Exploring implementation processes in general practice in a feedback intervention aiming to reduce potentially...

Area of Science:

• Health Services Research
• General Practice
• Quality Improvement

Background:

• Potentially inappropriate prescribing (PIP) is linked to adverse health outcomes and increased costs.
• Feedback interventions show promise for reducing PIP, but real-world implementation is challenging.
• Normalisation Process Theory (NPT) provides a framework to explore implementation in general practice.

Purpose of the Study:

• To explore the implementation processes of a real-life quality improvement intervention using feedback on practice-level prescribing in general practices.
• To understand how general practices enacted a feedback intervention targeting potentially inappropriate prescribing.

Main Methods:

• A prescribing feedback intervention was delivered to 376 general practices.
• Evaluation questionnaires were sent to all practices, with a 45% response rate.
• Semi-structured interviews were conducted with ten general practitioners (GPs) from practices that reported changes, analyzed thematically using NPT.

Main Results:

• Implementation processes aligned with the four NPT constructs.
• Motivators included professional values and pragmatic considerations (coherence).
• Observed approaches included collective and individual engagement (cognitive participation), and practice-level versus GP-level actions (collective action).
• Challenges included patient influences and competing priorities (reflexive monitoring), with varying degrees of internal evaluation and normalization.

Conclusions:

• NPT is a useful framework for understanding general practice implementation.
• Clear professional aims and feasible intervention content are key for GP motivation and uptake.
• Recognizing both practice-level and GP-level strategies is crucial for sustainable prescribing improvements.
• Competing demands and patient influences require further attention in future research to reduce PIP.