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...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Implementation science : IS Jg. 17; H. 1; S. 9 - 24
Hauptverfasser: 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
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 27.01.2022
Springer Nature B.V
BMC
Schlagworte:
ISSN:1748-5908, 1748-5908
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Abstract 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.
AbstractList 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.
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.
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). 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. 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. 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.
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).BACKGROUNDImplementing 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).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.METHODSWe 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.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.RESULTSWe 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.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.CONCLUSIONSVariable 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.
Abstract 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.
ArticleNumber 9
Author Foy, Robbie
Glidewell, Liz
Lawton, Rebecca
McEachan, Rosemary R. C.
Hartley, Suzanne
Farrin, Amanda J.
Ward, Vicky
Collinson, Michelle
Holland, Michael
Hunter, Cheryl
Willis, Thomas A.
Author_xml – sequence: 1
  givenname: Liz
  orcidid: 0000-0003-2519-2654
  surname: Glidewell
  fullname: Glidewell, Liz
  email: liz.glidewell@york.ac.uk
  organization: Leeds Institute of Health Sciences, University of Leeds, Hull York Medical School, University of York
– sequence: 2
  givenname: Cheryl
  surname: Hunter
  fullname: Hunter, Cheryl
  organization: Leeds Institute of Health Sciences, University of Leeds, University of East London
– sequence: 3
  givenname: Vicky
  surname: Ward
  fullname: Ward, Vicky
  organization: Leeds Institute of Health Sciences, University of Leeds, School of Management, University of St Andrews
– sequence: 4
  givenname: Rosemary R. C.
  surname: McEachan
  fullname: McEachan, Rosemary R. C.
  organization: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS-Foundation Trust
– sequence: 5
  givenname: Rebecca
  surname: Lawton
  fullname: Lawton, Rebecca
  organization: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS-Foundation Trust, School of Psychology, University of Leeds
– sequence: 6
  givenname: Thomas A.
  surname: Willis
  fullname: Willis, Thomas A.
  organization: Leeds Institute of Health Sciences, University of Leeds
– sequence: 7
  givenname: Suzanne
  surname: Hartley
  fullname: Hartley, Suzanne
  organization: Leeds Institute of Clinical Trials Research, University of Leeds
– sequence: 8
  givenname: Michelle
  surname: Collinson
  fullname: Collinson, Michelle
  organization: Leeds Institute of Clinical Trials Research, University of Leeds
– sequence: 9
  givenname: Michael
  surname: Holland
  fullname: Holland, Michael
  organization: Leeds Institute of Clinical Trials Research, University of Leeds
– sequence: 10
  givenname: Amanda J.
  surname: Farrin
  fullname: Farrin, Amanda J.
