Engaging General Practitioners in Service Development and Quality Improvement in Care Homes: a Realist Synthesis of the Published Evidence
Award Number
NIHR127257Programme
Health and Social Care Delivery ResearchStatus / Stage
CompletedDates
2 June 2019 -1 September 2020
Duration (calculated)
01 years 02 monthsFunder(s)
NIHRFunding Amount
£148,956.22Funder/Grant study page
NIHRContracted Centre
The University of NottinghamPrincipal Investigator
Professor Adam GordonPI Contact
Adam.Gordon@nottingham.ac.ukPI ORCID
0000-0003-1676-9853WHO Catergories
Methodologies and approaches for risk reduction researchRisk reduction intervention
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 198 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | NIHR127257 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20190602 |
| End Date | 20200901 |
| Duration (calculated) | 01 years 02 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | The University of Nottingham |
| Funding Amount | £148,956.22 |
Abstract
How, when and under what circumstances does GP involvement in service development, implementation and improvement in care homes result in effective implementation or improved outcomes for residents? 425,000 older people live in UK care homes. Their healthcare is complex due to multiple health conditions, prominent cognitive impairment and physical dependency. There is growing evidence that healthcare to the sector delivers better outcomes if NHS staff have protected time and space to develop relational working with care home staff, if they have expertise in dementia care, and if services are organised around the care home. The recent Optimal (NIHR HS+DR) and PEACH (Dunhill Medical Trust) studies identified an important role for general practitioners in successful service development and quality improvement (QI) in the sector, mediated in part by their role as primary healthcare providers and in part by their role as gatekeepers for healthcare. Both studies reported examples where poor GP engagement limited progress with service development or QI. To understand the role which GPs have been demonstrated to play, as part of a wider multidisciplinary team, in development, implementation and improvement of healthcare in care homes, in order to shape recommendations about when they need to be involved, and how to get them involved, in QI in the sector. Objectives Using realist synthesis (RS), develop a programme theory which describes the types of outcomes for which GP involvement is required for service development, delivery and improvement in care homes, and the mechanisms by which GP involvement helps realise the outcomes. To describe contextual factors influencing GP engagement with service development, delivery and improvement for healthcare interventions in care homes. Methods An initial programme theory will be developed through interviews with teams leading QI in healthcare for care homes. We will convene an expert content group with expertise in developing and improving healthcare in care homes including, amongst others, GPs, care home staff and resident/relative representatives. We will use bibliographic databases and our knowledge of the grey literature to identify sources describing the role of GPs in QI and service development initiatives in care homes in the UK or overseas. We will look for mechanisms and contextual factors that determine the need for GP engagement in service development or QI. Where involvement is necessary, we will look for the mechanisms and contexts that influence GP engagement. By working iteratively with the literature and our expert content group we will develop context, mechanism, outcome configurations to further develop our programme theory. Timelines for delivery Months 1-3: locate existing theories from interviews and expert content group; Months 3-5: search for/identify evidence; Months 5-8: extract and organise data; Months 7-14: synthesise evidence, iterate programme theory; Months 12-15: write-up and disseminate findings. Anticipated impact and dissemination We will articulate when GP involvement in service development and QI is, and is not, required. When it is required, we will articulate how to entrain GP support. This will inform future service development and QI projects in the care home sector. We will produce protocol and findings papers and present results at relevant health, social care and lay-facing conferences.
Aims
To understand the role which GPs have been demonstrated to play, as part of a wider multidisciplinary team, in development, implementation and improvement of healthcare in care homes, in order to shape recommendations about when they need to be involved, and how to get them involved, in QI in the sector.