Implementing screening programmes in primary care versus a centralised administration: a qualitative study of atrial fibrillation screening.

backgroundGeneral practices have been tasked with increasing detection of atrial fibrillation (AF) to reduce stroke. Paroxysmal AF is often missed through usual care but can be detected through screening with repeated ECGs over a period of time using hand-held ECG devices. As part of the drive to detect AF, screening with such devices is being encouraged by both policy makers and industry. It is unclear whether general practice should be leading this effort. Previously, we showed that there was no quantitative difference between a centralised administration and general practice-delivered AF screening programme in terms of the quality and numbers of ECGs generated. Here, we aimed to assess the strengths and weaknesses of each approach using qualitative methods.

methodsWe compared programme delivery by one UK general practice and by a non-clinical centralised administration for two UK general practices in a qualitative study to explore how to conduct screening for AF in a planned trial. From September to December 2020, we conducted semi-structured interviews with 19 staff members. We took field notes of implementation issues arising during observation of 4.5 h of training and collected 15 training evaluation forms. Data were analysed thematically sensitised by the Consolidated Framework for Implementation Research. Analysis focused on the strengths and weaknesses of the different approaches.

resultsWhile both general practice staff and centralised administrators showed motivation to deliver a screening programme, there were differences in skills and capacity. General practice staff provided continuity of care and offer other care in parallel. They could use relational and communication skills to potentially engage those from underserved communities, but were limited by resources. Centralised administrators, with a singular focus on screening, could deliver a consistently high performance and undertake more complicated administration. Their initial anxieties about communication skills reduce with training and experience.

conclusionsIn screening for AF, primary care and centralised administration demonstrate different strengths and weaknesses. A hybrid approach with centralised screening and primary care signposting, particularly for underserved communities, might be optimal. Awareness of this may help policy makers optimise the use of primary care in the drive to detect AF.