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

Research Article

Christi Deaton¹  Roman Kislov²  Stephanie Tierney³ 

[1] Florence Nightingale Foundation Professor of Clinical Nursing Research, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK;Manchester Business School, University of Manchester, Manchester, UK;Royal College of Nursing Research Institute, University of Warwick, Coventry, UK;

关键词: Evidence-based practice;    Knowledge mobilisation;    Qualitative research;    Semi-structured interviews;    Heart failure;    Facilitation;   

DOI  :  10.1186/1471-2296-15-153

 received in 2014-05-25, accepted in 2014-08-26,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThere 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?MethodsData 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.ResultsWe 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.ConclusionsWhen facilitating the transfer of evidence, context is an important aspect to consider at a macro and micro level; a complex interplay can exist between these levels, which may constrain or enable efforts to amend practice. Those involved in facilitating change within primary care have to manage tensions arising from the interplay of these different contextual forces to minimise their impact on efforts to alter practice based on best evidence.

【 授权许可】

CC BY   
© Tierney et al.; licensee BioMed Central Ltd. 2014