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Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care.

ABSTRACT: AIM:To understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care. DESIGN AND PROCEDURE:Mixed-measures design. Quantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software. SETTING:The first HealthPathways UK site, South Tyneside, England. PARTICIPANTS:General practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76). RESULTS:Use of the pathways significantly increased over time. Themes were developed showing how online care pathways were used-leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways. CONCLUSIONS:This study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments.

SUBMITTER: Akehurst J

PROVIDER: S-EPMC6318508 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care.

Akehurst Joy J Sattar Zeibeda Z Gordon Isabel I Ling Jonathan J

BMJ open 20181231 12

<h4>Aim</h4>To understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care.<h4>Design and procedure</h4>Mixed-measures design. <i>Q</i>uantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software.<h4>Setting</h4>The first HealthPathways ...[more]

PMID: 30598485

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Project description:OBJECTIVES:To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. DESIGN:Mixed-method evaluation of a primary care e-consultation system. SETTING:Primary care practices in South West England. METHODS:Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients' records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients' and staff touchpoints. RESULTS:We found different expectations between patients and staff on how to use e-consultations 'appropriately'. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. CONCLUSIONS:Where both patients and staff interact with technology, it is in effect 'co-implemented'. How patients used e-consultations impacted on practice staff's experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints.

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Dataset Information

Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care.

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Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care.

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