scholarly journals A mixed methods study on medicines information needs and challenges in New Zealand general practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chloë Campbell ◽  
Rhiannon Braund ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
New Zealand ◽  
Side Effects ◽  
General Practitioners ◽  
Information Needs ◽  
Qualitative Data ◽  
Mixed Methods Study ◽  
Information Support ◽  
Medicines Information

Abstract Background Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. Methods A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. Results Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners’ medicines information needs were identified from the qualitative data: a ‘common core’ related to medicine dose, side effects and interactions and a ‘perplexing periphery’. Challenges in the perplexing periphery were the variation in information needs, complexity, ‘known unknowns’ and ‘unknown unknowns’. Key factors affecting general practitioners’ strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. Conclusions General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

scholarly journals Exploration of sedentary behaviour among general practitioners: protocol for a mixed methods study

2021 ◽  
Vol 8 (1) ◽  
pp. 51
Author(s):  
Richard S. Mayne ◽  
Nigel D. Hart ◽  
Neil Heron
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
Sedentary Behaviour ◽  
General Practitioners ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
New Ways Of Working ◽  
Adverse Health Outcomes ◽  
Sequential Mixed Methods ◽  
Working Day

<p class="abstract"><strong>Background:</strong> Many general practitioners (GPs) are sedentary for most of their working day. Levels of sedentary behaviour may have been exacerbated by increased use of telemedicine in light of the COVID-19 pandemic, as this is traditionally performed while sitting down. Excessive sedentary behaviour is associated with many adverse health outcomes and increased all-cause mortality. This study will gain quantitative data on levels of sedentary behaviour among GPs and general practice specialty trainees (GPSTs), to identify to what extent general practice is a sedentary occupation, as well as qualitative data regarding the barriers and facilitators to reducing sedentary behaviour in the general practice setting.</p><p class="abstract"><strong>Methods:</strong> The study follows a sequential, mixed-methods model. The first stage will involve the dissemination of a questionnaire survey, where participants self-estimate their sedentary behaviour on a working day and on a non-working day. The second stage will use thigh-worn accelerometers and a sleep/work log to obtain objective data regarding sedentary behaviour among a purposive subset of participants who responded to the questionnaire. The third stage will involve semi-structured interviews with a purposive subset of accelerometer study participants, analysed with the application of a theoretical framework regarding the acceptability of healthcare interventions.</p><p class="abstract"><strong>Conclusions: </strong>This paper outlines a protocol for a sequential, mixed-methods study exploring sedentary behaviour among GPs and GPSTs. Findings of this study will shed light on the new ways of working as a result of the COVID-19 pandemic, which will be relevant to clinicians working in similar primary care settings throughout the world.</p><p class="abstract"><strong>Trial Registration:</strong> ClinicalTrials.gov Identifier: NCT04556695. Date of registration: 21<sup>st</sup> September 2020.</p><p class="abstract"> </p>

scholarly journals General Practitioners’ Attitudes toward Municipal Initiatives to Improve Antibiotic Prescribing—A Mixed-Methods Study

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 120 ◽  
Author(s):  
Marthe Sunde ◽  
Marthe Marie Nygaard ◽  
Sigurd Høye
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Mixed Methods ◽  
General Practitioners ◽  
Treatment Guidelines ◽  
National Level ◽  
Medical Officer ◽  
Mixed Methods Study ◽  
Antibiotic Prescribing ◽  
E Mail

Antimicrobial stewardship (AMS) interventions directed at general practitioners (GPs) contribute to an improved antibiotic prescribing. However, it is challenging to implement and maintain such interventions at a national level. Involving the municipalities’ Chief Medical Officer (MCMO) in quality improvement activities may simplify the implementation and maintenance, but may also be perceived challenging for the GPs. In the ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) study, MCMOs acted as facilitators of an AMS intervention for GPs. We explored GPs’ views on their own antibiotic prescribing, and their views on MCMO involvement in improving antibiotic prescribing in general practice. This is a mixed-methods study combining quantitative and qualitative data from two data sources: e-mail interviews with 15 GPs prior to the ENORM intervention, and online-form answers to closed and open-ended questions from 132 GPs participating in the ENORM intervention. The interviews and open-ended responses were analyzed using systematic text condensation. Many GPs admitted to occasionally prescribing antibiotics without medical indication, mainly due to pressure from patients. Too liberal treatment guidelines were also seen as a reason for overtreatment. The MCMO was considered a suitable and acceptable facilitator of quality improvement activities in general practice, and their involvement was regarded as unproblematic (scale 0 (very problematic) to 10 (not problematic at all): mean 8.2, median 10). GPs acknowledge the need and possibility to improve their own antibiotic prescribing, and in doing so, they welcome engagement from the municipality. MCMOs should be involved in quality improvement and AMS in general practice.

scholarly journals Primary prevention in general practice – views of German general practitioners: a mixed-methods study

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Christine Holmberg ◽  
Giselle Sarganas ◽  
Nadine Mittring ◽  
Vittoria Braun ◽  
Lorena Dini ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
Primary Prevention ◽  
General Practitioners ◽  
Mixed Methods Study

Analyzing trends in the aural decoding errors of Japanese EFL learners

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kriss Lange ◽  
Joshua Matthews
Keyword(s):  
Mixed Methods ◽  
Qualitative Data ◽  
Mixed Methods Study ◽  
First Year ◽  
Formulaic Language ◽  
Decoding Skills ◽  
Efl Learners ◽  
Japanese University ◽  
Syntactic Knowledge ◽  
L2 Listening

