Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales
Background Evidence from a national clinical audit of early inflammatory arthritis (EIA) shows considerable variability between hospitals in performance, unexplained by controlling for case-mix.Objective To explore the macro-level, meso-level and micro-level barriers and facilitators to the provisio...
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BMJ Publishing Group
2021-08-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/7/3/e001616.full |
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| author | Sam Norton Cath Taylor James Galloway Magdalena Zasada Mark Yates Nicola Ayers Zoë Ide |
| author_facet | Sam Norton Cath Taylor James Galloway Magdalena Zasada Mark Yates Nicola Ayers Zoë Ide |
| author_sort | Sam Norton |
| collection | DOAJ |
| description | Background Evidence from a national clinical audit of early inflammatory arthritis (EIA) shows considerable variability between hospitals in performance, unexplained by controlling for case-mix.Objective To explore the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality EIA care.Methods A qualitative study within 16 purposively sampled rheumatology units across England and Wales. Quality was assessed in relation to 11 quality indicators based on clinical opinion, evidence and variability observed in the data. Data from semi-structured interviews with staff (1–5 from each unit, 56 in total) and an online questionnaire (n=14/16 units) were integrated and analysed using the framework method for thematic analysis using a combined inductive and deductive approach (underpinned by an evidence-based framework of healthcare team effectiveness), and constant comparison of data within and between units and its relationship with the quality criteria.Findings Quality of care was influenced by an interplay between macro, meso and micro domains. The macro (eg, shared care arrangements and relationships with general practitioners) and meso (eg, managerial support and physical infrastructure) factors were found to act as crucial enablers of and barriers to higher quality service provision at the micro (team) level. These organisational factors directly influenced team structure and function, and thereby EIA care quality.Conclusions Variability in quality of EIA care is associated with an interplay between macro, meso and micro service features. Tackling macro and meso barriers is likely to have a significant impact on quality of EIA service, and ultimately patient experience and outcomes. |
| format | Article |
| id | doaj-art-33f3108a488a49239cbcb4db41f085aa |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-33f3108a488a49239cbcb4db41f085aa2025-02-06T06:35:11ZengBMJ Publishing GroupRMD Open2056-59332021-08-017310.1136/rmdopen-2021-001616Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and WalesSam Norton0Cath Taylor1James Galloway2Magdalena Zasada3Mark Yates4Nicola Ayers5Zoë Ide62 Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKSchool of Health Sciences, University of Surrey, Guildford, UKCentre for Rheumatic Diseases, King`s College London, London, UKFaculty of Health and Medical Sciences, University of Surrey, Guildford, UK49 Centre for Rheumatic Diseases, King`s College London, London, UKSchool of Health Sciences, University of Surrey, Guildford, UKPatient Representative, London, UKBackground Evidence from a national clinical audit of early inflammatory arthritis (EIA) shows considerable variability between hospitals in performance, unexplained by controlling for case-mix.Objective To explore the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality EIA care.Methods A qualitative study within 16 purposively sampled rheumatology units across England and Wales. Quality was assessed in relation to 11 quality indicators based on clinical opinion, evidence and variability observed in the data. Data from semi-structured interviews with staff (1–5 from each unit, 56 in total) and an online questionnaire (n=14/16 units) were integrated and analysed using the framework method for thematic analysis using a combined inductive and deductive approach (underpinned by an evidence-based framework of healthcare team effectiveness), and constant comparison of data within and between units and its relationship with the quality criteria.Findings Quality of care was influenced by an interplay between macro, meso and micro domains. The macro (eg, shared care arrangements and relationships with general practitioners) and meso (eg, managerial support and physical infrastructure) factors were found to act as crucial enablers of and barriers to higher quality service provision at the micro (team) level. These organisational factors directly influenced team structure and function, and thereby EIA care quality.Conclusions Variability in quality of EIA care is associated with an interplay between macro, meso and micro service features. Tackling macro and meso barriers is likely to have a significant impact on quality of EIA service, and ultimately patient experience and outcomes.https://rmdopen.bmj.com/content/7/3/e001616.full |
| spellingShingle | Sam Norton Cath Taylor James Galloway Magdalena Zasada Mark Yates Nicola Ayers Zoë Ide Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales RMD Open |
| title | Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales |
| title_full | Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales |
| title_fullStr | Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales |
| title_full_unstemmed | Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales |
| title_short | Exploring the macro-level, meso-level and micro-level barriers and facilitators to the provision of good quality early inflammatory arthritis (EIA) care in England and Wales |
| title_sort | exploring the macro level meso level and micro level barriers and facilitators to the provision of good quality early inflammatory arthritis eia care in england and wales |
| url | https://rmdopen.bmj.com/content/7/3/e001616.full |
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