  organization: Leeds Institute of Clinical Trials Research, University of Leeds
– sequence: 11
  givenname: Robbie
  surname: Foy
  fullname: Foy, Robbie
  organization: Leeds Institute of Health Sciences, University of Leeds
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35086528$$D View this record in MEDLINE/PubMed
BookMark eNp9ks1u1DAUhSNURH_gBVigSGzYBPybOCyQqqpApUpsYG3dODfBxbGDnRnBm_C4eCZDabvoytbN-U7Otc5pceSDx6J4SclbSlX9LlFOKKsIoxWhtK4r8aQ4oY1QlWyJOrpzPy5OU7ohREhR82fFMZdE1ZKpk-LP5a_ZgfXWj-UWooXOYYnDgGZJZRhK8CX0MC_7uZ1mhxP6BRYbfDmD-QEjlkso5ximsGRya3v0BqsOEvZ5DGaxJpNZHe0E8XdpIOL7EkoX_GiXTW89uB1vMKXMg9vs3Z8XTwdwCV8czrPi28fLrxefq-svn64uzq8rIwVZqqYGGKjoRKMYUcQQ2SGINufHgUjCB2SkQehozwGM4n1npIGG5RW7hoiWnxVXq28f4EYfQuoAVu8HIY4aYt7BoYZWKSOHXtRECgpcEYIt60UvmxbrjmSvD6vXvOkm7E1-qQjunun9L95-12PYatW0nBGZDd4cDGL4ucG06Mkmg86Bx7BJmtWMq5Yy0WTp6wfSm7CJ-S13Kk4Ep63cqV7dTXQb5V8BsoCtAhNDShGHWwkletcyvbZM55bpfcu0yJB6ABm7diJvZd3jKF_RlP_jR4z_Yz9C_QWGk-pp
CitedBy_id crossref_primary_10_1136_bmjopen_2024_087795
crossref_primary_10_1186_s13012_024_01362_y
crossref_primary_10_1016_j_copsyc_2024_101854
crossref_primary_10_1186_s12913_024_11801_7
crossref_primary_10_1016_j_midw_2024_104148
crossref_primary_10_1186_s13012_023_01311_1
crossref_primary_10_1186_s12913_024_10915_2
Cites_doi 10.1186/s13012-016-0479-2
10.1016/j.socscimed.2014.09.023
10.1186/1748-5908-1-4
10.1056/NEJMsa055505
10.1136/bmjqs-2017-007554
10.1002/14651858.CD001096.pub2
10.1371/journal.pmed.1003045
10.1186/1741-7015-8-63
10.3310/pgfar08040
10.1186/s12875-015-0350-6
10.1186/s13012-017-0704-7
10.1186/1471-2288-13-117
10.1136/qshc.2004.011155
10.1136/bmjqs-2017-007667
10.1037/0278-6133.23.5.443
10.1186/1748-5908-7-37
10.1136/bmjqs-2017-006963
10.1186/1748-5908-5-67
10.1186/s13012-018-0758-1
10.1186/s13012-017-0605-9
10.1016/j.jhin.2018.08.006
10.1177/0038038509103208
10.3310/hta8060
10.1186/1748-5908-9-2
10.7326/M15-2248
10.1007/s11606-014-2913-y
ContentType Journal Article
Contributor Alderson, Sarah
Clamp, Susan
Hulme, Claire
Richardson, Judith
Carder, Paul
West, Robert
Rathfelder, Martin
Stokes, Tim
Watt, Ian
Contributor_xml – sequence: 1
  givenname: Sarah
  surname: Alderson
  fullname: Alderson, Sarah
– sequence: 2
  givenname: Paul
  surname: Carder
  fullname: Carder, Paul
– sequence: 3
  givenname: Susan
  surname: Clamp
  fullname: Clamp, Susan
– sequence: 4
  givenname: Robert
  surname: West
  fullname: West, Robert
– sequence: 5
  givenname: Martin
  surname: Rathfelder
  fullname: Rathfelder, Martin
– sequence: 6
  givenname: Claire
  surname: Hulme
  fullname: Hulme, Claire
– sequence: 7
  givenname: Judith
  surname: Richardson
  fullname: Richardson, Judith
– sequence: 8
  givenname: Tim
  surname: Stokes
  fullname: Stokes, Tim
– sequence: 9
  givenname: Ian
  surname: Watt
  fullname: Watt, Ian
Copyright The Author(s) 2022
2022. The Author(s).
2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Copyright_xml – notice: The Author(s) 2022
– notice: 2022. The Author(s).
– notice: 2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
CorporateAuthor on behalf of the ASPIRE programme team
ASPIRE programme team
CorporateAuthor_xml – name: on behalf of the ASPIRE programme team
– name: ASPIRE programme team
DBID C6C
AAYXX
CITATION
CGR
CUY
CVF
ECM
EIF
NPM
3V.
7X7
7XB
88E
8FI
8FJ
8FK
ABUWG
AFKRA
AZQEC
BENPR
CCPQU
DWQXO
FYUFA
GHDGH
K9.
