Self-help organisations: A qualitative study of successful collaboration with general practice

Thousands of self-help organisations (SHOs) exist in Australia but little is known about how they relate to the mainstream health care system. This qualitative study, based in south-east Queensland, aimed to identify examples of collaboration between general practitioners (GPs) and SHOs in order to examine the attributes of successful partnerships. Representatives of six SHOs, identified by key informants as having good collaborative links with GPs, and seven GPs with whom they collaborated, completed semi-structured interviews. The interviews focused on evidence of collaboration and perceptions of benefits and barriers experienced. Maximum variation sampling enabled a cross-section of SHOs in terms of size, funding, and health issue. Although GPs readily identified SHO benefits, they referred patients to them only rarely. SHO credibility, evidence of tangible benefits for patients, ease of contacting the SHO, and correspondence between the SHO?s focus and the GP?s personal and professional interests appear to contribute to the success of partnerships. We conclude that mutually beneficial partnerships between GPs and SHOs exist but are under-utilised. A more coordinated effort is needed to strengthen links between the two sectors.

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Development of an eHealth programme for self-management of persistent physical symptoms: a qualitative study on user needs in general practice

BMC Family Practice ◽

10.1186/s12875-021-01380-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mette Trøllund Rask ◽

Pernille Ravn Jakobsen ◽

Jane Clemensen ◽

Marianne Rosendal ◽

Lisbeth Frostholm

Keyword(s):

General Practice ◽

Qualitative Study ◽

Physical Symptoms ◽

Self Management ◽

Structured Interviews ◽

Patient Interviews ◽

Mapping Strategy ◽

Management Interventions ◽

Self Help ◽

Key Issues

Abstract Background Persistent physical symptoms (PPS) are estimated to be present in 17% of patients in general practice. Hence, general practitioners (GPs) play a key role in both the diagnostic assessment and the management of PPS. However, research indicates a need to improve their strategies to support self-help in patients, and eHealth tools may serve as an opportunity. This study aimed to explore patients’ and GPs’ needs related to self-management of PPS. The study was designed to inform the future development of eHealth interventions in this field. Methods This qualitative study was based on 20 semi-structured interviews (6 GPs and 14 patients with PPS). Interviews were audiotaped, transcribed verbatim and analysed through a five-step thematic analysis approach. First, we conducted an inductive analysis to identify and explore emerging subthemes. Second, using a deductive mapping strategy, we categorised the derived subthemes according to the COM-B behaviour change model and its three domains: capability, opportunity and motivation. Results We identified eleven subthemes in the patient interviews and seven subthemes in the GP interviews. Several unmet needs emerged. First, we identified a need to consider PPS early in the illness trajectory by taking a bio-psycho-social approach. Second, both patients and GPs need better skills to manage uncertainty. Third, hope is important for the patients. Fourth, patients need guidance from their GP in how to self-manage their PPS. Conclusions This study provides important insight into key issues and needs related to capability, opportunity and motivation that should be addressed in the design of future eHealth self-management interventions targeting patients with PPS in general practice in order to support and improve care.

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General Practitioners’ Perspectives Over Solutions To Change BZD Prescription Trends – A Qualitative Study

10.21203/rs.3.rs-889021/v1 ◽

2021 ◽

Author(s):

Teresa Reis ◽

Helena Serra ◽

Inês Faria ◽

Miguel Xavier

Keyword(s):

