scholarly journals Implementation of remote asthma consulting in general practice in response to the COVID19 pandemic: evaluation using extended normalisation process theory

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0189
Author(s):  
Jonathan Stewart ◽  
Noleen McCorry ◽  
Helen Reid ◽  
Nigel Hart ◽  
Frank Kee
Keyword(s):  
General Practice ◽  
Healthcare System ◽  
Healthcare Professionals ◽  
Complex Interventions ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Asthma Care ◽  
Practice Staff ◽  
Willingness To Use

BackgroundThe COVID-19 pandemic has led to the rapid and reactive deployment of remote consulting in UK General Practice. The delivery of acute and chronic asthma care has been affected. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context-intervention interactions affect Implementation.AimTo explore the implementation of remote asthma consulting in UK General Practice in response to the COVID-19 pandemic.Design & settingMixed methods evaluation, informed by eNPT.SettingGeneral Practice in Northern Ireland.MethodData was collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews and multidisciplinary focus groups. Analysis was informed by eNPT.ResultsWe identified ten themes to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to in-person review. Having a practice champion to drive implementation forward, and engage other Practice staff, was important. Patient, staff and healthcare system contextual factors influencing implementation were identified including access to, understanding of and willingness to use the technology required for remote consulting.ConclusionThe experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it. Work is required at Practice and healthcare system levels to realise this potential, and ensure implementation does not exacerbate existing healthcare inequalities.

scholarly journals Normalisation process theory: a framework for developing, evaluating and implementing complex interventions

BMC Medicine ◽  
2010 ◽  
Vol 8 (1) ◽  
Author(s):  
Elizabeth Murray ◽  
Shaun Treweek ◽  
Catherine Pope ◽  
Anne MacFarlane ◽  
Luciana Ballini ◽  
...  
Keyword(s):  
Complex Interventions ◽  
Process Theory ◽  
Normalisation Process Theory

scholarly journals Achieving ‘coherence’ in routine practice: a qualitative case-based study to describe speech and language therapy interventions with implementation in mind

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Avril Nicoll ◽  
Margaret Maxwell ◽  
Brian Williams
Keyword(s):  
Empirical Work ◽  
Complex Interventions ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Speech And Language ◽  
Language Therapy ◽  
Speech And Language Therapy ◽  
Child Speech ◽  
Intervention Description ◽  
Case Based

Abstract Background Implementation depends on healthcare professionals being able to make sense of a new intervention in relation to their routine practice. Normalisation Process Theory refers to this as coherence work. However, specifying what it takes to achieve coherence is challenging because of variations in new interventions, routine practices and the relationship between them. Frameworks for intervention description may offer a way forward, as they provide broad descriptive categories for comparing complex interventions. To date such frameworks have not been informed by implementation theory, so do not account for the coherence work involved in holding aspects of routine practice constant while doing other aspects differently. Using speech and language therapy as an empirical exemplar, we explored therapists’ experiences of practice change and developed a framework to show how coherence of child speech interventions is achieved. Methods We conducted a retrospective case-based qualitative study of how interventions for child speech problems had changed across three NHS speech and language therapy services and private practice in Scotland. A coherence framework was derived through interplay between empirical work with 42 therapists (using in-depth interviews, or self-organised pairs or small focus groups) and Normalisation Process Theory’s construct of coherence. Findings Therapists reported a range of practice changes, which had demanded different types of coherence work. Non-traditional interventions had featured for many years in the profession’s research literature but not in clinical practice. Achieving coherence with these interventions was intellectually demanding because they challenged the traditional linguistic assumptions underpinning routine practice. Implementation was also logistically demanding, and therapists felt they had little agency to vary what was locally conventional for their service. In addition, achieving coherence took considerable relational work. Non-traditional interventions were often difficult to explain to children and parents, involved culturally uncomfortable repetitive drills and required therapists to do more tailoring of intervention for individual children. Conclusions The intervention coherence framework has practical and theoretical applications. It is designed to help therapists, services and researchers anticipate and address barriers to achieving coherence when implementing non-routine interventions. It also represents a worked example of using theory to make intervention description both user-focused and implementation-friendly.

scholarly journals Pharmacist-led adherence support in general practice: a qualitative interview study of adults with asthma

