The University of Manchester Mark Allan Jeffries Doctor of Philosophy The implementation of electronic audit and feedback systems for medicines optimisation in primary care: understandings from a sociotechnical perspective. September 2017 Abstract Background: Ensuring medicines optimisation is important since medication errors are common and can lead to adverse drug events. Interventions to improve medicines optimisation have made increasing use of information technology (IT). In contrast to traditional approaches that only focus upon technology, sociotechnical approaches to the understanding of the implementation of IT in healthcare settings depict implementation as a social process involving a range of social and organisational factors. The aim of this thesis was to explore, evaluate and understand the socio-technical processes involved in the implementation, adoption and use of two different information technology interventions for medicines optimisation in primary care. Method: This research adopted a qualitative approach using semi-structured interviews and focus groups with a range of stakeholders in order to understand the use of two electronic audit and feedback (EAandF) systems. Three studies were undertaken each adopting a different sociotechnical approaches. The use of the first system (Eclipse Live) was explored in two studies; the first utilised strong structuration theory, the second adopted a realist evaluation approach. The use of a different EAandF system, the SMASH dashboard, was then explored through normalisation process theory in order to understand how this pharmacist-led intervention was implemented, adopted and embedded into everyday practice. Results: Strong structuration theory showed how the adoption and implementation of the EAandF system was dependent upon broad institutional contexts, the dispositions of users and the structures embedded in the technology. Differing patterns of engagement and adaptation of work practices, in the use of the EAandF system were highlighted by the realist evaluation. Normalisation process theory illustrated how the SMASH intervention was understood by users, and the ways pharmacists, clinicians and other GP staff worked collaboratively to set-up, operate and sustain the intervention. Implementation and adoption of the two systems was seen to be a dynamic social process that involved social and organisational structures the material properties of the systems, social norms, work practices and divisions of labour. In particular, the interventions involved collaborative processes, requiring communication and cooperation between stakeholders. In contrast systems were often utilised by individual groups of health professionals. Conclusions: The findings from this work represent an important contribution in understanding how EAandF systems are utilised by different health professionals. The novel use of three different sociotechnical theories was of particular value in understand these interventions for medicines optimisation in primary care. Both systems were seen as beneficial for medication safety activities. The implications from this work suggest a valuable role for information technology and for clinical pharmacists in medicines optimisation in primary care. Further evaluation of such interventions would benefit from drawing upon the insights gained from sociotechnical approaches in order to ensure effective implementation of such initiatives in the future.