scholarly journals First Contact Practitioners’ (FCPs) and General Practitioners’ Perceptions Towards FCPs Delivering Vocational Advice to Patients with Musculoskeletal Conditions: A Qualitative Investigation of the Implementation Potential of the I-SWAP Initiative

2021 ◽  
Author(s):  
Benjamin Saunders ◽  
Nadine E. Foster ◽  
Jonathan C. Hill ◽  
Gail Sowden ◽  
Nicola Evans ◽  
...  
Keyword(s):  
Primary Care ◽  
Return To Work ◽  
Controlled Trial ◽  
Normalisation Process Theory ◽  
Future Research ◽  
Work Absence ◽  
Qualitative Investigation ◽  
Test Bed ◽  
Structured Interviews ◽  
First Contact

AbstractPurpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days’ work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of ‘coherence’ (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs’ recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.

scholarly journals Recruiting and retaining general practitioners to a primary care asthma-intervention study in Australia

2014 ◽  
Vol 20 (1) ◽  
pp. 98 ◽  
Author(s):  
Smita Shah ◽  
Jessica K. Roydhouse ◽  
Brett G. Toelle ◽  
Craig M. Mellis ◽  
Christine R. Jenkins ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Retention Rate ◽  
Controlled Trial ◽  
Independent Research ◽  
Project Staff ◽  
Recruitment Methods ◽  
General Practices ◽  
Randomised Controlled ◽  
First Contact

The need for more evidence-based interventions in primary care is clear. However, it is challenging to recruit general practitioners (GPs) for interventional research. This paper reports on the evaluation of three methods of recruitment that were sequentially used to recruit GPs for a randomised controlled trial of an asthma communication and education intervention in Australia. The recruitment methods (RMs) were: general practices were contacted by project staff from a Department of General Practice, University of Sydney (RM1); general practices were contacted by staff from an independent research organisation (RM2); and general practices were contacted by a medical peer (chief investigator) (RM3). A GP was defined as ‘recruited’ once they consented and were randomised to a group, and ‘retained’ if they provided baseline data and did not notify staff of their intention to withdraw at any time during the 12-month study. RM1 was used for the first 6 months, during which 34 (4%) GPs were recruited and 21 (62%) retained from a total of 953 invitations. RM2 was then used for the next 5 months, during which 32 (6%) GPs were recruited and 26 (81%) were retained. Finally over the next 7 months, RM3 recruited 84 (12%) GPs and retained 75 (89%) GPs. In conclusion, use of a medical peer as the first contact was associated with the highest recruitment and retention rate.

scholarly journals Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Julien A. M. Vos ◽  
Robin de Best ◽  
Laura A. M. Duineveld ◽  
Henk C. P. M. van Weert ◽  
Kristel M. van Asselt
Keyword(s):  
Primary Care ◽  
Colon Cancer ◽  
Cancer Survivorship ◽  
Daily Practice ◽  
System Level ◽  
Normalisation Process Theory ◽  
Survivorship Care ◽  
Structured Interviews ◽  
Delivery Of Care ◽  
Roles And Responsibilities

Abstract Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

scholarly journals Awareness of ADHD in primary care: stakeholder perspectives

2019 ◽  
Author(s):  
Blandine French ◽  
Elvira Perez-Vallejos ◽  
Kapil Sayal ◽  
David Daley
Keyword(s):  
Primary Care ◽  
Future Research ◽  
Care Pathways ◽  
Clear Understanding ◽  
Structured Interviews ◽  
Multiple Stakeholders ◽  
Adhd Assessment ◽  
Hyperactivity Disorder ◽  
Stakeholder Perspectives ◽  
Key Issues

Abstract Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5), patients (adults with ADHD n=5) and parents (n=5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

scholarly journals Maori cultural adaptation of a brief mental health intervention in primary care

