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

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

doi:10.3399/BJGPO.2021.0109

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

BJGP Open. 2021 Oct 26;5(5):BJGPO.2021.0109. doi: 10.3399/BJGPO.2021.0109. Print 2021 Oct.

Authors

Azwa Shamsuddin¹, Mark Jeffries^{2

3}, Aziz Sheikh⁴, Libby Laing⁵, Nde-Eshimuni Salema^{3

5}, Anthony J Avery^{3

5}, Antony Chuter⁴, Justin Waring⁶, Richard N Keers^{2

7}

Affiliations

¹ Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK azwashamsuddin88@gmail.com.
² Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK.
³ National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
⁴ Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
⁵ Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK.
⁶ School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK.
⁷ Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.

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.

Keywords: general practice; implementation; patient safety; prescribing safety; primary health care; sustainability.