title: Research "push", long term-change, and general practice.
abstract: OBJECTIVE
  Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond.
  
  
  METHODS
  Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes.
  
  
  RESULTS
  Macro-level policy imperatives shaped practice priorities which resulted in the "whole system" new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.
  
  
  CONCLUSIONS
  The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions.
  
  
  CONCLUSIONS
  The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial "research push". The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Morden
authors.forename: Lauren
authors.initials: L
authors.lastname: Brooks
authors.forename: Clare
authors.initials: C
authors.lastname: Jinks
authors.forename: Mark
authors.initials: M
authors.lastname: Porcheret
authors.forename: Bie Nio
authors.initials: BN
authors.lastname: Ong
authors.forename: Krysia
authors.initials: K
authors.lastname: Dziedzic
mesh_terms: D058006:General Practice; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D010003:Osteoarthritis / Q000628:therapy; D011320:Primary Health Care; D036301:Qualitative Research; D012648:Self Care; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom
keywords: Clinical guidelines; General practice; Implementation; Organizational change; Qualitative research; Sustainability