Abstract
BACKGROUND: De-adoption of healthcare involves stopping or removing provision of an intervention, usually because of concerns about harm, effectiveness, and/or cost-effectiveness. De-adoption is integral to upholding the quality and sustainability of healthcare systems, but can be challenging to achieve. Previous research conducted with healthcare decision-makers identified a desire for more national support to identify and implement de-adoption opportunities. The 'Evidence-Based Interventions' (EBI) programme was a de-adoption programme introduced in the English National Health Service (NHS), comprising national recommendations to guide provision of over 40 healthcare interventions. This study aimed to investigate commissioners' actions in response to this initiative, providing insights to improve the success and impact of future de-adoption programmes. METHODS: This was a qualitative study, employing in-depth, semi-structured interviews with NHS commissioners. Interviews were analysed thematically using the constant comparison approach. This work was part of a wider mixed-methods study, which aimed to investigate the delivery, impact, and acceptability of the EBI programme across the NHS. RESULTS: Twenty-five interviews were conducted with 21 commissioners from 7 regions of England. Although commissioners were supportive of the ethos of using evidence-based criteria to guide equitable provision of care, they described inconsistent or limited adoption of EBI recommendations. Commissioners questioned the value and relevance of the recommendations, which often targeted interventions with pre-existing local policies. Local policies often set higher thresholds for accessing interventions, raising concern that adoption of national policies would raise activity to an unsustainable level given strained budgets. Interviews also revealed how implementation of national de-adoption recommendations was not a straightforward process, as they still needed to pass through multi-faceted local ratification processes, which required time, resource, and information/justification that was not always available, making implementation problematic. CONCLUSION: This study is, to our knowledge, the first investigation of how devolved healthcare policymakers respond to national de-adoption recommendations. Our study highlights that local implementation of national de-adoption policies is not necessarily straightforward, by virtue of the fact that de-adoption concerns entrenched interventions for which devolved policies may already exist. It is therefore critical that national de-adoption initiatives provide guidance around how devolved policymakers should reconcile national recommendations with local policies and processes.