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BMC Primary Care
Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Research article

It could be a ‘Golden Goose’: a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation

Authors: Alison Porter, Mark Rhys Kingston, Bridie Angela Evans, Hayley Hutchings, Shirley Whitman, Helen Snooks

Published in: BMC Primary Care | Issue 1/2016

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Abstract

Background

Rising demand for health care has prompted interest in new technologies to support a shift of care from hospital to community and primary care, which may require clinicians to undertake new working practices. A predictive risk stratification tool (Prism) was developed for use in primary care to estimate patients’ risk of an emergency hospital admission. As part of an evaluation of Prism, we aimed to understand what might be needed to bring Prism into effective use by exploring clinicians and practice managers’ attitudes and expectations about using it. We were informed by Normalisation Process Theory (NPT) which examines the work needed to bring an innovation into use.

Methods

We conducted 4 focus groups and 10 interviews with a total of 43 primary care doctors and colleagues from 32 general practices. All were recorded and transcribed. Analysis focussed in particular on the construct of ‘coherence’ within NPT, which examines how people understand an innovation and its purpose.

Results

Respondents were in agreement that Prism was a technological formalisation of existing practice, and that it would function as a support to clinical judgment, rather than replacing it. There was broad consensus about the role it might have in delivering new models of care based on active management, but there were doubts about the scope for making a difference to some patients and about whether Prism could identify at-risk patients not already known to the clinical team. Respondents did not expect using the tool to be onerous, but were concerned about the work which might follow in delivering care. Any potential value would not be of the tool in isolation, but would depend on the availability of support services.

Conclusions

Policy imperatives and the pressure of rising demand meant respondents were open to trying out Prism, despite underlying uncertainty about what difference it could make.

Trial registration

Controlled Clinical Trials no. ISRCTN55538212.
Footnotes
1
Grimm’s Fairy Tales contain two stories about geese and gold: the goose who lays the golden eggs is the source of undreamt of bounty; but another story has a golden goose to which the unwary stick when they grab it, with unfortunate consequences. We assume that our respondent was thinking of the former.
 
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Metadata
Title
It could be a ‘Golden Goose’: a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation
Authors
Alison Porter
Mark Rhys Kingston
Bridie Angela Evans
Hayley Hutchings
Shirley Whitman
Helen Snooks
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-015-0398-3

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