scholarly journals Multiplicity and complexity: a qualitative exploration of influences on prescribing in UK general practice

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041460
Author(s):  
Mary Carter ◽  
Sarah Chapman ◽  
Margaret C Watson
Keyword(s):  
General Practice ◽  
Focus Group ◽  
Evidence Based ◽  
Key Informants ◽  
Telephone Interviews ◽  
Shared Beliefs ◽  
Practice Culture ◽  
Unwarranted Variation ◽  
Evidence Based Guidelines ◽  
Qualitative Exploration

ObjectivesDespite widespread availability of evidence-based guidelines to inform rational use of medicines, considerable unwarranted variation exists in prescribing. A greater understanding of key determinants of contemporary prescribing in UK general practice could inform strategies to promote evidence-based prescribing. This study explored (1) current influences on prescribing in general practice and (2) the possibility that general practice-based pharmacists (PBPs) may contribute to greater engagement with evidence-based prescribing.DesignSemistructured, telephone interviews and a focus group were conducted, audio-recorded and transcribed verbatim. Thematic analysis was undertaken.ParticipantsGeneral practice prescribers: general practitioners (GPs), PBPs, nurses.Key informants: individuals within the National Health Service (NHS) with responsibility for influencing, monitoring and measuring general practice prescribing.SettingGeneral practices and NHS organisations in England.ResultsInterviews with 17 prescribers (GPs (n=6), PBPs (n=6), nurses (n=5)) and 6 key informants, and one focus group with five key informants were undertaken between November 2018 and April 2019. Determinants operating at individual, practice and societal levels impacted prescribing and guideline use. Prescribers’ professional backgrounds, for example, nursing, pharmacy, patient populations and patient pressure were perceived as substantial influences, as well as media portrayal and public perceptions of medicines.Prescribers identified practice-level determinants of prescribing, including practice culture and shared beliefs. Key informants tended to emphasise higher-level influences, including NHS policies, availability of support and advice from secondary care and generic challenges associated with medicines use, for example, multimorbidity.Participants expressed mixed views about the potential of PBPs to promote evidence-based prescribing in general practice.ConclusionPrescribing in UK general practice is influenced by multiple intersecting factors. Strategies to promote evidence-based prescribing should target modifiable influences at practice and individual levels. Customising strategies for medical and non-medical prescribers may maximise their effectiveness.

scholarly journals Guidelines for assessing postnatal problems: introducing evidence-based guidelines in Australian general practice

2003 ◽  
Vol 20 (4) ◽  
pp. 382-389 ◽  
Author(s):  
Jane Gunn ◽  
Donna Southern ◽  
Patty Chondros ◽  
Philippa Thomson ◽  
Kathryn Robertson
Keyword(s):  
General Practice ◽  
Evidence Based ◽  
Australian General Practice ◽  
Evidence Based Guidelines

Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting

2015 ◽  
Vol 21 (1) ◽  
pp. 96 ◽  
Author(s):  
Melanie Attard ◽  
Alexa McArthur ◽  
Dagmara Riitano ◽  
Edoardo Aromataris ◽  
Chris Bollen ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Focus Group ◽  
Health Care Professionals ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
South Australia ◽  
Evidence Based ◽  
Practice Staff ◽  
Practice Nurses

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient’s primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

Treatment of hypertension in Finnish general practice seems unsatisfactory despite evidence‐based guidelines

2009 ◽  
Vol 18 (1-2) ◽  
pp. 62-67 ◽  
Author(s):  
Juha Varis ◽  
Heljä Savola ◽  
Risto Vesalainen ◽  
Ilkka Kantola
Keyword(s):  
General Practice ◽  
Evidence Based ◽  
Treatment Of Hypertension ◽  
Evidence Based Guidelines

scholarly journals Experiences of telehealth in general practice in Australia: research protocol for a mixed methods study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0187
Author(s):  
Sarah J White ◽  
Amy Nguyen ◽  
Peter Roger ◽  
Tim Tse ◽  
John A Cartmill ◽  
...  
Keyword(s):  
General Practice ◽  
Conversation Analysis ◽  
General Practitioners ◽  
Direct Evidence ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Practice Setting ◽  
Australian General Practice ◽  
Evidence Based Guidelines ◽  
The Impact

BackgroundDue to the COVID-19 pandemic, use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood.AimThis study will explore interactional practices of general practitioners (GPs) and patients in telehealth consultations to develop evidence-based resources to improve communication.Design & settingThe study will be conducted within the Australian general practice setting.MethodConversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews and collaborative workshops with telehealth users, including both general practitioners and patients.ConclusionEffective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. This study will co-develop with end-users, evidence-based guidelines encompassing effective telehealth communication strategies.

scholarly journals Implementing evidence-based medicine in general practice: a focus group based study

2005 ◽  
Vol 6 (1) ◽  
Author(s):  
Karin Hannes ◽  
Marcus Leys ◽  
Etienne Vermeire ◽  
Bert Aertgeerts ◽  
Frank Buntinx ◽  
...  
Keyword(s):  
General Practice ◽  
Focus Group ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Based Medicine

scholarly journals Prescribing Antipsychotics in Montenegro: a Focus Group Analysis

2014 ◽  
Vol 15 (1) ◽  
pp. 39-42
Author(s):  
Ivana Ilickovic ◽  
Slobodan M. Jankovic
Keyword(s):  
Focus Group ◽  
Tertiary Care ◽  
Group Analysis ◽  
Comparison Method ◽  
Evidence Based ◽  
Care Services ◽  
Adherence To Medication ◽  
Psychiatric Institution ◽  
Restrictive Procedures ◽  
Evidence Based Guidelines

ABSTRACT Background. Although prescribing antipsychotics to patients with schizophrenia is advised by national and/or international evidence-based practice guidelines, the implementation of the guidelines in clinical practice is still matter of concern. Objective. The aim of our study was to estimate schizophrenia guideline adherence and identify eventual barriers to its implementation in Montenegro. Method. This study used focus group methodology. The focus group was composed of two psychiatrists, one psychologist, one pharmacist from a community pharmacy, one pharmacist from the State reimbursement fund, one pharmacist from a drug wholesaler and the chief investigator, a clinical pharmacologist. The focus group took place in Podgorica, Montenegro, in 2013. The analysis of recordings was performed using an iterative, qualitative technique and a constant comparison method. Results. The most important barriers to the implementation of evidence-based guidelines for the treatment of schizophrenia in Montenegro are non-adherence to medication, low level of psychiatrist-patient concordance, restrictive procedures for prescribing atypical antipsychotics, lack of availability of newer antipsychotics and some dosage forms, and mixing primary, secondary and tertiary care services within a tertiary care psychiatric institution. Conclusion. Addressing the barriers identified by this focus group and avoiding the consequences of poor adherence would be the first

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