Interdisciplinary team working in the Irish primary healthcare system: Analysis of ‘invisible’ bottom up innovations using Normalisation Process Theory

BackgroundThe COVID-19 pandemic has led to the rapid and reactive deployment of remote consulting in UK General Practice. The delivery of acute and chronic asthma care has been affected. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context-intervention interactions affect Implementation.AimTo explore the implementation of remote asthma consulting in UK General Practice in response to the COVID-19 pandemic.Design & settingMixed methods evaluation, informed by eNPT.SettingGeneral Practice in Northern Ireland.MethodData was collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews and multidisciplinary focus groups. Analysis was informed by eNPT.ResultsWe identified ten themes to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to in-person review. Having a practice champion to drive implementation forward, and engage other Practice staff, was important. Patient, staff and healthcare system contextual factors influencing implementation were identified including access to, understanding of and willingness to use the technology required for remote consulting.ConclusionThe experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it. Work is required at Practice and healthcare system levels to realise this potential, and ensure implementation does not exacerbate existing healthcare inequalities.

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‘Participation is integral’: understanding the levers and barriers to the implementation of community participation in primary healthcare: a qualitative study using normalisation process theory

BMC Health Services Research ◽

10.1186/s12913-019-4331-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Rachel McEvoy ◽

Edel Tierney ◽

Anne MacFarlane

Keyword(s):

Qualitative Study ◽

Community Participation ◽

Primary Healthcare ◽

Process Theory ◽

Normalisation Process Theory ◽

Levers And Barriers

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Interdisciplinary Team Working in Physical and Rehabilitation Medicine – the European View

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/s-0029-1238184 ◽

2009 ◽

Vol 19 (04) ◽

Author(s):

C Gutenbrunner ◽

V Neumann

Keyword(s):

Interdisciplinary Team ◽

Rehabilitation Medicine ◽

Team Working ◽

Physical And Rehabilitation Medicine

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Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists

BMC Psychiatry ◽

10.1186/s12888-020-03004-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Åse Lundin ◽

Anna Bergenheim

Keyword(s):

At Risk ◽

Healthcare System ◽

Primary Healthcare ◽

Qualitative Content Analysis ◽

Western Hemisphere ◽

Mental Wellbeing ◽

Healthcare Personnel ◽

Public Health Issue ◽

Structured Interviews ◽

Patients At Risk

Abstract Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.

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