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A qualitative study of a primary-care based intervention to improve the management of patients with heart failure : the dynamic relationship between facilitation and context
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Tierney, Stephanie, Kislov, Roman and Deaton, Christi (2014) A qualitative study of a primary-care based intervention to improve the management of patients with heart failure : the dynamic relationship between facilitation and context. BMC Family Practice, Volume 15 (Number 1). Article number 153. doi:10.1186/1471-2296-15-153 ISSN 1471-2296.
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Official URL: http://dx.doi.org/10.1186/1471-2296-15-153
Abstract
Background:
There is currently a growing emphasis in primary care on upscaling the provision of evidence-based services for specific conditions, such as heart failure (HF), which have traditionally been seen as part of a specialist’s domain. While contextual challenges associated with improvement in primary care have been documented previously, we still know relatively little about how the intentional, theory-informed facilitation of evidence-based change is shaped by contextual factors within this healthcare setting. Hence, a qualitative study was conducted to address the question: How is the process of facilitating evidence-based practice affected by the context of primary care?
Methods:
Data collection took place across general practices in northwest England as part of a process evaluation of the Greater Manchester HF Investigation Tool (GM-HFIT) - a programme of work aiming to improve the management of HF in primary care. Semi-structured interviews, with purposefully selected GM-HFIT team members (n = 9) and primary care practitioners (n = 7), were supplemented by observational data and a three-month diary reflecting on facilitation activities. Framework analysis was used to manage and interpret data.
Results:
We describe a complex and dynamic interplay between facilitation and context, focusing on three major themes: (1) Addressing macro and micro agendas; (2) Forming a facilitative unit; (3) Maintaining momentum. We show that HF specialist nurses (HFSNs) have a high level of professional credibility, which allows them to play a key role in making recommendations to practices for improving patient care. At the same time, we argue that contextual factors, such as top-level endorsement, the necessity to comply with a performance measurement system, and the varying involvement of practice nurses produce tensions that can have both an enabling and constraining effect on the process of facilitation.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RA Public aspects of medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Warwick Research in Nursing > Royal College of Nursing Research Institute (RCN) (- July 2017) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Primary care (Medicine), Heart failure -- Treatment | ||||||||
Journal or Publication Title: | BMC Family Practice | ||||||||
Publisher: | BioMed Central Ltd. | ||||||||
ISSN: | 1471-2296 | ||||||||
Official Date: | 18 September 2014 | ||||||||
Dates: |
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Volume: | Volume 15 | ||||||||
Number: | Number 1 | ||||||||
Number of Pages: | 10 | ||||||||
Article Number: | Article number 153 | ||||||||
DOI: | 10.1186/1471-2296-15-153 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 28 December 2015 | ||||||||
Date of first compliant Open Access: | 28 December 2015 | ||||||||
Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||||
Adapted As: |
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