2012 ◽  
Vol 4 (3) ◽  
pp. 231 ◽  
Author(s):  
Fiona Mathieson ◽  
Kara Mihaere ◽  
Sunny Collings ◽  
Anthony Dowell ◽  
James Stanley
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Self Management ◽  
Structured Interviews ◽  
Post Intervention ◽  
Mental Health Patient ◽  
Intervention Delivery

INTRODUCTION: There are no brief psychological mental health interventions designed specifically for Maori in a primary care setting. AIM: To adapt an existing cognitive behavioural therapy–based, guided self-management intervention for near-threshold mental health syndromes in primary care, for Maori, and to examine its acceptability and effectiveness. METHODS: Semi-structured interviews with primary care clinicians and Maori patients were conducted to inform adaptations to the intervention. Clinicians were then trained in intervention delivery. Patients were recruited if they self-identified as Maori, were aged 18–65 years, were experiencing stress or distress and scored =35 on the Kessler-10 (K10) measure of global psychological distress. Patient and clinician satisfaction was measured through a questionnaire and semi-structured interviews. Post-intervention, patients’ mental health status was measured at two weeks, six weeks and three months. RESULTS: Maori adaptations included increased emphasis on forming a relationship; spirituality; increased use of Maori language and changes to imagery in the self-management booklets. Nine of the 16 patients recruited into the study completed the intervention. Patients and clinicians rated the intervention favourably and provided positive feedback. Improvement was seen in patients’ K10 scores using intention-to-treat rated global psychological distress following intervention. DISCUSSION: This study found that it was not difficult to adapt an existing approach and resources, and they were well received by both providers and Maori patients. Further research is required with a larger sample utilising a randomised controlled trial, to establish whether this approach is effective. KEYWORDS: Primary health care; Maori mental health; patient satisfaction; brief intervention

scholarly journals Physiotherapy managers’ views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study

2017 ◽  
Vol 19 (01) ◽  
pp. 77-87 ◽  
Author(s):  
Helen P. French ◽  
Rose Galvin
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Service Provision ◽  
Urban Areas ◽  
Resource Constraints ◽  
Early Stage ◽  
Future Research ◽  
Structured Interviews ◽  
Physiotherapy Service ◽  
Stage Of Development

Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers’ experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed. Results Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy. Conclusions A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

scholarly journals Addressing medical and social needs to reduce unnecessary health care utilization and costs: a qualitative study

2021 ◽  
Author(s):  
DAVID T LISS ◽  
Adriana Guzman ◽  
Emily Walsh ◽  
Sara Shaunfield ◽  
Tiffany Brown
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Coordination ◽  
Social Needs ◽  
Care Utilization ◽  
Future Research ◽  
Structured Interviews ◽  
Medical Needs

Background: There are few if any well-known approaches to reducing avoidable health care utilization and costs in patients with social needs. This study's objective was to explore the goals, and approaches to organizing and delivering care, of interventions attempting to reduce avoidable resource use by addressing patients' medical and social needs. Methods: Semi-structured interviews were conducted with study investigators about early interventions in the peer-reviewed literature. A template analysis approach was used to review interview transcripts for common themes and create a final code list. Coder dyads separately coded each interview and resolved any discrepancies. Results: Interviews were conducted with 15 investigators of interventions that delivered a variety of health services and addressed several individual social needs. Participants frequently described their overall goal as meeting patients' diverse needs to prevent unnecessary acute care utilization. Reported approaches to addressing medical needs included assistance with receipt of primary care and care coordination across settings. Social needs were described as tightly linked with medical needs; addressing social support and housing were perceived as distinct from addressing other social needs. Participants described their overall approach to meeting patients' needs in terms of establishing connections, partnership, respect, and being adaptable to patients' priorities. Conclusions: Findings shed new light on how to simultaneously address medical and social needs. Opportunities for future research include evaluating different approaches to addressing medical needs (primary care versus care coordination), separately evaluating the impacts of housing or social support, and hiring and training procedures to promote trauma-informed, patient-centered care.

