Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

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Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

BMC Health Services Research ◽

10.1186/s12913-020-05715-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Emmanuel Allory ◽

Hélène Lucas ◽

Arnaud Maury ◽

Ronan Garlantezec ◽

Candan Kendir ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Primary Care Practice ◽

Healthcare Providers ◽

Primary Care Providers ◽

Self Management ◽

Care Practice ◽

Geographical Proximity ◽

Facilitators And Barriers ◽

Improve Access

Abstract Background Diabetes self-management education (DSME) is an effective intervention for patients with type 2 diabetes mellitus (T2DM); nevertheless, patient participation in this type of programme is low. Implementation of DSME programmes in primary care practices by the local multi-professional team is a potential strategy to improve access to DSME for T2DM patients. The aim of this study was to identify perceived facilitators and barriers by patients to participation in local DSME delivered by primary care professionals in France. Method T2DM patients, informed and recruited during consulting with their usual care provider, who had attended a structured and validated DSME programme delivered by 13 primary care providers within a multi-professional primary care practice in a deprived area of 20,000 inhabitants, were invited to participate in this study. A qualitative study with semi-structured, in-depth interviews was conducted with study participants, between July 2017 and February 2018. A reflexive thematic analysis of the interviews was carried out. Coding schemes were developed to generate thematic trends in patient descriptions of facilitators and barriers to DSME participation. Results Nineteen interviews (mean length 31 min; [20–44 min]) were completed with T2DM patients. Four themes on facilitators for programme participation emerged from the data: geographical proximity of a DSME programme held in the local multi-professional primary care practice; effective promotion of the DSME programme by the local multi-professional team; pre-existing relationship between patients and their healthcare providers; and potential to establish new social interactions within the neighbourhood by participating in the programme. Three themes on barriers to attendance emerged: integrating the DSME programme into their own schedules; difficulties in expressing themselves in front of a group; and keeping the motivation for self-managing their T2DM. Conclusions From the patient perspective, the programme geographical proximity and the pre-existing patient-healthcare provider relationship were important factors that contributed to participation. Healthcare providers should consider these factors to improve access to DSME programmes and diabetes self-management in deprived populations. Longitudinal studies should be performed to measure the impact of these programmes.

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Self-management support activities in primary care: A qualitative study to compare provision across common health problems

Patient Education and Counseling ◽

10.1016/j.pec.2020.07.003 ◽

2020 ◽

Vol 103 (12) ◽

pp. 2532-2539

Author(s):

Emma Harris ◽

Caroline Barker ◽

Kim Burton ◽

Mike Lucock ◽

Felicity Astin

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Health Problems ◽

Self Management ◽

Management Support

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The Impact of COVID-19 on Chronic Care: A Qualitative Study Among Primary Care Practices in Belgium

10.21203/rs.3.rs-42353/v1 ◽

2020 ◽

Author(s):

Katrien Danhieux ◽

Veerle Buffel ◽

Anthony Pairon ◽

Asma Benkheil ◽

Roy Remmen ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Qualitative Study ◽

Chronic Care ◽

Self Management ◽

Management Support ◽

Risk Patients ◽

Care Practices ◽

Primary Care Practices ◽

Second Wave

Abstract Background. The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for a second wave or flare-ups of the pandemic.Methods. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. 21 people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).Results. Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated.Conclusion: Our findings show the delivery of chronic care as disrupted. It indicates that the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during a second wave or in flare-ups.

