scholarly journals Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners’ views

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019084 ◽  
Author(s):  
Sally Fowler Davis ◽  
Hilary Piercy ◽  
Sarah Pearson ◽  
Ben Thomas ◽  
Shona Kelly
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Hospital Admissions ◽  
Local Level ◽  
Qualitative Evaluation ◽  
Urgent Care ◽  
Structured Interviews ◽  
Care Programme ◽  
Access To Primary Care ◽  
Programme Planning

ObjectivesTo report general practitioners’ (GPs’) views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister’s Challenge Fund (second wave) for England which aimed to extend patient access to primary care.SettingPrimary care in Sheffield, England.ParticipantsSemi-structured interviews with a purposive sample of GPs working in 24 practices across the city.ResultsFour core themes were derived: GPs’ receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload.ConclusionsThe variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.

scholarly journals Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN)

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Fitriana Murriya Ekawati ◽  
Mora Claramita
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Universal Coverage ◽  
Care Practice ◽  
Health Coverage ◽  
Structured Interviews ◽  
Access To Primary Care ◽  
Universal Health ◽  
Maximum Variation Sample ◽  
Universal Coverage Scheme

Introduction The Indonesian government has been implementing Jaminan Kesehatan Nasional (JKN) as the national universal coverage scheme to help Indonesian citizens affording medical care since 2014. However, after a few years of its implementation, a very limited study has been conducted to explore general practitioners’ (GPs) views and experiences of practicing in primary care under JKN implementation. Methods The study applied semi-structured interviews with GPs from January to February 2016, guided by a phenomenology approach in Yogyakarta province, Indonesia. The GPs were recruited using a maximum variation sample design. The interviews were recorded and transcribed, and the data were analyzed thematically. Result A total of 19 GPs were interviewed. Three major themes emerged, namely: powerlessness, clinical resources, and administration. Transition to the JKN system has improved patient access to primary care without significant economic barrier, however, GP participants experienced a sense of powerless practice during JKN implementation. They also commented on limited clinical resources and claimed that JKN administration was complicated and burdened their practice. Conclusion This study identifies various perspectives from GPs practicing in primary care under JKN implementation. The JKN improves access to primary care practice, but there are limited supports for GPs to practice optimally and maintain their relationships with patients. Extensive improvements are needed to upgrade the GP practice in primary care.

scholarly journals An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study

2018 ◽  
Vol 20 ◽  
Author(s):  
Ratan S. Randhawa ◽  
Joht S. Chandan ◽  
Tom Thomas ◽  
Surinder Singh
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Healthcare Setting ◽  
List Type ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Telephone Consultation ◽  
Video Consultation ◽  
Mixed Feelings ◽  
The Government

AbstractBackgroundIn 2014, in the United Kingdom, the government made a commitment to spend £3.6 million on the introduction of Skype video calling consultations in general practice, however the efficacy of such technology has not yet been explored fully.AimThe study aimed to explore the views and attitudes of General Practitioners (GPs) towards video consultation in primary care; specifically, in three broad areas∙The benefits of video consultations to patients and healthcare professionals.∙Potential problems with video consultation and its implementation.∙The cost-effectiveness of video consultation in this setting.MethodA convenience sample of the views of 12 general practitioners across two primary care centres in North London were identified using topic guide based semi-structured interviews. A thematic framework approach was used to analyse the data collected to isolate main and sub-themes.FindingsThree main themes were identified1.Technology – GPs expressed concerns about the ability of patients to use technology, the availability of technology and the quality of technology available.2.Utility – encompassing GP’s ideas about the usefulness of video consultations to patients, practitioners and the doctor–patient relationship. GPs presented mixed views on the extent to which video consultation would be useful.3.Practicality – covering the views of GPs on implementation and effects on workload. GPs unanimously felt that it was not a practical substitute for face-to-face consultation. There were mixed feelings about it being used as an alternative to telephone consultation.ConclusionGPs did see potential benefits to using video consultations but also expressed concerns that need to be addressed if they are to have full confidence in the system. The views of those who are going to use video consultation as a means of increasing patient access are paramount if such tools are to be a core part of primary care.

