Christie Cabral1, Kathryn Curtis2, Vasa Curcin3, Jesús Domínguez3, Vibhore Prasad3, Anne Schilder4, Nicholas Turner5, Scott Wilkes6, Jodi Taylor5, Sarah Gallagher7, Paul Little8, Brendan Delaney9, Michael Moore8, Alastair D Hay2, Jeremy Horwood2. 1. Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. chrisitie.cabral@bristol.ac.uk. 2. Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. 3. School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Addison House 3.07, Guy's Campus, London, SE1 1UL, UK. 4. NIHR University College London Hospitals Biomedical Research Centre and evidENT, UCL Ear Institute, 91 Gower Street, London, WC1E 6AB, UK. 5. Bristol Randomised Trial Collaboration (BRTC), Part of the Bristol Trial Centre, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS82PS, UK. 6. School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sciences Complex, City Campus, Chester Road, Sunderland, SR1 3SD, UK. 7. The Portland Practice, St Pauls Medical Centre, 121 Swindon Road, Cheltenham, GL50 4DP, Gloucestershire, UK. 8. Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University Of Southampton, Southampton, SO17 1BJ, UK. 9. Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
Abstract
BACKGROUND: Within-consultation recruitment to primary care trials is challenging. Ensuring procedures are efficient and self-explanatory is the key to optimising recruitment. Trial recruitment software that integrates with the electronic health record to support and partially automate procedures is becoming more common. If it works well, such software can support greater participation and more efficient trial designs. An innovative electronic trial recruitment and outcomes software was designed to support recruitment to the Runny Ear randomised controlled trial, comparing topical, oral and delayed antibiotic treatment for acute otitis media with discharge in children. A qualitative evaluation investigated the views and experiences of primary care staff using this trial software. METHODS: Staff were purposively sampled in relation to site, role and whether the practice successfully recruited patients. In-depth interviews were conducted using a flexible topic guide, audio recorded and transcribed. Data were analysed thematically. RESULTS: Sixteen staff were interviewed, including GPs, practice managers, information technology (IT) leads and research staff. GPs wanted trial software that automatically captures patient data. However, the experience of getting the software to work within the limited and complex IT infrastructure of primary care was frustrating and time consuming. Installation was reliant on practice level IT expertise, which varied between practices. Although most had external IT support, this rarely included supported for research IT. Arrangements for approving new software varied across practices and often, but not always, required authorisation from Clinical Commissioning Groups. CONCLUSIONS: Primary care IT systems are not solely under the control of individual practices or CCGs or the National Health Service. Rather they are part of a complex system that spans all three and is influenced by semi-autonomous stakeholders operating at different levels. This led to time consuming and sometimes insurmountable barriers to installation at the practice level. These need to be addressed if software supporting efficient research in primary care is to become a reality.
BACKGROUND: Within-consultation recruitment to primary care trials is challenging. Ensuring procedures are efficient and self-explanatory is the key to optimising recruitment. Trial recruitment software that integrates with the electronic health record to support and partially automate procedures is becoming more common. If it works well, such software can support greater participation and more efficient trial designs. An innovative electronic trial recruitment and outcomes software was designed to support recruitment to the Runny Ear randomised controlled trial, comparing topical, oral and delayed antibiotic treatment for acute otitis media with discharge in children. A qualitative evaluation investigated the views and experiences of primary care staff using this trial software. METHODS: Staff were purposively sampled in relation to site, role and whether the practice successfully recruited patients. In-depth interviews were conducted using a flexible topic guide, audio recorded and transcribed. Data were analysed thematically. RESULTS: Sixteen staff were interviewed, including GPs, practice managers, information technology (IT) leads and research staff. GPs wanted trial software that automatically captures patient data. However, the experience of getting the software to work within the limited and complex IT infrastructure of primary care was frustrating and time consuming. Installation was reliant on practice level IT expertise, which varied between practices. Although most had external IT support, this rarely included supported for research IT. Arrangements for approving new software varied across practices and often, but not always, required authorisation from Clinical Commissioning Groups. CONCLUSIONS: Primary care IT systems are not solely under the control of individual practices or CCGs or the National Health Service. Rather they are part of a complex system that spans all three and is influenced by semi-autonomous stakeholders operating at different levels. This led to time consuming and sometimes insurmountable barriers to installation at the practice level. These need to be addressed if software supporting efficient research in primary care is to become a reality.
Entities:
Keywords:
Electronic health records; Information technology; Primary health care
Authors: Henry Brodaty; Louisa Hr Gibson; Melissa L Waine; Allan M Shell; Ruth Lilian; Constance Dimity Pond Journal: Ment Health Fam Med Date: 2013-09
Authors: Tjeerd-Pieter van Staa; Lisa Dyson; Gerard McCann; Shivani Padmanabhan; Rabah Belatri; Ben Goldacre; Jackie Cassell; Munir Pirmohamed; David Torgerson; Sarah Ronaldson; Joy Adamson; Adel Taweel; Brendan Delaney; Samhar Mahmood; Simona Baracaia; Thomas Round; Robin Fox; Tommy Hunter; Martin Gulliford; Liam Smeeth Journal: Health Technol Assess Date: 2014-07 Impact factor: 4.014