Comparison of overall qualitative assessment of implementation and quantitative measures or reach, delivery, maintenance and effectiveness
| Practice | Overall qualitative assessment of implementation* | Reach % of eligible patients† with a review recorded at any point during the intervention period | Delivery to patients % of eligible patients‡ with change in prescribing recorded§ | Maintenance % of eligible patients‡ with a review recorded in the final 24 weeks of the intervention | Effectiveness % reduction in high-risk prescribing¶ |
|---|---|---|---|---|---|
| Orosay | DQIP intervention was not adopted because there was a failure to collectively legitimise the intervention. This was too much work for one individual so no process for implementation was agreed | 3 | 2 | 0.7 | 19 |
| Boreray | DQIP intervention was not adopted. Initially the GPs agreed to share the work, but failed to implement any changes because of understaffing and a prioritisation of clinical work | 2 | 0 | 0 | −24 |
| Hellisay | DQIP was adopted, initially delivered to patients but with low maintenance. The GPs dealt with the initial bulk immediately but staff changes meant they struggled to consistently maintain reviewing | 64 | 5 | 7 | 6 |
| Mingulay | DQIP was adopted with reasonable initial reach. One GP had 2 hours per month allocated to deliver review, but this was inadequate to address the numbers identified with limited communication with other GPs | 62 | 29 | 48 | 28 |
| Gighay | DQIP was adopted with limited delivery to patients. They agreed that one GP would review all patients and flag notes for when next seen, so relied on patient consulting and other GPs acting on the flag | 83 | 14 | 43 | 56 |
| Lingay | DQIP intervention was not initially adopted. GPs initially agreed to divide the work but problems with access to the informatics tool led to lost motivation. DQIP was implemented fully by one GP after a delay | 78 | 32 | 44 | 53 |
| Scalpay | DQIP was fully implemented from the start. The practice did not agree process at EOV but one GP reviewed all patients | 95 | 19 | 50 | 67 |
| Hirta | DQIP was fully implemented from the start. The initial bulk of work was divided among all GPs and then one GP maintained reviewing | 90 | 45 | 43 | 75 |
| Monach | DQIP was fully implemented from the start. The practice initially agreed to divide the work but one GP actually did all the reviewing | 89 | 38 | 47 | 77 |
| Taransay | DQIP was fully implemented from the start. DQIP was delivered by all GPs and co-ordinated by an administrative member of staff | 92 | 33 | 68 | 59 |
*Ordered from top to bottom in terms of the practices judged from qualitative analysis to have been the least (top) to most (bottom) successful implementers.
†Eligible defined as patients with one or more high-risk prescriptions issued during the 48-week intervention period.
‡Eligible defined as patients with one or more high-risk prescriptions issued during the second half (24 weeks) of the intervention period.
§Patients without a review recorded were assumed not to have a change in prescribing.
¶Defined as the relative change in high-risk prescribing in each practice in the final 24 weeks of the intervention compared with the 48 weeks before the intervention started (negative numbers indicate an increase in high-risk prescribing).
DQIP, Data-driven Quality Improvement in Primary Care.