Use of focus groups for identifying specialty needs of primary care physicians

BackgroundEvidence about how primary care can best enable survivors of transient ischaemic attack (TIA)/stroke return to work is limited.AimThis study explored the role of primary care in supporting survivors of transient ischaemic attack (TIA)/stroke return to work with stakeholders from a local UK community.DesignA qualitative study using framework analysis.MethodFour focus groups were carried out in Cambridgeshire, UK, between September and November 2015. The 18 participants included survivors of TIA/stroke, carers, an employer representative, GPs, occupational therapists (OTs), and clinical commissioners.ResultsThere was a mismatch between patient and carer needs and what is provided by primary care. This included: lack of GP awareness of invisible impairments; uncertainty how primary care could help in time-limited consultations; and complexity of return-to-work issues. Primary care physicians were not aware of relevant services they could refer patients to, such as OT support. In addition, there was an overall lack of coordination between different stakeholders in the return-to-work process. Linking with other services was considered important but challenging because of ongoing changes in service structure and the commissioning model. Suggestions for improvement include: a central contact in primary care for signposting to available services; a rehabilitation assessment integrated with the electronic record; and a patient-held shared-care plan at discharge from stroke wards.ConclusionImproving the role for primary care in helping survivors of TIA/stroke return to work is challenging. However, primary care could play a central role in initiating/coordinating vocational rehabilitation. Through focus group discussions with stakeholders from a local community, patients, carers, and clinical commissioners were able to put forward concrete proposals to address the barriers identified.

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Cancer survivorship care in rural community: Provider perspective.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.50 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 50-50

Author(s):

Katia Noyes ◽

David Holub ◽

Irfan Rizvi ◽

Alex Swanger ◽

Coty Reisdorf ◽

...

Keyword(s):

Primary Care ◽

Focus Group ◽

Focus Groups ◽

Multidisciplinary Team ◽

Cancer Care ◽

Financial Incentives ◽

Primary Care Physicians ◽

Performance Metrics ◽

Care Delivery ◽

Successful Implementation

50 Background: Advances in oncologic sciences have resulted in successful treatments for many cancers with improved survival for millions of patients. Efficient delivery of cancer care now requires not only skills and professionalism of each provider but also well-orchestrated performances of multiple oncology, primary care and social services providers acting as one multidisciplinary team. It is unknown, however, whether providers are prepared for and accept their new roles in patient cancer care teams across region. This study assessed perspectives of providers involved in care for patients with cancer about their changing roles. Methods: We conducted a focus group with a diverse group of stakeholders involved in cancer care (2 primary care physicians, 1 rural surgeon, 2 rural oncologists, 2 oncology nurses, 2 cancer patients and a caregiver). The focus group was conducted using ThinkTank software, a collaborative tool that allows participants to communicate virtually in real time, screen share, express preferences and confidentially rank each other responses. We also conducted two traditional focus groups with rural care managers, nurses, social workers and public health providers. Results: The focus groups identified significant differences in attitudes and beliefs toward regional team-based cancer care between various providers. PCPs ranked oncology issues as less important to their practices compared to other chronic conditions associated with performance metrics and financial incentives. APPs ranked care coordination issues as more important compared to PCP rankings from the same practices. Rural providers identified limited staffing, outdated health IT systems, and lack of expertise as major barriers to multidisciplinary team care. Both patients and providers highlighted importance of trust and face-to-face communication in treatment adherence and choice of care setting. Conclusions: Current health information systems, performance metrics and payment models represent significant barriers to integrated care delivery in oncology and survivorship. Successful implementation of efficient and sustainable regional oncology program will require a multi-dimensional intervention to address each of these barriers.

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Perceptions of virtual primary care physicians: A focus group study of medical and data science graduate students

PLoS ONE ◽

10.1371/journal.pone.0243641 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243641

Author(s):

Courtney M. Goetz ◽

Judith E. Arnetz ◽

Sukhesh Sudan ◽

Bengt B. Arnetz

Keyword(s):

Primary Care ◽

Medical Students ◽

Graduate Students ◽

Focus Groups ◽

Primary Care Physician ◽

Primary Care Physicians ◽

Data Science ◽

Care Physician ◽

First Year ◽

Engineering Data

Background Artificial and virtual technologies in healthcare have advanced rapidly, and healthcare systems have been adapting care accordingly. An intriguing new development is the virtual physician, which can diagnose and treat patients independently. Methods and findings This qualitative study of advanced degree students aimed to assess their perceptions of using a virtual primary care physician as a patient. Four focus groups were held: first year medical students, fourth year medical students, first year engineering/data science graduate students, and fourth year engineering/data science graduate students. The focus groups were audiotaped, transcribed verbatim, and content analyses of the transcripts was performed using a data-driven inductive approach. Themes identified concerned advantages, disadvantages, and the future of virtual primary care physicians. Within those main categories, 13 themes emerged and 31 sub-themes. Discussion While participants appreciated that a virtual primary care physician would be convenient, efficient, and cost-effective, they also expressed concern about data privacy and the potential for misdiagnosis. To garner trust from its potential users, future virtual primary physicians should be programmed with a sufficient amount of trustworthy data and have a high level of transparency and accountability for patients.

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Primary care physicians’ attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-034983 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034983

Author(s):

Rachel M Zetts ◽

Andrea Stoesz ◽

Andrea M Garcia ◽

Jason N Doctor ◽

Jeffrey S Gerber ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Antibiotic Resistance ◽

Family Medicine ◽

Focus Groups ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Physician Attitudes ◽

Urgent Care ◽

Antibiotic Prescribing

ObjectivesAt least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.DesignEight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods.SettingFocus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles.ParticipantsTwo focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated.ResultsParticipants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will ‘game the system’ to improve their measures, and dissatisfaction and distrust of quality measurement in general.ConclusionsStakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.

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A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit

Journal of Hospital Medicine ◽

10.12788/jhm.3370 ◽

2020 ◽

Vol 15 (9) ◽

pp. 518-525 ◽

Cited By ~ 1

Author(s):

Sarah W Riddle ◽

Susan N Sherman ◽

Margo J Moore ◽

Allison M Loechtenfeldt ◽

Heather L Tubbs-Cooley ◽

...

Keyword(s):

Primary Care ◽

Focus Groups ◽

Primary Care Physicians ◽

Home Visit ◽

Controlled Trial ◽

Hospital Medicine ◽

Warning Sign ◽

Red Flags ◽

Hospital To Home ◽

Home Nurse

BACKGROUND: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS: We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS: Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family’s reutilization decisions; hospital-affiliated RNs “directing traffic” back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits—one size does not fit all; and providing context and framing of red flags. CONCLUSION: Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.

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Barriers in providing primary care for immigrant patients with dementia: GPs’ perspectives

BJGP Open ◽

10.3399/bjgpopen18x101610 ◽

2018 ◽

Vol 2 (4) ◽

pp. bjgpopen18X101610 ◽

Cited By ~ 1

Author(s):

Rosa Vissenberg ◽

Ozgul Uysal ◽

Miriam Goudsmit ◽

Jos van Campen ◽

Bianca Buurman-van Es

Keyword(s):

Primary Care ◽

The Netherlands ◽

Focus Groups ◽

Primary Care Physicians ◽

Online Survey ◽

Information Provision ◽

Diagnostic Process ◽

Care Needs ◽

Optimal Care ◽

Care Community

BackgroundDementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention.AimTo describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs.Design & settingA mixed-method study, consisting of an online survey and focus groups.MethodAn online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care.ResultsGPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education.ConclusionImportant barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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