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Title: Implementation of complex interventions in UK General Practice
Author: Lau, Wing Kin Rosa
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2018
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The pace of change in UK healthcare continues to be rapid with a drive to implement more clinically and cost-effective interventions in order to improve practice/care. Literature suggests that the take-up of these interventions is often slow. This delay in translation of evidence-based interventions into routine clinical practice is known as the ‘Evidence-to-Practice Gap’. Almost all changes to practice involve ‘complex interventions’. Such interventions can be particularly hard to implement as they are likely to require change at multiple levels. Initially a systematic review of reviews was conducted to synthesise the literature on a) explanation(s) as to why complex interventions are not implemented and b)the effectiveness of strategies in facilitating implementation. A key insight was that despite an increasing recognition of the role of context in implementation there is a lack of empirical evidence. None of the reviews addressed context and the contextual influences were largely reported as perceived barriers and facilitators. Studies tended to focus on one intervention when in reality more than one intervention is likely to be implemented simultaneously in any given setting. The systematic review led to a qualitative case study to investigate the implementation of multiple complex interventions in three GP practices, focusing on the role of context as an explanation. Initial practice meetings indicated all three practices were implementing various changes to improve patient access. The decision was taken to focus on online and telephone access and the Named GP scheme. Data from observation, interviews and documentations were analysed using thematic analysis. This study enhances understanding of the process in which multiple complex interventions are implemented into general practice. Paying particular attention to the ‘shifts’ of context and how changes in the ‘fit’ between the intervention and the context over time, may increase the likelihood of implementation success. The study reveals the importance of relative intervention prioritisation particularly when practices face competing intervention options, as a novel explanation of why some interventions get implemented/prioritised first before others.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available