Developing a learning health system: Insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care

Abstract

IntroductionDevelopments in information technology offer opportunities to enhance medication safety in primary care. We evaluated the implementation and adoption of a complex pharmacist-led intervention involving the use of an electronic audit and feedback surveillance dashboard to identify patients potentially at risk of hazardous prescribing or monitoring of medicines in general practices. The intervention aimed to create a rapid learning health system for medication safety in primary care. This study aimed to explore how the intervention was implemented, adopted and embedded into practice using a qualitative process evaluation.MethodsTwenty two participants were purposively recruited from eighteen out of forty-three general practices receiving the intervention as well as clinical commissioning group staff across Salford UK, which reflected the range of contexts in which the intervention was implemented. Interviews explored how pharmacists and GP staff implemented the intervention and how this affected care practice. Data analysis was thematic with emerging themes developed into coding frameworks based on Normalisation Process Theory (NPT).ResultsEngagement with the dashboard involved a process of sense-making in which pharmacists considered it added value to their work. The intervention helped to build respect, improve trust and develop relationships between pharmacists and GPs. Collaboration and communication between pharmacists and clinicians was primarily initiated by pharmacists and was important for establishing the intervention. The intervention operated as a rapid learning health system as it allowed for the evidence in the dashboard to be translated into changes in work practices and into transformations in care.ConclusionsOur study highlighted the importance of the combined use of information technology and the role of pharmacists working in general practice settings. Medicine optimisation activities in primary care may be enhanced by the implementation of a pharmacist-led electronic audit and feedback system. This intervention established a rapid learning health system that swiftly translated data from electronic health records into changes in practice to improve patient care. Using NPT provided valuable insights into the ways in which developing relationships, collaborations and communication between health professionals could lead to the implementation, adoption and sustainability of the intervention.

Implementing a social network intervention: can the context for its workability be created? A quasi-ethnographic study

“…The second implication returns to the point made by Jefferies et al [ 15 , 16 ], which highlights the importance of communication between networks. It is the experience here that a significant element of the work was hidden to maintain relationships between members of the implementation network.…”

“…This was most noticeable in terms of the effect the infrastructure required for implementation [ 19 ]. The process experienced here hints towards the local health and social care community operating at capacity with limited resource availability or flex to perform the work necessary for successful implementation as the required facets were created directly by the implementation network [ 15 , 16 ].…”

“…Second, community-oriented SMS involves contact with the voluntary and community sector and encourages individuals to connect to, and engage with, their local community. Consequently, the role of network processes are likely to be drivers of implementation [ 14 ] and therefore crucial to explore, for example; understanding the way different organisations interact as a means of improving communication, building and reshaping existing relationships and increasing knowledge regarding the developing value of the intervention and sense of co-ownership [ 15 , 16 ]. With a focus on ‘local flexibility’, it is relevant to understand how SMS interventions can be successfully implemented in the light of the acknowledgement that these are likely to have (unfulfilled) potential to address the physical, social and psychological needs of people with long-term conditions [ 17 , 18 ].…”

Understanding the utilisation of a novel interactive electronic medication safety dashboard in general practice: a mixed methods study

“…The dashboard, that is refreshed daily, provides feedback about identified patients exposed to potentially hazardous prescribing and inadequate blood-test monitoring. A previous qualitative study specifically explored the ways in which the full SMASH intervention was adopted, implemented and embedded in general practices and revealed that the success of this work was critically dependent upon the pivotal role of the pharmacist and how they and other clinicians and staff members interacted with each other to create a learning health system [18]. This previous qualitative study focused on the ways in which the intervention was integrated into practice and drew upon Normalisation Process Theory to understand this process [19].…”

Implementing, embedding and sustaining simulation‐based education: What helps, what hinders

“…Normalisation process theory is based on the premise that ‘interventions become routinely embedded in their organisational and professional contexts as the result of people working, individually and collectively, to implement them’ 20 . Although there is much overlap between implementation theories, 21 NPT was chosen from other implementation frameworks as NPT offers a comprehensive explanation of implementation processes 22 and a valuable approach to researching SBE with participants in different contexts and at different stages of the process 23,24 …”