Patients’ experiences and preferences for primary care delivery: a focus group analysis

Abstract Background: In 2005, the Portuguese government launched a primary care (PC) reform. After a promising start, the reform is still incomplete and has been compromised by low investment. The incomplete nature of the reforms has resulted in the coexistence of different models of care delivery and heterogeneity in resource allocation and performance. PC has been extensively evaluated, but little is known about the patients’ views and preferences regarding PC and the ongoing reform. Aim: This study aims to examine patients’ experiences of and preferences for PC in Portugal and to explore their experience of the recent reforms. Methods: A qualitative study was undertaken which collected data from eight focus groups in the city of Braga, Portugal. Participants were recruited with the collaboration of eight local institutions. Focus groups’ discussions focused on patients’ experiences of and preferences for PC as well as their views on the reforms. Audio recordings were transcribed and analysed using an inductive thematic content analysis. Findings: The majority of participants perceived that the reform was positive. However, the improvements achieved by the reform were insufficient to lead to most participants having a positive experience of PC delivery in Portugal. Participants’ satisfaction/dissatisfaction with primary care was strongly associated with interpersonal relations and communication with doctors. Participants valued continuity of care, but felt the levels of responsiveness, flexibility and coordination in the current system were still unsatisfactory. Access and waiting times were seen as challenging and led participants to seek PC from emergency departments and private doctors. Policy Implications: The perception of increased inequity and the lack of effective choice undermined the social acceptability of the reform. Policies aimed at improving doctor–patient communication and continuity of care, as well as choice, may therefore lead to better satisfaction and more efficient use of health care settings.

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Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

BMC Family Practice ◽

10.1186/s12875-021-01496-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rachelle Ashcroft ◽

Catherine Donnelly ◽

Maya Dancey ◽

Sandeep Gill ◽

Simon Lam ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Qualitative Study ◽

Mental Health Care ◽

Focus Groups ◽

Care Delivery ◽

Virtual Care ◽

Primary Care Teams ◽

The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

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Strengthening of primary-care delivery in the developing world: IMAI and the need for integrated models of care

The Lancet Global Health ◽

10.1016/s2214-109x(13)70102-5 ◽

2013 ◽

Vol 1 (6) ◽

pp. e321-e323 ◽

Cited By ~ 6

Author(s):

Ashwin Vasan ◽

Andrew Ellner ◽

Stephen D Lawn ◽

Neil Gupta ◽

Manzi Anatole ◽

...

Keyword(s):

Primary Care ◽

Developing World ◽

Care Delivery ◽

Models Of Care ◽

Integrated Models ◽

Primary Care Delivery

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Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

10.21203/rs.3.rs-15628/v1 ◽

2020 ◽

Author(s):

Odala Sande ◽

Doris Burtscher ◽

Daneck Kathumba ◽

Hannock Tweya ◽

Sam Phiri ◽

...

Keyword(s):

Care Delivery ◽

Quality Care ◽

Waiting Times ◽

Physical Structure ◽

Models Of Care ◽

Hiv Care ◽

People Living With Hiv ◽

Care Providers ◽

Health Care Information ◽

Community Based

Abstract Background Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients. Methods To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis. Results Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule). Patients’ nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles. Conclusions The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factors – including staff transportation and workload – must be taken into consideration and purposefully planned.

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An assessment of implementation of Community Oriented Primary Care in Kenyan family medicine postgraduate medical education programmes

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v8i1.1064 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Ian J. Nelligan ◽

Jacob Shabani ◽

Stephanie Taché ◽

Gulnaz Mohamoud ◽

Megan Mahoney

Keyword(s):

Primary Care ◽

Family Medicine ◽

Focus Groups ◽

Learning Outcomes ◽

Care Delivery ◽

The United States ◽

Community Empowerment ◽

Successful Implementation ◽

Community Based ◽

Postgraduate Students

Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

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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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Patient and nurse perspectives of a nurse-led community-based model of HIV care delivery in Malawi: a qualitative study

10.21203/rs.3.rs-15628/v2 ◽

2020 ◽

Author(s):

Odala Sande ◽

Doris Burtscher ◽

Daneck Kathumba ◽

Hannock Tweya ◽

Sam Phiri ◽

...

