Accepted for/Published in: JMIR Human Factors
Date Submitted: Dec 21, 2023
Open Peer Review Period: Dec 26, 2023 - Feb 20, 2024
Date Accepted: Jun 2, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Exploring clinical acceptability of a new quality improvement program aiming to reduce cardiovascular disease risk in people with chronic kidney disease in Australian general practice: qualitative study
ABSTRACT
Background:
Future Health Today (FHT) is a technology program that integrates with general practice (GP) clinical software to provide point of care (PoC) clinical decision support and a quality improvement dashboard. This qualitative study looks at the use of FHT in the context of cardiovascular disease risk in chronic kidney disease (CKD).
Objective:
To explore factors influencing clinical implementation of the FHT module focusing on cardiovascular risk in CKD, from the perspectives of participating GP staff.
Methods:
Practices in Victoria were recruited to participate in a pragmatic cluster randomised control trial using FHT, of which 19 practices were randomly assigned to use FHT’s cardiovascular risk in CKD program. 13 semi-structured interviews were undertaken with a nominated GP (n =7) or practice nurse (n=6) from 10 participating practices. Interview questions focused on clinical usefulness of the tool and its place in clinical workflows. Qualitative data were coded by two researchers and analysed using Framework Analysis and Clinical Performance Feedback Intervention Theory (CP-FIT).
Results:
All 13 interviewees had used the FHT point of care tool, and feedback was largely positive. Overall, clinicians described engaging with the tool as a ‘prompt’ or ‘reminder’ system. Themes reflected that the tool’s goals and clinical content were aligned with clinician’s existing priorities and knowledge, and the tool’s design facilitated easy integration into existing workflows. The main barrier to implementation identified by two clinicians was notification fatigue. 7 interviewees had used the FHT dashboard tool. The main barriers to use were its limited integration into clinical workflows such that some participants did not know of its existence, and clinicians’ competing clinical priorities and limited time to learn and use the tool.
Conclusions:
This study identified many facilitators for successful use of the FHT point of care program in the context of cardiovascular risk in CKD, and barriers to use of the dashboard program. This work will be used to inform wider implementation of FHT, as well as development of future modules of FHT for other risk or disease states. Clinical Trial: Australian New Zealand Clinical Trial Registry ACTRN12620000993998
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