A qualitative evaluation of a pilot leadership programme for dentists

2015 ◽  
Vol 28 (3) ◽  
pp. 185-199 ◽  
Author(s):  
Jonathan Walsh ◽  
Nicholas Taylor ◽  
Donna Hough ◽  
Paul Brocklehurst
Keyword(s):  
Local Level ◽  
Qualitative Evaluation ◽  
Training Programme ◽  
Structured Interviews ◽  
Clinical Leadership ◽  
Content Type ◽  
North West ◽  
Dental Practitioners ◽  
Training Programmes ◽  
The Way

Purpose – The purpose of this paper was to evaluate a pilot training programme run by Health Education North West to promote clinical leadership amongst general dental practitioners (GDPs). New powers and responsibilities for clinicians have caused a fundamental shift in the way that local services are planned and delivered in England. GDPs are being appointed onto the boards of local professional networks (LPNs) to influence the way that services are delivered at a local level. Analogous to clinical commissioning groups in medicine, the role of LPNs is to ensure that GDPs lead change and drive up the quality of service provision. Clinical leadership has been argued to be fundamentally important in these new structures, but has received little attention in the dental literature. Design/methodology/approach – Semi-structured interviews and a focus group were held with participants of the pilot to explore their understanding and experience of clinical leadership. These were recorded, transcribed verbatim and underwent thematic analysis. Findings – Nineteen codes were identified and organized into four themes: nature of clinical leadership, challenges for clinical leaders in dentistry, Leadership Exploration and Discovery programme evaluation and future direction. Practical implications – The research provides an understanding of how GDPs conceptualise clinical leadership and provides recommendations for future leadership training programmes. Originality/value – This is the first evaluation of a leadership programme for GDPs and so helps address the paucity of evidence in the dental literature.

scholarly journals How to engage French professionals to undertake social responsibility at a local level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Gautier ◽  
Y Bourgueil
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Health Professionals ◽  
Local Level ◽  
Radical Change ◽  
Team Work ◽  
Professional Commitment ◽  
Fee For Service ◽  
Structured Interviews ◽  
Integration Of Care

Abstract Background In France, primary care is organised according to the principles of private practice: independent providers, payment by fee for service, freedom of settlement... Successive reforms have introduced more regulation i.e. gatekeeping role for GPs, better recognition of professional groups, new forms of payment and promotion of team work and multi-professional practices. Today, the concept of Health Territorial and Professional Communities (HTPC) is becoming a key element of health care reform encouraging primary care professionals to meet with specialists and social workers at a larger level than practice. HTPC should address issues such as access to services, coordination of care and promoting of preventive actions toward populations. This implies change in the roles, skills, methods and resources needed on both professional and regulatory sides. This study explores levers of the professional commitment in the HTPC and resources necessary for it. Methods We conducted a qualitative multiple case study in three French regions. Data was collected from thirty semi-structured interviews with key national informants, regional regulators and health professionals themselves. Results Professional commitment emerges at a local level on a territory defined by the collaboration practices and habits following a bottom-up process. The integration of care relies on the size of the HTPC which allows them to know each other and to work together to improve access to care and patient’s disease management. In order to achieve that, professionals claim to have access to administrative health data and to be able to analyze it. They need to develop news skills in management and group animation. The function and training of coordination professionals appear to be essential. Conclusions The professional commitment in HTPC relies on professional empowerment toward collective activities. This requires autonomy, skills and new roles both for professionals and regulatory authorities. Key messages French government relies on professionals’ investment at the territorial level by implementing HTPC to guarantee access to care and respond to population needs in primary care. HTPC implementation implies radical change for the professionals to undertake social and populational responsibility for which public health professionals should help to meet the challenge.

scholarly journals Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
K. Bristow ◽  
S. Edwards ◽  
E. Funnel ◽  
L. Fisher ◽  
L. Gask ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Help Seeking ◽  
Mental Health Problems ◽  
Health Problems ◽  
Structured Interviews ◽  
Care Givers ◽  
Common Mental Health Problems ◽  
Access To Primary Care ◽  
The Uk

Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from “hard-to-reach” groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from “hard-to-reach” groups including the need to offer a flexible, non-biomedical response to distress.

scholarly journals Recognising potential for preventing hospitalisation

2010 ◽  
Vol 34 (1) ◽  
pp. 116 ◽  
Author(s):  
David Banham ◽  
Tony Woollacott ◽  
John Gray ◽  
Brett Humphrys ◽  
Angel Mihnev ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Public Hospital ◽  
Hospital Admissions ◽  
South Australia ◽  
Local Area ◽  
Care Plan ◽  
Older Individuals ◽  
Preventable Hospitalisation ◽  
Access To Primary Care