Keyword(s):

Care Delivery ◽

Quality Care ◽

Waiting Times ◽

Physical Structure ◽

Models Of Care ◽

Hiv Care ◽

People Living With Hiv ◽

Care Providers ◽

Health Care Information ◽

Community Based

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Cardiac nursing: Achieving Competent Practitioners

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2005.01.002 ◽

2005 ◽

Vol 4 (1) ◽

pp. 15-21 ◽

Cited By ~ 15

Author(s):

Jillian Riley ◽

Lyndell Brodie ◽

Caroline Shuldham

Keyword(s):

Care Delivery ◽

Waiting Times ◽

Models Of Care ◽

Quality Of Services ◽

Cardiac Care ◽

Routine Practice ◽

Knowledge And Skills ◽

Career Pathway ◽

Fit For Purpose

This paper describes how competency statements were integrated into an academic framework to provide a transparent yet flexible career pathway for the nurse working in acute cardiac care. Nurses are expanding and developing their roles and use wide ranging skills and knowledge to care for patients. Additionally, models of care delivery are changing and patients are cared for in a variety of settings. Where evidence exists, these models demonstrate improvement in the provision and quality of services and contribute to improved quality of life, maximise medication and therapy and reduce waiting times for investigations. However, whilst many studies have demonstrated benefit, translating these results into routine practice requires skilled nurses who are “fit for purpose”, and to support this, professional competencies can be used to measure competence in practice whilst informing educational initiatives. This paper outlines the development of competency statements that identify the knowledge and skills required for safe, effective and competent care and direct the cardiac nurse acquire skills and knowledge in a focused and coherent way.

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Why Wait so Long for Child Care? An Analysis of Waits, Queues and Work in a South African Urban Health Centre

Tropical Doctor ◽

10.1177/004947559702700113 ◽

1997 ◽

Vol 27 (1) ◽

pp. 34-38 ◽

Cited By ~ 5

Author(s):

Max O Bachmann ◽

Peter Barron

Keyword(s):

Primary Care ◽

South African ◽

Urban Health ◽

Care Delivery ◽

Waiting Times ◽

Health Centre ◽

Cross Sectional ◽

Patient Dissatisfaction ◽

Primary Care Delivery ◽

Urban Health Centre

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

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Do patients with and without a regular primary care physician have their psychological distress looked after differently?

Journal of Public Health ◽

10.1093/pubmed/fdy112 ◽

2018 ◽

Vol 41 (2) ◽

pp. 399-404 ◽

Cited By ~ 1

Author(s):

Kai Sing Sun ◽

Tai Pong Lam ◽

Kwok Fai Lam ◽

Tak Lam Lo ◽

David Vai Kiong Chao ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Psychological Distress ◽

Mental Health Care ◽

Continuity Of Care ◽

Primary Care Physicians ◽

Care Delivery ◽

Care Physician ◽

Psychological Problems

Abstract Background While qualitative studies suggested that continuity of care by primary care physicians (PCPs) facilitated consultations for psychological problems, there was limited quantitative evidence. This survey compared management of psychological distress between patients with and without a regular PCP. Methods A questionnaire survey was conducted with 1626 adult primary care attenders from 13 private and 6 public clinics in Hong Kong. Management of psychological distress between respondents with a regular PCP and those without were compared. Effects of demographic factors were adjusted for by multivariable logistic regression. Results Among the 1626 respondents, 650 (40.0%) reported that they had ever experienced psychological distress. Of the 650 respondents experienced distress, 307 (47.2%) had a regular PCP. A significantly higher proportion of patients with a regular PCP than those without reported: (i) their PCPs sometimes/often asked about psychological problems [37.7 versus 20.1%, adjusted OR = 2.241]; (ii) they sometimes/often mentioned their psychological problems to PCPs [45.2 versus 24.9%, adjusted OR = 2.503]; and (iii) their distress had been treated by PCPs [22.1 versus 13.4%, adjusted OR = 1.702]. Conclusion Patients with a regular PCP have around double odds of receiving mental health care. Continuity of care by PCPs should be emphasized in mental health care delivery.

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Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.810014 ◽

2021 ◽

Vol 9 ◽

Author(s):

David Pina ◽

Paloma López-Ros ◽

Aurelio Luna-Maldonado ◽

Aurelio Luna Ruiz-Caballero ◽

Bartolomé Llor-Esteban ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Focus Groups ◽

Workplace Violence ◽

Health Care Professionals ◽

Waiting Times ◽

Professional Group ◽

Point Of View ◽

Care Services ◽

Primary Care Services

Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals.Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided.Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data.Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation.Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.

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