scholarly journals General practitioners’ concepts on issuing out-of-pocket prescriptions for hypnotics and sedatives in Germany

2019 ◽  
Vol 36 (6) ◽  
pp. 785-790
Author(s):  
Katharina Schmalstieg-Bahr ◽  
Christiane A Müller ◽  
Eva Hummers
Keyword(s):  
Health Insurance ◽  
Qualitative Study ◽  
General Practitioners ◽  
Statutory Health Insurance ◽  
Medication Use ◽  
Hypnotics And Sedatives ◽  
Structured Interviews ◽  
Medication Costs ◽  
Prescription Form ◽  
To Receive

Abstract Background In Germany, almost 50% of prescriptions for benzodiazepines and drugs as Zolpidem and Zopiclone are as out-of-pocket (OOP) prescriptions—requiring patients to buy the drug at their own expense—although almost 90% of the population has statutory health insurance covering medication costs. Objective To understand why general practitioners (GPs) choose this prescribing method since needed medications are insurance covered, and unnecessary drugs should not be prescribed at all. Methods In this qualitative study, 17 semi-structured interviews with GPs were conducted, audio recorded and transcribed verbatim. Transcripts were analysed with grounded theory to extract a model explaining the described behaviour. Results Knowing the significant medical risks and insecurity about regulations makes GPs wish to avoid hypnotics and sedatives. They achieve this by ‘Creating a barrier’ (central phenomenon) and employing the strategy ‘Using an out-of-pocket prescription’, which not only generates costs for the patient but also reduces the physicians´ legal and financial accountability. The perceived patient type, expected problem duration and diagnosis influence the decision about the prescription form: patients with an alcohol or drug addiction or those with ‘uncomplicated’ insomnia are more likely to receive an OOP prescription. Patients with any psychiatric diagnosis will likely receive a statutory health insurance prescription. Discussion Current regulations do not provide guidance to GPs regarding hypnotics and sedatives. A clear regulatory framework and guidelines could possibly reduce physicians’ defensive attitudes about these drugs and their use of OOP prescriptions. The approach to use OOP prescriptions as a barrier to reduce patients’ medication use lacks evidence regarding effectiveness.

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

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.

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

2016 ◽  
Vol 34 (4) ◽  
pp. 280-289 ◽  
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.

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

2003 ◽  
Vol 9 (3) ◽  
pp. 75 ◽  
Author(s):  
Frances M Boyle ◽  
T. Natasha Posner ◽  
Christopher B Del Mar ◽  
Jill McLean ◽  
Robert A Bush
Keyword(s):  
Health Care ◽  
General Practice ◽  
Qualitative Study ◽  
General Practitioners ◽  
Health Care System ◽  
Cross Section ◽  
Structured Interviews ◽  
Self Help ◽  
Successful Collaboration ◽  
Two Sectors

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.

scholarly journals Acceptability of a Hypothetical Zika Vaccine among Women from Colombia and Spain Exposed to ZIKV: A Qualitative Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 580
Author(s):  
Elena Marbán-Castro ◽  
Ana Villén-Gonzalvo ◽  
Cristina Enguita-Fernàndez ◽  
Kelly Carolina Romero-Acosta ◽  
Anna Marín-Cos ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare Providers ◽  
Vaccine Trial ◽  
Vaccine Safety ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Perceptions And Attitudes ◽  
Effective Delivery ◽  
Congenital Zika Syndrome ◽  
To Receive

Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015–2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women’s willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child’s health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable.

scholarly journals People living in poverty and their relationship to local church communities: An exploratory qualitative study in Mechelen, Belgium

2016 ◽  
Vol 72 (4) ◽  
Author(s):  
Annemie Dillen ◽  
Elke Van Hoof
Keyword(s):  
Qualitative Study ◽  
Empirical Research ◽  
Working Hours ◽  
Structured Interviews ◽  
The Poor ◽  
Positive Experiences ◽  
Private Religious Practices ◽  
To Receive ◽  
The Church ◽  
Church Communities

