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Helen Snooks, Alison Porter, Mark Kingston, Bridie Evans, Victoria Williams Hayley Hutchings and Shirley Whitman
Posters-Accepted Abstracts: J Clin Trials
Background: Primary care doctors are encouraged to use predictive risk tools to identify patients who might benefit from
community-based interventions and so avoid inappropriate emergency admissions.
Objectives: As part of a trial of the Prism predictive risk tool in Wales, UK, we aimed to understand how and why it might, or
might not, be adopted by practitioners.
Methods: Before practices received Prism, we held focus groups with 31 doctors and colleagues, and interviewed a further 11.
We asked about expectations of Prism use and impact, and any concerns. Three months after implementation, we interviewed
28 doctors and colleagues about their experiences of Prism. We recorded all groups and interviews. We analysed transcripts
thematically, informed by Normalisation Process Theory (NPT).
Results: Before implementation, respondents were generally supportive of the principle of identifying at-risk patients, already
familiar with risk prediction from using condition-specific tools, and willing to trial Prism. It fitted with policy imperatives. There
were anxieties about raising patient expectations, and about implications in terms of performance management. Three months after
implementation, respondents had found a range of ways of using Prism, and then selecting patients amenable to new interventions.
Contractual changes requiring doctors to identify and plan care for ‘at risk’ patients had been a very strong driver to adoption.
Conclusions: Though respondents were open to trying Prism and were prompted by contractual incentives, it will need to be part
of a bigger picture of community based services. The findings will have UK and international relevance at a time of heightened
focus on pro--active management of chronic conditions.
Helen Snooks is the Professor of Health Services Research in the Swansea University Medical School, UK. She is the Interim Director of the Swansea Trials Unit
(STU) and leads the Patient and Population Health and Informatics (PPHI) research stream at Swansea University. Helen’s main research interests and expertise
lie in the fields of Emergency Pre-hospital and Unscheduled Care, Clinical Audit and Effectiveness, and research support. The focus of her work is to plan, design
and carry out evaluations of health technologies and new models of service delivery. Helen has a Bsc (Hons) Economics, Sociology, Statistics from University of
Surrey with a PhD in Health Services Research ‘Post Traumatic Stress Disorder in seriously injured accident victims’ at the University of Sheffield in 2000.