M0S
M1P
PHGZM
PHGZT
PIMPY
PJZUB
PKEHL
PPXIY
PQEST
PQQKQ
PQUKI
PRINS
7X8
5PM
DOA
DOI 10.1186/s13012-021-01166-4
DatabaseName Springer Nature OA Free Journals
CrossRef
Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
ProQuest Central (Corporate)
Health & Medical Collection
ProQuest Central (purchase pre-March 2016)
Medical Database (Alumni Edition)
Hospital Premium Collection
Hospital Premium Collection (Alumni Edition)
ProQuest Central (Alumni) (purchase pre-March 2016)
ProQuest Central (Alumni)
ProQuest Central UK/Ireland
ProQuest Central Essentials - QC
ProQuest Central
ProQuest One Community College
ProQuest Central Korea
Health Research Premium Collection
Health Research Premium Collection (Alumni)
ProQuest Health & Medical Complete (Alumni)
ProQuest Health & Medical Collection
Medical Database
ProQuest Central Premium
ProQuest One Academic
ProQuest Publicly Available Content Database
ProQuest Health & Medical Research Collection
ProQuest One Academic Middle East (New)
ProQuest One Health & Nursing
ProQuest One Academic Eastern Edition (DO NOT USE)
ProQuest One Academic (retired)
ProQuest One Academic UKI Edition
ProQuest Central China
MEDLINE - Academic
PubMed Central (Full Participant titles)
DOAJ Directory of Open Access Journals
DatabaseTitle CrossRef
MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
Publicly Available Content Database
ProQuest One Academic Middle East (New)
ProQuest Central Essentials
ProQuest Health & Medical Complete (Alumni)
ProQuest Central (Alumni Edition)
ProQuest One Community College
ProQuest One Health & Nursing
ProQuest Central China
ProQuest Central
ProQuest Health & Medical Research Collection
Health Research Premium Collection
Health and Medicine Complete (Alumni Edition)
ProQuest Central Korea
Health & Medical Research Collection
ProQuest Central (New)
ProQuest Medical Library (Alumni)
ProQuest One Academic Eastern Edition
ProQuest Hospital Collection
Health Research Premium Collection (Alumni)
ProQuest Hospital Collection (Alumni)
ProQuest Health & Medical Complete
ProQuest Medical Library
ProQuest One Academic UKI Edition
ProQuest One Academic
ProQuest One Academic (New)
ProQuest Central (Alumni)
MEDLINE - Academic
DatabaseTitleList Publicly Available Content Database

MEDLINE
MEDLINE - Academic

Database_xml – sequence: 1
  dbid: DOA
  name: Directory of Open Access Journals
  url: https://www.doaj.org/
  sourceTypes: Open Website
– sequence: 2
  dbid: NPM
  name: PubMed
  url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 3
  dbid: PIMPY
  name: ProQuest Publicly Available Content Database
  url: http://search.proquest.com/publiccontent
  sourceTypes: Aggregation Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
Public Health
EISSN 1748-5908
EndPage 24
ExternalDocumentID oai_doaj_org_article_a988c5fd460541a3800e92d4d579e6b0
PMC8793205
35086528
10_1186_s13012_021_01166_4
Genre Research Support, Non-U.S. Gov't
Journal Article
GeographicLocations United Kingdom--UK
GeographicLocations_xml – name: United Kingdom--UK
GrantInformation_xml – fundername: Programme Grants for Applied Research
  grantid: RP-PG-1209-10040
  funderid: http://dx.doi.org/10.13039/501100007602
– fundername: ;
  grantid: RP-PG-1209-10040
GroupedDBID ---
0R~
29I
2WC
44B
53G
5GY
5VS
7X7
88E
8FI
8FJ
AAFWJ
AAJSJ
AASML
AAWTL
ABDBF
ABUWG
ACGFO
ACGFS
ACHQT
ACIHN
ACUHS
ADBBV
ADUKV
AEAQA
AENEX
AFKRA
AFPKN
AHBYD
AHMBA
AHYZX
ALMA_UNASSIGNED_HOLDINGS
AMKLP
AMTXH
AOIJS
BAPOH
BAWUL
BCNDV
BENPR
BFQNJ
BMC
BPHCQ
BVXVI
C6C
CCPQU
CS3
DIK
DU5
E3Z
EBD
EBLON
EBS
ESX
F5P
FYUFA
GROUPED_DOAJ
GX1
HMCUK
HYE
IAO
IHR
INH
INR
ITC
KQ8
M1P
M48
MK0
M~E
O5R
O5S
OK1
OVT
P2P
PGMZT
PHGZM
PHGZT
PIMPY
PJZUB
PPXIY
PQQKQ
PROAC
PSQYO
PUEGO
RBZ
RNS
ROL
RPM
RSV
SMD
SOJ
TR2
TUS
UKHRP
WOQ
WOW
~8M
AAYXX
AFFHD
CITATION
-5E
-5G
-A0
-BR
3V.
