scholarly journals The payment for performance model and its influence on British general practitioners' principles and practice

2014 ◽  
Vol 30 (1) ◽  
pp. 55-67 ◽  
Author(s):  
Armando Henrique Norman ◽  
Andrew J. Russell ◽  
Jane Macnaughton
Keyword(s):  
General Practitioners ◽  
Nurse Practitioners ◽  
Financial Incentive ◽  
Healthcare Services ◽  
Performance Model ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Middle Income ◽  
The Uk

This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

Staff Perceptions of Implementation of a Team-Based Model of Patient-Centered Primary Care

2015 ◽  
Vol 4 (4) ◽  
pp. 244-250
Author(s):  
Sherri L LaVela ◽  
Jennifer N Hill
Keyword(s):  
Primary Care ◽  
Team Building ◽  
Organizational Factors ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Optimal Care ◽  
Team Based Care

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

How Involuntary Admission Might Have Been Avoided: An Interview Study of Referring General Practitioners

2017 ◽  
Vol 41 (S1) ◽  
pp. S150-S151 ◽  
Author(s):  
K. Røtvold ◽  
R. Wynn
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Care Staff ◽  
Health Care Staff ◽  
Involuntary Admission ◽  
Central Question ◽  
Home Care Nursing ◽  
Main Factors ◽  
Care Nursing

IntroductionThe legal criteria for involuntary admission in Norway are that the patient has a serious psychiatric disorder (i.e. psychosis) and is in need of admission to secure needed treatment or that there is a risk of danger. While there have been some studies focusing on coercion in hospitals, less is known about the processes leading up to involuntary admission and the reasoning of referring doctors. In Norway, it is primarily general practitioners (GPs) that refer patients.AimsTo study which factors that GPs who had recently referred patients to involuntary admission thought might have made their latest referral unnecessary.MethodsSeventy-four GPs were interviewed by phone. They had all recently referred patients involuntarily to a major Norwegian university psychiatric hospital. One central question concerned how their latest involuntary referral might have been avoided.ResultsThese are the main factors that the GPs thought could have been of importance in avoiding involuntary referral of their patients:– that the patient took the prescribed medication (28%);– that they personally had the opportunity to closely follow up the patient in the following days (22%);– that other health care staff could follow up the patient closely in the patient's own home (i.e. home care nursing, etc.) (19%);– that a family member of the patient could help the patient (8%).ConclusionsThe GPs suggested that an increased availability of resources and more assistance from other parts of the health service were some of the factors that could be of importance in reducing involuntary admissions.

Clinical Commissioning Groups in the UK

2011 ◽  
Vol 3 (4) ◽  
pp. 44-59
Author(s):  
Vikraman Baskaran ◽  
Steve E. Johns ◽  
Rajeev K. Bali ◽  
Raouf N. G. Naguib ◽  
Nilmini Wickramasinghe
Keyword(s):  
Primary Care ◽  
Knowledge Management ◽  
General Practitioners ◽  
Primary Care Trust ◽  
Small Sample ◽  
Care Staff ◽  
Management Tools ◽  
Sample Group ◽  
The Uk ◽  
Tools And Techniques

This paper investigates whether Knowledge Management (KM) tools and techniques would be useful to General Practitioners within the new UK Commissioning Consortia when they adopt the role of General Practitioners commissioners from the current Primary Care Trusts. Empirical data based on questionnaires were sent to a small sample group made up of General Practitioners, Primary Care Staff and Academics in addition to data collected from a set of one to one interviews with some of the sample group. The authors’ findings show that stakeholders (n=30) are not accustomed to using KM as a way to maximize existing knowledge of commissioning of services within the Primary Care Trust but it does show that they are not too far away from possibly realizing that some type of KM strategy would probably work for them. General Practitioners are already using some of the knowledge management tools under different guises. A lot of resources will be saved if General Practitioners can capture as much of the knowledge already available within the Primary Care Trust by incorporating KM tools and techniques.

scholarly journals Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation

2019 ◽  
Vol 20 ◽  
Author(s):  
Rebecca J. Schwei ◽  
Natalie Guerrero ◽  
Alissa L. Small ◽  
Elizabeth A. Jacobs
Keyword(s):  
Health Care ◽  
Limited English Proficient ◽  
Health Care Systems ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Team Members ◽  
Medical Interpreters ◽  
Care Systems

AbstractPurposeThe purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.BackgroundLanguage barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.MethodsWe conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.FindingsPhysicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

scholarly journals General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study

2018 ◽  
Vol 36 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Abigail Moore ◽  
Caroline Croxson ◽  
Sara McKelvie ◽  
Dan Lasserson ◽  
Gail Hayward
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
General Practitioners ◽  
Older Patients ◽  
Ageing Population ◽  
Structured Interviews ◽  
Suspected Infection ◽  
Qualitative Interview Study ◽  
System Factors ◽  
The Uk

Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.

Paediatric multiple sclerosis: a qualitative study of families’ diagnosis experiences

2014 ◽  
Vol 100 (7) ◽  
pp. 623-629 ◽  
Author(s):  
Denise Hinton ◽  
Susan Kirk
Keyword(s):  
Multiple Sclerosis ◽  
Comparative Method ◽  
Healthcare Services ◽  
Early Investigation ◽  
Delayed Presentation ◽  
Structured Interviews ◽  
Paediatric Multiple Sclerosis ◽  
Long Term Prognosis ◽  
Delayed Referral ◽  
The Uk

ObjectiveTo examine children's and parents’ experiences of obtaining a diagnosis of paediatric multiple sclerosis (MS) and identify potential facilitators and barriers to early diagnosis.DesignQualitative, semi-structured interviews conducted face-to-face in home settings with 31 parents and 21 children and adolescents (8–17 years old) with a clinical diagnosis of MS. Participants were recruited from 16 NHS Trusts and four MS voluntary organisations in the UK. Interviews were recorded and transcribed verbatim and analysed using the constant comparative method.ResultsTime to diagnosis ranged from 1 to 96 months (median 11.5, mean 23.3, SD 27.3). The findings suggest that delayed presentation to healthcare services, generalists’ assumptions about the nature of reported symptoms, lack of awareness of paediatric MS and delayed referral to specialists in paediatric MS were barriers to early investigation and accurate diagnosis. Children, adolescents and parents felt that their concerns about the child's health were not always taken seriously during medical consultations and that clinicians could be reluctant to diagnose MS in childhood. This created additional uncertainty about the child's condition and long-term prognosis.ConclusionsObtaining a diagnosis of paediatric MS can be a challenging and lengthy process with potentially adverse implications for the health of children/adolescents. Valuing families’ knowledge and experience of their child's health, performing a thorough medical examination early in the disease course and organising prompt referrals may aid the early investigation and diagnosis of this disease. In view of the diagnostic challenges, children/adolescents with suspected MS would benefit from early referrals to specialists in paediatric MS.

scholarly journals International Students’ Experience With Health Care in Japan

SAGE Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 215824402110092
Author(s):  
Masumi Soneta ◽  
Akiko Kondo ◽  
Renaguli Abuliezi ◽  
Aya Kimura
Keyword(s):  
Health Care ◽  
International Students ◽  
Medical System ◽  
Care Staff ◽  
Health Care Staff ◽  
Culturally Competent ◽  
Structured Interviews ◽  
International Graduate ◽  
Medical Fees ◽  
Medical University

The number of foreign residents and visitors in Japan is increasing, which necessitates culturally competent care in hospitals. This study aimed to describe the experience of international students who visited hospitals in Japan. In total, nine international graduate students in a medical university participated in semi-structured interviews in English. The interview contents were transcribed and analyzed using content analysis. While participants were satisfied with an efficient medical system and kind staff, they also had difficulty communicating with staff and receiving health care due to language and cultural differences. Participants desired Japanese health care staff speak English, as well as have English documents. The differences from their own countries were mainly medical fees, insurance, the medical system itself, and use of English to communicate with foreign patients. It is necessary to improve staff’s English skills, provide English documents, use multilanguage interpreter services, and explain Japanese hospitals’ medical system.

scholarly journals In-hours acute home visits by advanced nurse practitioners in primary care: a qualitative study

2021 ◽  
Vol 30 (13) ◽  
pp. 788-792
Author(s):  
Alison Wells ◽  
Edward Tolhurst
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Nurse Practitioners ◽  
Role Ambiguity ◽  
Qualitative Data ◽  
Home Visits ◽  
Holistic Care ◽  
Structured Interviews ◽  
Home Setting ◽  
The Uk

