Strategies to optimize management of incidental radiographic findings in the primary care setting: A mixed methods study

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

Download Full-text

“It'd Be Great to Have the Options There”: A Mixed-Methods Study of Gender Identity Questions on Clinic Forms in a Primary Care Setting

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2020.03.030 ◽

2020 ◽

Vol 67 (4) ◽

pp. 590-596 ◽

Cited By ~ 1

Author(s):

Carly E. Guss ◽

Rose Eiduson ◽

Anqa Khan ◽

Olivia Dumont ◽

Sara F. Forman ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Gender Identity ◽

Care Setting ◽

Primary Care Setting ◽

Mixed Methods Study

Download Full-text

Comparison of self-report and objective measures of male sexual dysfunction in a Japanese primary care setting: a cross-sectional, self-administered mixed methods survey

Family Medicine and Community Health ◽

10.1136/fmch-2020-000403 ◽

2021 ◽

Vol 9 (1) ◽

pp. e000403

Author(s):

Yuki Takeuchi ◽

Ryohei Otsuka ◽

Hajime Kojima ◽

Michael D Fetters

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Sexual Dysfunction ◽

Family Medicine ◽

Care Setting ◽

Primary Care Setting ◽

Cross Sectional ◽

Medicine Clinic ◽

Barriers To Access ◽

Male Patients

ObjectivesErectile dysfunction (ED) is a common problem among middle-aged males and men often do not talk about sexual problems with their primary care physicians (PCPs). We hypothesised that many Japanese men who meet the criteria for ED would not recognise their condition based on responses to an internationally validated scale. Our secondary aims were to examine potential barriers to seeking treatment for ED by their PCPs. We sought to elucidate their perspectives about male sexual dysfunction qualitatively. Through merging of the quantitative and qualitative findings, we sought an enhanced understanding of the factors affecting sexual dysfunction treatment.DesignA cross-sectional, self-administered mixed methods survey was distributed at a suburban family medicine clinic in Sapporo, Japan. Eligible participants were 40 to 69-year-old men who came for routine scheduled visits from 5 November to 21 December 2018. During the office visit, participants completed a confidential 11-item survey addressing sexual dysfunction including the 5-item version of the International Index of Erectile Function scale and open-ended questioning.SettingTeine Family Medicine Clinic, a suburban family medicine clinic in Sapporo, Japan.ParticipantsWe enroled 66 male patients aged 40–69 years who presented for routine outpatient care in the Teine Family Medicine Clinic.ResultsOf surveyed participants, 39% (26/66) reported having sexual dysfunction, but 92% (61/66) met ED criteria. Of respondents, 48% (16/33) had desire for treatment, but only one man had discussed sexual dysfunction with his PCP. Among the 12 desiring treatment from PCPs, the main barriers to discussing were shame (n=7) and lack of awareness that PCPs can treat ED (n=5). These men’s perspectives about sexual dysfunction included viewing sexual dysfunction as normal ageing, attributing sexual dysfunction to decreased libido, considering sexual activity for a healthy life, having good rapport with PCPs, having incomplete knowledge about treatment and lacking an intimate relationship. Through a resulting model, the merged mixed methods findings illustrate how patient perceptions can reinforce or attenuate issues of awareness, desire for treatment and barriers to access.ConclusionsIn a Japanese primary care setting, the majority of participating male patients met ED criteria on an internationally validated measure, namely, the five-item version of the International Index of Erectile Function, but many were not aware of their ED. Misperceptions, lack of knowledge and personal factors are barriers to treatment. The mixed methods findings suggest misperceptions and personal attributes reinforce or attenuate awareness, preference for treatment and barriers to access. We conclude PCPs should routinely inquire about sexual dysfunction of men at risk and offer treatment to men who would benefit.

Download Full-text

Spiritual care at the end of life in the primary care setting: experiences from spiritual caregivers - a mixed methods study

BMC Palliative Care ◽

10.1186/s12904-019-0484-8 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Ian Koper ◽

H. Roeline W. Pasman ◽

Bart P. M. Schweitzer ◽

Annemieke Kuin ◽

Bregje D. Onwuteaka-Philipsen

Keyword(s):

Primary Care ◽

Palliative Care ◽

Mixed Methods ◽

Focus Group ◽

End Of Life ◽

Spiritual Care ◽

Care Setting ◽

Primary Care Setting ◽

Healthcare Providers ◽

Spiritual Issues

Abstract Background Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this. Method Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding. Results Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers’ services. Also, structural funding for spiritual caregivers in the primary care setting should be organized. Conclusion Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers’ services.

Download Full-text

Primary care professionals’ attitudes towards digital health interventions for common mental disorders: study protocol for a mixed methods systematic review

BMJ Open ◽

10.1136/bmjopen-2020-045657 ◽

2021 ◽

Vol 11 (6) ◽

pp. e045657

Author(s):

Maria Hanf ◽

Julian Hirt ◽

Marjan van den Akker

Keyword(s):

Systematic Review ◽

Primary Care ◽

Mixed Methods ◽

Mental Disorders ◽

Care Setting ◽

Primary Care Setting ◽

Digital Health ◽

Health Interventions ◽

Mental Health Interventions ◽

Primary Care Professionals

IntroductionMental disorders such as depression are common, and an estimated 264 million people are affected by them throughout the world. In recent years, studies on digital health interventions to treat mental disorders have shown evidence of their efficacy, and interest in using them has increased as a result. In the primary care setting, depression and anxiety are the two most frequently diagnosed and treated mental disorders. When they do not refer them to specialists, primary care professionals such as general practitioners treat patients with mental disorders themselves but have insufficient time to treat them adequately. Furthermore, there is a shortage of psychotherapists and those that exist have long waiting lists for an appointment. The purpose of this mixed methods systematic review is to explore the attitudes of primary care professionals towards the use of digital health interventions in the treatment of patients with mental disorders. Their attitudes will provide an indication whether digital mental health interventions can effectively complement standard care in the primary care setting.Methods and analysisWe searched for qualitative, quantitative and mixed methods studies published in English, German, Spanish, Russian, French and Dutch after January 2010 for inclusion in the review. The included studies must involve digital mental health interventions conducted via computer and/or mobile devices in the primary care setting. The search was conducted in July 2020 in the following electronic bibliographic databases: MEDLINE, Embase, CINAHL, PsycINFO and Web of Science Core Collection. Two reviewers will independently screen titles, abstracts and full texts and extract data. We will use the ‘Integrated methodology’ framework to combine both quantitative and qualitative data.Ethics and disseminationEthical approval is not required. We will disseminate the results of the mixed methods systematic review in a peer-reviewed journal and scientific conferences.PROSPERO registration numberCRD42020188879.

Download Full-text