PT - JOURNAL ARTICLE AU - Bridie Angela Evans AU - Jeremy Dale AU - Jan Davies AU - Hayley Hutchings AU - Mark Kingston AU - Alison Porter AU - Ian Russell AU - Victoria Williams AU - Helen Snooks TI - Implementing emergency admission risk prediction in general practice: a qualitative study AID - 10.3399/BJGP.2021.0146 DP - 2022 Feb 01 TA - British Journal of General Practice PG - e138--e147 VI - 72 IP - 715 4099 - http://bjgp.org/content/72/715/e138.short 4100 - http://bjgp.org/content/72/715/e138.full SO - Br J Gen Pract2022 Feb 01; 72 AB - Background Using computer software in general practice to predict patient risk of emergency hospital admission has been widely advocated, despite limited evidence about effects. In a trial evaluating the introduction of a Predictive Risk Stratification Model (PRISM), statistically significant increases in emergency hospital admissions and use of other NHS services were reported without evidence of benefits to patients or the NHS.Aim To explore GPs’ and practice managers’ experiences of incorporating PRISM into routine practice.Design and setting Semi-structured interviews were carried out with GPs and practice managers in 18 practices in rural, urban, and suburban areas of south Wales.Method Interviews (30–90 min) were conducted at 3–6 months after gaining PRISM access, and ∼18 months later. Data were analysed thematically using Normalisation Process Theory.Results Responders (n = 22) reported that the decision to use PRISM was based mainly on fulfilling Quality and Outcomes Framework incentives. Most applied it to <0.5% practice patients over a few weeks. Using PRISM entailed undertaking technical tasks, sharing information in practice meetings, and making small-scale changes to patient care. Use was inhibited by the model not being integrated with practice systems. Most participants doubted any large-scale impact, but did cite examples of the impact on individual patient care and reported increased awareness of patients at high risk of emergency admission to hospital.Conclusion Qualitative results suggest mixed views of predictive risk stratification in general practice and raised awareness of highest-risk patients potentially affecting rates of unplanned hospital attendance and admissions. To inform future policy, decision makers need more information about implementation and effects of emergency admission risk stratification tools in primary and community settings.