scholarly journals Motivations for the Adoption of Chronic Disease Information Systems in General Practice

2009 ◽  
Vol 4 (1) ◽  
Author(s):  
Daniel Carbone ◽  
Stephen Burgess
Keyword(s):  
Risk Management ◽  
General Practice ◽  
Information Systems ◽  
Patient Care ◽  
Financial Incentives ◽  
Successful Implementation ◽  
Care Gap ◽  
Disease Information ◽  
General Practices

The purpose of this paper is to highlight the key motivational factors that lead to the successful implementation of Chronic Diseases Information Systems (CDISs) in twenty eight general practices in a case study of a large general practice division network in Australia. The literature identified three major areas of CDIS motivation: patient care gap motivator, internal motivators and external motivators. Patient care emerged as the most important motivation for adopting CDIS, followed by risk management and financial incentives. However, the study also determined that the motivational forces are inter-related and suggests that the decision to adopt CDIS should consider a number of these identified factors.

scholarly journals Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Edwina Brown ◽  
Lucie Rychetnik
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Care ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Full Potential ◽  
Australian General Practice ◽  
General Practices

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

scholarly journals Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031245
Author(s):  
Johanna Forstner ◽  
Aline Kunz ◽  
Cornelia Straßner ◽  
Lorenz Uhlmann ◽  
Stephanie Kuemmel ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Care ◽  
Process Evaluation ◽  
Study Protocol ◽  
Care Providers ◽  
Total N ◽  
Outcomes Evaluation ◽  
Quasi Experimental ◽  
Discharge Model ◽  
General Practices

IntroductionHospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals.Methods and analysisThe process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models.Ethics and disseminationEthics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences.Trial registration numberhttp://www.drks.de/DRKS00015183.Trial statusThe study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.

scholarly journals A Tale of Two Systems: Success and Failure in a Single Information System Implementation

2021 ◽  
Author(s):  
Catherine A. Middleton
Keyword(s):  
Information System ◽  
Information Systems ◽  
System Design ◽  
Successful Implementation ◽  
System Implementation ◽  
Secondary Users ◽  
Primary Users ◽  
Systems Implementation ◽  
The University

This paper presents a case study of an information system implementation. The system, a computerized student record system, was introduced into a small university when the university opened. Unlike many other case studies of systems implementation, there was no existing system to replace, thus it was expected that there would be little resistance to the system. Successful implementation was anticipated, particularly as the systems designers were also the primary users. An evaluation of the system shows this was not the case. Two groups of users are identified, one pleased with the system, the other dissatisfied. The secondary users did not display their dissatisfaction with the system by resistance, however. They used the system frequently, but were denied the full access they required to do their jobs. Ostensibly due to technical limitations of the system, the primary users acted as gatekeepers. An examination of the culture and management structure of the university reveals strong political motivations for the primary users to exert power over the secondary users. Markus’s (1983) interpretation of interaction theory is used to discuss the political implications of the system design. It is concluded that senior management must be aware of the importance of information systems to their organizations, and understand the potential for designers to use these systems as sources of power. The case study is reconstructed from the author’s experiences as a staff member at the university during the system implementation, initially as a primary user of the system (but not an active member of the system design team), and later as a secondary user. The case is evaluated from the perspective of both user groups, using a framework derived from the literature on information systems failure and successful systems implementation.

scholarly journals Dealing with unpredictable risk - The influence of external factors on information systems development and implementations

2021 ◽  
Author(s):  
◽  
Ettiene Esterhuizen
Keyword(s):  
Risk Factors ◽  
Risk Management ◽  
Project Management ◽  
Information Systems ◽  
Systems Development ◽  
Information Systems Development ◽  
Management Processes ◽  
Huge Impact ◽  
Risk Processes

