scholarly journals Exploring the Prescribing Process of Domperidone for Low Milk Supply: A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

2020 ◽  
pp. 089033442096407
Author(s):  
Lara A. Tauritz Bakker ◽  
Liset van Dijk ◽  
Patricia M. L. A. van den Bemt
Keyword(s):  
Qualitative Study ◽  
Family Physicians ◽  
Milk Supply ◽  
Clinical Protocol ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Family Doctors ◽  
Provider Perspectives ◽  
Lactation Consultants ◽  
Dutch Family

Background When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians’ journal to support Dutch family physicians in prescribing domperidone to stimulate lactation. Research aim To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol. Methods A cross-sectional qualitative study was performed using semi-structured interviews ( N = 40) based on a topic list covering the prescribing process. Participants were mothers ( n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants ( n = 9), and their family physicians ( n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics. Results In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented. Conclusions Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

scholarly journals Roles and challenges of family physicians in Uganda: A qualitative study

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Innocent K. Besigye ◽  
Jude Onyango ◽  
Fred Ndoboli ◽  
Vincent Hunt ◽  
Cynthia Haq ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Teaching And Learning ◽  
Clinical Care ◽  
Family Physicians ◽  
World Health ◽  
World Health Report ◽  
Cross Sectional ◽  
Health Report ◽  
Geographical Regions ◽  
The World

Background: The World Health report (2008), the World Health Assembly (2009) and the Declaration of Astana (2018) acknowledge the significant contribution of family physicians (FPs) in clinical and primary healthcare. Given the lack of resources and low numbers of FPs coupled with the contextual nature of family medicine (FM), the scope of practice of African FPs is likely to differ from that of colleagues in America and Europe. Thus, this study explored the roles of Ugandan FPs and the challenges they face.Methods: This cross-sectional qualitative study was conducted through in-depth interviews with FPs who are working in Uganda. Participants who work in public and private healthcare systems including non-governmental organisations and in all geographical regions were purposively selected. Interviews were conducted from July 2016 to June 2017. Qualitative thematic content analysis of the transcripts was performed using a framework approach.Results: The study team identified three and six thematic roles and challenges, respectively, from the interview transcripts. The roles were clinician, leadership and teaching and learning. Challenges included lack of common identity, low numbers of FPs, conflicting roles, unrealistic expectations, poor organisational infrastructure and lack of incentives.Conclusion: The major roles of FPs in Uganda are similar to those of their counterparts in other parts of the world. Family physicians provide clinical care for patients, including preventive and curative services; providing leadership, management and mentorship to clinical teams; and teaching and learning. However, their roles are exercised differently as a result of lack of proper institutionalisation of FM within the Uganda health system. Family physicians in Uganda have found many opportunities to contribute to healthcare leadership, education and service, but have not yet found a stable niche within the healthcare system.

scholarly journals Patient use of blood pressure self-screening facilities in general practice waiting rooms: a qualitative study in the UK

2017 ◽  
Vol 67 (660) ◽  
pp. e467-e473 ◽  
Author(s):  
Alice C Tompson ◽  
Sabrina Grant ◽  
Sheila M Greenfield ◽  
Richard J McManus ◽  
Susannah Fleming ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Qualitative Study ◽  
Ease Of Use ◽  
Structured Interviews ◽  
Waiting Room ◽  
Cross Sectional ◽  
History Of ◽  
The Uk ◽  
Patient Use ◽  
At Home

BackgroundBlood pressure (BP) self-screening, whereby members of the public have access to BP monitoring equipment outside of healthcare consultations, may increase the detection and treatment of hypertension. Currently in the UK such opportunities are largely confined to GP waiting rooms.AimTo investigate the reasons why people do or do not use BP self-screening facilities.Design and settingA cross-sectional, qualitative study in Oxfordshire, UK.MethodSemi-structured interviews with members of the general public recruited using posters in GP surgeries and community locations were recorded, transcribed, and coded thematically.ResultsOf the 30 interviewees, 20% were hypertensive and almost half had self-screened. Those with no history of elevated readings had limited concern over their BP: self-screening filled the time waiting for their appointment or was done to help their doctor. Patients with hypertension self-screened to avoid the feelings they associated with ‘white coat syndrome’ and to introduce more control into the measurement process. Barriers to self-screening included a lack of awareness, uncertainty about technique, and worries over measuring BP in a public place. An unanticipated finding was that several interviewees preferred monitoring their BP in the waiting room than at home.ConclusionBP self-screening appeared acceptable to service users. Further promotion and education could increase awareness among non-users of the need for BP screening, the existence of self-screening facilities, and its ease of use. Waiting room monitors could provide an alternative for patients with hypertension who are unwilling or unable to monitor at home.

scholarly journals Evaluating the Structural Reform of Outpatient Psychotherapy in Germany (ES-Rip Trial) - A Qualitative Study of Provider Perspectives

2021 ◽  
Author(s):  
Poß-Doering Regina ◽  
Hegelow Martin ◽  
Borchers Milena ◽  
Hartmann Mechthild ◽  
Kruse Johannes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Intrinsic Motivation ◽  
Rural Areas ◽  
Information Exchange ◽  
Structural Reform ◽  
Framework Analysis ◽  
Outpatient Psychotherapy ◽  
Psychotherapeutic Treatment ◽  
Cross Sectional ◽  
Provider Perspectives

Abstract Background: Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ’Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods: This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured open-ended telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results: Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease.Conclusions: The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provides an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration: Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020344)

scholarly journals Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037136
Author(s):  
Chloe Grimmett ◽  
Claire Foster ◽  
Katherine Bradbury ◽  
Phillippa Lally ◽  
Carl R May ◽  
...  
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Intervention Development ◽  
Well Being ◽  
Rapid Expansion ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Gi Cancer ◽  
The Impact

ObjectivesIn the last decade, there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer (LWBC). The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal (GI) cancer, and identify barriers and facilitators of this behaviour.DesignCross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a PA programme in the UK, explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Themes and subthemes were identified. Differences between individuals were recognised and a typology of PA engagement was developed.ParticipantsTwenty-seven individuals (n=15 male, mean age=66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation.SettingUK.ResultsSeven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated: (1) maintained PA, (2) intermittent PA, (3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual’s level of physical functioning and is highly valued is key to supporting long-term PA engagement.ConclusionThe typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people LWBC.

scholarly journals Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians

10.2196/13382 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13382 ◽  
Author(s):  
Mariell Hoffmann ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Hans-Christoph Friederich ◽  
Markus W Haun
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Practice ◽  
Family Physicians ◽  
Health Conditions ◽  
Care Practice ◽  
Cross Sectional ◽  
Mental Health Specialist ◽  
Health Specialist

Background Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487

scholarly journals Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

2021 ◽  
Vol 41 (6) ◽  
pp. 182-189
Author(s):  
Joshua Goodwin ◽  
Susan Kirkland
Keyword(s):  
Qualitative Study ◽  
Cancer Pain ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Barriers And Facilitators ◽  
Health Concern ◽  
Prescription Opioid ◽  
Monitoring And Control ◽  
Structured Interviews ◽  
Physician Patient Relationship

Introduction Harms caused by prescription opioid analgesics (POAs) have been identified as a major international public health concern. Recent statistics show rising numbers of opioid-related deaths across Canada. However, Canadian family physicians appear to have inadequate resources to safely and effectively prescribe opioid analgesics to treat chronic non-cancer pain (CNCP). Methods We completed a qualitative study of the barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP through semi-structured interviews with eight family physicians in Nova Scotia. Thematic analysis was used to identify the barriers and facilitators. Results Family physicians identified challenges in prescribing opioid analgesics for CNCP: the complexity of CNCP management, addictions risks and prescribing tools, physician training, the physician–patient relationship, prescription monitoring and control, and systemic factors. Conclusion Family physicians described themselves as inadequately supported in their prescribing of opioid analgesics for CNCP and could benefit from an integrated and coordinated approach to prescriber support.

scholarly journals Managing orthodontic appliances in everyday life: A qualitative study of young people’s experiences with removable functional appliances, fixed appliances and retainers

2020 ◽  
Vol 47 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Jennifer E Kettle ◽  
Amy C Hyde ◽  
Tom Frawley ◽  
Clare Granger ◽  
Sarah J Longstaff ◽  
...  
Keyword(s):  
Young People ◽  
Qualitative Study ◽  
Everyday Life ◽  
Social Process ◽  
The Body ◽  
Orthodontic Appliances ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional ◽  
Orthodontic Patients

Objective: To compare young people’s experiences of wearing a range of orthodontic appliances. Design: A cross-sectional, qualitative study with purposive sampling. Setting: UK dental teaching hospital. Participants: Twenty-six orthodontic patients aged 11–17 years. Methods: Patients participated in in-depth semi-structured interviews. All interviews were transcribed verbatim and analysed thematically. Results: Young people reported physical, practical and emotional impacts from their appliances. Despite these reported impacts, participants described ‘getting used’ to and, therefore, not being bothered by their appliance. Framework analysis of the data identified a multi-dimensional social process of managing everyday life with an appliance. This involves addressing the ‘dys-appearance’ of the body through physically adapting to an appliance. This process also includes psychological approaches, drawing on social networks, developing strategies and situating experiences in a longer-term context. Engaging in this process allowed young people to address the physical, practical and emotional impacts of their appliances. Conclusion: This qualitative research has identified how young people manage everyday life with an appliance. Understanding this process will help orthodontists to support their patients.

scholarly journals GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care

2019 ◽  
Vol 69 (688) ◽  
pp. e752-e759
Author(s):  
Laura Condon ◽  
Vibhore Prasad
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young People ◽  
Qualitative Study ◽  
Health Concern ◽  
Health Consequences ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Children And Young People ◽  
Being Bullied

BackgroundBullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help from a GP. However, there is currently little research on GPs’ views on and perceptions of their role in dealing with disclosures of bullying in primary care.AimTo explore GPs’ views about their role in dealing with CYPs’ disclosures of being bullied, especially factors that have an impact on GPs’ roles.Design and settingIn this cross-sectional qualitative study, semi-structured interviews were conducted with GPs in primary care in England from October to December 2017.MethodPurposive sampling was used to achieve variation in GP age, professional status in practice, profile of the patients served by the practice, practice size and location, and whether the GPs considered themselves to be actively in research or teaching.ResultsData from 14 semi-structured interviews revealed three main themes: remaining clinically vigilant; impact of bullying in schools; and training and guidance on dealing with bullying and cyberbullying. GPs felt that dealing with disclosures of bullying and cyberbullying came down to their clinical experience rather than guideline recommendations, which do not currently exist, and that bullying was a precipitating factor in presentations of CYPs’ mental health issues.ConclusionGPs feel they have a role to play in managing and supporting the health of CYP who disclose being bullied during consultations. However, they feel ill-equipped to deal with these disclosures because of lack of professional development opportunities, and guidance on treating and managing the health consequences of being bullied.

scholarly journals Evaluating the structural reform of outpatient psychotherapy in Germany (ES-RiP trial) - a qualitative study of provider perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poß-Doering Regina ◽  
Hegelow Martin ◽  
Borchers Milena ◽  
Hartmann Mechthild ◽  
Kruse Johannes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Intrinsic Motivation ◽  
Rural Areas ◽  
Information Exchange ◽  
Structural Reform ◽  
Framework Analysis ◽  
Outpatient Psychotherapy ◽  
Psychotherapeutic Treatment ◽  
Cross Sectional ◽  
Provider Perspectives

Abstract Background Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ‘Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease. Conclusions The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provide an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials.

scholarly journals Keeping doors open: A cross-sectional survey of family physician practice patterns during COVID-19, needs, and intentions

2021 ◽  
Author(s):  
Tara Kiran ◽  
Ri Wang ◽  
Curtis Handford ◽  
Nadine Laraya ◽  
Azza Eissa ◽  
...  
Keyword(s):  
Family Physician ◽  
Practice Patterns ◽  
Clinical Care ◽  
Family Physicians ◽  
Cross Sectional Survey ◽  
Related Factors ◽  
Cross Sectional ◽  
Policy Makers ◽  
Family Doctors ◽  
Future Practice

Objective: To determine the extent to which family physicians closed their doors altogether or for in-person visits during the pandemic, their future practice intentions, and related factors. Methods: Between March and June 2021, we conducted a cross-sectional survey using email, fax, and phone of 1,186 family doctors practicing comprehensive family medicine in Toronto, Ontario. We asked about practice patterns in January 2021, use of virtual care, and practice intentions. Results: Of the 1,016 (86%) that responded to the survey, 99.7% (1001/1004) indicated their practice was open in January 2021 with 94.8% (928/979) seeing patients in-person and 30.8% (264/856) providing in-person care to patients reporting COVID-19 symptoms. Respondents estimated spending 58.2% of clinical care time on phone visits and an additional 5.8% on video and 7.5% on email. 17.2% (77/447) were planning to close their current practice in the next five years. There was a higher proportion of physicians who worked alone in a clinic among those who did not see patients in-person (27.6% no vs 12.4% yes, p<0.05), did not see symptomatic patients (15.6% no vs 6.5 % yes, p<0.001), and those who planned to close their practice in the next 5 years (28.9% yes vs 13.9% no, p<0.01). Interpretation: The vast majority of family physicians in Toronto were open to in-person care in January 2021 but almost one-fifth are considering closing their practice in the next five years. Policy-makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention.

Sign in / Sign up

Export Citation Format

Share Document