Identifying barriers and facilitators to audit & feedback in general practice in Italy: a qualitative study

Audit & Feedback (A&F) interventions are recognized as effective strategies for enhancing healthcare quality, yet they remain relatively underutilized in Italian primary care settings. Recent literature highlights the importance of examining the factors influencing the implementation of these interventions across diverse clinical and organizational settings. Thus, this study aimed to identify such factors by exploring the experiences of professionals involved in an A&F intervention tailored for General Practitioners (GPs) treating chronic illnesses. Using qualitative research methods, this study organized focus groups (FGs) separately for each professional role involved in A&F: GPs, GPs acting as internal group coordinators, Public Health Physicians (PHPs) who served as liaisons between the Local Health Districts (LHDs) and groups of GPs, and Directors at LHD involved. All participants were invited to contribute to the FGs. A moderator guide was prepared, and sessions were audio-recorded and transcribed verbatim. Initial open coding led to development of a preliminary codebook, refined through iterative recoding cycles. Resultant codes were organized into 3 categories: barriers, facilitators, and recommendations and suggestions. Participation rates among FGs varied, ranging from 9.3% (8/86 GPs) to 77.8% (7/9 PHPs). Participants identified barriers and facilitators to the implementation of A&F strategies. Factors described both as obstacles and facilitators to adoption included the time and organizational commitment; the participants’ motivation; the credibility of data sources; the characteristics of the GP coordinators and the PHP liaisons; and the perceived usefulness of participating in A&F. Furthermore, barriers included the excessive theoretical load of the education and training program; some contextual factors; personal characteristics of GPs; heterogeneity in available technology, and the habit of GPs working as individuals. Conversely, facilitators included some logistical and organizational factors; the involvement of recipients in the topic’s identification; social interactions with other professionals; and incentives. Participants proposed some recommendations and suggestions on how to improve A&F interventions involving GPs. FGs allowed participants to share valuable insights into the barriers and facilitators essential for shaping improvement strategies in A&F interventions within general practice. Implementing these findings may enhance the acceptability, feasibility, and effectiveness of future A&F interventions and increase their uptake.