ACRMQ
ADINQ
ALIPV
C24
CGR
CUY
CVF
ECM
EIF
NPM
7XB
8FK
AZQEC
DWQXO
K9.
PKEHL
PQEST
PQUKI
PRINS
7X8
5PM
ID FETCH-LOGICAL-c540t-76aaf14b4782080c05bea49fecef0503fe207eab1d3aac83dbc5ca72effb70493
IEDL.DBID DOA
ISICitedReferencesCount 10
ISICitedReferencesURI http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000749581900001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN 1748-5908
IngestDate Fri Oct 03 12:43:43 EDT 2025
Tue Nov 04 01:57:31 EST 2025
Sun Nov 09 12:43:07 EST 2025
Wed Oct 15 14:30:14 EDT 2025
Thu Jan 02 22:53:52 EST 2025
Sat Nov 29 06:04:46 EST 2025
Tue Nov 18 20:52:07 EST 2025
Sat Sep 06 07:24:47 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 1
Keywords 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
Language English
License 2022. The Author(s).
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c540t-76aaf14b4782080c05bea49fecef0503fe207eab1d3aac83dbc5ca72effb70493
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ORCID 0000-0003-2519-2654
OpenAccessLink https://doaj.org/article/a988c5fd460541a3800e92d4d579e6b0
PMID 35086528
PQID 2630431957
PQPubID 54980
PageCount 24
ParticipantIDs doaj_primary_oai_doaj_org_article_a988c5fd460541a3800e92d4d579e6b0
pubmedcentral_primary_oai_pubmedcentral_nih_gov_8793205
proquest_miscellaneous_2623891247
proquest_journals_2630431957
pubmed_primary_35086528
crossref_primary_10_1186_s13012_021_01166_4
crossref_citationtrail_10_1186_s13012_021_01166_4
springer_journals_10_1186_s13012_021_01166_4
PublicationCentury 2000
PublicationDate 2022-01-27
PublicationDateYYYYMMDD 2022-01-27
PublicationDate_xml – month: 01
  year: 2022
  text: 2022-01-27
  day: 27
PublicationDecade 2020
PublicationPlace London
PublicationPlace_xml – name: London
– name: England
PublicationTitle Implementation science : IS
PublicationTitleAbbrev Implementation Sci
PublicationTitleAlternate Implement Sci
PublicationYear 2022
Publisher BioMed Central
Springer Nature B.V
BMC
Publisher_xml – name: BioMed Central
– name: Springer Nature B.V
– name: BMC
References J Cane (1166_CR10) 2012; 7
JC Brehaut (1166_CR26) 2016; 164
1166_CR11
CR May (1166_CR16) 2018; 13
N Ivers (1166_CR4) 2012; 6
S Michie (1166_CR9) 2005; 14
1166_CR15
TA Willis (1166_CR12) 2020; 17
1166_CR18
JM Grimshaw (1166_CR2) 2004; 8
1166_CR17
H Hasson (1166_CR27) 2010; 5
K Charmaz (1166_CR20) 2003
K Currie (1166_CR24) 2019; 101
C Sinnott (1166_CR28) 2018; 27
T Doran (1166_CR23) 2006; 355
MA O'Brien (1166_CR5) 2007; 4
RE Burke (1166_CR30) 2018; 27
NM Ivers (1166_CR3) 2014; 29
J Ritchie (1166_CR22) 2003
AJ Bellg (1166_CR19) 2004; 23
(ICEBeRG) ICEtBRG (1166_CR7) 2006; 1
C May (1166_CR14) 2009; 43
JE Szymczak (1166_CR25) 2014; 120
NK Gale (1166_CR21) 2013; 13
B Rushforth (1166_CR1) 2015; 16
E Etchells (1166_CR29) 2018; 27
1166_CR6
1166_CR8
L Atkins (1166_CR13) 2017; 12
References_xml – ident: 1166_CR8
  doi: 10.1186/s13012-016-0479-2
– volume: 120
  start-page: 252
  year: 2014
  ident: 1166_CR25
  publication-title: Soc Sci Med
  doi: 10.1016/j.socscimed.2014.09.023
– volume: 1
  start-page: 4
  year: 2006
  ident: 1166_CR7
  publication-title: Implement Sci
  doi: 10.1186/1748-5908-1-4
– volume: 355
  start-page: 375
  issue: 4
  year: 2006
  ident: 1166_CR23
  publication-title: N Engl J Med
  doi: 10.1056/NEJMsa055505
– volume: 27
  start-page: 254
  issue: 4
