Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia.
MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia.
BMJ Health Care Inform. 2024 Jun 23;31(1):e100946. doi: 10.1136/bmjhci-2023-100946.
The learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an LHS in general practice, and even fewer that are underpinned by implementation science. This study aimed to describe the barriers and facilitators to achieving an LHS in primary care and provide practical recommendations for general practices on their journey towards an LHS.
This study is a secondary data analysis from a qualitative investigation of an LHS in a university-based general practice in Sydney, Australia. A framework analysis was conducted using transcripts from semistructured interviews with clinic staff. Data were coded according to the theoretical domains framework, and then to an LHS framework.
91% (n=32) of practice staff were interviewed, comprising general practitioners (n=15), practice nurses (n=3), administrative staff (n=13) and a psychologist. Participants reported that the practice alignment with LHS principles was influenced by many behavioural determinants, some of which were applicable to healthcare in general, for example, some staff lacked about practice policies and in using software. However, many were specific to the general practice environment, for example, the of general practice meant that administrative staff were an integral part of the LHS, particularly in facilitating partnerships with patients.
The LHS journey in general practice is influenced by several factors. Mapping the LHS domains in relation to the theoretical domains framework can be used to generate a roadmap to hasten the journey towards LHS in primary care settings.
学习型卫生系统（LHS）的概念是解决当前基层医疗面临挑战的潜在解决方案。尽管有一些关于在一般实践中实现 LHS 的障碍和促进因素的描述，但很少有基于实施科学的描述。本研究旨在描述在一般实践中实现 LHS 的障碍和促进因素，并为一般实践在实现 LHS 的过程中提供实用建议。
这是对澳大利亚悉尼一所大学附属医院的 LHS 进行定性研究的二次数据分析。使用半结构化访谈诊所工作人员的记录进行了框架分析。根据理论领域框架对数据进行编码，然后对 LHS 框架进行编码。
91%（n=32）的实践人员接受了采访，包括全科医生（n=15）、执业护士（n=3）、行政人员（n=13）和心理学家。参与者报告说，该实践与 LHS 原则的一致性受到许多行为决定因素的影响，其中一些适用于一般医疗保健，例如，一些员工对实践政策缺乏了解，并且不熟悉软件使用。然而，许多因素是特定于一般实践环境的，例如，一般实践的性质意味着行政人员是 LHS 的一个组成部分，特别是在促进与患者的合作方面。
一般实践中的 LHS 之旅受到多种因素的影响。将 LHS 领域与理论领域框架相关联可以用来制定路线图，以加速在初级保健环境中实现 LHS 的进程。
