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Sheringham J, Solmi F, Ariti C, et al. The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care. PLoS One. 2017;12(3):e0174086doi: 10.1371/journal.pone.0174086.
Sheringham, J., Solmi, F., Ariti, C., Baim-Lance, A., Morris, S., & Fulop, N. J. (2017). The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care. PloS one, 12(3), e0174086. https://doi.org/10.1371/journal.pone.0174086
Sheringham, Jessica, et al. "The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care." PloS one vol. 12,3 (2017): e0174086. doi: https://doi.org/10.1371/journal.pone.0174086
Sheringham J, Solmi F, Ariti C, Baim-Lance A, Morris S, Fulop NJ. The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care. PLoS One. 2017 Mar 22;12(3):e0174086. doi: 10.1371/journal.pone.0174086. eCollection 2017. PMID: 28328942; PMCID: PMC5362095.
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PLoS One. 2017 Mar 22;12(3):e0174086. doi: 10.1371/journal.pone.0174086. eCollection 2017.

The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care.

PloS one

Jessica Sheringham, Francesca Solmi, Cono Ariti, Abigail Baim-Lance, Steve Morris, Naomi J Fulop

Affiliations

  1. Department of Applied Health Research, University College London, 1-19 Torrington Place, London, United Kingdom.
  2. Nuffield Trust, London, United Kingdom.

PMID: 28328942 PMCID: PMC5362095 DOI: 10.1371/journal.pone.0174086

Abstract

BACKGROUND: Programmes have had limited success in improving guideline adherence for chronic disease. Use of theory is recommended but is often absent in programmes conducted in 'real-world' rather than research settings.

MATERIALS AND METHODS: This mixed-methods study tested a retrospective theory-based approach to evaluate a 'real-world' programme in primary care to improve adherence to national guidelines for chronic obstructive pulmonary disease (COPD). Qualitative data, comprising analysis of documents generated throughout the programme (n>300), in-depth interviews with planners (clinicians, managers and improvement experts involved in devising, planning, and implementing the programme, n = 14) and providers (practice clinicians, n = 14) were used to construct programme theories, experiences of implementation and contextual factors influencing care. Quantitative analyses comprised controlled before-and-after analyses to test 'early' and evolved' programme theories with comparators grounded in each theory. 'Early' theory predicted the programme would reduce emergency hospital admissions (EHA). It was tested using national analysis of standardized borough-level EHA rates between programme and comparator boroughs. 'Evolved' theory predicted practices with higher programme participation would increase guideline adherence and reduce EHA and costs. It was tested using a difference-in-differences analysis with linked primary and secondary care data to compare changes in diagnosis, management, EHA and costs, over time and by programme participation.

RESULTS: Contrary to programme planners' predictions in 'early' and 'evolved' programme theories, admissions did not change following the programme. However, consistent with 'evolved' theory, higher guideline adoption occurred in practices with greater programme participation.

CONCLUSIONS: Retrospectively constructing theories based on the ideas of programme planners can enable evaluators to address some limitations encountered when evaluating programmes without a theoretical base. Prospectively articulating theory aided by existing models and mid-range implementation theories may strengthen guideline adoption efforts by prompting planners to scrutinise implementation methods. Benefits of deriving programme theory, with or without the aid of mid-range implementation theories, however, may be limited when the evidence underpinning guidelines is flawed.

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