ArticleFamily practice2016
Contextual barriers to implementation in primary care: an ethnographic study of a programme to improve chronic kidney disease care.
Article in Family practice, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review.BMC nephrology · 2020Pooled it
- Implementation of Coach McLungsBMC medical informatics and decision making · 2022Trial
- Learning from scale-up: a qualitative study of scaling-up interventions for people with multiple long-term conditions in primary care.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- Understanding Barriers and Facilitators of Primary Care Use Among Assertive Community Treatment Teams Via Qualitative Analysis of Clients and Clinicians.Community mental health journal · 2024Article
- Examining the optimal factors that promote implementation and sustainability of a network intervention to alleviate loneliness in community contexts.Health & social care in the community · 2022Article
- Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies.BMJ quality & safety · 2022Article
- Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel.Implementation science communications · 2021Article
- Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study.BMC health services research · 2021Article
- The influence of contextual factors on healthcare quality improvement initiatives: a realist review.Systematic reviews · 2020Review
- Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention.BMC health services research · 2020Article
- Implementing a social network intervention: can the context for its workability be created? A quasi-ethnographic study.Implementation science communications · 2020Article
- Evaluation of a shared decision-making intervention for pediatric patients with asthma in the emergency department.Implementation science communications · 2020Article
- Measurement of harms in community care: a qualitative study of use of the NHS Safety Thermometer.BMJ quality & safety · 2018Observational
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundContext is important in implementation-we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique context both in relation to the care delivered and efforts to carry out research and implementation of new evidence.
objectiveTo explore some of the distinctive features of the primary care environment that may influence implementation.
methodsWe conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients. Analysis was based on the constant comparative method.
resultsFour elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement.
conclusionsThose seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context.
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Registered trials
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