What influences general practitioners' use of child psychiatry services?

There are good reasons for Improving liaison between child psychiatrists and general practitioners. This study examined whether characteristics of the GP, patient or service influenced the referral of patients from primary care to the local child psychiatry service. Data collected by semi-structured interview from two samples of general practitioners who had either referred frequently or not at all over a two year period failed to show many of the associations found in other studies. Referral behaviour appears to be a complex phenomenon which may be influenced by increasing personal contact between professionals.

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The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners

British Paramedic Journal ◽

10.29045/14784726.2021.12.6.3.1 ◽

2021 ◽

Vol 6 (3) ◽

pp. 1-6

Author(s):

Damian Muldoon ◽

Chris Seenan

Keyword(s):

Primary Care ◽

Northern Ireland ◽

General Practitioners ◽

Well Being ◽

Structured Interview ◽

Ageing Population ◽

Structured Interviews ◽

Allied Health Professionals ◽

Qualitative Descriptive ◽

Advanced Paramedics

Background: Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs’ experiences are of these developments.Aims: To examine the experiences of GPs who have introduced an advanced paramedic into their primary care team in Northern Ireland.Design: A qualitative descriptive design was chosen as the most suitable approach to allow participants to relay their experiences in their own words within the loose confines of a semi-structured interview.Methods: Semi-structured interviews were conducted with a group of four purposively selected GPs who had direct experience of the phenomena of interest. These interviews were transcribed verbatim, anonymised and then analysed thematically.Results: The thematic analysis produced three superordinate themes of alleviating pressure, acceptance and psychological well-being. These were underpinned by seven ordinate themes that were supported using verbatim quotes. These were then discussed and contextualised with themes from existing literature.Conclusion: Generally, there was widespread support from the GPs for the introduction of advanced paramedics into primary care teams. The reasons were multi-factorial but the reduction in GP workload featured prominently. The participants reported benefits in terms of increased resilience and work‐life balance. The capacity to provide a clinician with experience of dealing with acute and emergency presentations, in combination with managing routine procedures, was also reported to be of great importance.

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‘I mean what is depression?’ A qualitative exploration of UK general practitioners’ perceptions of distinctions between emotional distress and depressive disorder

BMJ Open ◽

10.1136/bmjopen-2019-032644 ◽

2019 ◽

Vol 9 (12) ◽

pp. e032644

Author(s):

Adam W A Geraghty ◽

Miriam Santer ◽

Charlotte Beavis ◽

Samantha J Williams ◽

Tony Kendrick ◽

...

Keyword(s):

Primary Care ◽

Depressive Disorder ◽

General Practitioners ◽

Emotional Distress ◽

Mental Healthcare ◽

Structured Interview ◽

Emotional Symptoms ◽

Reactive Depression ◽

Qualitative Interview Study ◽

Primary Care Practices

ObjectiveDetection of depression is a key part of primary mental healthcare. However, determining whether depressive disorder is or is not present in primary care patients is complex. The aim of this qualitative study was to explore general practitioners’ (GPs) perceptions of distinctions between emotional distress and depressive disorder.DesignQualitative interview study.SettingFace-to-face and telephone interviews with GPs from the South of England.ParticipantsGPs working in UK primary care practices (n=21).MethodInterviews followed a semi-structured interview guide, were audio recorded and transcribed. Data were analysed thematically.ResultsViews were divergent when directly considering whether emotional distress could be distinguished from depressive disorder. Some GPs suggested a distinction was not possible as symptoms lay on a continuum, with severity as a proxy for disorder. Others focused on the difficulty of the distinction and were uncertain. Some GPs perceived a distinction and referred to emotional distress as more likely in the presence of a stressor with the absence of biological symptoms. It was also common for GPs to refer to endogenous and reactive depression when considering possible distinctions between distress and depressive disorder.ConclusionsGPs’ perceptions of when emotional symptoms reflect disorder varied greatly, with a broad range of views presented. Further research is needed to develop more consistent frameworks for understanding emotional symptoms in primary care.

