scholarly journals Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Huddlestone ◽  
Jessica Turner ◽  
Helen Eborall ◽  
Nicky Hudson ◽  
Melanie Davies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Implementation Processes ◽  
Primary Care Settings ◽  
The Uk

scholarly journals Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings

2019 ◽  
Vol 26 (1) ◽  
pp. e100088
Author(s):  
Rebecca G Mishuris ◽  
Joseph Palmisano ◽  
Lauren McCullagh ◽  
Rachel Hess ◽  
David A Feldstein ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Implementation Barriers ◽  
Clinical Workflow ◽  
Primary Care Settings ◽  
Registration Number

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.

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

scholarly journals Effectiveness of physical activity promotion and exercise referral in primary care: protocol for a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jean-Pierre Laake ◽  
Joanna Fleming
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Primary Care ◽  
Sedentary Behaviour ◽  
Physical Activity Promotion ◽  
Self Report ◽  
Activity Promotion ◽  
Randomised Controlled ◽  
The Uk ◽  
Exercise Referral

Abstract Background Physical inactivity is the fourth leading risk factor for global mortality. Reducing sedentary behaviour and increasing physical activity are efficacious for improving many physical and mental health conditions including cardiovascular disease, type 2 diabetes and depression. Reducing sedentary behaviour and increasing physical activity can also be effective at reducing obesity; however, sedentary behaviour and reduced physical activity are also associated with mortality independently. Despite this, most adults in the UK do not currently meet the UK Chief Medical Officers’ guidelines for weekly physical activity. As most adults visit their general practitioner at least once a year, the primary care consultation provides a unique opportunity to deliver exercise referral or physical activity promotion interventions. This is a protocol for a systematic review of randomised controlled trials for the effectiveness of physical activity promotion and referral in primary care. Methods A comprehensive literature search of Embase, MEDLINE (Ovid), Web of Science (Core Collection), Scopus, CINAHL, PsycINFO, and The Cochrane Library (CENTRAL) will be conducted for studies with a minimum follow-up of 12 months that report physical activity as an outcome measure (by either self-report or objective measures) including an intention to treat analysis. The authors will screen papers, first by title and abstract and then by full text, independently assess studies for inclusion, appraise risk of bias and extract data. The quality of the evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) approach. The primary outcome will be participation in physical activity at 12 months. Pooled effects will be calculated using random effects models. Results will be submitted for publication in a peer-reviewed journal and for presentation at UK national primary care conferences. Discussion This systematic review and meta-analyses will summarise the evidence for the effectiveness of physical activity promotion and referral as interventions for improving physical activity, as well as whether studies using objective measures of physical activity have similar effects to those studies using self-report measures. This knowledge has importance for primary care clinicians, patients and, given the focus of the recent NHS long-term plan on preventive medicine, those making policy decisions. Systematic review registration The protocol is registered with PROSPERO the international prospective register of systematic reviews, ID CRD42019130831

scholarly journals Contribution of paramedics in primary and urgent care: a systematic review

2020 ◽  
Vol 70 (695) ◽  
pp. e421-e426 ◽  
Author(s):  
Georgette Eaton ◽  
Geoff Wong ◽  
Veronika Williams ◽  
Nia Roberts ◽  
Kamal R Mahtani
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Clinical Work ◽  
Ambulance Service ◽  
Urgent Care ◽  
Free Text ◽  
Clinical Role ◽  
Primary Care Workforce ◽  
The Uk

BackgroundWithin the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.AimTo provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.Design and settingA systematic review.MethodSearches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.ResultsIn total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.ConclusionCurrent published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

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

PLoS ONE ◽  
2017 ◽  
Vol 12 (7) ◽  
pp. e0181893 ◽  
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

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

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019966 ◽  
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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