Use of primary care electronic records to monitor and improve intervention delivery of a GP practice level intervention

Background: The routine use of electronic patient records (EPRs) in primary care provides opportunities and challenges for researchers conducting clinical trials in this setting. Although the use of EPRs to search for eligible patient populations is well established they can also be used as a resource to improve trial conduct and quality. The Footprints in Primary Care study is a feasibility study and pilot cluster randomised trial exploring the acceptability of a GP practice level intervention for frequently attending patients. Two key components of the intervention are; increased continuity of care with a named GP, and delivery of a psychosocial consultation technique called BATHE.
Methods: Automated searches were set up within the EPR system in the four intervention practices. These were designed to collect consultation data, such as the number and type of consultations and name of consulting GP, for patients eligible for the Footprints in Primary Care study. Information on study GP use of the BATHE technique, denoted by the GP adding a pre-specified read-code to the EPR when they had used the technique in consultations with study patients, were also collected. These automated searches were run in the practices every 6 weeks during the 12 month intervention period and anonymised data emailed to the research team. Consultations data were also collected for the same patients for the 12 months prior to the start of the study to provide a baseline comparison.
Findings: The collection of data from EPRs at regular time points allowed the research team to monitor intervention delivery whilst the study was ongoing. This included assessment of the extent to which continuity of care had increased and the reach and dose of the BATHE consultation technique i.e. with how many patients had BATHE been used and on how many occasions. This made it possible for issues with intervention delivery, such as the low uptake of the BATHE technique amongst GPs or difficulty booking appointments with the named GP, to be followed up with study practice staff. Individualised feedback could also be provided to practices during top-up training sessions with the aim of improving intervention delivery. Furthermore the positive impact of these training sessions could be demonstrated by looking at subsequent EPR data.
Conclusions: Within the Footprints in Primary Care study the use of data from EPRs has been important for monitoring intervention delivery, reach and dose, in providing feedback to participating practice staff, and in helping to select a maximum-variation sample of staff and patients for interview. This information, alongside qualitative interview and observational data, has been instrumental to our understanding of the feasibility and acceptability of the intervention. This approach however is not without its challenges and further consideration is needed regarding how the process of data collection and the collation of feedback would be delivered on a larger scale or in real-world implementation.