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Cited by 96Health Policy Implementation ScienceClinical practice guidelines implementationHealth Sciences Research and Education

Why does primary care need more implementation research?

Open access
Foy, R., Eccles, M., Grimshaw, J.·2001·Family Practice
DOI 10.1093/fampra/18.4.353
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Abstract

Foy R, Eccles M and Grimshaw J. Why does primary care need more implementation research? Family Practice 2001; 18: 353–355. Clinical research continually produces new findings that can contribute to effective and efficient patient care. However, such research cannot change patient outcomes unless health services and health care professionals adopt them in practice. Uneven uptake of research findings—and thus inappropriate care—occurs across different health care settings, countries and specialities, as demonstrated by two papers on implementing evidence-based medicine published in this issue of Family Practice.1,2 In primary care, the detection and management of risks related to hypertension3 or hyperlipidaemia are highly variable.4 The impact of secondary prevention, including the administration of secondary prophylactic drugs to patients surviving a myocardial infarction, is reduced by similar disparities.5–7 Much of this variation is not attributable to either patient or resource factors. There are mounting expectations to deliver high quality primary care from governments impatient for results. Legitimate challenges to improve the quality of care8 must be informed by research that can offer clinicians and managers effective and efficient means to enhance service delivery.9 Implementation research (the scientific study of methods to promote the uptake of research findings, and hence to reduce inappropriate care) aims to inform policy decisions about how best to use resources to improve the uptake of research findings by testing approaches to change professional and organizational behaviour. As with clinical care, systematic reviews of rigorous studies have contributed greatly to our knowledge about what works in changing professional and organizational behaviour. A recent overview of systematic reviews10 suggested that it was possible to identify strategies that were more, or less, effective. Strategies such as postal distribution of guidelines or didactic educational sessions were suggested to be largely ineffective. Local consensus conferences, the use of opinion leaders or audit and feedback were of variable effectiveness, and strategies such as interactive educational workshops, reminder systems, educational outreach and multifaceted interventions were suggested as largely effective. This sounds very promising but, as is ever the case, the devil is in the detail. On closer scrutiny, the evidence for effective interventions may not stand up to the real world of local implementation because of limited or unpredictable transferability. Our understanding of what makes professionals and organizations change (or not) is based upon superficial and, sometimes, hopeful interpretation of the processes. ‘Academic detailing’ (or educational outreach) involves the use of a trained person providing information, including feedback on performance, to professionals in their practice settings with the intent of changing behaviour. This appears to be effective when combined with ‘social marketing’ approaches that help identify and overcome barriers to change—but demonstrated benefits have been largely confined to prescribing in North America.11 We need to understand in greater detail which factors influence the effectiveness of interventions in other circumstances, such as different settings, types of professional or targeted behaviours. Attempts to generalize research findings to primary care (or any other setting) encounter three main problems. First, we are unsure of what factors are important in the relative success or failure of reported strategies because of the lack of an established theoretical framework. Secondly, studies do not measure or report potential effect modifiers, e.g. the influence of different attributes of targeted behaviours on outcomes.12 Thirdly, interventions are often poorly described—thus posing a problem for aggregation within systematic reviews and for subsequent interpretation in order to reproduce successful interventions. These problems are analogous to those of applying clinical research findings from secondary to primary care settings without considering population characteristics or available resources and skills.13 Systematic reviews of more rigorous evaluations (including randomized trials) indicate variable effectiveness within the same interventions, such as audit and feedback or use of local opinion leaders (people identified by their peers as being educationally influential. These variations might be attributable to the modifying effects of context and content. For example, it might be more feasible to identify and use local opinion leaders in secondary care settings than in primary care. Inconsistent findings might also be explained by variations in the intensity or quality of the interventions tested. Although prompts and reminders appear to be consistently effective, their frequency and proximity to the point of clinical decision making may influence the size of their impact

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  • Identifying the key factors associated with healthcare professional behavior can provide a basis for developing interventions to help healthcare professionals to use research findings more effectively.

    “Identifying the key factors associated with healthcare professional behavior can provide a basis for developing interventions to help healthcare professionals to use research findings more effectively [14].”

    From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [14]

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Authors
Foy, R., Eccles, M., & Grimshaw, J.
ORCID
Venue
Family Practice
Publisher
Oxford University Press (OUP)
Published
2001-08-01
Volume
18
Issue
4
Pages
353-355
ISSN
  • 0263-2136 (ISSN-L)
  • 1460-2229
DOI
10.1093/fampra/18.4.353
OpenAlex
W2161378632
Cited by
96
References
20
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 5 · 2021: 5 · 2020: 1 · 2019: 7 · 2018: 4 · 2017: 3 · 2016: 1 · 2015: 6 · 2014: 7 · 2013: 2 · 2012: 7
Type
journal article
Language
en
Open access
Locations
  • Family Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
implementation research, primary care, academic detailing, educational outreach, social marketing, multicomponent intervention, audit and feedback, guideline dissemination, quality of care variation, secondary prevention
MeSH terms
Family Practice, Humans, Primary Health Care, Research, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence

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