BACKGROUND Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016-June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice. METHODS A realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory. RESULTS GPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP 'screening champion' had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated. CONCLUSIONS Introducing an AF screening program is likely to be successful in contexts where there is a senior GP 'screening champion', a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke. TRIAL REGISTRATIONS AF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry). AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).

中文翻译：

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采纳初级保健房颤筛查程序（AF-SMART）：对大城市和农村普通实践实施情况的现实评估。

背景技术国际指南建议对≥65岁的人群进行房颤（AF）筛查。自2016年11月至2019年6月，进行了16种大城市和农村普通实践中的房颤筛查，管理和指南推荐疗法（AF-SMART）的机会性AF筛查研究。这些研究试用了定制设计的eHealth工具，以支持所有阶段的一般情况下进行房颤筛查。方法对AF-SMART研究的真实评估，旨在解释该程序在何种情况下（或不通过）增加AF筛查人群的比例。最初的程序理论是基于我们以前的研究，政策文件和筛选研究。为了验证这一点，我们对全科医生（GPs）进行了45次半结构化访谈，参与所有实践的护士和实践经理，并收集了观察和定量筛查数据。对这些数据进行了分析和解释，以完善程序理论。结果全科医生/护士喜欢eHealth工具，尽管有时技术问题会干扰筛查。时间是筛查GP /护士的主要障碍，因此系统必须非常高效。在一位高级全科医生“筛查冠军”的领导下，尤其是在护理团队中，实践得到了广泛的采用。定期提供有关筛查数据的反馈有助于提高质量和提高动力。要在分级系统中成功进行由护士指导的筛查，就需要明确的方案来跟踪异常结果。参加该计划在提高房颤知识和提高心血管健康水平方面具有更广泛的益处。对于分配了足够工作人员时间的实践，筛选较短的更长时间（例如在接种流感疫苗期间）效果很好。结论在有高级GP“筛查冠军”，存在明确的处理异常结果的方案以及定期向员工报告数据的情况下，引入AF筛查程序可能会成功。这些环境与动机，领导力，护士赋权和有效的筛查系统相关的机制相关。环境和机制有助于长期结果，从而增加针对房颤进行筛查和治疗的人群比例，指南建议将其作为预防房颤相关中风的关键策略。AF SMART（大都会）试验区：ACTRN12616000850471（澳大利亚新西兰临床试验注册处）。AF SMART II（农村）：ACTRN12618000004268（澳大利亚新西兰临床试验注册处）。