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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regina Poß-Doering ◽  
Martin Hegelow ◽  
Milena Borchers ◽  
Mechthild Hartmann ◽  
Johannes Kruse ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Structural Reform ◽  
Outpatient Psychotherapy ◽  
Provider Perspectives

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 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 When to break the news and whose responsibility is it? A cross-sectional qualitative study of health professionals’ views regarding disclosure of BRCA genetic cancer risk

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033127
Author(s):  
Alison Luk Young ◽  
Phyllis N Butow ◽  
Katherine M Tucker ◽  
Claire E Wakefield ◽  
Emma Healey ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Qualitative Study ◽  
Health Professionals ◽  
Rural Areas ◽  
Life Stage ◽  
Tertiary Care ◽  
Cross Sectional ◽  
The Ideal

ObjectivesDisclosure of a hereditary condition in the family poses notable challenges for patients who often seek the assistance of genetic health professionals (GHPs). This study aimed to investigate GHPs’ opinions about the ideal time for disclosure to offspring and their responsibility to at-risk relatives.DesignCross-sectional qualitative study.SettingGenetic familial cancer clinics related to mostly secondary and tertiary care hospitals and centres in urban, regional and rural areas across all states of Australia.ParticipantsGHPs (N=73) including clinical geneticists, genetic counsellors, medical specialists, nurses, surgeons and mental health specialists (eg, psychiatrists, psychologists) who had worked with BRCA1 and BRCA2 families for an average of 9 years.ResultsFocus groups and interviews were transcribed and analysed thematically. GHPs perceived that life stage, maturity, parents’ knowledge and capacity to disseminate information influenced parent–offspring disclosure. In general, GHPs recommended early informal conversations with offspring about a family illness. GHPs considered that facilitation of disclosure to relatives using counselling strategies was their responsibility, yet there were limitations to their role (eg, legal and resource constraints). Variability exists in the extent to which genetic clinics overcome challenges to disclosure.ConclusionsGHPs’ views on the ideal time for the disclosure of genetic risk are generally dependent on the patient’s age and relative’s ability to disclose information. A responsibility towards the patient and their at-risk relative was widely accepted as a role of a GHP but views vary depending on legislative and specialty differences. Greater uniformity is needed in genetic procedural guidelines and the role of each discipline (eg, geneticists, genetic counsellors, oncologists, nurses and mental health specialists) in genetic clinics to manage disclosure challenges.

scholarly journals Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: A Pilot Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Lisa Freise ◽  
Ana Luisa Neves ◽  
Kelsey Flott ◽  
Paul Harrison ◽  
John Kelly ◽  
...  
Keyword(s):  
Information Exchange ◽  
Online Survey ◽  
Personal Health Information ◽  
Free Text ◽  
Patient Portal ◽  
Medical Terminology ◽  
Framework Analysis ◽  
User Friendliness ◽  
Cross Sectional ◽  
Electronic Health

BACKGROUND Sharing personal health information positively impacts quality of care across several domains, and particularly safety and patient-centeredness. Patients when reading their electronic health records (EHRs) may identify and flag up inconsistencies, leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their electronic records. OBJECTIVE This study assesses patients’ ability to identify errors present in their EHRs. Specifically, it evaluates the degree to which patients comprehend the information in their EHRs, what barriers exist to their understanding, and what, if any, errors patients can identify when given access to their EHRs. METHODS A cross-sectional online survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange patient portal, with at least one access during the time of the study, were invited to complete the survey containing both structured (multiple choice) and unstructured (free-text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore to identify errors. Free-text questions allowed respondents to expand on the reasoning behind their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data was systematically reviewed by two independent researchers using the framework analysis method, in order to identify emerging themes. RESULTS A total of 160 participants completed the survey (response rate=23.5%). The majority of participants (68.7%) reported they understood the information. The main barriers identified were information-related (medical terminology and knowledge, and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Participants identified inconsistencies relating to incomplete and incorrect information in 14% of their records. CONCLUSIONS While the majority of patients reportedly understand the information contained within their EHRs, both technology and information-based barriers persist. There is a potential to improve system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality and timeliness of the information held in the EHRs and also a mechanism to further engage patients in their heath and healthcare. CLINICALTRIAL Not applicable

