چکیده (انگلیسی):

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.