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Table 2 Context-Mechanism-Outcome configurations concerning access and engagement

From: Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation

Context Mechanism Outcome
General Practitioner monitoring individual patients Focuses attention on medications Attention focused on patients most in need of review
General Practitioner prescribing audited and monitored in practices Proactively conducting own audits Practice prescribing patterns benchmarked against each other across the Clinical Commissioning Group
Communication between Clinical Commissioning Group and General Practitioner Real time feedback Patients reviewed to ensure appropriate monitoring, to optimise medications, or to avoid dangerous combinations of drugs
Clinical Commissioning Group conducting searches of prescribing based upon “projects” and “initiatives” Prescribing patterns and trends benchmarked against national targets and guidelines
Clinical Commissioning Group encouraging clinicians to be engaged in more proactive safety management Engagement of practices in using the system for feedback
Voluntary engagement by clinicians
Audits conducted as a means of support to General Practitioners
The effectiveness of safety initiatives audited more quickly
Improved engagement with safety monitoring of prescribing