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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Family Practice 1/2016

It could be a ‘Golden Goose’: a qualitative study of views in primary care on an emergency admission risk prediction tool prior to implementation

BMC Family Practice > Ausgabe 1/2016
Alison Porter, Mark Rhys Kingston, Bridie Angela Evans, Hayley Hutchings, Shirley Whitman, Helen Snooks
Wichtige Hinweise
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1186/​s12875-016-0416-0.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AP, MRK and BAE contributed to writing the paper, study design, and data collection and analysis. HH managed the project, contributed to study design, and commented on drafts of the paper. SW gave patient/user input into study design and conduct, contributed to data analysis, and commented on drafts of the paper. HS was Chief Investigator for the study, contributed to study design and conduct, and commented on drafts of this paper. All authors read and approved the final manuscript.



Rising demand for health care has prompted interest in new technologies to support a shift of care from hospital to community and primary care, which may require clinicians to undertake new working practices. A predictive risk stratification tool (Prism) was developed for use in primary care to estimate patients’ risk of an emergency hospital admission. As part of an evaluation of Prism, we aimed to understand what might be needed to bring Prism into effective use by exploring clinicians and practice managers’ attitudes and expectations about using it. We were informed by Normalisation Process Theory (NPT) which examines the work needed to bring an innovation into use.


We conducted 4 focus groups and 10 interviews with a total of 43 primary care doctors and colleagues from 32 general practices. All were recorded and transcribed. Analysis focussed in particular on the construct of ‘coherence’ within NPT, which examines how people understand an innovation and its purpose.


Respondents were in agreement that Prism was a technological formalisation of existing practice, and that it would function as a support to clinical judgment, rather than replacing it. There was broad consensus about the role it might have in delivering new models of care based on active management, but there were doubts about the scope for making a difference to some patients and about whether Prism could identify at-risk patients not already known to the clinical team. Respondents did not expect using the tool to be onerous, but were concerned about the work which might follow in delivering care. Any potential value would not be of the tool in isolation, but would depend on the availability of support services.


Policy imperatives and the pressure of rising demand meant respondents were open to trying out Prism, despite underlying uncertainty about what difference it could make.

Trial registration

Controlled Clinical Trials no. ISRCTN55538212.
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