BackgroundFacilitators are known to be influential in the implementation of evidence-based health care (EBHC). However, little evidence exists on what it is that they do to support the implementation process. This research reports on how knowledge transfer associates (KTAs) working as part of the UK National Institute for Health Research ‘Collaboration for Leadership in Applied Health Research and Care’ for Greater Manchester (GM CLAHRC) facilitated the implementation of EBHC across several commissioning and provider health care agencies.MethodsA prospective co-operative inquiry with eight KTAs was carried out comprising of 11 regular group meetings where they reflected critically on their experiences. Twenty interviews were also conducted with other members of the GM CLAHRC Implementation Team to gain their perspectives of the KTAs facilitation role and process.ResultsThere were four phases to the facilitation of EBHC on a large scale: (1) Assisting with the decision on what EBHC to implement, in this phase, KTAs pulled together people and disparate strands of information to facilitate a decision on which EBHC should be implemented; (2) Planning of the implementation of EBHC, in which KTAs spent time gathering additional information and going between key people to plan the implementation; (3) Coordinating and implementing EBHC when KTAs recruited general practices and people for the implementation of EBHC; and (4) Evaluating the EBHC which required the KTAs to set up (new) systems to gather data for analysis. Over time, the KTAs demonstrated growing confidence and skills in aspects of facilitation: research, interpersonal communication, project management and change management skills.ConclusionThe findings provide prospective empirical data on the large scale implementation of EBHC in primary care and community based organisations focusing on resources and processes involved. Detailed evidence shows facilitation is context dependent and that ‘one size does not fits all’. Co-operative inquiry was a useful method to enhance KTAs learning. The evidence shows that facilitators need tailored support and education, during the process of implementation to provide them with a well-rounded skill-set. Our study was not designed to demonstrate how facilitators contribute to patient health outcomes thus further prospective research is required.

The study has shown that alert cards can increase the involvement of CHFSNs in the ongoing care and discharge planning process. They can also empower patients and carers to take an active role in their own care.

IntroductionHeart failure (HF) is a complex and highly debilitating clinical syndrome. Clear guidelines identify the optimum management of patients living with HF in primary settings but implementation of these is suboptimal.AimThe aim of this service improvement project was to develop a tool kit, The Greater Manchester Heart Failure Investigation Tool (GM-HFIT), to improve the ongoing management of people diagnosed with HF.MethodsThe GM-HFIT development was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. A prospective, pre-test, post-test design informed an audit conducted between 13th February 2012 and 12th December 2013 with data from two clinical commissioning groups (CCGs) across North West Manchester.ResultsData from 1146 matched cases were analysed using McNemar tests (SPSS v20). Preliminary analysis suggests that at baseline, 22% of patients were not eligible to be on the HF register, which decreased to 15% after introduction of the tool (P < 0.001). The recording of blood pressure (BP) was high at both time points (95%), while the recording of pulse and rhythm improved from 58% to 64% and 44% to 49% respectively (P = 0.005). While control of BP remained the same (with 62% of patients with target BP <130/70), the proportion of patients receiving the target dose of ACE Inhibitors and beta blockers improved significantly (70% to 85% and 68% to 85% respectively, P < 0.001). In addition 578 missing patients were added to the heart failure register as a result of the case finding element of the project and a further 6 were recommended for further investigation before adding.ConclusionThe GM-HFIT service improvment project led to improvements in identification and management of patients with HF in primary care.

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