Health Care ◽

Primary Health Care ◽

Qualitative Study ◽

General Practitioners ◽

Public Health Issue ◽

Structured Interviews ◽

Health Care Settings ◽

Prescription Practices ◽

Primary Health ◽

Primary Health Care Settings

Abstract Background: This qualitative study explores General Practitioners’ (GPs) perspectives on solutions to address the problem of excessive prescription of benzodiazepines (BZDs). Over-prescription of BZDs at a primary health care settings is a prevalent issue in the region under analysis, but also elsewhere internationally. GPs are the gatekeepers to these medicines in primary care, but for several subjective, organizational and external reasons, they find it difficult to change current prescription patterns. Simultaneously, GPs recognize the issue of BZD excessive prescription practices, and propose possible solutions to invert the trend.Methods: Qualitative data were collected in seven primary health care centers in an interior and mostly rural region of Portugal. We conducted 12 semi-structured interviews with GPs. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. The themes were integrated and organized into eight axes for action.Results: Solutions proposed by GPs focused on organizational aspects, such as human resources, infrastructure and training (including on withdrawal schemes), alternative approaches, and wider community-based initiatives to counter societal aspects affecting mental health in the identified region. The themes were integrated and organized into eight axes for action.Conclusions: The findings provide an assessment of the priorities to change excessive BZDs prescription, as suggested by the GPs in primary health care settings, and hence reflecting what they consider to be context specific needs. Both experts and multi-stakeholders bottom-up perspectives should be taken into account when proposing new policies and local strategies to tackle current excessive BZD prescription, especially considering the failure of previous strategies to change this well-known public health issue. We consider that our results to be generalizable to all countries where primary health care plays a central role in care provision.Trial registration: ClinicalTrials.gov number NCT04925596

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‘Motivational work’: a qualitative study of preventive health dialogues in general practice

BMC Family Practice ◽

10.1186/s12875-020-01249-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Marie Broholm-Jørgensen ◽

Siff Monrad Langkilde ◽

Tine Tjørnhøj-Thomsen ◽

Pia Vivian Pedersen

Keyword(s):

General Practice ◽

General Practitioners ◽

Support System ◽

Preventive Intervention ◽

Digital Health ◽

Clinical Encounter ◽

Preventive Health ◽

Structured Interviews ◽

General Practices ◽

Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

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Complicated grief knowledge and practice: a qualitative study of general practitioners in Ireland

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.122 ◽

2021 ◽

pp. 1-6

Author(s):

Abiola Muhammed ◽

Anne Dodd ◽

Suzanne Guerin ◽

Susan Delaney ◽

Philip Dodd

Keyword(s):

Qualitative Study ◽

General Practitioners ◽

Current Knowledge ◽

Complicated Grief ◽

Phenomenological Approach ◽

Structured Interviews ◽

Relevant Research ◽

Loved One ◽

Knowledge And Practice ◽

Purposive Sample

Objective: Complicated grief is a debilitating condition that individuals may experience after losing a loved one. General practitioners (GPs) are well positioned to provide patients with support for grief-related issues. Traditionally, Irish GPs play an important role in providing patients with emotional support regarding bereavement. However, GPs have commonly reported not being aptly trained to respond to bereavement-related issues. This study explores GPs’ current knowledge of and practice regarding complicated grief. Methods: A qualitative study adopting a phenomenological approach to explore the experiences of GPs on this issue. Semi-structured interviews were carried out with a purposive sample of nine GPs (five men and four women) in Ireland. Potential participants were contacted via email and phone. Interviews were audio-recorded, transcribed and analysed using Braun & Clarke’s (2006) model of thematic analysis. Results: GPs had limited awareness of the concept of complicated grief and were unfamiliar with relevant research. They also reported that their training was either non-existent or outdated. GPs formed their own knowledge of grief-related issues based on their intuition and experiences. For these reasons, there was not one agreed method of how to respond to grief-related issues reported by patients, though participants recognised the need for intervention, onward referral and review. Conclusions: The research highlighted that GPs felt they required training in complicated grief so that they would be better able to identify and respond to complicated grief.