  year: 2018
  ident: 1166_CR30
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2017-007554
– ident: 1166_CR6
  doi: 10.1002/14651858.CD001096.pub2
– volume: 6
  start-page: CD000259
  year: 2012
  ident: 1166_CR4
  publication-title: Cochrane Database Syst Rev
– volume: 17
  start-page: e1003045
  issue: 2
  year: 2020
  ident: 1166_CR12
  publication-title: PLoS Med
  doi: 10.1371/journal.pmed.1003045
– ident: 1166_CR15
  doi: 10.1186/1741-7015-8-63
– ident: 1166_CR18
  doi: 10.3310/pgfar08040
– start-page: 219
  volume-title: Qualitative Research Practice: A guide for Social Science Students and Researchers
  year: 2003
  ident: 1166_CR22
– volume: 16
  start-page: 156
  issue: 1
  year: 2015
  ident: 1166_CR1
  publication-title: BMC Fam Pract
  doi: 10.1186/s12875-015-0350-6
– ident: 1166_CR11
  doi: 10.1186/s13012-017-0704-7
– volume: 13
  start-page: 117
  year: 2013
  ident: 1166_CR21
  publication-title: BMC Med Res Methodol
  doi: 10.1186/1471-2288-13-117
– volume: 14
  start-page: 26
  issue: 1
  year: 2005
  ident: 1166_CR9
  publication-title: Qual Saf Health Care
  doi: 10.1136/qshc.2004.011155
– volume: 27
  start-page: 176
  issue: 3
  year: 2018
  ident: 1166_CR28
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2017-007667
– volume: 4
  year: 2007
  ident: 1166_CR5
  publication-title: Cochrane Database Syst Rev
– volume: 23
  start-page: 443
  issue: 5
  year: 2004
  ident: 1166_CR19
  publication-title: Health Psychol
  doi: 10.1037/0278-6133.23.5.443
– volume: 7
  start-page: 37
  year: 2012
  ident: 1166_CR10
  publication-title: Implement Sci
  doi: 10.1186/1748-5908-7-37
– volume: 27
  start-page: 61
  issue: 1
  year: 2018
  ident: 1166_CR29
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2017-006963
– volume: 5
  start-page: 67
  year: 2010
  ident: 1166_CR27
  publication-title: Implement Sci
  doi: 10.1186/1748-5908-5-67
– volume: 13
  start-page: 80
  issue: 1
  year: 2018
  ident: 1166_CR16
  publication-title: Implement Sci
  doi: 10.1186/s13012-018-0758-1
– volume: 12
  start-page: 77
  issue: 1
  year: 2017
  ident: 1166_CR13
  publication-title: Implementation Sci
  doi: 10.1186/s13012-017-0605-9
– volume: 101
  start-page: 100
  year: 2019
  ident: 1166_CR24
  publication-title: J Hosp Infect
  doi: 10.1016/j.jhin.2018.08.006
– volume: 43
  start-page: 535
  issue: 3
  year: 2009
  ident: 1166_CR14
  publication-title: Sociology
  doi: 10.1177/0038038509103208
– volume: 8
  start-page: 1
  issue: 6
  year: 2004
  ident: 1166_CR2
  publication-title: Health Technol Asses
  doi: 10.3310/hta8060
– ident: 1166_CR17
  doi: 10.1186/1748-5908-9-2
– start-page: 249
  volume-title: Strategies of Qualitative Inquiry
  year: 2003
  ident: 1166_CR20
– volume: 164
  start-page: 435
  issue: 6
  year: 2016
  ident: 1166_CR26
  publication-title: Ann Intern Med
  doi: 10.7326/M15-2248
– volume: 29
  start-page: 1534
  issue: 11
  year: 2014
  ident: 1166_CR3
  publication-title: J Gen Intern Med
  doi: 10.1007/s11606-014-2913-y
SSID ssj0045463
Score 2.3776512
Snippet Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline...
Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations...
Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline...
Abstract Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline...
