Healthcare practitioners’ experiences of an intervention to detect and treat patients with liver disease (the LOCATE intervention): a qualitative process evaluation

OBJECTIVES: The local care and treatment of liver disease (LOCATE) intervention embedded specialist liver nurses in general practitioner (GP) practices to improve the identification of progressive liver disease, enabling earlier intervention. This current process evaluation examines GP practice staffs’ perceptions of the LOCATE intervention, in order to understand any potential barriers to successful implementation in clinical practice. STUDY DESIGN AND SETTING: A qualitative process evaluation nested within the LOCATE feasibility trial, using semistructured interviews with practice staff from five GP surgeries in the UK. PARTICIPANTS: A purposive sample of 29 interviews with practice staff (GPs, nurses, practice managers). DATA COLLECTION: Interview transcripts were subjected to thematic analysis. FINDINGS: The intervention was found to be acceptable to practice staff and a number of barriers and facilitators to the success of the intervention were identified. However, interviews suggested that the intervention did not provide sufficient guidance for clinicians to be able to help patients make the behavioural changes needed to reduce risk factors associated with liver disease. The intervention did appear to improve clinician awareness and knowledge about liver disease, enabling GPs to feel more confident interpreting and managing liver function blood tests in order to identify the early signs of liver disease. CONCLUSIONS: This study enabled identification of potential barriers to implementation of specialist nurses in primary care to identify progressive liver disease and enable earlier intervention. The next steps are to improve the intervention to make it more feasible to implement in practice and more likely to help patients to make the behavioural changes required to prevent a major liver event. TRIAL REGISTRATION NUMBER: 13/SC/0012; Post-results. ETHICS: This study was reviewed and approved by NRES Committee South Central—Hampshire A, Bristol Research Ethics Committee Centre, level 3, block B, Whitefriars, Lewins Mead Bristol BS1 2NT.