<p>Organisations and especially Government departments develop information systems for their own specific needs, due to this Government departments invests a great deal in information systems development and implementation projects. The intention is to save on cost and develop information systems according to their needs and requirements. Unfortunately such projects are vulnerable and subject to a range of risks.  This case study identifies the risk factors involved in information systems development and implementation projects and the risk processes that are in place to mitigate against those risk factors. Furthermore the case study investigates an information systems development and implementation project where four legacy systems were to be merged into one newly developed system. The project was interrupted when an organisational merger resulted in the loss of key members of the governance board and the project team, either through redundancy or being allocated other responsibilities within the organisation. This exposed the project to unpredictable risk which caused the project to head down the path of possible failure.  The case study outlines the project plan, what actually happened and what according to the interviewed participants happened during the project. It is clear that the risk management processes wasn't followed and that wrongful decisions were made during the organisational merger. Unpredictable risks as a result of the merger and the decision to continue the project required a strong governance board, proper project management, proper risk management and the execution of the risk management processes. The lack of governance and project management had a huge impact on the project while the loss of expertise and knowledge added to the risk profile which resulted in further complications to the project. It’s during these situation that a strong governance board and proper project management is needed to make those critical decisions and steer the project towards success.</p>

scholarly journals Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

2018 ◽  
Vol 68 (669) ◽  
pp. e293-e300 ◽  
Author(s):  
Helen Atherton ◽  
Heather Brant ◽  
Sue Ziebland ◽  
Annemieke Bikker ◽  
John Campbell ◽  
...  
Keyword(s):  
General Practice ◽  
Participant Observation ◽  
Health Issues ◽  
Ethnographic Case Study ◽  
Structured Interviews ◽  
Face To Face ◽  
The Face ◽  
General Practices ◽  
The One

BackgroundNHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.AimTo understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.Design and settingFocused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.MethodNon-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report.ResultsCase study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.ConclusionExperience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

scholarly journals The implementation, use and sustainability of a clinical decision support system for medication optimisation in primary care: A qualitative evaluation

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250946
Author(s):  
Mark Jeffries ◽  
Nde-Eshimuni Salema ◽  
Libby Laing ◽  
Azwa Shamsuddin ◽  
Aziz Sheikh ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Medication Safety ◽  
Qualitative Evaluation ◽  
Clinical Decision ◽  
Population Characteristics ◽  
Successful Implementation ◽  
General Practices

Background The quality and safety of prescribing in general practice is important, Clinical decision support (CDS) systems can be used which present alerts to health professionals when prescribing in order to identify patients at risk of potentially hazardous prescribing. It is known that such computerised alerts may improve the safety of prescribing in hospitals but their implementation and sustainable use in general practice is less well understood. We aimed to understand the factors that influenced the successful implementation and sustained use in primary care of a CDS system. Methods Participants were purposively recruited from Clinical Commissioning Groups (CCGs) and general practices in the North West and East Midlands regions of England and from the CDS developers. We conducted face-to-face and telephone-based semi-structured qualitative interviews with staff stakeholders. A selection of participants was interviewed longitudinally to explore the further sustainability 1–2 years after implementation of the CDS system. The analysis, informed by Normalisation Process Theory (NPT), was thematic, iterative and conducted alongside data collection. Results Thirty-nine interviews were conducted either individually or in groups, with 33 stakeholders, including 11 follow-up interviews. Eight themes were interpreted in alignment with the four NPT constructs: Coherence (The purpose of the CDS: Enhancing medication safety and improving cost effectiveness; Relationship of users to the technology; Engagement and communication between different stakeholders); Cognitive Participation (Management of the profile of alerts); Collective Action (Prescribing in general practice, patient and population characteristics and engagement with patients; Knowledge);and Reflexive Monitoring (Sustaining the use of the CDS through maintenance and customisation; Learning and behaviour change. Participants saw that the CDS could have a role in enhancing medication safety and in the quality of care. Engagement through communication and support for local primary care providers and management leaders was considered important for successful implementation. Management of prescribing alert profiles for general practices was a dynamic process evolving over time. At regional management levels, work was required to adapt, and modify the system to optimise its use in practice and fulfil local priorities. Contextual factors, including patient and population characteristics, could impact upon the decision-making processes of prescribers influencing the response to alerts. The CDS could operate as a knowledge base allowing prescribers access to evidence-based information that they otherwise would not have. Conclusions This qualitative evaluation utilised NPT to understand the implementation, use and sustainability of a widely deployed CDS system offering prescribing alerts in general practice. The system was understood as having a role in medication safety in providing relevant patient specific information to prescribers in a timely manner. Engagement between stakeholders was considered important for the intervention in ensuring prescribers continued to utilise its functionality. Sustained implementation might be enhanced by careful profile management of the suite of alerts in the system. Our findings suggest that the use and sustainability of the CDS was related to prescribers’ perceptions of the relevance of alerts. Shared understanding of the purpose of the CDS between CCGS and general practices particularly in balancing cost saving and safety messages could be beneficial.

