Implementation of remote asthma consulting in general practice in response to the COVID19 pandemic: evaluation using extended normalisation process theory

BACKGROUND: The 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. AIM: To explore the implementation of remote asthma consulting in UK general practice in response to the COVID-19 pandemic. DESIGN & SETTING: Mixed-methods evaluation, which was informed by eNPT, in general practice in Northern Ireland. METHOD: Data were collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews, and multidisciplinary focus groups. Analysis was informed by eNPT. RESULTS: Ten themes were identified 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. CONCLUSION: The 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

Performance measures for substance use disorders -- what research is needed?

Abstract In 2010, the Washington Circle convened a meeting, supported by the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), for a multidisciplinary group of experts to focus on the research gaps in performance measures for substance use disorders. This article presents recommendations in three areas: development of new performance measures; methodological and other considerations in using performance measures; and implementation research focused on using performance measures for accountability and quality improvement