Home medicines reviews: a qualitative study of GPs' experiences

2020 ◽  
Vol 26 (1) ◽  
pp. 24 ◽  
Author(s):  
Kristie Rebecca Weir ◽  
Vasi Naganathan ◽  
Debbie Rigby ◽  
Kirsten McCaffery ◽  
Carissa Bonner ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Rural Areas ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Interprofessional Communication ◽  
Location Data ◽  
Purposeful Sampling ◽  
Included Patient ◽  
Effective Use ◽  
Patient Resistance

This qualitative study explored GPs’ experiences with pharmacist-led home medicines reviews (HMRs) and the barriers and facilitators to GPs using HMRs to optimise medicines for older people. Semi-structured interviews were conducted with 32 GPs Australia-wide. Purposeful sampling was undertaken to obtain a representative group in terms of age, gender and location. Data were analysed using framework analysis. Overall, GPs found HMRs useful for educating patients about their medicines, improving adherence and understanding the patient’s home environment. Barriers to effective use of HMRs included patient resistance to having medicines reviewed and limited access to HMRs in regional or rural areas. GPs differed in the extent and way they use HMRs. One group found HMRs very useful, wanted more access to HMRs and reported frequent interactions with pharmacists. A second group was ambivalent, and perceived HMRs could be useful but had limitations in what they can achieve. A third group was sceptical, and reported HMRs rarely provide new insights, and recommendations were not clinically relevant to patients. Understanding GPs’ expectations and preferences through interprofessional communication and partnerships are ways to address these barriers. Future improvements to the HMR program may include incentives and resources that promote collaboration between GPs and pharmacists.

Types of information that patients with lung cancer with targetable driver mutations and their caregivers learn from online forums: Results of a qualitative study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 161-161
Author(s):  
Laura A Petrillo ◽  
Ashley Zhou ◽  
Haiwen Gui ◽  
Robert Sommer ◽  
Jessica Jiyeong Lin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Side Effects ◽  
Qualitative Study ◽  
Information Exchange ◽  
Driver Mutations ◽  
Online Forums ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cancer Subtypes ◽  
Types Of Information

161 Background: Patients and caregivers seek information about cancer from a variety of sources in addition to their medical team. In recent years, patients with specific lung cancer subtypes have created advocacy groups with active online forums for networking, support, and information exchange. We sought to describe the types of information that patients and caregivers learned from their peers online about lung cancer with targetable driver mutations. Methods: In this qualitative study, we enrolled patients with lung cancer with targetable driver alterations in EGFR, ALK, or ROS1 genes and their caregivers. We conducted individual, semi-structured interviews with participants from a single academic center, asking about their experiences learning about and living with lung cancer. Three reviewers used a framework analysis to code transcripts, and we synthesized the codes into themes. In this analysis, we focused on one theme that emerged from the data related to the information that participants learned from online forums. Results: Of 59 patients approached, 39 patients (mean age = 59, 56% female, median time from diagnosis 16 months) and 16 caregivers (69% male, all spouses or long-term partners) agreed to participate and completed interviews. Participants used online forums to compare their experiences with others to gain a preview of what might lie ahead. Specifically, they read about patients with long survival that were a source of hope, as well as patients’ experiences of progression and dying from cancer that made clinical estimates of prognosis more personal and vivid. Online forums provided a venue to learn about the latest research, available clinical trials, how to manage side effects, and where to find expert clinicians. Participants learned about the treatments received by patients at other centers. They were also exposed to emotionally intense stories of patients from around the world who lacked access to targeted therapy and sought advice from other forum members about how to find specialized care. Caregivers pointed out the distressing effect on patients of learning bad news about online peers as a downside of online forums, but overall found them beneficial and supported patients’ engagement with them. Conclusions: Online forums, particularly those that narrowly focus on specific diseases or treatments, provide patients and caregivers with anecdotal evidence that helps them with practical matters, such as how to manage side effects, as well as more existential issues, such as how long they can expect to live. These results suggest that clinicians should be open to and curious about the information that patients and caregivers learn from online forums in order to better understand the perspectives that patients and caregivers bring to discussions and decisions about their cancer.

scholarly journals Assessment of Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey

10.2196/19074 ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. e19074
Author(s):  
Lisa Freise ◽  
Ana Luisa Neves ◽  
Kelsey Flott ◽  
Paul Harrison ◽  
John Kelly ◽  
...  
Keyword(s):  
Information Exchange ◽  
Personal Health Information ◽  
Free Text ◽  
Patient Portal ◽  
Medical Terminology ◽  
Framework Analysis ◽  
Cross Sectional ◽  
Web Based ◽  
Patient Reported ◽  
Electronic Health

Background Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.

Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Geographic Location ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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