Developing change proposals to improve the management of coronary heart disease in primary care

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The National Service Framework for Coronary Heart Disease provides indicators and criteria, which can guide improvement activity in primary care, but this guidance will need to be complemented by local initiatives to promote change. The need for change strategies to be tailored to the problems and settings they are meant to address is only now clearly understood. Effective evidence-based implementation will require a correct diagnosis of underlying barriers to change, an understanding of the effectiveness and appropriateness of alternative change strategies and a judicious selection from the available options. In this paper we show how local investigations of barriers to change might be used to generate change proposals for implementation by primary care organisations. Although the change proposals we developed were complex, the policy context in primary care is favourable for engaging practitioners and patients and for delivering change. It is our hope that local investigations will be used alongside the research literature on the implementation of change, to develop change proposals that are grounded in evidence and tailored to particular settings.


Document Type: Research Article

Affiliations: Department of Primary Care and Population Sciences, Royal Free and University College London Medical School, London, UK

Publication date: December 1, 2003

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