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Implementing emergency admission risk prediction in general practice: a qualitative study.

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Implementing predictive risk stratification software in general practice led to increased hospital admissions without clear patient benefits. Further research is needed on the effects of these tools in primary care.

Keywords:
chronic diseaseemergency service, hospitalgeneral practicehealth risk appraisalhealth service evaluationqualitative research

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Health Informatics

Background:

  • Predictive risk stratification software for emergency hospital admissions is advocated in general practice, but evidence of its effects is limited.
  • A trial of the Predictive Risk Stratification Model (PRISM) showed increased emergency admissions and NHS service use without patient or NHS benefits.

Purpose of the Study:

  • To explore General Practitioners' (GPs) and practice managers' experiences with integrating PRISM into routine general practice.
  • To understand the implementation and perceived impact of predictive risk stratification tools.

Main Methods:

  • Semi-structured interviews were conducted with 22 GPs and practice managers across 18 practices in various settings.
  • Interviews occurred 3-6 months and ~18 months after PRISM access.
  • Thematic analysis using Normalisation Process Theory guided data analysis.

Main Results:

  • The decision to use PRISM was often driven by Quality and Outcomes Framework incentives.
  • PRISM use involved technical tasks and minor care adjustments, but integration issues with practice systems were a barrier.
  • Participants reported increased awareness of high-risk patients and some impact on individual care, despite doubts about large-scale effects.

Conclusions:

  • Qualitative findings indicate mixed views on predictive risk stratification in general practice.
  • Awareness of high-risk patients may influence unplanned hospital attendance and admissions.
  • More information on the implementation and effects of emergency admission risk stratification tools in primary care is needed for policy decisions.