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032084 ◽  
Author(s):  
Marissa Ayano Mes ◽  
Caroline Brigitte Katzer ◽  
Vari Wileman ◽  
Amy Hai Yan Chan ◽  
Robert Horne ◽  
...  
Keyword(s):  
General Practice ◽  
Healthcare Professionals ◽  
Qualitative Interview ◽  
Semistructured Interview ◽  
Asthma Care ◽  
Online Questionnaire ◽  
Adherence Support ◽  
Qualitative Interview Study ◽  
Healthcare Model ◽  
The Uk

ObjectivesThe National Health Service (NHS) in England recently introduced general practice pharmacists (GPPs) to provide medication-focused support to both patients and the general practice team. This healthcare model may benefit people with asthma, who currently receive suboptimal care and demonstrate low medication adherence. This study aimed to explore the perspectives of adults with asthma on the potential for pharmacist-led adherence support delivered in general practice, with a focus on how these perspectives are formed.Design and settingThe study was conducted in the United Kingdom (UK) utilising a qualitative interview methodology. Participants were invited to partake in a telephone-based semistructured interview, followed by an online questionnaire for demographic details and asthma history. Qualitative data were analysed using thematic analysis.ParticipantsParticipants (n=17) were adults with asthma in the UK with a prescription for an inhaled corticosteroid. Participants did not have previous experience with GPPs and were asked to provide their views on a proposed GPP-led service.ResultsParticipant perspectives of GPPs were determined by trust in pharmacists, perceived gaps in asthma care and the perceived strain on the NHS. Trust was based on pharmacists’ perceived clinical competency, established over time, and gauged through a ‘benchmarking’ process. GPP’s fit in current asthma care was assessed based on potential role overlap with other healthcare professionals, continuity of care and medication-related support needs. Participants navigated the NHS based on a perceived hierarchy of healthcare professionals (general practitioners on top, nurses, then pharmacists), and this influenced their perspectives of GPPs.ConclusionWhile the GPP scheme shows promise based on the perspectives of people with asthma, the identified barriers to optimal patient engagement and service implementation will need to be addressed for the service to be effective.

scholarly journals General practice responses to opioid prescribing feedback: a qualitative process evaluation

2021 ◽  
pp. BJGP.2020.1117
Author(s):  
Su Wood ◽  
Robbie Foy ◽  
T. A. Willis ◽  
Paul Carder ◽  
Stella Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Process Evaluation ◽  
High Achievers ◽  
Normalisation Process Theory ◽  
Structured Interviews ◽  
Feedback Intervention ◽  
Practice Staff ◽  
Opioid Prescribing ◽  
Qualitative Process Evaluation

Background: The rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations and mortality. We developed and implemented an evidence-based bi-monthly feedback intervention to reduce opioid prescribing targeting 316 general practices in West Yorkshire over one year. Aim: To understand how general practice staff received and responded to the feedback intervention. Design and Setting: Qualitative process evaluation involving semi-structured interviews, guided by Normalisation Process Theory (NPT), of primary care healthcare professionals targeted by feedback. Method: We purposively recruited participants according to baseline opioid prescribing levels and degree of change following feedback. Interview data were coded to NPT constructs, and thematically analysed. Results: We interviewed 21 staff from 20 practices. Reducing opioid prescribing was recognised as a priority. Whilst high achievers had clear structures for quality improvement, feedback encouraged some less structured practices to embed changes. The non-prescriptive nature of the feedback reports allowed practices to develop strategies consistent with their own ways of working and existing resources. Practice concerns were allayed by the credibility of the reports and positive experiences of reducing opioid prescribing. The scale, frequency and duration of feedback may have ensured a good overall level of practice population reach. Conclusion: The intervention engaged general practice staff in change by targeting an issue of emerging concern and allowing adaption to different ways of working. Practice efforts to reduce opioid prescribing were reinforced by regular feedback, credible comparative data showing progress, and shared experiences of patient benefit.

scholarly journals Implementing person-centred outcome measures in palliative care: An exploratory qualitative study using Normalisation Process Theory to understand processes and context

2020 ◽  
pp. 026921632097204
Author(s):  
Andy Bradshaw ◽  
Martina Santarelli ◽  
Malene Mulderrig ◽  
Assem Khamis ◽  
Kathryn Sartain ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Outcome Measures ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Successful Implementation ◽  
Causal Mechanisms ◽  
Care Services ◽  
Palliative Care Services

