Journal
BMC HEALTH SERVICES RESEARCH
Volume 14, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12913-014-0594-1
Keywords
Cluster trial; Pragmatic trial; Point of care; Antibiotic utilisation; Primary care; Implementation science
Categories
Funding
- Electronic Patient Records and Databases in Research, a partnership between the Wellcome Trust
- Medical Research Council, Economics & Social Research Council and Engineering & Physical Sciences Research Council
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's
- St Thomas' NHS Foundation Trust
- King's College London
- MHRA
- Wellcome Trust
- Medical Research Council
- NIHR Health Technology Assessment programme
- Innovative Medicine Initiative
- UK Department of Health
- Technology Strategy Board
- Seventh Framework Programme EU
- various universities
- contract research organisations and pharmaceutical companies
- GlaxoSmithKline
- Novo Nordisk
- private-public funded Top Institute Pharma
- Dutch Medicines Evaluation Board
- Dutch Ministry of Health
- Economic and Social Research Council [ES/F029624/1] Funding Source: researchfish
- Medical Research Council [MC_PC_13042, MR/K006665/1] Funding Source: researchfish
- National Institute for Health Research [RP-PG-0407-10098] Funding Source: researchfish
- ESRC [ES/F029624/1] Funding Source: UKRI
- MRC [MR/K006665/1] Funding Source: UKRI
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Background: The study aimed to conduct a process evaluation for a cluster randomised trial of a computer-delivered, point-of-care intervention to reduce antibiotic prescribing in primary care. The study aimed to evaluate both the intervention and implementation of the trial. Methods: The intervention comprised a set of electronic educational and decision support tools that were remotely installed and activated during consultations with patients with acute respiratory infections over a 12 month intervention period. A mixed method evaluation was conducted with 103 general practitioners (GPs) who participated in the trial. Semi-structured telephone interviews were conducted with 20 GPs who had been in the intervention group of the trial and 4 members of the implementation staff. Questionnaires, consisting of both intervention evaluation and theory-based measures, were self-administered to 83 GPs (56 control group and 27 intervention group). Results: Interviews suggested that a key factor influencing GPs' use of the intervention appeared to be their awareness of the implementation of the system into their practice. GPs who were aware of the implementation of the intervention reported feeling confident in using it if they chose to and understood the purpose of the intervention screens. However, GPs who were unaware that the intervention would be appearing often reported feeling confused when they saw the messages appear on the screen and not fully understanding what they were for or how they could be used. Intervention evaluation questionnaires indicated that GPs were satisfied with the usability of the prompts, and theory-based measures revealed that intervention group GPs reported higher levels of self-efficacy in managing RTI patients according to recommended guidelines compared to GPs in the control group. Conclusions: Remote installation of a computer-delivered intervention for use at the point-of-care was feasible and acceptable. Additional measures to promote awareness of the intervention may be required to promote health care professionals' utilisation of the intervention and these might sometimes compromise the pragmatic intention of a trial.
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