Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland

2018 ◽  
pp. 174239531881596
Author(s):  
Kylie J McKenzie ◽  
David Pierce ◽  
Stewart W Mercer ◽  
Jane M Gunn
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Motivational Interviewing ◽  
Secondary Analysis ◽  
Future Research ◽  
Global Rating ◽  
Coding System ◽  
Interviewing Skills ◽  
Multimorbid Patients

Objectives To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity. Methods Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system. Results Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations. Discussion MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.

scholarly journals The incidence, prevalence, and management of plantar heel pain in Dutch general practice

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703217
Author(s):  
Nadine Rasenberg ◽  
Sita MA Bierma-Zeinstra ◽  
Patrick Bindels ◽  
Johan van der Lei ◽  
Marienke Van Middelkoop
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Records ◽  
Search Algorithm ◽  
Heel Pain ◽  
Future Research ◽  
Healthcare Database ◽  
Plantar Heel Pain ◽  
Wait And See ◽  
Multiple Interventions

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.

scholarly journals Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019233 ◽  
Author(s):  
Martine W J Huygens ◽  
Ilse C S Swinkels ◽  
Robert A Verheij ◽  
Roland D Friele ◽  
Onno C P van Schayck ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Patient Characteristics ◽  
Retrospective Observational Study ◽  
Electronic Health Record Data ◽  
Face To Face ◽  
Patients With Diabetes ◽  
General Practices ◽  
Electronic Health

ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

Challenges in developing primary care physicians’ motivational interviewing skills.

2015 ◽  
Vol 33 (4) ◽  
pp. 330-338 ◽  
Author(s):  
Daniel J. Mullin ◽  
Lisa Forsberg ◽  
Judith A. Savageau ◽  
Barry Saver
Keyword(s):  
Primary Care ◽  
Motivational Interviewing ◽  
Primary Care Physicians ◽  
Interviewing Skills

scholarly journals Does burnout affect clinical reasoning? An observational study among residents in general practice

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Philippe Guillou ◽  
Thierry Pelaccia ◽  
Marie-Frédérique Bacqué ◽  
Mathieu Lorenzo
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Clinical Reasoning ◽  
Emotional Exhaustion ◽  
Negative Impact ◽  
Maslach Burnout Inventory ◽  
Conventional Approach ◽  
Personal Accomplishment ◽  
Future Research ◽  
The Impact

Abstract Background Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians’ clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents. Methods We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach’s burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group (“emotional exhaustion +1” approach). Results One hundred ninety-nine residents were included. The participants’ mean SCT score was 76.44% (95% CI: 75.77–77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the “exhaustion + 1“ approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or “exhaustion + 1“ approaches. Conclusions Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process’s analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.

scholarly journals General practice in the Nordic countries

2016 ◽  
Vol 4 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Kim Rose Olsen ◽  
Anders Anell ◽  
Unto Häkkinen ◽  
Tor Iversen ◽  
Thorhildur Ólafsdóttir ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Private Practice ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Nordic Countries ◽  
Future Research ◽  
The Future ◽  
Care Systems ◽  
Common Framework

Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly, Sweden appears to be the most innovative in relation to introducing new incentive schemes, perhaps because decisions are made at a more decentralised level.Published: April 2016.

Changes in health services usage associated with insulin initiation in primary care

2018 ◽  
Vol 24 (2) ◽  
pp. 155
Author(s):  
Samuel Johnson ◽  
Sharmala Thuraisingam ◽  
John Furler ◽  
Jo-Anne Manski Nankervis
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Health Services ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Clinical Work ◽  
Insulin Initiation ◽  
Health Services Planning ◽  
Randomised Controlled

Insulin initiation is often delayed in primary care partly because of clinician concerns about the additional clinical work. This study describes health services usage (HSU) pre- and post-insulin initiation in people with type 2 diabetes and out-of-target glycaemic levels. Secondary analysis of participant data from the Stepping Up randomised controlled trial of a model of care for insulin initiation in general practice was undertaken. For 142 people who commenced insulin, HSU in the 6 months prior was compared to that in the 12 months following insulin initiation. Overall, HSU events increased in the 6 months following insulin initiation from a median (IQR) of 18 (15, 29) to 23 (16, 36); (P=0.05), mostly because of an increase in general practitioner (GP) consultations (6 (4, 10) to 8 (5, 11); (P=0.01)). HSU and GP consultations subsequently returned to baseline at 12 months. There was no effect on hospitalisations or specialist consultations. Insulin initiation is associated with a small increase in GP consultations that reverts to baseline after 12 months without affecting other health services. This study can inform health services planning and resource allocation at practice and health policy levels to support insulin initiation in general practice.

scholarly journals Perceived limitations of telemedicine from a phenomenological perspective

2020 ◽  
Author(s):  
Michael Knop ◽  
Marius Mueller ◽  
Henrik Freude ◽  
Caroline Ressing ◽  
Bjoern Niehaves
Keyword(s):  
Primary Care ◽  
Communication Technology ◽  
Primary Care Physicians ◽  
Secondary Analysis ◽  
Future Research ◽  
Structured Interviews ◽  
Technological Transformation ◽  
Holistic View ◽  
Phenomenological Perspective ◽  
Information And Communication

In the course of healthcare digitization, the roles of therapists and patients are likely to change. To shape a theoretical based process of technological transformation, a phenomenological perspective on Information and Communication Technology (ICT) is introduced. Therefore, this paper illustrates the benefit of a holistic view on patients and therapists to describe and explain phenomena concerning Human Technology Interaction (HTI). The differentiation between a measurable objective body and a habitual subjective body helps to evaluate and anticipate constituting factors of accepting telemedicine systems. Taking into account findings from a secondary analysis of semi-structured interviews we conducted with primary care physicians, we develop a phenomenological framework for HTI in healthcare. Our aim is to structure future research concerning design implications for ICT and the implementation of telemedicine systems in clinical and primary care.

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