title: Process evaluation of a point-of-care cluster randomised trial using a computer-delivered intervention to reduce antibiotic prescribing in primary care.
abstract: BACKGROUND
  The study aimed to conduct a process evaluation for a cluster randomised trial of a computer-delivered, point-of-care intervention to reduce antibiotic prescribing in primary care. The study aimed to evaluate both the intervention and implementation of the trial.
  
  
  METHODS
  The intervention comprised a set of electronic educational and decision support tools that were remotely installed and activated during consultations with patients with acute respiratory infections over a 12 month intervention period. A mixed method evaluation was conducted with 103 general practitioners (GPs) who participated in the trial. Semi-structured telephone interviews were conducted with 20 GPs who had been in the intervention group of the trial and 4 members of the implementation staff. Questionnaires, consisting of both intervention evaluation and theory-based measures, were self-administered to 83 GPs (56 control group and 27 intervention group).
  
  
  RESULTS
  Interviews suggested that a key factor influencing GPs' use of the intervention appeared to be their awareness of the implementation of the system into their practice. GPs who were aware of the implementation of the intervention reported feeling confident in using it if they chose to and understood the purpose of the intervention screens. However, GPs who were unaware that the intervention would be appearing often reported feeling confused when they saw the messages appear on the screen and not fully understanding what they were for or how they could be used. Intervention evaluation questionnaires indicated that GPs were satisfied with the usability of the prompts, and theory-based measures revealed that intervention group GPs reported higher levels of self-efficacy in managing RTI patients according to recommended guidelines compared to GPs in the control group.
  
  
  CONCLUSIONS
  Remote installation of a computer-delivered intervention for use at the point-of-care was feasible and acceptable. Additional measures to promote awareness of the intervention may be required to promote health care professionals' utilisation of the intervention and these might sometimes compromise the pragmatic intention of a trial.
  
  
  BACKGROUND
  ISRCTN47558792 (registered on 17 March 2010).
authors.forename: Lisa
authors.initials: L
authors.lastname: McDermott
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van Staa
authors.forename: Alex
authors.initials: A
authors.lastname: Dregan
authors.forename: Gerard
authors.initials: G
authors.lastname: McCann
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.forename: Martin
authors.initials: M
authors.lastname: Gulliford
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003658:Decision Making, Computer-Assisted; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards; D011247:Pregnancy; D000067490:Prescription Drug Overuse / Q000517:prevention & control*; D011320:Primary Health Care / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents