scholarly journals Regional differences in the patient population of general practices in northern Germany: results of a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041762
Author(s):  
Heike Hansen ◽  
Ingmar Schäfer ◽  
Nadine Janis Pohontsch ◽  
Agata Kazek ◽  
Hanna Hardt ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Rural Areas ◽  
Urban Areas ◽  
Regional Differences ◽  
Medical Training ◽  
Qualitative Content Analysis ◽  
Mixed Methods Study ◽  
Northern Germany ◽  
Care Needs

ObjectivesThe aim of our study was to explore patient types in general practitioner (GP) practices and to quantify the regional differences of the frequencies of these patient types in northern Germany.Design and settingWe conducted a mixed-methods study based on focus groups and standardised interviews with GPs. All counties and independent cities within a radius of 120 km around Hamburg were assigned one of three regional categories (urban areas, environs, rural areas). The focus groups were analysed using qualitative content analysis. Relative frequencies of consultations by patient types and differences between the regions were calculated. Logistic regression analyses were used to identify differences among regions.ParticipantsNine focus groups with 65 GPs (67.7% male). From the 280 initially recruited GPs 211 (65.4% male) could be personally interviewed.ResultsFour themes with 27 patient types were derived from the focus groups: patients classified by morbidity, sociodemographic characteristics, special care needs and patient behaviour. Five patient characteristics were significantly more prevalent in urban areas than rural areas: patients with migration background and culturally different disease concepts (OR 1.23; 95% CI 1.06 to 1.42), privately insured patients (OR 1.17; 95% CI 1.05 to 1.31), educationally disadvantaged patients with low health literacy (OR 1.11; 95% CI 1.04 to 1.19), patients with psychiatric disorders (OR 1.07; 95% CI 1.02 to 1.12) and senior citizens living on their own without caregivers (OR 1.05; 95% CI 1.05 to 1.31). Three patient types were significantly less prevalent in urban areas: minors accompanied by their parents (OR 0.71; 95% CI 0.61 to 0.83), patients with poor therapy adherence (OR 0.87, 95% CI 0.80 to 0.95) and patients with dementia (OR 0.90; 95% CI 0.82 to 0.99).ConclusionsGPs could compensate the specific needs of their patients with medical training aligned with the requirements of their region. Urban GPs need skills treating patients with psychiatric, social and cultural problems, rural GPs regarding the care for children or noncompliant patients.Trial registration numberNCT02558322

scholarly journals An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Judy Brook ◽  
Leanne M. Aitken ◽  
Julie-Ann MacLaren ◽  
Debra Salmon
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Focus Groups ◽  
Academic Staff ◽  
Skills Training ◽  
Early Career ◽  
Mixed Methods Study ◽  
Healthcare Organisation ◽  
Structured Interviews ◽  
Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Regional differences in reasons for consultation and general practitioners’ spectrum of services in Northern Germany – Results of a cross-sectional observational study

2019 ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Thomas Ruppel ◽  
Dagmar Lühmann ◽  
Hans-Otto Wagner ◽  
...  
Keyword(s):  
Observational Study ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Training ◽  
Practice Trial ◽  
Cross Sectional ◽  
Federal States ◽  
German Federal States ◽  
Number Of Patients ◽  
Individual Consultation

Abstract Background Among other factors, the patients’ consultation reasons and GPs’ spectrum of services determine the process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultation and GPs’ services between urban and rural areas. Our study’s goal was thus to investigate these factors in relation to the regional location of GPs’ practices. Methods We conducted a cross-sectional observational study based on standardised GP interviews in a quota sampling design. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban area, environs, rural area) and stratified proportionally to the population size. Differences in the number of reasons for consultation and services were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the German federal states and administrative districts. Differences in individual consultation reasons and services were identified by logistic regression via stepwise forward and backward selection. Results Primary care practices in 34 of the 37 selected administrative districts (91.9%) were represented in the dataset. In total, 211 GPs were personally interviewed. On average, GPs saw 344 patients per month with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultation and 30.3 + 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was a broader service spectrum by rural GPs (ß=-1.42; 95% confidence interval -2.75/-0.08; p=0.038) which was statistically explained by a higher level of medical training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas. Conclusion GPs in rural areas performed more frequently services usually provided by medical specialists in urban areas. This might be caused by a low availability of specialists in rural areas. The association between medical training and service spectrum might imply that GPs compensate the specific needs of their patients by completing advanced medical training before or after setting up a medical practice. Trial registration The study was registered in ClinicalTrials.gov (NCT02558322).

scholarly journals Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101058
Author(s):  
Petra Hanson ◽  
Amy Clarke ◽  
Manuel Villarreal ◽  
Majid Khan ◽  
Jeremy Dale
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Help Seeking ◽  
High Stress ◽  
Mixed Methods Study ◽  
Mindfulness Practice ◽  
Negative Effects ◽  
High Prevalence ◽  
High Level ◽  
And Coping

BackgroundTrainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice.AimTo explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme.Design & settingA qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire.MethodThis mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice.ResultsIn total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training.ConclusionThis study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.

scholarly journals Seeking the balance between caregiving in dementia, family and employment: study protocol for a mixed methods study in Northern Germany