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Dual leadership in a hospital practice

Leadership in Health Services ◽

10.1108/lhs-09-2015-0030 ◽

2017 ◽

Vol 30 (1) ◽

pp. 101-112 ◽

Cited By ~ 3

Author(s):

Bettina Ravnborg Thude ◽

Svend Erik Thomsen ◽

Egon Stenager ◽

Erik Hollnagel

Keyword(s):

Health Care ◽

Qualitative Study ◽

Design Methodology ◽

Leadership Teams ◽

Decision Processes ◽

Power Balance ◽

Structured Interviews ◽

Hospital Practice ◽

Content Type ◽

Danish Hospital

Purpose Despite the practice of dual leadership in many organizations, there is relatively little research on the topic. Dual leadership means two leaders share the leadership task and are held jointly accountable for the results of the unit. To better understand how dual leadership works, this study aims to analyse three different dual leadership pairs at a Danish hospital. Furthermore, this study develops a tool to characterize dual leadership teams from each other. Design/methodology/approach This is a qualitative study using semi-structured interviews. Six leaders were interviewed to clarify how dual leadership works in a hospital context. All interviews were transcribed and coded. During coding, focus was on the nine principles found in the literature and another principle was found by looking at the themes that were generic for all six interviews. Findings Results indicate that power balance, personal relations and decision processes are important factors for creating efficient dual leaderships. The study develops a categorizing tool to use for further research or for organizations, to describe and analyse dual leaderships. Originality/value The study describes dual leadership in the hospital context and develops a categorizing tool for being able to distinguish dual leadership teams from each other. It is important to reveal if there are any indicators that can be used for optimising dual leadership teams in the health-care sector and in other organisations.

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Models for Integrating Medical Acupuncture into Practice: An Exploratory Qualitative Study of Physicians— Experiences

Acupuncture in Medicine ◽

10.1136/acupmed-2015-010992 ◽

2016 ◽

Vol 34 (4) ◽

pp. 280-289 ◽

Cited By ~ 3

Author(s):

Ellen T Crumley

Keyword(s):

Qualitative Study ◽

General Practitioners ◽

Full Time ◽

Snowball Sampling ◽

Core Concept ◽

Structured Interviews ◽

The Core ◽

Individual Physician ◽

Part Time ◽

Medical Acupuncture

Background Internationally, physicians are integrating medical acupuncture into their practice. Although there are some informative surveys and reviews, there are few international, exploratory studies detailing how physicians have accommodated medical acupuncture (eg, by modifying schedules, space and processes). Objective To examine how physicians integrate medical acupuncture into their practice. Methods Semi-structured interviews and participant observations of physicians practising medical acupuncture were conducted using convenience and snowball sampling. Data were analysed in NVivo and themes were developed. Despite variation, three principal models were developed to summarise the different ways that physicians integrated medical acupuncture into their practice, using the core concept of ‘helping’. Quotes were used to illustrate each model and its corresponding themes. Results There were 25 participants from 11 countries: 21 agreed to be interviewed and four engaged in participant observations. Seventy-two per cent were general practitioners. The three models were: (1) appointments (44%); (2) clinics (44%); and (3) full-time practice (24%). Some physicians held both appointments and regular clinics (models 1 and 2). Most full-time physicians initially tried appointments and/or clinics. Some physicians charged to offset administration costs or compensate for their time. Discussion Despite variation within each category, the three models encapsulated how physicians described their integration of medical acupuncture. Physicians varied in how often they administered medical acupuncture and the amount of time they spent with patients. Although 24% of physicians surveyed administered medical acupuncture full-time, most practised it part-time. Each individual physician incorporated medical acupuncture in the way that worked best for their practice.

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Self-initiation and self-help: Promises and pitfalls

PEDIATRICS ◽

10.1542/peds.60.4.544 ◽

1977 ◽

Vol 60 (4) ◽

pp. 544-546

Author(s):

BARBARA STARFIELD

Keyword(s):

Health Care ◽

Elementary School ◽

Health Care System ◽

School Nurse ◽

Demonstration Project ◽

Self Help ◽

Care System

Self-help is in vogue. Stimulated at least partly by the purported inadequacies of our health care system, it promises better results if only people would take responsibility for their own destinies. The Lewises and their colleagues (p. 499), in their customary fashion, have added an innovative twist to the idea. Why not start the process in childhood? In their article they describe a demonstration project in which children enrolled in an elementary school could initiate their own care from a school nurse. The nurse was trained to involve the children in the decisions required to cope with their problems. If

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