scholarly journals ‘Do I, don’t I?’ A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic

2021 ◽  
pp. archdischild-2020-321260
Author(s):  
Gabriella Watson ◽  
Lucy Pickard ◽  
Bhanu Williams ◽  
Dougal Hargreaves ◽  
Mitch Blair
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Recovery Period ◽  
Severe Illness ◽  
Care Seeking ◽  
Community Perception ◽  
Healthcare Provision ◽  
North West ◽  
Care Experience

BackgroundPaediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care.MethodsSemistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach.ResultsFrom interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them.ConclusionA pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.

scholarly journals Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S74-S75
Author(s):  
Ritika Devadas ◽  
Douglas Murdie ◽  
Idris Thomas ◽  
Rhona Hannah ◽  
Wiktoria Karbowniczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Psychiatric Services ◽  
Severe Illness ◽  
Healthcare Provision ◽  
North West ◽  
The North ◽  
The Impact

AimsCOVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.

scholarly journals Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020521 ◽  
Author(s):  
Anne-Marie Burn ◽  
Jane Fleming ◽  
Carol Brayne ◽  
Chris Fox ◽  
Frances Bunn
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Hospital Staff ◽  
Case Finding ◽  
Care Staff ◽  
Dementia Case ◽  
Primary Care Staff ◽  
Views Of Healthcare Professionals

ObjectivesIn 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.DesignQualitative study involving interviews, focus groups and thematic content analysis.SettingPrimary care and secondary care across six counties in the East of England.ParticipantsHospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.ResultsWe recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.ConclusionsThe study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.

scholarly journals Features of primary care practice influence emergency care-seeking behaviors by caregivers of persons with dementia: A multiple-perspective qualitative study

Dementia ◽  
2020 ◽  
pp. 147130122090523
Author(s):  
Aaron P Beck ◽  
Gwen C Jacobsohn ◽  
Matthew Hollander ◽  
Andrea Gilmore-Bykovskyi ◽  
Nicole Werner ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Emergency Care ◽  
Primary Care Practice ◽  
Care Practice ◽  
Care Seeking ◽  
Multiple Perspective

scholarly journals Medication reviews in hospitalized patients: a qualitative study on perceptions of primary and secondary care providers on interprofessional collaboration

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bregje Walraven ◽  
Godelieve Ponjee ◽  
Wieke Heideman ◽  
Fatma Karapinar Çarkit
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Interprofessional Collaboration ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hospitalised Patients ◽  
Medication Reviews ◽  
Insight Into

Abstract Background In-hospital medication reviews are regularly performed. However, discontinuity in care could occur because secondary care providers lack insight into the outpatient history. Furthermore, for the implementation or follow-up of some medication review-based interventions, the help of primary care providers is essential. This requires interprofessional collaboration between secondary and primary care. Therefore, the aim of this qualitative study was to gain insight into the perceptions of primary and secondary care providers on interprofessional collaboration on medication reviews in hospitalised patients. Methods Ten face-to-face semi-structured interviews and three focus group discussions were conducted with 20 healthcare providers from three hospitals and community health services. The interviews were aimed at exploring general practitioners’, community pharmacists’, geriatricians’, and hospital pharmacists’ experiences, attitudes, and views of interprofessional collaboration. Focus groups consisted of representatives of all professional groups. Through group discussion, interprofessional collaboration was explored by addressing three main questions: 1) What are the benefits of in-hospital medication reviews? 2) What are the barriers to in-hospital medication reviews from an interprofessional collaboration perspective? 3) Given the barriers mentioned, how should this interprofessional collaboration between primary and secondary care be designed? Data were analysed using a thematic-content approach. Results The need for in-hospital medication reviews was underlined due to their many benefits, such as reducing potentially preventable re-admissions. Barriers regarding interprofessional collaboration between primary and secondary care can be subdivided into three main themes: 1) defining in-hospital medication reviews (e.g., lack of clear goals), 2) execution of medication reviews (e.g., hospital setting is dynamic), and 3) follow-up after discharge (e.g., unclear instructions). Care providers suggested solutions for each of the barriers mentioned, for example, by using supportive staff in order to overcome the gap between primary and secondary care providers and making clear agreements on proper means of communication. Conclusion Primary and secondary care providers recognise the importance of in-hospital medication reviews and the need for interprofessional collaboration. To create satisfying interprofessional collaboration, conditions should be met on defining in-hospital medication reviews across settings and involving both primary and secondary care providers in implementing medication reviews and organising their follow-up.

scholarly journals Transitions to palliative care in acute hospitals in England: qualitative study

BMJ ◽  
2011 ◽  
Vol 342 ◽  
pp. d1773 ◽  
Author(s):  
Merryn Gott ◽  
Christine Ingleton ◽  
Michael I Bennett ◽  
Clare Gardiner
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Health Professionals ◽  
Secondary Care ◽  
Acute Hospital ◽  
Smooth Transition ◽  
Acute Hospitals ◽  
Care Approach ◽  
Policy Guidance

Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703421
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Luke Vale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Clinical Test ◽  
Output Response ◽  
Response To Stress

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.

scholarly journals Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care

2018 ◽  
Vol 68 (669) ◽  
pp. e260-e267 ◽  
Author(s):  
Brian McMillan ◽  
Katherine Easton ◽  
Elizabeth Goyder ◽  
Brigitte Delaney ◽  
Priya Madhuvrata ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Secondary Care ◽  
Future Research ◽  
Increased Risk ◽  
Risk Of Progression

BackgroundDespite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group.AimTo examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM.Design and settingA qualitative study of a purposive sample of 27 postnatal females leaving secondary care with a recent diagnosis of GD.MethodSemi-structured interviews were conducted with 27 females, who had been previously diagnosed with GD, at around 6–12 weeks postnatally. Interviews were audiotaped, transcribed, and analysed thematically.ResultsFacilitators and barriers to engaging in a healthy postnatal lifestyle were identified, the most dominant being competing demands on time. Although females were generally satisfied with the secondary care they received antenatally, they felt abandoned postnatally and were uncertain what to expect from their GP in terms of follow-up and support. Females felt postnatal care could be improved by greater clarity regarding this, and enhanced by peer support, multidisciplinary input, and subsidised facilities. Technology was seen as a potential adjunct by providing information, enabling flexible and personalised self-management, and facilitating social support.ConclusionA more tailored approach for females previously diagnosed with GD may help reduce the risk of progression to T2DM. A need for future research to test the efficacy of using technology as an adjunct to current care was identified.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028122
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Tamara Metzler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Clinical Test ◽  
Output Response ◽  
Diagnostic Technology ◽  
Response To Stress ◽  
Barriers To Implementation

ObjectiveTo explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.DesignQualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.SettingNewcastle upon Tyne, UK.ParticipantsFourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

scholarly journals A proposed Primary Health Early Warning Score (PHEWS) with emphasis on early detection of sepsis in the elderly

2016 ◽  
Vol 8 (1) ◽  
pp. 5 ◽  
Author(s):  
Ian Anderson
Keyword(s):  
Primary Care ◽  
Early Detection ◽  
Acute Care ◽  
Early Warning ◽  
Secondary Care ◽  
The Elderly ◽  
Early Warning Score ◽  
Severe Illness ◽  
Primary Health ◽  
Early Warning Scores

ABSTRACT There are several secondary care early warning scores which alert for severe illness including sepsis. None are specifically adjusted for primary care. A Primary Health Early Warning Score (PHEWS) is proposed which incorporates practical parameters from both secondary and primary care. KEYWORDS: Emergency medical services; acute care; sepsis; early intervention

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