Investigating the barriers to implementation of new technology in primary eye care: a qualitative study

Optometric practices increasingly use ocular imaging as part of routine eye care. Alongside the increase in e-referral systems, the use of such images provides an opportunity for more accurate triaging of referrals, to ensure the most appropriate use of limited hospital resources. To encourage the incorporation of images into anterior eye pathology referrals, an NHS commissioner for Calderdale and Kirklees (West Yorkshire, UK) provided slit lamp mountable cameras to 20 local optometric practices. This study qualitatively explored the outcomes from this pilot study, identifying barriers and enablers for incorporating similar technology more widely.

Six months after receiving the camera, participating optometrists were contacted to discuss their experiences via semi-structured interviews. Opinions were also sought from commissioners of the initiative. Transcripts were reviewed and coded by the research team and organised via thematic analysis.

Twelve semi-structured interviews took place. Five themes were identified: practice autonomy, communication, financial and time costs, hardware and software issues, and wider application of technology. Practitioners typically reported that the device had not been used much. This was partly due to difficulties integrating the device into their routine practice and partly due to the relatively low prevalence of anterior eye pathology requiring referral. A wider remit for the technology, other than simply improving triaging efficiencies, was also identified as part of this study.

This study highlights the importance of conducting small pilot studies prior to significant investment of scarce NHS resources. It also highlights the importance of sharing negative findings to share best practice and avoid wastage. Limitations of this investigation included the voluntary approach of both the camera scheme and our interviews; practitioners who took part in the study were more likely to be engaged and to participate in these types of schemes compared with non-participating practitioners, and the study was unable to investigate the barriers to entry for non-participants. Nevertheless, consulting with local practitioners during service design for similar new schemes may pre-empt potential barriers and facilitate greater engagement and practice autonomy for future schemes.