Explaining variable effects of an adaptable implementation package to promote evidence-based practice in primary care: a longitudinal process evaluation

Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations competing for attention. Implementation packages that can be adapted and hence applied to target multiple guideline recommendations could...

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Vydáno v:Implementation science : IS Ročník 17; číslo 1; s. 9 - 24
Hlavní autoři: Glidewell, Liz, Hunter, Cheryl, Ward, Vicky, McEachan, Rosemary R. C., Lawton, Rebecca, Willis, Thomas A., Hartley, Suzanne, Collinson, Michelle, Holland, Michael, Farrin, Amanda J., Foy, Robbie
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 27.01.2022
Springer Nature B.V
BMC
Témata:
Adaptable implementation package
Audit and feedback
Blood pressure
Cardiac arrhythmia
Data collection
Data processing
Delivery of Health Care
Diabetes
Diabetes Mellitus - therapy
Dictionaries
Evidence-Based Practice
Feedback
Health Administration
Health Informatics
Health Policy
Health Promotion and Disease Prevention
Health Services Research
Humans
Influence
Intervention
Interviews
Medicine
Medicine & Public Health
Meetings
Normalization Process Theory
Primary care
Primary Health Care - methods
Process evaluation
Prospective Studies
Public Health
Sociology
Stroke
Tailored intervention
Theoretical Domains Framework
United Kingdom > UK
Fidelity
Clinical reminders
Adaptable implementation package
Theoretical Domains Framework
Tailored intervention
Computerised prompts
Normalization Process Theory
Process evaluation
Audit and feedback
Primary care
Educational outreach
ISSN:1748-5908, 1748-5908
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Shrnutí:Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations competing for attention. Implementation packages that can be adapted and hence applied to target multiple guideline recommendations could offer efficiencies for recommendations with common barriers to achievement. We developed and evaluated a package of evidence-based interventions (audit and feedback, educational outreach and reminders) incorporating behaviour change techniques to target common barriers, in two pragmatic trials for four “high impact” indicators: risky prescribing; diabetes control; blood pressure control; and anticoagulation in atrial fibrillation. We observed a significant, cost-effective reduction in risky prescribing but there was insufficient evidence of effect on the other outcomes. We explored the impact of the implementation package on both social processes (Normalisation Process Theory; NPT) and hypothesised determinants of behaviour (Theoretical Domains Framework; TDF). Methods We conducted a prospective multi-method process evaluation. Observational, administrative and interview data collection and analyses in eight primary care practices were guided by NPT and TDF. Survey data from trial and process evaluation practices explored fidelity. Results We observed three main patterns of variation in how practices responded to the implementation package. First, in integration and achievement , the package “worked” when it was considered distinctive and feasible. Timely feedback directed at specific behaviours enabled continuous goal setting, action and review, which reinforced motivation and collective action. Second, impacts on team-based determinants were limited, particularly when the complexity of clinical actions impeded progress . Third, there were delivery delays and unintended consequences . Delays in scheduling outreach further reduced ownership and time for improvement. Repeated stagnant or declining feedback that did not reflect effort undermined engagement. Conclusions Variable integration within practice routines and organisation of care, variable impacts on behavioural determinants, and delays in delivery and unintended consequences help explain the partial success of an adaptable package in primary care.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1748-5908
1748-5908
DOI:10.1186/s13012-021-01166-4