Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory

BackgroundEffective implementation of technologies into clinical workflow is hampered by lack of integration into daily activities. Normalisation process theory (NPT) can be used to describe the kinds of ‘work’ necessary to implement and embed complex new practices. We determined the suitability of NPT to assess the facilitators, barriers and ‘work’ of implementation of two clinical decision support (CDS) tools across diverse care settings.MethodsWe conducted baseline and 6-month follow-up quantitative surveys of clinic leadership at two academic institutions’ primary care clinics randomised to the intervention arm of a larger study. The survey was adapted from the NPT toolkit, analysing four implementation domains: sense-making, participation, action, monitoring. Domains were summarised among completed responses (n=60) and examined by role, institution, and time.ResultsThe median score for each NPT domain was the same across roles and institutions at baseline, and decreased at 6 months. At 6 months, clinic managers’ participation domain (p=0.003), and all domains for medical directors (p<0.003) declined. At 6 months, the action domain decreased among Utah respondents (p=0.03), and all domains decreased among Wisconsin respondents (p≤0.008).ConclusionsThis study employed NPT to longitudinally assess the implementation barriers of new CDS. The consistency of results across participant roles suggests similarities in the work each role took on during implementation. The decline in engagement over time suggests the need for more frequent contact to maintain momentum. Using NPT to evaluate this implementation provides insight into domains which can be addressed with participants to improve success of new electronic health record technologies.Trial registration numberNCT02534987.

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Correction: Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

PLoS ONE ◽

10.1371/journal.pone.0181893 ◽

2017 ◽

Vol 12 (7) ◽

pp. e0181893 ◽

Cited By ~ 2

Author(s):

Pauline O’Reilly ◽

Siew Hwa Lee ◽

Madeleine O’Sullivan ◽

Walter Cullen ◽

Catriona Kennedy ◽

...

Keyword(s):

Primary Care ◽

Interdisciplinary Team ◽

Integrative Review ◽

Process Theory ◽

Normalisation Process Theory ◽

Team Working ◽

Facilitators And Barriers

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Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2014.07.013 ◽

2014 ◽

Vol 36 (6) ◽

pp. 575-580 ◽

Cited By ~ 6

Author(s):

Joseph M. Cerimele ◽

Abigail C. Halperin ◽

Clarence Spigner ◽

Anna Ratzliff ◽

Wayne J. Katon

Keyword(s):

Primary Care ◽

Bipolar Disorder ◽

Qualitative Study ◽

Collaborative Care

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Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production

BMJ Open ◽

10.1136/bmjopen-2017-019966 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019966 ◽

Cited By ~ 20

Author(s):

Michelle Farr ◽

Jonathan Banks ◽

Hannah B Edwards ◽

Kate Northstone ◽

Elly Bernard ◽

...

Keyword(s):

Primary Care ◽

Mixed Method ◽

Process Theory ◽

Normalisation Process Theory ◽

Free Text ◽

Method Evaluation ◽

Current Form ◽

Financial Investment ◽

Face To Face ◽

Consultation System

ObjectivesTo examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved.DesignMixed-method evaluation of a primary care e-consultation system.SettingPrimary care practices in South West England.MethodsQualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients’ records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients’ and staff touchpoints.ResultsWe found different expectations between patients and staff on how to use e-consultations ‘appropriately’. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation.ConclusionsWhere both patients and staff interact with technology, it is in effect ‘co-implemented’. How patients used e-consultations impacted on practice staff’s experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints.

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Exploring the scope for Normalisation Process Theory to help evaluate and understand the processes involved when scaling up integrated models of care: a case study of the scaling up of the Gnosall memory service

Journal of Integrated Care ◽

10.1108/jica-11-2018-0072 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Michael Clark ◽

David Jolley ◽

Susan Mary Benbow ◽

Nicola Greaves ◽

Ian Greaves

Keyword(s):

Primary Care ◽

Scale Up ◽

Scaling Up ◽

Process Theory ◽

Normalisation Process Theory ◽

Small Scale ◽

Content Type ◽

Service Models ◽

Integrated Service

PurposeThe scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).Design/methodology/approachThe article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.FindingsNPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.Research limitations/implicationsThe research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.Practical implicationsNPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.Social implicationsNPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.Originality/valueThis paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.

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