SourceID doaj
pubmedcentral
proquest
pubmed
crossref
springer
SourceType Open Website
Open Access Repository
Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage 9
SubjectTerms 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
SummonAdditionalLinks – databaseName: ProQuest Publicly Available Content Database
  dbid: PIMPY
  link: http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Lj9MwELagywEJ8X4EFmQkbhA18SN2uCBArODAqgeQlpPl2M5SsSSlj_0t_FxmHKdVeeyJazKp7PTzZ09m5htCnnGpVOkrcHIkZ7nQgcGSsjzX3kvFrOCCNbHZhDo-1icn9SyVR69SWuXIiZGoB7VnzNsGEp763uEX8ymrOKrC1FK9WvzIsYcUxlpTQ43L5ACFt_SEHMw-fJx9GZlZoPT7WDijq-kK-BsTExg61GVV5WJvc4oa_n87eP6ZP_lbEDXuTUc3_u-sbpLr6YxKXw-gukUuhe42uTZ84KND3dId8hOz94b2EvQcHG4swaIpO4T2LbUdtd4u1vH6_PuYpo44oOCnfwMeo-ueLmI6IDyZupvmuK16OhZv0TlYD4IYFJPUXlJLz3rssbTx2M-LLoZCB7pTLb9LPh-9-_T2fZ7aPOQOjovrXFXWtqVoBEr36cIVsglW1DDe0KJaTRtYoYJtSs-tdZr7xklnFYMpNQocHH6PTLq-Cw8I5aEFf883AZlJBt7U8FseSC1IFwoXMlKO_69xSQMdW3GcmegL6coMmDCACRMxYURGnm-fSRO-0PoNwmZrierd8UK_PDWJDIyttXay9RiTFrAy4NAeauYFLI86VE2RkcMRLSZRysrswJGRp9vbQAYY4bFd6DdowzDuzATY3B8wuh0Jh6N4JZnOiNpD795Q9-90869RcFwDibNCZuTFiPPdsP79Kh5ePItH5CrDUpKizJk6JJP1chMekyvufD1fLZ-kpfsLrDJWIQ
  priority: 102
  providerName: ProQuest
– databaseName: Springer LINK
  dbid: RSV
  link: http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1bb9UwDLZgIDQJcRkMCgMFiTeoaHNpUt4AMfHChLhpb1WapHDEaI_OZb-Fn4udpmc6MJDgtXUqt74kru3PAI-F0rr0FQY5SvBcmsDRpKzIjfdKcyuF5G0cNqGPjszxcf0uNYUtp2r3KSUZPXU0a1M9W6K3pTICTuFvWVW5vAiXcLszZI7vP3ye_K8kgPepPebcdVtbUETqP-94-XuV5C-p0rgDHV7_P95vwLV04mQvRhW5CRdCvwdX3qac-h5cHf_csbEh6Rb8oLK8cW4EO8VImnqrWCr7YEPHbM-st_NVvD77PtWfk4AZBuDf0EGx1cDmsc4PV6axpTntl55NXVlshtQj0gWj6rPnzLKTgYYnrT0N6mLzsYOBncGR34ZPh68_vnqTp_kNucNz4CrXlbVdKVtJmHymcIVqg5U18hs6gqHpAi90sG3phbXOCN865azm-EqtxshF7MNOP_ThLjAROgzkfBvI5agg2hqf5dFbBeVC4UIG5STSxiVwc5qxcdLEIMdUzSiCBkXQRBE0MoMnmzXphf9K_ZI0ZUNJsNzxwrD40iQrb2xtjFOdp2SzRJXH03iouZeo93Wo2iKDg0nPmuQrlg2vBCEc1Upn8GhzG62cUje2D8OaaDgllLlEmjujWm44EXjGrhQ3Gegthd1idftOP_sakcQNemdeqAyeTmp7xtafP8W9fyO_D7ucekaKMuf6AHZWi3V4AJfd6Wq2XDyMtvsTK31CUA
  priority: 102
  providerName: Springer Nature
Title Explaining variable effects of an adaptable implementation package to promote evidence-based practice in primary care: a longitudinal process evaluation
URI https://link.springer.com/article/10.1186/s13012-021-01166-4
https://www.ncbi.nlm.nih.gov/pubmed/35086528
https://www.proquest.com/docview/2630431957
https://www.proquest.com/docview/2623891247
https://pubmed.ncbi.nlm.nih.gov/PMC8793205
https://doaj.org/article/a988c5fd460541a3800e92d4d579e6b0
Volume 17
WOSCitedRecordID wos000749581900001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