scholarly journals Design of the ZWOT-CASE study: an observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Suzanne Marchal ◽  
Monika Hollander ◽  
Marieke Schoenmakers ◽  
Michiel Schouwink ◽  
Jorik R. Timmer ◽  
...  
Keyword(s):  
Risk Management ◽  
General Practice ◽  
Cardiovascular Risk ◽  
Observational Study ◽  
Usual Care ◽  
Integrated Care ◽  
Ldl Cholesterol ◽  
Cvd Risk ◽  
Cardiovascular Risk Management

Abstract Background Cardiovascular diseases (CVD) contribute considerably to mortality and morbidity. Prevention of CVD by lifestyle change and medication is important and needs full attention. In the Netherlands an integrated programme for cardiovascular risk management (CVRM), based on the Chronic Care Model (CCM), has been introduced in primary care in many regions in recent years, but its effects are unknown. In the ZWOT-CASE study we will assess the effect of integrated care for CVRM in the region of Zwolle on two major cardiovascular risk factors: systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-cholesterol) in patients with or at high risk of CVD. Methods This study is a pragmatic observational study comparing integrated care for CVRM with usual care among patients aged 40–80 years with CVD (n = 370) or with a high CVD risk (n = 370) within 26 general practices. After 1 yr follow-up, primary outcomes (SBP and LDL-cholesterol level) are measured. Secondary outcomes include lifestyle habits (smoking, dietary habits, alcohol use, physical activity), risk factor awareness, 10-year risk of cardiovascular morbidity or mortality, health care consumption, patient satisfaction and quality of life. Conclusion The ZWOT-CASE study will provide insight in the effects of integrated care for CVRM in general practice in patients with CVD or at high CVD risk. Trial registration The ZWOlle Transmural Integrated Care for CArdiovaScular Risk Management Study; ClinicalTrials.gov; Identifier: NCT03428061; date of registration: 09-02-2018; This study has been retrospectively registered.

scholarly journals How did a Quality Premium financial incentive influence antibiotic prescribing in primary care? Views of Clinical Commissioning Group and general practice professionals

2020 ◽  
Vol 75 (9) ◽  
pp. 2681-2688 ◽  
Author(s):  
Aleksandra J Borek ◽  
Sibyl Anthierens ◽  
Rosalie Allison ◽  
Cliodna A M McNulty ◽  
Donna M Lecky ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Antibiotic Prescribing ◽  
Telephone Interviews ◽  
Local Resources ◽  
Additional Funding ◽  
General Practices ◽  
Competing Priorities

Abstract Background The Quality Premium (QP) was introduced for Clinical Commissioning Groups (CCGs) in England to optimize antibiotic prescribing, but it remains unclear how it was implemented. Objectives To understand responses to the QP and how it was perceived to influence antibiotic prescribing. Methods Semi-structured telephone interviews were conducted with 22 CCG and 19 general practice professionals. Interviews were analysed thematically. Results The findings were organized into four categories. (i) Communication: this was perceived as unstructured and infrequent, and CCG professionals were unsure whether they received QP funding. (ii) Implementation: this was influenced by available local resources and competing priorities, with multifaceted and tailored strategies seen as most helpful for engaging general practices. Many antimicrobial stewardship (AMS) strategies were implemented independently from the QP, motivated by quality improvement. (iii) Mechanisms: the QP raised the priority of AMS nationally and locally, and provided prescribing targets to aim for and benchmark against, but money was not seen as reinvested into AMS. (iv) Impact and sustainability: the QP was perceived as successful, but targets were considered challenging for a minority of CCGs and practices due to contextual factors (e.g. deprivation, understaffing). CCG professionals were concerned with potential discontinuation of the QP and prescribing rates levelling off. Conclusions CCG and practice professionals expressed positive views of the QP and associated prescribing targets and feedback. The QP helped influence change mainly by raising the priority of AMS and defining change targets rather than providing additional funding. To maximize impact, behavioural mechanisms of financial incentives should be considered pre-implementation.

Sign in / Sign up

Export Citation Format

Share Document