Research "push", long term-change, and general practice

Abstract

Purpose: Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond.

Design/methodology/approach: Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes.

Findings: Macro-level policy imperatives shaped practice priorities which resulted in the "whole system" new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.

Research limitations/implications: The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions.

Originality/value: The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial "research push". The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.

Keywords: Clinical guidelines; General practice; Implementation; Organizational change; Qualitative research; Sustainability.