To identify the incidence and distribution of public hospital admissions in South Australia that could potentially be prevented with appropriate use of primary care services, analysis was completed of all public hospital separations from July 2006 to June 2008 in SA. This included those classified as potentially preventable using the Australian Institute of Health and Welfare criteria for selected potentially preventable hospitalisations (SPPH), by events and by individual, with statistical local area geocoding and allocation of relative socioeconomic disadvantage quintile. A total of 744 723 public hospital separations were recorded, of which 79 424 (10.7%) were classified as potentially preventable. Of these, 59% were for chronic conditions, and 29% were derived from the bottom socioeconomic status (SES) quintile. Individuals in the lowest SES quintile were 2.5 times more likely to be admitted for a potentially preventable condition than those from the top SES quintile. Older individuals, males, those in the most disadvantaged quintiles, non-metropolitan areas and Indigenous people were more likely to have more than one preventable admission. People living in more disadvantaged areas in SA appear to have poorer utilisation of effective primary care, resulting in preventable hospital admissions, than those in higher SES groups. The SA Health Care Plan, 2007–2016 is aimed at investing in improved access to primary care in those areas of most disadvantage. The inclusion of SPPHs in future routine reporting should identify if this has occurred. What is known about the topic?Ambulatory care sensitive conditions, or selected potentially preventable hospitalisation separations (SPPH), are an indicator of the availability and effectiveness of primary health care. SPPHs are increasingly reported by area level disadvantage. What does this paper add?This paper offers analysis by individuals. It shows around three-quarters of individuals had one potentially preventable public hospital separation. The rate among those living in the most disadvantaged areas was more than twice that of lowest disadvantage areas. What are the implications for practitioners?Realising the potential for preventing potentially avoidable hospitalisation may involve focus on particular target areas and subpopulations. Potentially preventable separations by area of disadvantage can assist with monitoring performance and evaluating policy and program initiatives. Analysis by numbers of individuals will enhance this further.

scholarly journals Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting

2016 ◽  
Vol 18 (01) ◽  
pp. 3-13 ◽  
Author(s):  
Bonnie M. Vest ◽  
Victoria M. Hall ◽  
Linda S. Kahn ◽  
Arvela R. Heider ◽  
Nancy Maloney ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Real World ◽  
Hospital Admissions ◽  
Lessons Learned ◽  
Diabetic Patients ◽  
Structured Interviews ◽  
Economic Context ◽  
Care Practices ◽  
Primary Care Practices

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Background Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Methods Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. Conclusions This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

scholarly journals Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

2021 ◽  
Vol 13 (4) ◽  
pp. 340
Author(s):  
Chloë Campbell ◽  
Caroline Morris ◽  
Lynn McBain
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
General Practitioners ◽  
Community Pharmacists ◽  
Unintended Consequences ◽  
Structured Interviews ◽  
Interprofessional Communication ◽  
Potential Benefits ◽  
Handwritten Signature ◽  
Purposive Sample

ABSTRACTINTRODUCTIONDuring the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy.AIMThe purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy.METHODSSemi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants’ perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach.RESULTSFour themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs).DISCUSSIONBoth general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.

scholarly journals Atrial fibrillation screening: feasible approaches and implementation challenges across Europe

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
D Engler ◽  
C Hanson ◽  
L Desteghe ◽  
G Boriani ◽  
S Z Diederichsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Healthcare Services ◽  
Sufficient Evidence ◽  
Opportunistic Screening ◽  
Structured Interviews ◽  
Implementation Challenges ◽  
Access To Primary Care ◽  
Public Grant ◽  
Personal Devices

Abstract Background Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown. Purpose We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios. Method This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis. Results Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting. 3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations. There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed. Conclusions There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening Scenarios  Graphical abstract

scholarly journals The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners

2021 ◽  
Vol 6 (3) ◽  
pp. 1-6
Author(s):  
Damian Muldoon ◽  
Chris Seenan
Keyword(s):  
Primary Care ◽  
Northern Ireland ◽  
General Practitioners ◽  
Well Being ◽  
Structured Interview ◽  
Ageing Population ◽  
Structured Interviews ◽  
Allied Health Professionals ◽  
Qualitative Descriptive ◽  
Advanced Paramedics

Background: Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs’ experiences are of these developments.Aims: To examine the experiences of GPs who have introduced an advanced paramedic into their primary care team in Northern Ireland.Design: A qualitative descriptive design was chosen as the most suitable approach to allow participants to relay their experiences in their own words within the loose confines of a semi-structured interview.Methods: Semi-structured interviews were conducted with a group of four purposively selected GPs who had direct experience of the phenomena of interest. These interviews were transcribed verbatim, anonymised and then analysed thematically.Results: The thematic analysis produced three superordinate themes of alleviating pressure, acceptance and psychological well-being. These were underpinned by seven ordinate themes that were supported using verbatim quotes. These were then discussed and contextualised with themes from existing literature.Conclusion: Generally, there was widespread support from the GPs for the introduction of advanced paramedics into primary care teams. The reasons were multi-factorial but the reduction in GP workload featured prominently. The participants reported benefits in terms of increased resilience and work‐life balance. The capacity to provide a clinician with experience of dealing with acute and emergency presentations, in combination with managing routine procedures, was also reported to be of great importance.

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