Abstract Japanese EFL learners’ difficulty with accurately decoding connected English speech motivated this mixed methods study. The aural decoding capacities of 63 first-year Japanese university students, with low to intermediate level English proficiency, were first measured with a battery of paused transcription tests (PTT). The transcriptions were clusters of three-words that each possessed attributes typical of co-articulated speech. In addition, after each test, a subgroup of 10 participants individually listened to the same PTT and recounted introspective self-observations of their perceived difficulties with the aural decoding tasks in their L1. These quantitative and qualitative data were used to identify four trends in decoding errors which were categorized as follows: limited collocation familiarity, syntactic knowledge constraints, difficulties utilizing co-text, and L1 phonological influence. This study investigates some of the difficulties associated with aural decoding, highlights the challenges of identifying the origins of decoding errors and suggests that more focus is needed on developing decoding skills as well as knowledge of formulaic language in L2 listening education.

Multicultural teaching competence among undergraduate faculty: a convergent mixed methods study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Chandler Puhy ◽  
Nalini Prakash ◽  
Clarissa Lacson ◽  
Joke Bradt
Keyword(s):  
Mixed Methods ◽  
Qualitative Data ◽  
Teaching Practice ◽  
Mixed Methods Study ◽  
Student Diversity ◽  
Content Type ◽  
Knowledge And Skills ◽  
Teaching Competence ◽  
Quantitative Results ◽  
K 12

Purpose Increased student diversity in universities across the USA has increased the need for post-secondary educators to develop multicultural teaching competence (MTC). Most studies of MTC focus on educators teaching grades K-12. The purpose of this study is to determine how faculty members rate themselves in terms of MTC, what multicultural knowledge and skills faculty report and how they integrate these skills into their teaching practice and what barriers exist to developing and implementing MTC. The purpose of this study was to examine the factors that impact undergraduate faculty integration of multicultural awareness and attitudes into their teaching practices to enhance student learning. Design/methodology/approach A convergent mixed methods study used survey and interview data from undergraduate faculty. Select items from the MTC Inventory (MTCI) and social justice scales (SJS) were administered. Interviews (N = 7) were transcribed and analyzed using thematic analysis. Quantitative and qualitative data were compared to examine convergence and divergence. Findings Quantitative results revealed undergraduate faculty’s awareness, knowledge and skills as indicated by percent agreement with items from the MTCI and SJS instruments. Qualitative findings included the following four themes: knowledge building, addressing diversity in the classroom, barriers and challenges, and needs and recommendations. Qualitative data corroborated or explained many of the quantitative results and provided insight into these trends and barriers that impact MTC. Originality/value This is the first study of its kind, to our knowledge, that has used a mixed methods research design to examine factors that impact MTCs and associated barriers among a sample of undergraduate faculty across disciplines in one urban university.

scholarly journals Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice

2020 ◽  
Vol 70 (694) ◽  
pp. e322-e329 ◽  
Author(s):  
Sarah C Hillman ◽  
Carol Bryce ◽  
Rachel Caleychetty ◽  
Jeremy Dale
Keyword(s):  
Mental Health ◽  
General Practice ◽  
Mixed Methods ◽  
Polycystic Ovary Syndrome ◽  
Mental Health Problems ◽  
Polycystic Ovary ◽  
Mixed Methods Study ◽  
Ovary Syndrome ◽  
Women’S Experiences ◽  
Women's Experiences

BackgroundPolycystic ovary syndrome (PCOS) is a common lifelong metabolic condition with serious associated comorbidities. Evidence points to a delay in diagnosis and inconsistency in the information provided to women with PCOS.AimTo capture women’s experiences of how PCOS is diagnosed and managed in UK general practice.Design and settingThis was a mixed-methods study with an online questionnaire survey and semi-structured telephone interviews with a subset of responders.MethodAn online survey to elicit women’s experiences of general practice PCOS care was promoted by charities and BBC Radio Leicester. The survey was accessible online between January 2018 and November 2018. A subset of responders undertook a semi-structured telephone interview to provide more in-depth data.ResultsA total of 323 women completed the survey (average age 35.4 years) and semi-structured interviews were conducted with 11 women. There were five key themes identified through the survey responses. Participants described a variable lag time from presentation to PCOS diagnosis, with a median of 6–12 months. Many had experienced mental health problems associated with their PCOS symptoms, but had not discussed these with the GP. Many were unable to recall any discussion about associated comorbidities with the GP. Some differences were identified between the experiences of women from white British backgrounds and those from other ethnic backgrounds.ConclusionFrom the experiences of the women in this study, it appears that PCOS in general practice is not viewed as a long-term condition with an increased risk of comorbidities including mental health problems. Further research should explore GPs’ awareness of comorbidities and the differences in PCOS care experienced by women from different ethnic backgrounds.

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 Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study

2019 ◽  
Vol 7 (14) ◽  
pp. 1-288 ◽  
Author(s):  
John L Campbell ◽  
Emily Fletcher ◽  
Gary Abel ◽  
Rob Anderson ◽  
Rupatharshini Chilvers ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Mixed Methods ◽  
Patient Care ◽  
Mixed Methods Study ◽  
Direct Patient Care ◽  
South West ◽  
Career Break ◽  
South West England

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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