Optimising personal continuity in general practice: process evaluation of a toolkit.

Area of Science:

• Implementation Science
• General Practice Research
• Healthcare Management

Background:

• Personal continuity with a General Practitioner (GP) is crucial in primary care but increasingly challenged.
• The TOOL-kit intervention was developed to optimize personal continuity for patients aged 65 and above.
• Societal and healthcare changes necessitate new strategies to maintain patient-provider relationships.

Purpose of the Study:

• To evaluate the implementation of the multi-component TOOL-kit intervention.
• To identify barriers and facilitators affecting the delivery of the TOOL-kit.
• To assess the impact on personal continuity for older adult patients in general practice.

Main Methods:

• A mixed-methods study embedded within a main effect trial.
• Data collection included 3-monthly surveys and 93 interviews with GPs and practice staff (n=221) across 32 general practices.
• Evaluation focused on recruitment, reach, fidelity, dose delivered/received, and barriers/facilitators at multiple levels.

Main Results:

• 23 out of 32 practices adhered to the protocol; however, the TOOL-kit was delivered at a low dose in 17 practices.
• At study end, 55% of practice goals were met, with 19 practices showing sustained positive effects on personal continuity after 24 months.
• A strong quality improvement infrastructure facilitated implementation, while work pressure and staff shortages (exacerbated by COVID-19) were key barriers.

Conclusions:

• The TOOL-kit intervention demonstrated an ability to enhance work procedures and focus on personal continuity, despite implementation challenges.
• Sustained improvements in personal continuity were observed in a majority of practices that adhered to the protocol.
• Strengthening quality improvement infrastructure and decision-making processes is recommended to improve future implementation success.