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Strategies supporting sustainable prescribing safety improvement interventions in English primary care: A qualitative study

Shamsuddin, Azwa; Jeffries, Mark; Sheikh, Aziz; Laing, Libby; Salema, Nde-Eshimuni; Avery, Anthony; Chuter, Antony; Waring, Justin; Keers, Richard

Authors

Azwa Shamsuddin

Mark Jeffries

Aziz Sheikh

Libby Laing

Nde-Eshimuni Salema

Anthony Avery

Antony Chuter

Justin Waring

Richard Keers



Abstract

Background: While the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice.

Aim: To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care.

Design & setting: Qualitative study in primary care settings across England.

Method: Anchoring on a complex pharmacist-led
IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, a qualitative study was conducted using sequential, multiple methods. The methods comprised documentary analysis, semi-structured interviews, and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, while template analysis was used for the semi-structured interviews.
Findings across the three methods were synthesised using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework.

Results: Forty-eight documents were analysed, and 27 interviews and two workshops involving 20 participants were undertaken. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care
(maintenance); and emphasising complementarity (maintenance).

Conclusion: Extending ownership of prescribing safety beyond primary care-based pharmacists, and achieving greater alignment between general practice and hospital prescribing safety initiatives, is
fundamental to achieve sustained impact of PSI-based interventions in primary care.

Citation

Shamsuddin, A., Jeffries, M., Sheikh, A., Laing, L., Salema, N.-E., Avery, A., Chuter, A., Waring, J., & Keers, R. (2021). Strategies supporting sustainable prescribing safety improvement interventions in English primary care: A qualitative study. BJGP Open, 5(5), https://doi.org/10.3399/BJGPO.2021.0109

Journal Article Type Article
Acceptance Date Jun 25, 2021
Online Publication Date Oct 26, 2021
Publication Date 2021-10
Deposit Date Apr 22, 2022
Publicly Available Date Apr 22, 2022
Print ISSN 2398-3795
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 5
Issue 5
DOI https://doi.org/10.3399/BJGPO.2021.0109
Keywords General practice; Implementation; Patient safety; Prescribing safety; Primary health care; Sustainability
Public URL https://hull-repository.worktribe.com/output/3866479

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