Background: The extension of roles within the primary care team is one approach recommended to address the shortage of GPs in the UK. A key aspect of care that advanced nurse practitioners (ANPs) can undertake is acute home visits. Aim: To evaluate the perspectives of ANPs performing acute in-hours home visits in primary care. Methods: Qualitative data were gathered in eight semi-structured interviews across a primary care locality, then analysed via a process of thematic analysis. Findings: Three key themes were identified: providing holistic care; engaging with the home setting; and negotiating role ambiguity. Conclusion: Practices wishing to involve ANPs in acute home visits should ensure clear definition and good understanding of the ANP role. Effective interprofessional relationships should be fostered with appropriate mentorship and clinical supervision to support ANPs in optimising their contribution to acute home visits.

scholarly journals Clinically led commissioning: past, present and future?

2016 ◽  
Author(s):  
Kath Checkland ◽  
Anna Coleman ◽  
Imelda McDermott ◽  
Stephen Peckham
Keyword(s):  
Primary Care ◽  
Health Policy ◽  
General Practitioners ◽  
Social Care ◽  
Healthcare Services ◽  
Historical Evidence ◽  
Present Evidence ◽  
Health And Social Care ◽  
The Uk

One of the key elements of the Health and Social Care Act 2010 (HSCA 2012) was the transfer of responsibility for commissioning healthcare services from managerially led Primary Care Trusts (PCTs) to newly established Clinical Commissioning Groups (CCGs), led by General Practitioners. In this chapter, the authors explore what can be learned from previous attempts to involve GPs in commissioning care. They then apply that learning to the provisions of the HSCA 2012, highlighting the correspondences and discontinuities between what is known from history and what was proposed. They then present evidence from their research on CCGs, exploring what happened in practice when CCGs were established. Finally, the authors discuss the continuing evolution of health policy in the UK in the light of both historical evidence and their current findings.

Use of Thin Dressings Under N95 Respirators: Exploring Their Effect on Quantitative Fit Testing Results to Guide Hospital Practice During the COVID-19 Pandemic

2020 ◽  
Vol 66 (11) ◽  
pp. 13-17
Author(s):  
Susan Guschel ◽  
Karen Chmiel ◽  
Jennifer Rosenstein
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Skin Barrier ◽  
Hospital Staff ◽  
Health Care Facilities ◽  
Care Staff ◽  
Health Care Staff ◽  
Hydrocolloid Dressing ◽  
Effective Seal ◽  
N95 Respirators

At the beginning of the coronavirus disease-19 pandemic, health care staff at a level 1 trauma center in the state of New York experienced facial irritation and skin breakdown under their N95 respirators due to increased and prolonged use. PURPOSE: Members of the Certified Wound and Ostomy Nurse, Nurse Practitioners staff were charged with developing recommendations within 48 hours to help prevent and manage facial skin issues using available products that would not compromise the seal of the respirators. METHOD: With the assistance of a health care safety specialist from the Environmental Health and Safety Department of the hospital, an ambient particle counting device was used to measure the N95 fit factor following application of a liquid skin barrier, transparent film dressing, light silicone-based adhesive dressing, or an extra-thin hydrocolloid dressing on the bridge of the nose and the cheekbones underneath an N95 respirator of 2 hospital staff members who volunteered to test the dressings. RESULTS: All thin dressings tested showed a fit factor over 100, reflecting an effective seal. The highest fit factors were seen with the liquid skin barrier in the 2 volunteers (200 and 198, respectively). Thin dressing usage information was included in the hospital guidelines for N95 respirators and shared with staff. Subsequent feedback suggests that the light silicone-based adhesive dressing and the extra-thin hydrocolloid dressing were preferred. CONCLUSION: Thin dressing use may help reduce skin complications among hospital staff during periods of extended N95 respirator wear time. Because use of the dressings did not result in failure of the quantitative fit test, they were permitted for use by health care staff under their N95 respirators. Studies are needed to help health care facilities optimize N95 respirator use to protect staff from coronavirus disease-19 and respirator-related skin complications while supply shortages remain.

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