Influences of peer facilitation in general practice – a qualitative study

Abstract

BackgroundPractice facilitation is increasingly used to support guideline implementation and practice development in primary care and there is a need to explore how this implementation approach works in real-life settings.We focus on a facilitation intervention from the perspective of the visited practices to gain a more detailed understanding of how peer facilitation influenced practices and how they valued the facilitation.MethodsThe facilitation intervention was conducted in general practice in the Capital Region of Denmark with the purpose of supporting the implementation of chronic disease management programmes. We carried out a qualitative study, where we observed 30 facilitation visits in 13 practice settings and interviewed the visited practices after their first and last visits. We then performed a thematic analysis.ResultsMost of the respondents reported that facilitation visits had increased their knowledge and skills as well as their motivation and confidence to change. These positive influences were ascribed to a) the facilitation approach b) the credibility and know-how associated with the facilitators’ being peers c) the recurring visits providing protected time and invoking a sense of commitment. Despite these positive influences, both the facilitation and the change process were impeded by several challenges, e.g. competing priorities, heavy workload, problems with information technology and in some cases inadequate facilitation.ConclusionPractice facilitation is a multifaceted, interactive approach that may affect participants in several ways. It is important to attune the expectations of all the involved actors through elaborate discussions of needs, capabilities, wishes, and approaches, and to adapt facilitation interventions according to an analysis of influential contextual conditions and change opportunities.

A conceptual framework for increasing clinical staff member involvement in general practice: a proposed strategy to improve the management of low back pain

“…A unique and novel aspect to our proposal is that for the first time these components have been combined into a useful primary care ‘tool box’ for the treatment of LBP. The components included in our implementation strategy are therefore multifaceted and described on a general level and we would highlight that some of the individual components may need to be adapted following an assessment of the specific national context and change opportunities [28].…”

Implementation of healthcare accreditation in Danish general practice: a questionnaire study exploring general practitioners’ perspectives on external support

“…The impact of peers for making changes in general practice is also well known in the literature; one example is the positive impact on practice facilitation [ 7 , 8 ]. The importance of peers is also acknowledged in the accreditation survey as one of the surveyors is a GP [ 6 ].…”

“…This study also found that some clinics supplemented the regional support with informal support from experts and colleagues [ 6 ]. We know from other quality interventions that practice facilitation and peer discussion can be useful [ 7 , 8 ], but it remains unknown whether these tools are used and perceived as useful in the accreditation process.…”

An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

“…Coaching has less frequently been used to facilitate practice change, as practice facilitators are typically used in studies of clinical transformation where they assist in adopting quality improvement and change management processes to implement new approaches to care. [7][8][9] However, they seldom have experience with the training of health professionals.…”