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OMH funds public/private effort to link pedestrians, primary care M.D.s with child psychiatrists, child mental health experts

PsycEXTRA Dataset ◽

10.1037/e571512011-001 ◽

2010 ◽

Keyword(s):

Mental Health ◽

Primary Care ◽

Child Mental Health ◽

Private Effort ◽

Health Experts ◽

Child Psychiatrists

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Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

BMC Medical Education ◽

10.1186/s12909-020-02459-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M.-C. Audétat ◽

S. Cairo Notari ◽

J. Sader ◽

C. Ritz ◽

T. Fassier ◽

...

Keyword(s):

Primary Care ◽

Clinical Reasoning ◽

Primary Care Physicians ◽

Video Sequence ◽

Structured Interview ◽

Ambulatory Setting ◽

Structured Interviews ◽

Stimulated Recall ◽

Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

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Barriers and facilitators to the adoption of electronic clinical decision support systems: a qualitative interview study with UK general practitioners

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01557-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elizabeth Ford ◽

Natalie Edelman ◽

Laura Somers ◽

Duncan Shrewsbury ◽

Marcela Lopez Levy ◽

...

Keyword(s):

Decision Support ◽

Decision Support Systems ◽

General Practitioners ◽

Clinical Decision Support ◽

Support Systems ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Structured Interview ◽

Qualitative Interview Study ◽

High Level

Abstract Background Well-established electronic data capture in UK general practice means that algorithms, developed on patient data, can be used for automated clinical decision support systems (CDSSs). These can predict patient risk, help with prescribing safety, improve diagnosis and prompt clinicians to record extra data. However, there is persistent evidence of low uptake of CDSSs in the clinic. We interviewed UK General Practitioners (GPs) to understand what features of CDSSs, and the contexts of their use, facilitate or present barriers to their use. Methods We interviewed 11 practicing GPs in London and South England using a semi-structured interview schedule and discussed a hypothetical CDSS that could detect early signs of dementia. We applied thematic analysis to the anonymised interview transcripts. Results We identified three overarching themes: trust in individual CDSSs; usability of individual CDSSs; and usability of CDSSs in the broader practice context, to which nine subthemes contributed. Trust was affected by CDSS provenance, perceived threat to autonomy and clear management guidance. Usability was influenced by sensitivity to the patient context, CDSS flexibility, ease of control, and non-intrusiveness. CDSSs were more likely to be used by GPs if they did not contribute to alert proliferation and subsequent fatigue, or if GPs were provided with training in their use. Conclusions Building on these findings we make a number of recommendations for CDSS developers to consider when bringing a new CDSS into GP patient records systems. These include co-producing CDSS with GPs to improve fit within clinic workflow and wider practice systems, ensuring a high level of accuracy and a clear clinical pathway, and providing CDSS training for practice staff. These recommendations may reduce the proliferation of unhelpful alerts that can result in important decision-support being ignored.

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What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

Dementia ◽

10.1177/1471301220977710 ◽

2020 ◽

pp. 147130122097771

Author(s):

Conceição Balsinha ◽

Steve Iliffe ◽

Sónia Dias ◽

Alexandre Freitas ◽

Joana Grave ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Social Contexts ◽

Dementia Care ◽

Family Carers ◽

Primary Care Teams ◽

Qualitative Interview Study ◽

Framework Approach ◽

Advanced Stages ◽

Patient Relationships

Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.

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Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/1363459319874100 ◽

2019 ◽

pp. 136345931987410

Author(s):

Julie Høgsgaard Andersen ◽

Tine Tjørnhøj-Thomsen ◽

Susanne Reventlow ◽

Annette Sofie Davidsen

Keyword(s):

Mental Health ◽

Primary Care ◽

Young Adults ◽

General Practitioners ◽

Mental Health Problems ◽

Psychosocial Problems ◽

Health Problems ◽

Care Work ◽

Psychiatric Nurses ◽

Provision Of Care

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

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Attitudes to and experience of disease management programs in primary care—an exploratory survey of general practitioners in Germany

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-021-00867-1 ◽

2021 ◽

Author(s):

Julian Wangler ◽

Michael Jansky

Keyword(s):

Primary Care ◽

Disease Management ◽

Patient Care ◽

General Practitioners ◽

Linear Regression Analysis ◽

Chronically Ill ◽

Disease Management Programs ◽

Federal States ◽

Set Up ◽

Chronically Ill Patients

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

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