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Improving mental health in autistic young adults: a qualitative study exploring help-seeking barriers in UK primary care

British Journal of General Practice ◽

10.3399/bjgp20x709421 ◽

2020 ◽

Vol 70 (694) ◽

pp. e356-e363

Author(s):

Edmund Coleman-Fountain ◽

Carole Buckley ◽

Bryony Beresford

Keyword(s):

Mental Health ◽

Primary Care ◽

Learning Disabilities ◽

Young Adults ◽

Qualitative Study ◽

Help Seeking ◽

Mental Health Problems ◽

Health Problems ◽

Self Management ◽

Mental Health Difficulties

BackgroundAutistic people are at increased risk of developing mental health problems. To reduce the negative impact of living with autism in a non-autistic world, efforts to improve take-up and access to care, and support in early years, which will typically start with a GP appointment, must be grounded in the accounts of autistic young adults.AimTo explore how autistic young adults understand and manage mental health problems; and to consider help seeking as a focus.Design and settingA cross-sectional, qualitative study. Autistic participants were purposively selected to represent a range of mental health conditions including anxiety and depression. A subsample were recruited from a population cohort screened for autism in childhood. The study concerns access to primary care.MethodNineteen autistic young adults without learning disabilities, aged 23 or 24 years, were recruited. In-depth, semi-structured interviews explored how they understood and managed mental health problems. Data were analysed thematically.ResultsYoung adults preferred self-management strategies. Multiple factors contributed to a focus on self-management, including: beliefs about the aetiology of mental health difficulties and increased vulnerability with the context of a diagnosis of autism, knowledge of self-management, and a view that formal support was unavailable or inadequate. Families had limited awareness of professional support.ConclusionYoung autistic adults without learning disabilities, and their families, may hold erroneous beliefs about autism and mental health. This may affect help seeking and contribute to an exacerbation of symptoms. GPs need to be alert to the fact that autistic young adults in their care may be experiencing mental health difficulties but may not recognise them as such.

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What does it take to set goals for self-management in primary care? A qualitative study: Table 1.

Family Practice ◽

10.1093/fampra/cmw054 ◽

2016 ◽

Vol 33 (6) ◽

pp. 698-703 ◽

Cited By ~ 13

Author(s):

Stephanie Anna Lenzen ◽

Jerôme Jean Jacques van Dongen ◽

Ramon Daniëls ◽

Marloes Amantia van Bokhoven ◽

Trudy van der Weijden ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Self Management

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Understanding how patients establish strategies for living with asthma: a qualitative study in UK primary care as part of IMP2ART

British Journal of General Practice ◽

10.3399/bjgp20x708869 ◽

2020 ◽

Vol 70 (694) ◽

pp. e303-e311 ◽

Cited By ~ 4

Author(s):

Luke Daines ◽

Susan Morrow ◽

Sharon Wiener-Ogilvie ◽

Caroline Scott ◽

Liz Steed ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Focus Groups ◽

Cognitive Skills ◽

Action Plan ◽

Management Strategies ◽

Asthma Patient ◽

Self Management ◽

Children With Asthma ◽

Prompt Action

BackgroundIn the context of a variable condition such as asthma, patient recognition of deteriorating control and knowing what prompt action to take is crucial. Yet, implementation of recommended self-management strategies remains poor.AimTo explore how patients with asthma and parents/carers of children with asthma develop and establish recommended self-management strategies for living with asthma, and how clinicians can best support the process.Design and settingA qualitative study in UK primary care.MethodPatients with asthma and parents/carers of children with asthma from 10 general practices were purposively sampled (using age, sex, and duration of asthma) to participate in focus groups or interviews between May 2016 and August 2016. Participants’ experiences of health care, management of asthma, and views on supported self-management were explored. Interviews and focus group sessions were audio-recorded and transcribed verbatim. Iterative thematic analysis was conducted, guided by the research questions and drawing on habit theory in discussion with a multidisciplinary research team.ResultsA total of 49 participants (45 patients; 4 parents/carers) took part in 32 interviews and five focus groups. Of these, 11 reported using an action plan. Patients learnt how to self-manage over time, building knowledge from personal experience and other sources, such as the internet. Some regular actions, for example, taking medication, became habitual. Dealing with new or unexpected scenarios required reflective abilities, which may be supported by a tailored action plan.ConclusionPatients reported learning intuitively how to self-manage. Some regular actions became habitual; dealing with the unexpected required more reflective cognitive skills. In order to support implementation of optimal asthma self- management, clinicians should consider both these aspects of self-management and support, and educate patients proactively.

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