Background: Despite evidence demonstrating the utility of using Person-Centred Outcome Measures within palliative care settings, implementing them into routine practice is challenging. Most research has described barriers to, without explaining the causal mechanisms underpinning, implementation. Implementation theories explain how, why, and in which contexts specific relationships between barriers/enablers might improve implementation effectiveness but have rarely been used in palliative care outcomes research. Aim: To use Normalisation Process Theory to understand and explain the causal mechanisms that underpin successful implementation of Person-Centred Outcome Measures within palliative care. Design: Exploratory qualitative study. Data collected through semi-structured interviews and analysed using a Framework approach. Setting/participants: 63 healthcare professionals, across 11 specialist palliative care services, were purposefully sampled by role, experience, seniority, and settings (inpatient, outpatient/day therapy, home-based/community). Results: Seven main themes were developed, representing the causal mechanisms and relationships underpinning successful implementation of outcome measures into routine practice. Themes were: Subjectivity of measures; Frequency and version of Integrated Palliative care Outcome Scale; Training, education, and peer support; Building and sustaining community engagement; Electronic system readiness; The art of communication; Reinforcing use through demonstrating value. Conclusions: Relationships influencing implementation resided at individual and organisational levels. Addressing these factors is key to driving the implementation of outcome measures into routine practice so that those using palliative care services can benefit from the systematic identification, management, and measurement of their symptoms and concerns. We provide key questions that are essential for those implementing and using outcome measures to consider in order to facilitate the integration of outcome measures into routine palliative care practice.

Implementing emergency admission risk prediction in general practice: a qualitative study

2021 ◽  
pp. BJGP.2021.0146
Author(s):  
Bridie Angela Evans ◽  
Jeremy Dale ◽  
Jan Davies ◽  
Hayley Hutchings ◽  
Mark Rhys Kingston ◽  
...  
Keyword(s):  
General Practice ◽  
Risk Stratification ◽  
Patient Care ◽  
Normalisation Process Theory ◽  
Small Scale ◽  
Routine Practice ◽  
Emergency Hospital ◽  
Number Of Patients ◽  
Short Period ◽  
Predictive Risk

Background: Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated despite limited evidence about effects. In a trial evaluating introduction of a predictive risk stratification model (PRISM), we reported statistically significant increases in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS. Aim: to explore experiences of incorporating PRISM into routine practice. Design and setting: semi-structured interviews with 22 general practitioners and practice managers in 18 practices in South Wales. Methods: Interviews at two timepoints: 3-6 months after gaining PRISM access; study end, approximately 18 months later. We analysed data thematically using Normalisation Process Theory. Results: Respondents reported the decision to use PRISM was based mainly on fulfilling reporting requirements for Quality and Outcome Framework (QOF) incentives. Most applied it to a very small number of patients for a short period. Using PRISM entailed technical tasks, information sharing within practice meetings and small-scale changes to patient care. Use was inhibited by PRISM not being integrated with practice systems. Most doubted any large scale impact, but cited examples of impact on individual patient care. They reported increased awareness of patients in high-risk groups. Conclusions: Qualitative results suggest mixed views of predictive risk stratification in general practice and raised awareness of highest-risk patient groups, potentially affecting unplanned hospital attendance and admissions. To inform future policy, decision-makers need more information about implementation and effects of emergency admissions risk stratification tools in primary and community settings.

scholarly journals Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029914
Author(s):  
Carl de Wet ◽  
Paul Bowie ◽  
Catherine A O'Donnell
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Science Literature ◽  
Leadership Roles ◽  
Structured Interviews ◽  
Theoretical Frameworks ◽  
Practice Nurses ◽  
Healthcare Interventions

ObjectivesPatient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.DesignQualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).SettingScottish general practice.ParticipantsWe conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.ResultsWe identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants’ involvement; (3) the characteristics of the reviewers—implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.ConclusionsThis study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.

Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study

2020 ◽  
Vol 37 (5) ◽  
pp. 711-718
Author(s):  
Oscar James ◽  
Karen Cardwell ◽  
Frank Moriarty ◽  
Susan M Smith ◽  
Barbara Clyne
Keyword(s):  
General Practice ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Approach ◽  
Structured Interviews ◽  
Practice Staff ◽  
Practice Nurses ◽  
Practice Team ◽  
Prescribing Quality ◽  
Descriptive Qualitative

Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.

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