Article Text
PDF
Abstract
Objectives The local care and treatment of liver disease (LOCATE) intervention embedded specialist liver nurses in general practitioner (GP) practices to improve the identification of progressive liver disease, enabling earlier intervention. This current process evaluation examines GP practice staffs’ perceptions of the LOCATE intervention, in order to understand any potential barriers to successful implementation in clinical practice.
Study design and setting A qualitative process evaluation nested within the LOCATE feasibility trial, using semistructured interviews with practice staff from five GP surgeries in the UK.
Participants A purposive sample of 29 interviews with practice staff (GPs, nurses, practice managers).
Data collection Interview transcripts were subjected to thematic analysis.
Findings The intervention was found to be acceptable to practice staff and a number of barriers and facilitators to the success of the intervention were identified. However, interviews suggested that the intervention did not provide sufficient guidance for clinicians to be able to help patients make the behavioural changes needed to reduce risk factors associated with liver disease. The intervention did appear to improve clinician awareness and knowledge about liver disease, enabling GPs to feel more confident interpreting and managing liver function blood tests in order to identify the early signs of liver disease.
Conclusions This study enabled identification of potential barriers to implementation of specialist nurses in primary care to identify progressive liver disease and enable earlier intervention. The next steps are to improve the intervention to make it more feasible to implement in practice and more likely to help patients to make the behavioural changes required to prevent a major liver event.
Trial registration number 13/SC/0012; Post-results.
Ethics This study was reviewed and approved by NRES Committee South Central—Hampshire A, Bristol Research Ethics Committee Centre, level 3, block B, Whitefriars, Lewins Mead Bristol BS1 2NT.
- intervention implementation
- qualitative
- liver disease
- primary care
- process analysis
- alcohol
- behaviour change
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors The LOCATE conception and original protocol were written by NS and MM. The substantial amendment to carry out the research was written by TR. Data collection, analysis and interpretation were conducted by TR. KB provided qualitative supervision throughout, discussing and agreeing the themes and codes. TR and KB drafted the article, critical revision was provided by KB, MM and NS. TR approved the final version.
Funding The British Liver Trust supported this work: registration study ID 14131 awarded to NS https://www.britishlivertrust.org.uk/. The University of Southampton sponsored this work.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Immediately following publication the study protocol, informed consent form and audit trail for codes and themes will be available, but may not be reused, on request from: t.reinson@soton.ac.uk. The is no end date to requesting this information.
Patient consent for publication Not required.