tradrous, Michael E Green, Isaac Bogoch, Dominik Alex Nowak, Kavita Mehta, Laura Desveaux, Lydia-Joi Marshall, Sophia Ikura, Monica Taljaard, Jia Hu, Sabina Vohra-Miller, Justin Presseau, Holly Witteman, Aisha Lofters, Tara Kiran, and Noah Ivers.
• Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada (Shuldiner, Shah, Tradrous, Desveaux, Ivers); Jennifer.shuldiner@wchospital.ca.
• Ann Fam Med. 2023 Nov 1; 21 (6): 526533526-533.

PurposeWe offered a practice facilitation intervention to family physicians in Ontario, Canada, known to have large numbers of patients not yet vaccinated against coronavirus disease 2019 (COVID-19).MethodsWe conducted a multimethod process evaluation embedded within a randomized controlled trial (clinical trial #NCT05099497). We collected descriptive statistics regarding engagement and qualitative interview data from family physicians and practice facilitators, as well as data from facilitator field notes. We analyzed and triangulated the data using thematic analysis and mapped barriers to and enablers for implementation to structural, organizational, physician, and patient factors.ResultsOf the 300 approached, 90 family physicians (30%) accepted facilitation. Of these, 57% received technical support to identify unvaccinated patients, 29% used trained medical student volunteers to contact patients on their behalf, and 30% used automated calling to reach patients. Key factors affecting engagement with the intervention were staff shortages owing to COVID-19 (structural), clinic characteristics such as technical issues and gatekeeping by staff, which prevented facilitators from talking with physicians (organizational), burnout (physician), and specialized populations that required targeted resources (patient). The facilitator's ability to address technical issues and connect family physicians with medical students helped with engagement.ConclusionsStrategies to help underresourced family physicians serving high-needs populations for issues of public health importance, such as vaccine promotion, must acknowledge the scarcity of physicians' time and provide new resources. To successfully engage family physicians, practice facilitators should seek to build trust and relationships over time, including with front-office staff.© 2023 Annals of Family Medicine, Inc.

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