An adaptable implementation package targeting evidence-based indicators in primary care: A pragmatic...

Area of Science:

• Primary care research
• Health services research
• Implementation science

Background:

• Primary care faces challenges in bridging evidence and practice due to competing priorities.
• Existing implementation studies often lack generalizability by focusing on single conditions.
• This study evaluated an adaptable implementation package across multiple quality indicators.

Purpose of the Study:

• To compare an adaptable implementation package against a control for adherence to four evidence-based quality indicators in primary care.
• To assess the clinical and cost-effectiveness of the implementation package for various clinical areas.

Main Methods:

• Two parallel, pragmatic cluster-randomised trials with balanced incomplete block designs were conducted in West Yorkshire, England.
• An 'opt-out' recruitment strategy was used, randomizing 144 general practices to targeted implementation packages (diabetes, risky prescribing, blood pressure, or anticoagulation).
• The implementation package integrated behavior change techniques within audit and feedback, educational outreach, and computerized support, with tailored content.

Main Results:

• The implementation package significantly reduced risky prescribing (OR 0.82; p=0.017) and was cost-effective (£1,359 per QALY).
• No significant effects were found for diabetes control, blood pressure control, or anticoagulation prescribing in atrial fibrillation.
• A secondary outcome showed reduced co-prescription of aspirin and clopidogrel without gastro-protection in older patients (aOR 0.62; p=0.021).

Conclusions:

• A multifaceted implementation package demonstrated clinical and cost-effectiveness for prescribing behaviors controllable by clinicians.
• The package was less effective for complex behaviors requiring patient engagement.
• Limitations include inability to isolate effects of individual intervention components and a potentially too-challenging diabetes control endpoint.