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Influences on the achievement of four indicators, categorised using the Theoretical Domains Framework.7
 
Avoidance of risky prescribing, especially of NSAIDs
Treatment targets in type 2 diabetes
Anticoagulation in atrial fibrillation
Blood pressure targets in treated hypertension
Knowledge
GPs more knowledgeable compared to other staff 
Awareness of drug interactions and patient history
 
Variable awareness of recommended HbA1c levels
Knowing the rationale and evidence behind recommendations
Guidance generally familiar as standard practice
Indicators familiar because of QOF
Importance of access to specialist knowledge
Treatment often initiated in secondary care
Lack of staff experience in starting treatment given relatively infrequent clinical presentation in primary care
Indicators familiar because of QOF
Indicators ingrained as “bread and butter” of general practice
Skills
Communication skills for effective patient counselling
Limited time to use skills, e.g. communication
 
Communication skills for effective patient counselling
Need for technical skills such as medication initiation and titration
Communication skills for effective patient counselling
 
Communication skills for effective patient counselling
Practice staff typically well skilled in measuring blood pressure and initiating and titrating treatment
Social professional role and identity
Prescribing perceived to be mainly the role of GPs
GP autonomy to deviate from guidance
Threat of litigation reinforces nurse prescribers’ adherence to guidance
Key role of pharmacist in improving prescribing
Prescribing practice driven by perceived patient needs than by guidance
 
Clarity of roles and responsibilities
Can refer to practice diabetic lead if patient taking multiple medicines
Tailoring care to patient needs more important than achieving strict targets
Tailored patient care can both help and hinder adherence, e.g. in elderly patients and patients with multiple conditions
Role more focused on long-term rather than acute care as atrial fibrillation often initially presents to secondary care
Contradictory advice from secondary care
Clinicians with more cardiac expertise tend to be responsible for most patients
Practice nurses viewed their input as restricted to reviewing medicines if required
Clarity of roles and responsibilities
Professional ethics and threat of litigation promote adherence
Tailoring care to patient needs more important than achieving strict targets