Strategies supporting sustainable prescribing safety improvement interventions in english primary care: qualitative study.

Shamsuddin, Azwa; Jeffries, Mark; Sheikh, Aziz; Laing, Libby; Salema, Nde-Eshimuni; Avery, Anthony J; Chuter, Antony; Waring, Justin; Keers, Richard N

BACKGROUND Whilst the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice. AIM To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care. DESIGN & SETTING Qualitative study in primary care settings across England. METHOD Anchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, we conducted a qualitative study using sequential, multiple methods which comprised of documentary analysis, semi-structured interviews and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, whilst template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM framework. RESULTS We analysed 48 documents, undertook 27 interviews and two workshops involving 20 participants. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance). CONCLUSIONS Extending ownership of prescribing safety beyond primary care-based pharmacists and achieving greater alignment between general practice and hospital prescribing safety initiatives is fundamental to achieve sustained impact of PSI-based interventions in primary care.