Much literature on church and poverty issues takes the church as the actor and people living in poverty as the acted upon, those who have to receive care or who will benefit from the church’s diaconal action. Not much is known about experiences of the church and the religion of people living in poverty themselves. The aim of this article is threefold: (1) To learn more about possible difficulties, also possibilities, for participation of people living in poverty in Catholic parishes in Flanders; (2) To give a voice to people living in poverty, to help them to express their ‘ordinary theology’ (Astley 2002) and to make their experiences visible to a broader ecclesial audience; (3) To discuss the ecclesial experiences of people living in poverty and people who know their experiences quite well, in light of church documents.This article presents the results of an exploratory qualitative study in Mechelen, a medium-tolarge city in Flanders, Belgium. We present the results of semi-structured interviews with 20 participants – 7 caregivers and 13 people living in poverty.We found both pragmatic difficulties and more religious difficulties for participation in parishes, named by people living in poverty, as well as by (voluntary and professional) caregivers. Pragmatic difficulties are, for example, mobility or time (in relation to working hours on Saturday/Sunday). More religious-related difficulties concern the doubts about God in relation to their own suffering, aspects of the moral teachings of the church (e.g. about homosexuality) and questions about the Eucharist itself, experienced in a non-satisfactory way. More positive experiences concern the silence or rest people experience in the church or the experience of a community. We discuss findings relating to experiences of ‘inclusion’ of people living in poverty within church communities and more private religious practices, named by people living in poverty.In a next step, we compare these results with other empirical research. Finally, we discuss what it can mean to be a ‘church of the poor’ and what ‘friendship with the poor’ might be and how this concept can be evaluated. 

scholarly journals Home-based palliative care management: what are the useful resources for general practitioners? a qualitative study among GPs in France

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carol-Anne Boudy ◽  
Tiphanie Bouchez ◽  
Didier Caprini ◽  
Isabelle Pourrat ◽  
Stéphane Munck ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
General Practitioners ◽  
Real Life ◽  
Continuous Medical Education ◽  
Care Practice ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Home Based ◽  
At Home

Abstract Background Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. Methods Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. Results The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. Conclusion This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

scholarly journals Changes over time in attitudes towards the management of older patients with heart failure by general practitioners: a qualitative study

2019 ◽  
Author(s):  
Laura Moscova ◽  
Fabien Leblanc ◽  
Jacques Cittee ◽  
Julien Le Breton ◽  
Sophie Vallot ◽  
...  
Keyword(s):  
Heart Failure ◽  
Patient Education ◽  
Qualitative Study ◽  
General Practitioners ◽  
Older Patients ◽  
Beta Blockers ◽  
Structured Interviews ◽  
Converting Enzyme Inhibitors ◽  
Changes Over Time ◽  
Over Time

Abstract Background Underdiagnosis and undertreatment of chronic heart failure (CHF) are common in older patients, who are usually treated by general practitioners (GPs). In 2007, the French ICAGE study explored GPs’ attitudes to the management of this condition in older patients. Objectives To explore changes over time in GPs’ attitudes towards the management of CHF in patients aged ≥75 and to identify barriers to optimal management. Methods In 2015, we performed a qualitative study of 20 French GPs via semi-structured interviews and a thematic content analysis. The results were compared with the findings of a 2007 study. Results In 2015, the perceived barriers to diagnosis were the same as in 2007. Echocardiography was still the preferred diagnostic method but the GPs relied on the cardiologist to confirm the diagnosis. Many GPs were still unaware of the different types of CHF. In contrast, they reported greater knowledge of decompensation factors and the ultrasound criteria for CHF. They also prescribed a brain natriuretic peptide assay more frequently. Angiotensin-converting enzyme inhibitors and beta blockers were more strongly perceived to be core treatments. Few GPs initiated drug treatments and optimized dosages. Although patient education was never mentioned, the importance of multidisciplinary care was emphasized. Conclusion Our results evidenced a small recent improvement in the management of older patients with CHF. Appropriate guidelines and training for GPs, patient education and multidisciplinary collaboration might further improve the care given to this population.

scholarly journals Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners’ Perspectives

2021 ◽  
Vol 18 (24) ◽  
pp. 12926
Author(s):  
India Bellairs-Walsh ◽  
Sadhbh J. Byrne ◽  
Sarah Bendall ◽  
Yael Perry ◽  
Karolina Krysinska ◽  
...  
Keyword(s):  
At Risk ◽  
Young People ◽  
Qualitative Study ◽  
General Practitioners ◽  
Suicidal Behaviour ◽  
Assessment Tools ◽  
Service Access ◽  
Structured Interviews ◽  
Mental Health Support ◽  
Self Harm

General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs’ perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools–the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.

scholarly journals GPs’ experiences of diagnosing and managing childhood eczema: a qualitative study in primary care

2018 ◽  
Vol 68 (667) ◽  
pp. e73-e80 ◽  
Author(s):  
Emma Le Roux ◽  
Kingsley Powell ◽  
Jonathan P Banks ◽  
Mathew J Ridd
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Disease Control ◽  
Medication Use ◽  
Self Care ◽  
Trial And Error ◽  
Structured Interviews ◽  
Common Cause ◽  
Topical Treatments ◽  
The Uk

BackgroundEczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition.AimTo explore the experiences of GPs in assessing and managing children with eczema.Design and settingQualitative study in primary care in England.MethodSemi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method.ResultsGPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants’ views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy.ConclusionGP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.

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