TY - JOUR

T1 - Contextual barriers to implementation in primary care

T2 - an ethnographic study of a program to improve chronic kidney disease care

AU - Armstrong , Natalie

AU - Herbert, Georgia

AU - Brewster, Liz

N1 - This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Family Practice following peer review. The definitive publisher-authenticated version Natalie Armstrong, Georgia Herbert, and Liz Brewster Contextual barriers to implementation in primary care: an ethnographic study of a programme to improve chronic kidney disease care Family Practice (2016) 33 (4): 426-431 first published online June 13, 2016 doi:10.1093/fampra/cmw049 is available online at: http://fampra.oxfordjournals.org/content/33/4/426

PY - 2016/8

Y1 - 2016/8

N2 - Background. Context is important in implementation—we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique contextboth in relation to the care delivered and efforts to carry out research and implementation of new evidence.Objective. To explore some of the distinctive features of the primary care environment that may influence implementation.Methods. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients.Analysis was based on the constant comparative method.Results. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement.Conclusions. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context.

AB - Background. Context is important in implementation—we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique contextboth in relation to the care delivered and efforts to carry out research and implementation of new evidence.Objective. To explore some of the distinctive features of the primary care environment that may influence implementation.Methods. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients.Analysis was based on the constant comparative method.Results. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement.Conclusions. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context.

KW - Context

KW - general practice

KW - Great Britain

KW - implementation

KW - primary health care

KW - qualitative research

U2 - 10.1093/fampra/cmw049

DO - 10.1093/fampra/cmw049

M3 - Journal article

VL - 33

SP - 426

EP - 431

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 4

ER -