journalDatabaseRights – providerCode: PRVADU
  databaseName: BioMedCentral
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: RBZ
  dateStart: 20060101
  isFulltext: true
  titleUrlDefault: https://www.biomedcentral.com/search/
  providerName: BioMedCentral
– providerCode: PRVAON
  databaseName: Directory of Open Access Journals
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: DOA
  dateStart: 20060101
  isFulltext: true
  titleUrlDefault: https://www.doaj.org/
  providerName: Directory of Open Access Journals
– providerCode: PRVHPJ
  databaseName: ROAD: Directory of Open Access Scholarly Resources
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: M~E
  dateStart: 20060101
  isFulltext: true
  titleUrlDefault: https://road.issn.org
  providerName: ISSN International Centre
– providerCode: PRVPQU
  databaseName: AUTh Library subscriptions: ProQuest Central
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: BENPR
  dateStart: 20090101
  isFulltext: true
  titleUrlDefault: https://www.proquest.com/central
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: Health Medical collection
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: 7X7
  dateStart: 20090101
  isFulltext: true
  titleUrlDefault: https://search.proquest.com/healthcomplete
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: ProQuest Publicly Available Content Database
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: PIMPY
  dateStart: 20090101
  isFulltext: true
  titleUrlDefault: http://search.proquest.com/publiccontent
  providerName: ProQuest
– providerCode: PRVAVX
  databaseName: SpringerLINK Contemporary 1997-Present
  customDbUrl:
  eissn: 1748-5908
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0045463
  issn: 1748-5908
  databaseCode: RSV
  dateStart: 20061201
  isFulltext: true
  titleUrlDefault: https://link.springer.com/search?facet-content-type=%22Journal%22
  providerName: Springer Nature
link http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1Lj9MwELZg4YCEEG8CS2UkbhBt4kfscGPRruBAVS0PlZPl2I6oWNJqm-5v4ecyYyddyvPCpVKSiTXxjMcz9cw3hDzlUqnSVxDkSM5yoQODJWV5rr2XilnBBWtiswk1ner5vJ790OoLc8ISPHCauANba-1k6_H8TsAo4OCEmnkBQ9WhamK0Dl7PGEwlGywQ5H0skdHVwRosNaYgMAydy6rKxc42FNH6f-di_pop-dNxadyFjm-SG4P7SF8mtm-RS6G7Ta6n_95oKim6Q75hYl3q_EDPIRbG6ig6JG7QZUttR623qz7eX3wdM8hRRBRC6C9gYmi_pKuYqQdvDo1Hc9zxPB3rqugCqBNWBcX8sRfU0tMltj_aeGy1RVepBoFeAIrfJR-Oj96_ep0PHRhyB55cn6vK2rYUjUBUPV24QjbBihr4DS0CybSBFSrYpvTcWqe5b5x0VjH4pEZB7MHvkb1u2YUHhPLQQijmm4BGQwbe1DCWB3sTpAuFCxkpR4EYN8CTY5eMUxPDFF2ZJEQDQjRRiEZk5Nn2neGD_0p9iHLeUiKwdrwB6mYGdTP_UreM7I9aYobVvjas4ohRVEuVkSfbx7BO8fDFdmG5QRqGR8JMAM39pFRbTjh4yZVkOiNqR912WN190i0-RyxwDfaVFTIjz0fFvGDrz1Px8H9MxSNyjWEtSFHmTO2Tvf5sEx6Tq-68X6zPJuSymqv4qyfkyuHRdHYyiWsUrmZv3s4-wdXJu4_fASFUQLo
