Title: Action to Support Practices Implementing Research Evidence (ASPIRE)
Funder: Department of Health (England)

Abstract: AIM: To develop and evaluate an adaptable intervention package to target implementation of ‘high impact’ clinical practice recommendations in general practice. WORK PACKAGES: The programme will focus on ‘high impact’ clinical practice recommendations from NICE clinical guidelines and NHS Quality Standards where a measurable change in clinical practice can lead to significant patient benefit. WP1a: Identify high impact clinical practice recommendations WP1b: Measure and analyse levels of adherence to high impact clinical practice recommendations WP2a: Develop an intervention package adaptable to target the implementation of each recommendation WP2b: Evaluate the effects and cost-effectiveness of the adapted intervention package in targeting the implementation of high impact recommendations WP2c: Conduct an in-depth, process evaluation to examine intervention delivery and mechanisms of action BACKGROUND: Clinical evidence that can help cut avoidable deaths and enhance quality of life does not reliably find its way into everyday patient care. The gap between evidence and practice is strategically important because it limits the health, social and economic impacts of clinical research. NICE clinical guidelines and the emerging NHS Quality Standards promote treatments of proven benefit and discourage ineffective or less cost-effective interventions. Dissemination of best practice is necessary but seldom sufficient by itself to ensure implementation. Furthermore, the general practice context presents particular challenges. Many implementation studies focus on one condition (e.g. depression, back pain). This limits generalisability; it is uncertain how an intervention developed for one clinical condition will work for another. It is also impracticable and inefficient to invent an implementation strategy for every new guideline. Adaptable implementation strategies are required which can be generalised across different types of recommendation and sustainably integrated into available primary care systems and resources. RESEARCH PLANS WP 1a: screening of NICE guidelines and NHS Quality Standards to identify recommendations on basis of: burden of illness; potential for significant patient benefit from improved practice; likelihood of cost savings without patient harm; and feasibility of measuring change. A consensus process will prioritise recommendations and rate their generalisable characteristics. WP 1b: cross sectional analysis of patient data to identify up to 8 high impact recommendations with greatest scope for improvement (low adherence) and explore variations in adherence. WP 2a: interviews to explore barriers to and enablers of adherence to each of 8 selected high impact recommendations in general practice; matching behaviour change techniques to identified barriers and enablers; development of an intervention package (computerised decision support, audit and feedback, and outreach educational visits) which can be adapted to target different types of recommendation. WP 2b: intervention piloting and formative evaluation; cluster randomised trial of general practices to determine effects of the intervention package adapted for 2 high impact (or exemplar) recommendations; modelling of intervention cost-effectiveness. WP 2c: longitudinal case studies to examine process of intervention delivery, mechanisms of action and unintended consequences. RESEARCH TEAM: An interdisciplinary team experienced in implementation research, guideline dissemination, primary care, behavioural sciences, statistics and trial methods, health informatics and health economics. PROGRAMME MANAGEMENT: Leadership by the PI with Work Package leads; a Programme Steering Group will provide overall oversight, with specific inputs by patient and public involvement and scientific advisory groups. RESEARCH ENVIRONMENT: We build upon interests in translating evidence into practice amongst NHS and research partners, recent investments in primary care research capacity and a strategic partnership between the University of Leeds and the NHS Information Centre. OUTPUTS. We will: (i) Identify high impact clinical practice recommendations which can improve population outcomes if implemented more commonly in general practice; (ii) Develop an intervention package which can be embedded within general practice and adapted to target barriers to change for different recommendations; (iii) Demonstrate whether and how this intervention improves patient care and outcomes, and maximises health gain and returns on investment for 2 high impact recommendations; (iv) Produce an implementation manual for general practice. This programme will lead on to further evaluation of the intervention package for the remaining 6 high impact recommendations. PATIENT AND PUBLIC INVOLVEMENT will be embedded our programme oversight and operation, including recommendation selection, intervention development, and knowledge transfer.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE