scholarly journals Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039674 ◽  
Author(s):  
Veronique Verhoeven ◽  
Giannoula Tsakitzidis ◽  
Hilde Philips ◽  
Paul Van Royen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Decision Making ◽  
Core Competencies ◽  
Well Being ◽  
Clinical Decision ◽  
Framework Analysis ◽  
Profound Impact ◽  
The Core ◽  
Qualitative Interview Study

ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

scholarly journals Medical professionalism: Navigating modern challenges

2021 ◽  
pp. 175573802110526
Author(s):  
Nicola Cooper-Moss ◽  
Helen Hooper ◽  
Kartina A. Choong ◽  
Umesh Chauhan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
General Practice ◽  
Professional Practice ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Clinical Decision ◽  
Medical Professionalism ◽  
The Public ◽  
General Practice Training

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.

scholarly journals Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

2018 ◽  
Vol 68 (669) ◽  
pp. e234-e244 ◽  
Author(s):  
Hilary Davies-Kershaw ◽  
Irene Petersen ◽  
Irwin Nazareth ◽  
Fiona Stevenson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Public Health Problem ◽  
Clinical Decision ◽  
Epidemiological Studies ◽  
Drug Misuse ◽  
Electronic Patient Records ◽  
National Surveys ◽  
Qualitative Interview Study ◽  
Face Complex

BackgroundDrug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.AimTo explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.Design and settingA semi-structured qualitative interview study of GPs working in general practices across England.MethodPurposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs’ actions if a patient asks for the information not to be recorded, and GPs’ actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.ResultsThe complexity of asking about drug misuse preceded GPs’ decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.ConclusionWhen making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

scholarly journals GPs’ use of gut feelings when assessing cancer risk in primary care: A qualitative study

2020 ◽  
pp. bjgp21X714269
Author(s):  
Claire Friedemann Smith ◽  
Benedikte Moller Kristensen ◽  
Rikke Sand Andersen ◽  
FD Richard Hobbs ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Cancer Risk ◽  
Clinical Decision Making ◽  
Good Clinical Practice ◽  
Clinical Decision ◽  
Careful Examination ◽  
Qualitative Interview Study ◽  
Gut Feelings ◽  
The One

Background: The use of gut feelings to guide clinical decision-making in primary care has been frequently described but is not considered a legitimate reason for cancer referral. Aim: To explore the role that gut feelings play in clinical decision-making in primary care. Design and Setting: Qualitative interview study with 19 General Practitioners (GPs) in Oxfordshire, UK. Methods: GPs who had referred patients to a cancer pathway allowing the use of gut feeling as a referral criterion were invited to participate. Interview transcripts were analysed using the One Sheet of Paper method. Results: Gut feeling was seen as an essential part of decision-making that facilitated appropriate and timely care. GPs distanced their gut feelings from descriptions that could be seen as unscientific, describing successful use as reliant on experience and clinical knowledge. This was especially true for patients who fell within a ‘grey-area’ where clinical guidelines did not match the GP’s assessment of cancer risk, either because the guidance inadequately represented the patient’s presentation, or the patient’s presentation was missing. GPs sought to legitimise their gut feelings by gathering objective clinical evidence, careful examination of referral procedures, and consultation with colleagues. Conclusion: The GPs described their gut feelings as important to decision-making in primary care and a necessary addition to clinical guidance. The steps taken to legitimise their gut feelings matched what would be expected in good clinical practice.

Managing Hygiene

2012 ◽  
Author(s):  
David Voegeli
Keyword(s):  
Clinical Decision Making ◽  
Core Competencies ◽  
Well Being ◽  
Clinical Decision ◽  
Nursing Intervention ◽  
Personal Hygiene ◽  
Fundamental Aspect ◽  
Personal Care ◽  
Human Right

This chapter addresses the fundamental nursing role in managing hygiene. The ability to maintain personal and oral hygiene forms some of the activities of living that everyone undertakes every day, but which are often taken for granted until a deterioration in a person’s physical or mental state, such as illness or ageing, prevents individuals from meeting these needs independently. Being able to assess the need for nursing intervention accurately, and to deliver appropriate evidence-based care, requires considerable skill. It draws on many of the core competencies of professional nursing, such as observation, communication, and clinical decision-making. Therefore it is inappropriate that, in a majority of care settings, these activities are often delegated by the registered nurse to those with the least experience. It is important to remember that, registered nurses retain professional accountability for the quality and effectiveness of the interventions provided or delegated to the patients under their care. Increasingly, this fundamental aspect of care is viewed as an overall indicator of the quality of the care provided. Assisting individuals to maintain their personal hygiene needs promotes comfort, safety, well-being, and dignity, and also plays an important part in the prevention of infection. It is also an important aspect of many religions, such as the ritual washing performed by Muslims before prayer. Indeed Young (1991) suggested that cleanliness is a basic human right rather than a luxury. There has been criticism over the past decade that aspects of nursing care relating to the maintenance of patient hygiene have become neglected, and the Healthcare Commission (2007) reported that 30% of complaints received against UK hospitals related to issues of personal care and dignity, including:…● patients being left in soiled clothing or bedding; ● hygiene needs not being met (patients not being washed or mouthcare given); ● hair and nails not being cared for….In response to these criticisms, both the Nursing and Midwifery Council (NMC) and the Department of Health (DH) worked to improve the quality of personal care provided by nurses.

Religion and Medicine

2020 ◽  
Author(s):  
Jeff Levin ◽  
Stephen G. Post
Keyword(s):  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Religion And Medicine ◽  
Physical And Mental Health ◽  
Faith Based ◽  
Baylor University ◽  
Wide Range ◽  
History Of ◽  
The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

Music Therapy Pre-internship Education and Training: Support for a Methods-Based Approach

2021 ◽  
Author(s):  
Susan C Gardstrom ◽  
James Hiller ◽  
Annie Heiderscheit ◽  
Nancy L Jackson
Keyword(s):  
Music Therapy ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Education And Training ◽  
Population Based ◽  
Music Therapists ◽  
Training Support ◽  
And Training

Abstract As music therapists, music is our primary realm of understanding and action and our distinctive way of joining with a client to help them attain optimal health and well-being. As such, we have adopted and advocate for a music-focused, methods-based (M-B) approach to music therapy pre-internship education and training. In an M-B approach, students’ learning is centered on the 4 music therapy methods of composing, improvising, re-creating, and listening to music and how these music experiences can be designed and implemented to address the health needs of the diverse clientele whom they will eventually encounter as practicing clinicians. Learning is highly experiential, with students authentically participating in each of the methods and reflecting on these self-experiences as a basis for their own clinical decision-making. This is differentiated from a population based (P-B) approach, wherein students’ attention is directed at acquiring knowledge about the non-musical problems of specific “clinical populations” and the “best practice” music interventions that are presumed to address these problems. Herein, we discuss both approaches, identifying the limitations of a P-B perspective and outlining the benefits of an M-B curriculum and its relevance to 21st-century music therapy practice.

The value of a consultant physiotherapist within a primary care musculoskeletal interface service: part of the spinal multidisciplinary team

2021 ◽  
Vol 28 (1) ◽  
pp. 1-10
Author(s):  
Michelle L Angus ◽  
Victoria Dickens ◽  
Naveed Yasin ◽  
James Greenwood ◽  
Irfan Siddique
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Referral Centre ◽  
Allied Health Professionals ◽  
Convenience Sample ◽  
Surgical Services ◽  
Pain Pathway ◽  
The Uk ◽  
Case Based

Background/aims The national low back pain pathway in the UK suggests practitioners managing patients with spinal pathology should be specifically trained to do so and have the ability to link with tertiary spinal services when required. The aim of this study was to ensure referrals through to a tertiary spinal surgical centre are appropriate and patients get the correct advice early in their management pathway. Methods A retrospective review of 700 cases were discussed at a spinal case-based discussion meeting in a primary care interface service, compared to services without this model. A convenience sample of cases were analysed with the consultant physiotherapist and those referred from other allied health professionals into the tertiary spinal surgical centre. Case-based team discussion took place before every referral into the tertiary spinal service, with spinal surgical discussion where required. Results Patients referred from other interface services were more likely to require further work-up such as investigations, or be discharged from clinic on their first attendance than those who had been through the case-based discussion. Conclusions A consultant physiotherapist working as part of the spinal team of a tertiary referral centre can help advanced practitioners with their clinical decision making to help prevent unnecessary referrals to spinal surgical services.

scholarly journals Relationships between emotional schemas, mindfulness, self-compassion and unconditional self-acceptance on the regulation of psychological needs

2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Bruno Faustino ◽  
António Branco Vasco ◽  
Ana Nunes Silva ◽  
Telma Marques
Keyword(s):  
Experiential Avoidance ◽  
Clinical Decision Making ◽  
Psychological Symptoms ◽  
Well Being ◽  
Clinical Decision ◽  
Psychological Needs ◽  
Self Report ◽  
Cross Sectional ◽  
Self Compassion ◽  
Self Acceptance

Emotional schemas are pervasive mental structures associated with a wide array of psychological symptoms, while mindfulness, self-compassion, and self-acceptance are viewed as adaptive psychological constructs. Psychological needs may be described as the cornerstone of mental health and well-being. However, a study of the relationships between emotional schemas, mindfulness, self-compassion, and self-acceptance with psychological needs was not performed. For this purpose, 250 subjects (M=20.67, SD=4.88, Male=33, Female=217), were evaluated through self-report questionnaires, in a cross-sectional design. Negative correlations were found between emotional schemas, mindfulness, self-compassion, unconditional self-acceptance, and psychological needs. Symptomatology was positively correlated with emotional schemas. Mindfulness, self-compassion, and unconditional self-acceptance predicted the regulation of psychological needs and mediated the relationship between emotional schemas and psychological needs. Emotional schemas may be associated with a tendency for experiential avoidance of internal reality, self-rejection/shame and self-criticism which may impair the regulation of psychological needs. These variables may be targets of integrative case conceptualization and clinical decision making focused on patient’s timings, styles of communication and needs.

scholarly journals Teachers and clinical students' perception of the core competencies of different subjects of the undergraduate BDS curriculum

2017 ◽  
Vol 8 (2) ◽  
pp. 24-28
Author(s):  
Md Rasel Ahmad ◽  
Iffat Ara ◽  
Md Humayun Kabir Talukder ◽  
Dipak Kumer Paul Chowdhury ◽  
Md Immam Hossin ◽  
...  
Keyword(s):  
Medical Education ◽  
Clinical Skills ◽  
Core Competencies ◽  
Continuous Process ◽  
Well Being ◽  
Health Science ◽  
Personal Attributes ◽  
Patient Treatment ◽  
The Core ◽  
Competency Based

Background: Curriculum planning and designing is not a static process, rather a continuous process done regularly through a system. More than one decade have elapsed since the Centre for Medical Education (CME), in 1988, developed a national Undergraduate Dental Curriculum which was supposed to be community-oriented and competency based. The curriculum was partially implemented with the advancement of dental health science and application of newer techniques in dental practices in developed and developing countries.Rationale: Competency is the ability to combine evidence based knowledge, personal attitudes, and clinical skills to undertake holistic dental care. Personal attributes may include creativity, ethics, aesthetics, and critical sense and personal attributes include a desire for patient wellbeing and to self-evaluate the effectiveness of the treatment. As life-long learning becomes a crucial attribute for all modern clinicians, the ability to self-assess performance and identify future learning goals is an essential skill that needs to be developed in a modern healthcare curriculum. Self-assessment, self-reflection and selfregulation can promote a deeper understanding in current knowledge. The essential professional clinical skills may include a) diagnosis and treatment planning b) Preventative measures c) patient treatment and rehabilitation. Other skills that may be essential include professionalism, administrative and promotional skills. It is important that universities and dental schools help students nurture these values from a very early stage.Objectives: The present study was undertaken to identify the teachers and clinical students' perception of the core competencies of different subjects of the undergraduate BDS curriculum.Methods: This descriptive type of cross sectional study was conducted in seven public and private dental colleges of Bangladesh after getting written permission from the principal of the respective dental colleges. Voluntary participation of the students was ensured and the names of the students' as well as teachers were kept confidential. The teachers and students of final years from the different dental colleges were the study population; among them four hundred (400) students and one hundred twenty teachers (120) were taken as sample by convenient sampling. Data collection instrument was a semistructured questionnaire with 5-point Likert scale for final year students' and in depth interview was used for teachers.Results: The study revaled that 95% mentioned that introduction part of the curriculum competency in relation to the knowledge, skills and attitude of a dental graduate must be mentioned. Nearly 97 of the students mentioned that competency acquired by the newly passed dental graduate from the BDS course was satisfactory.Conclusion: Competency-based dental education is a continuous process in maintaining a degree of quality consistent with patient well-being and effective treatment management path, which the graduating dentist should achieve. The cultural and socioeconomic diversity among different communities might have an impact on the profile of the professional needed by the society.Bangladesh Journal of Medical Education Vol.8(2) 2017: 24-28

scholarly journals Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038398
Author(s):  
Kath Checkland ◽  
Jonathan Hammond ◽  
Lynsey Warwick-Giles ◽  
Simon Bailey
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Delivery ◽  
Service Providers ◽  
National Level ◽  
National Policy ◽  
Document Analysis ◽  
Policy Document ◽  
Qualitative Interview Study ◽  
Policy Objectives

ObjectivesEnglish general practice is suffering a workforce crisis, with general practitioners retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as primary care networks (PCNs). This study explored national policy objectives underpinning PCNs and the mechanisms expected to help achieve these, from the perspective of those driving the policy.DesignQualitative semistructured interviews and policy document analysis.Setting and participantsNational-level policy maker and stakeholder interviewees (n=16). Policy document analysis of the Network Contract Direct Enhanced Service draft service specifications.AnalysisInterviews were transcribed, coded and organised thematically according to policy objectives and mechanisms. Thematic data were organised into a matrix so prominent elements can be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.ResultsThree themes of policy objectives and associated mechanisms were identified: (1) supporting general practice, (2) place-based interorganisational collaboration and (3) primary care ‘voice’. Interviewees emphasised and sequenced themes differently, suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of theme 1. The objectives embedded in draft service delivery requirements primarily emphasised theme 2.ConclusionsThese policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

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