linkProvider Directory of Open Access Journals
linkToHtml http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Zb9QwELZKQQIJcR-BAkaCJ4ia-IgdJIS4qlYtKx6KtG-uYzuwYkmWPYr4J_wKfiMzOXa1HH3rA6-JEznOzOcZz_ER8ohLpVKfgZMjOYuFDgxUyvJYey8Vs4ILVjRkE2ow0MNh_n6D_OxrYTCtssfEBqh97fCMfJtlHPvA5FK9mHyNkTUKo6s9hUYrFvvh-zdw2WbP997A_33M2M7bw9e7cccqEDuwTuaxyqwtU1EI7BSnE5fIIliRl8GFEpujlIElKtgi9dxap7kvnHRWsVCWhQJ7msN7z5CzgOMKU8jUcOngCWwt3xfm6Gx7BvsDJj4wdNjTLIvF2ubXcAT8zbD9Mz_ztyBts_ftXP7fVu0KudRZ2fRlqxZXyUaorpGL7RElbSuvrpMfmH_YEmTQYwuKWIwD7fJbaF1SW1Hr7WTeXB996RPtUZLpxLrPgMR0XtNJk9AIT3b8rDEaBp725Wd0BKPblh4U0-yeUUvHNbJELTwyktFJW6pBV33Xb5APp7I4N8lmVVfhNqE8lOCx-iIgtsrAixze5QGWg3QhcSEiaS9BxnVd3JFMZGwab05nppU6A1JnGqkzIiJPls90H3zi6FcomMuR2H-8uVBPP5oOzozNtXay9BhVF6Db4HaEnHkBCp6HrEgistXLo-lAcWZWwhiRh8vbAGcYo7JVqBc4hmHknAkYc6vVguVMODgTmWQ6ImpNP9amun6nGn1qWqZr2IZYIiPytNek1bT-vRR3Tv6KB-T87uG7A3OwN9i_Sy4wLIxJ0pipLbI5ny7CPXLOHc9Hs-n9BiYoOTptDfsFQNipXA
linkToPdf http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1Zb9QwELagoKoS4ihXoICReIOoiY_Y4Y1rBQJWlTjUN8uJHVi1JKvdbH8LP5cZO9myUJAQr8l4Ze8cnsnMfEPIIy6Vyl0BQY7kLBXaM1Apy1PtnFTMCi5YFYZNqOlUHx6WBz918Ydq9zElGXsaEKWp7ffnrokqrov9JVheLClgGArnRZGK8-SCwKFBGK9_-DzaYoFg72OrzJnrNq6jgNp_lqv5e8XkL2nTcBtNrvz_Oa6Sy4MnSp9F0blGzvl2l2y_H3Ltu-RS_KJHY6PSdfIdy_XiPAl6AhE29lzRoRyEdg21LbXOzvvwfPZtrEtHxlMIzI_AcNG-o_NQ_wcrh3GmKd6jjo7dWnQG1BEBg2JV2lNq6XGHQ5VWDgd40XnsbKCnMOU3yKfJq48vXqfDXIe0Bv-wT1VhbZOLSiBWn87qTFbeihL26xuEp2k8y5S3Ve64tbXmrqplbRWDI1UKIhp-k2y1XetvE8p9AwGeqzyaIul5VcJvObBiXtY-q31C8pG9ph5Az3H2xrEJwY8uTGSBARaYwAIjEvJ4vWY48F-pn6PUrCkRrjs86BZfzKD9xpZa17JxmIQWoArgpfuSOQH6UPqiyhKyN8qcGWzI0rCCI_JRKVVCHq5fg_ZjSse2vlshDcNEMxNAcyuK6HonHHzvQjKdELUhvBtb3XzTzr4GhHENVptlMiFPRhE-3daf_4o7_0b-gGwfvJyYd2-mb--SHYZtJVmeMrVHtvrFyt8jF-uTfrZc3A8q_QOqd04Y
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Explaining+variable+effects+of+an+adaptable+implementation+package+to+promote+evidence-based+practice+in+primary+care%3A+a+longitudinal+process+evaluation&rft.jtitle=Implementation+science+%3A+IS&rft.au=Liz+Glidewell&rft.au=Cheryl+Hunter&rft.au=Vicky+Ward&rft.au=Rosemary+R.+C.+McEachan&rft.date=2022-01-27&rft.pub=BMC&rft.eissn=1748-5908&rft.volume=17&rft.issue=1&rft.spage=1&rft.epage=24&rft_id=info:doi/10.1186%2Fs13012-021-01166-4&rft.externalDBID=DOA&rft.externalDocID=oai_doaj_org_article_a988c5fd460541a3800e92d4d579e6b0
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1748-5908&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1748-5908&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1748-5908&client=summon