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019444 ◽  
Author(s):  
Lydia Neubert ◽  
Hans-Helmut König ◽  
Christian Brettschneider
Keyword(s):  
Mixed Methods ◽  
Labour Force ◽  
Informal Caregivers ◽  
Personal Characteristics ◽  
Labour Force Participation ◽  
Informal Caregiving ◽  
German Society ◽  
Mixed Methods Study ◽  
Northern Germany ◽  
Study Results

IntroductionThe debate on reconciliation between childcare and working has to be expanded to caregiving for the elderly, since the importance of informal caregiving will increase in the future due to populations’ ageing and women’s increasing labour force participation. Informal caregivers who are caring for the rising number of persons with dementia (PwD) are often female and subjected to high caregiving requirements. These are added to further demands emerging from their family and work life. How affected caregivers seek to balance those requirements depends on, inter alia, their own characteristics and the informal caregiving network to whom they relate. Both aspects were not yet considered in previous studies. This mixed methods study thus aims to explore the reconciliation between caregiving in dementia, family and employment by including different members of caregiving networks of home-dwelling PwD and by considering their personal characteristics.Methods and analysisBy purposive sampling, we include at least five caregiving networks of home-dwelling PwD; each of them consisting of at least three informal caregivers living in Northern Germany. Narrative interviews of participants will be recorded, transcribed verbatim and interpreted according to the Documentary Method (QUAL). By completing standardised questionnaires, participants will provide sociodemographic and psychographic data concerning themselves and the networks from whom they arise (quan). This supplemental, descriptive information will give further background to the themes and types emerging from the interviews. Hence, the quan-data enrich the QUAL-data by exploring the narratives of participants in the light of their personal and network-related characteristics.Ethics and disseminationEthical approval was obtained from the Ethics Committee of the German Society of Nursing Sciences. Study results will be disseminated through conference presentations and publications in peer-reviewed journals.Trial registration numberDRKS00012929.

scholarly journals Willingness and professional motivations of medical students to work in rural areas: a study in Alexandria, Egypt

2013 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Aida M. Mohamed
Keyword(s):  
Medical Students ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Training ◽  
Health Workers ◽  
Work Conditions ◽  
Motivational Factors ◽  
Willingness To Accept ◽  
Cross Sectional Survey ◽  
Rural Service

Retaining health workers in rural areas is challenging for a number of reasons, e.g. personal preferences, difficult work conditions and low remuneration. Our aim was to determine the effect of motivational factors on willingness to accept postings to rural underserved areas in Alexandria, Egypt and to identify perceived attributes of rural service.,A cross-sectional survey involving 302 4th-year medical students was conducted in March-July 2012. Logistic regression analysis was used to assess the association between students’ willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES). Perceived attributes to rural service were also assessed. Over 85% students were born in urban areas and 41.4% came from affluent backgrounds. More than half students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors significantly influenced willingness to practice in rural areas. High-family PPES was consistently associated with lower willingness to work in rural areas. A sizable portion of medical students are motivated to study and practice medicine in rural areas. Efforts should be made to build on motivation during medical training and designing rural postings, as well as favor lower PPES students for admission and improving organizational and contextual issues of rural service.

scholarly journals P2-502: FINDING THE BALANCE BETWEEN CAREGIVING IN DEMENTIA, FAMILY AND EMPLOYMENT: FIRST RESULTS OF A MIXED METHODS STUDY IN NORTHERN GERMANY

2019 ◽  
Vol 15 ◽  
pp. P810-P810
Author(s):  
Lydia Neubert ◽  
Sophie Gottschalk ◽  
Hans-Helmut König ◽  
Christian Brettschneider
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Northern Germany ◽  
First Results

scholarly journals A mixed-methods study of the Care Needs of individuals with idiopathic Pulmonary fibrosis and their carers—CaNoPy: a study protocol: Table 1

BMJ Open ◽  
2013 ◽  
Vol 3 (8) ◽  
pp. e003537 ◽  
Author(s):  
Anthony Byrne ◽  
Cathy Sampson ◽  
Jessica Baillie ◽  
Kim Harrison ◽  
Ben Hope-Gill ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Study Protocol ◽  
Mixed Methods Study ◽  
Care Needs

scholarly journals User Experience Methods and Maturity in Academic Libraries

2020 ◽  
Vol 39 (1) ◽  
Author(s):  
Scott W. H. Young ◽  
Zoe Chao ◽  
Adam Chandler
Keyword(s):  
Content Analysis ◽  
Mixed Methods ◽  
Statistical Analysis ◽  
User Experience ◽  
Academic Libraries ◽  
Qualitative Content Analysis ◽  
Mixed Methods Study ◽  
Organizational Characteristics ◽  
Recommended Practices ◽  
Survey Responses

This article presents a mixed-methods study of the methods and maturity of user experience (UX) practice in academic libraries. The authors apply qualitative content analysis and quantitative statistical analysis to a research dataset derived from a survey of UX practitioners. Results reveal the type and extent of UX methods currently in use by practitioners in academic libraries. Themes extracted from the survey responses also reveal a set of factors that influence the development of UX maturity. Analysis and discussion focus on organizational characteristics that influence UX methods and maturity. The authors conclude by offering a library-focused maturity scale with recommended practices for advancing UX maturity in academic libraries.

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