scholarly journals Awareness of ADHD in primary care: stakeholder perspectives

2019 ◽  
Author(s):  
Blandine French ◽  
Elvira Perez-Vallejos ◽  
Kapil Sayal ◽  
David Daley
Keyword(s):  
Primary Care ◽  
Future Research ◽  
Care Pathways ◽  
Clear Understanding ◽  
Structured Interviews ◽  
Multiple Stakeholders ◽  
Adhd Assessment ◽  
Hyperactivity Disorder ◽  
Stakeholder Perspectives ◽  
Key Issues

Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs’ ADHD awareness, this qualitative study aims to further explore individual stakeholders’ experiences. Methods Semi-structured interviews explored the views of multiple stakeholders- GPs (n=5), healthcare specialists (n=5) and patients (adults with ADHD n=5), (parents n=5) and with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

scholarly journals A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

2021 ◽  
Vol 12 ◽  
Author(s):  
Mairead Furlong ◽  
Christine Mulligan ◽  
Sharon McGarr ◽  
Siobhan O'Connor ◽  
Sinead McGilloway
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Qualitative Study ◽  
Child Protection ◽  
Service Providers ◽  
Controlled Trial ◽  
Parental Mental Illness ◽  
Structured Interviews ◽  
Mental Health Settings

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

scholarly journals Identification and management of frailty in English primary care: a qualitative study of national policy

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711161
Author(s):  
Harm van Marwijk ◽  
Tom Blakeman ◽  
David Reeves ◽  
Khulud Alharbi
Keyword(s):  
Primary Care ◽  
National Policy ◽  
Evidence Base ◽  
System Thinking ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Ageing Population ◽  
Structured Interviews ◽  
Data Collection And Analysis ◽  
General Practices

BackgroundPolicymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success or otherwise of the programme.AimTo explore the implementation of a national policy on frailty identification and management in English primary care.MethodSemi-structured interviews were conducted with GPs (n = 10), nurses (n = 6), practice managers (n = 3) and health advisors (n = 3). Normalisation Process Theory (NPT) and System Thinking provided sensitizing frameworks to support data collection and analysis.ResultsPrimary care professionals were starting to use the concept of frailty to structure care both within practices and across organisations, however, there was widespread concern about the challenge of providing expanded care for the identified needs within existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients.ConclusionFindings suggest that additional focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.

Corrigendum to: Supporting return to work through appropriate certification: a systematic approach for Australian primary care

2018 ◽  
Vol 42 (2) ◽  
pp. 239
Author(s):  
Harry Papagoras ◽  
Tania Pizzari ◽  
Paul Coburn ◽  
Kevin Sleigh ◽  
Andrew M. Briggs
Keyword(s):  
Primary Care ◽  
Return To Work ◽  
Professional Education ◽  
Systematic Approach ◽  
Critical Role ◽  
Injured Workers ◽  
Work Absence ◽  
Workplace Injuries ◽  
Psychosocial Sequelae ◽  
Primary Care Practitioners

Primary care practitioners play a critical role in supporting return to work (RTW) and minimising the detrimental physical and psychosocial sequelae of unnecessary and prolonged work absence in injured and ill workers. Accurate and consistent certification of capacity is an essential component of this role that has been scrutinised recently given the identified variation in certification practices between and within professions. This Perspective outlines the importance of correct certification of capacity for injured workers and provides a RTW flowchart to support systematised and appropriate certification. The flowchart is aimed at primary care practitioners (e.g. general practitioners or physiotherapists). The flowchart was developed at the Transport Accident Commission and WorkSafe Victoria as a guide for Australian primary care practitioners when certifying capacity. A more systematised approach to certification coupled with professional education and support may reduce variations and inaccuracies in certification, improve RTW rates and reduce the increasing burden of disease related to workplace injuries.

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