Implementation of remote asthma consulting in general practice in response to the COVID-19 pandemic: an evaluation using extended Normalisation Process Theory

Abstract

BackgroundThe COVID-19 pandemic has led to the rapid and reactive deployment of remote consulting in UK General Practice. The delivery of acute and chronic asthma care has been affected. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context-intervention interactions affect Implementation.AimTo explore the implementation of remote asthma consulting in UK General Practice in response to the COVID-19 pandemic.Design & settingMixed methods evaluation, informed by eNPT.SettingGeneral Practice in Northern Ireland.MethodData was collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews and multidisciplinary focus groups. Analysis was informed by eNPT.ResultsWe identified ten themes to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to in-person review. Having a practice champion to drive implementation forward, and engage other Practice staff, was important. Patient, staff and healthcare system contextual factors influencing implementation were identified including access to, understanding of and willingness to use the technology required for remote consulting.ConclusionThe experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it. Work is required at Practice and healthcare system levels to realise this potential, and ensure implementation does not exacerbate existing healthcare inequalities.

The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review

“…The practice champion suggested that it is necessary to finance the setup and filing, as well as the expenses for the time spent by nurses during the screening process. Stewart et al [ 40 ], UK Mixed-methods evaluation, online questionnaire, semi structured interviews and focus group interviews. Program Evaluation study N = 63 63 General practice staff To evaluate the rapid and reactive implementation of RAC in general practice in response to the COVID-19 pandemic, through the lens of eNPT, to identify factors that promoted or inhibited implementation, and identify the ‘work’ that is required for ‘normalization’ into routine clinical care.…”

“…Several studies underscored the importance of champions for successful implementation [ 29 – 31 , 34 – 38 , 40 – 43 , 49 ]. Four studies specifically highlighted champions as a key factor for success [ 34 , 36 , 37 , 43 ], and one study went further to describe champions as the most important factor for successful implementation [ 39 ].…”

“…Most studies associated champion roles with specific professions. In seven studies, the professional title was explicitly linked to the concept of champions, such as physician champions or clinical nurse champions, or through the strategic selection of specific professions [ 29 , 33 , 36 , 40 , 43 , 47 , 50 ]. Additionally, some studies did not specify professions, but utilized terms like clinicians [ 45 ] or health professionals [ 41 ].…”

“…In the included studies, the champion role encompassed two interrelated facilitators tasks: promoting the technology and supporting others in adopting the technology in their daily practice. Promoting the technology involved encouraging staff adaptation [ 32 , 34 , 35 , 37 , 40 , 41 , 49 ], generally described as being enthusiastic about the technology [ 32 , 35 , 37 , 41 , 48 ], influencing the attitudes and beliefs of colleagues [ 42 , 45 ] and legitimizing the introduction of the technology [ 42 , 46 , 48 ]. Supporting others in technology adaption involved training and teaching [ 31 , 35 , 38 , 40 , 51 ], as well as providing technical support [ 30 , 31 , 39 , 43 , 49 ] and social support [ 49 ].…”

Care by general practitioners for patients with asthma or COPD during the COVID-19 pandemic

“…workload and should be considered as a possible solution to the staffing shortages and high workloads in OOH services 30 . Several studies show that remote contacts for respiratory diseases have potential benefits for access to and effectiveness of care when fully integrated with face-to-face contacts [31][32][33][34] . A study into the differences between remote and face-to-face check-ups for asthma showed no significant effects with regard to exacerbations or quality of life 35 .…”