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Process evaluation of the data-driven quality improvement in primary care (DQIP) trial: active and less active ingredients of a multi-component complex intervention to reduce high-risk primary care prescribing

Citation
Grant A, Dreischulte T & Guthrie B (2017) Process evaluation of the data-driven quality improvement in primary care (DQIP) trial: active and less active ingredients of a multi-component complex intervention to reduce high-risk primary care prescribing, Implementation Science, 12 (1), Art. No.: 4.

Abstract
Background 

Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants’ perceptions about which intervention elements were active in changing their practice. 
Methods 
Data generation was by in-depth interview with key staff exploring participant’s perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory. 
Results 
All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness. 
Conclusions 
This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.

Keywords
General practice; Family practice; Prescribing; Quality and safety; Randomised controlled trials; Process evaluation

StatusPublished
AuthorsGrant Aileen, Dreischulte Tobias, Guthrie Bruce
Publication date07/01/2017
Publication date online07/01/2017
Date accepted by journal06/12/2016
PublisherBioMed Central
ISSN 1748-5908
LanguageEnglish

Journal
Implementation Science: Volume 12, Issue 1

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