scholarly journals Nutritionists and the comprehensive care of overweight individuals in primary care

2019 ◽  
Vol 32 ◽  
Author(s):  
Ana Luisa Souza de Paiva MOURA ◽  
Elisabetta RECINE
Keyword(s):  
Primary Care ◽  
Theoretical Domains Framework ◽  
Federal District ◽  
Theoretical Framework ◽  
Noncommunicable Diseases ◽  
Care Model ◽  
Structured Interviews ◽  
Appropriate Care ◽  
Different Types ◽  
Primary Care Professionals

ABSTRACT Objective This study sought to highlight the different types of challenges for the integral care of overweight individuals in primary care based on the perception of nutritionists. Methods This is a qualitative study with primary care professionals from the Federal District, Brazil. Semi-structured interviews were conducted to understand the perceptions regarding the organization of integral care. The analysis of the data was based on the theoretical framework Theoretical Domains Framework. Results Challenges related to 10 of the 12 different domains proposed by the theoretical framework were identifi ed. These challenges are related to the capability, opportunity and motivation of workers to act to offer moreeffective care. Conclusion The different nature of the barriers identifi ed were overlapped, which reveal the need for professional qualifi cation along with the consolidation of an appropriate care model for chronic noncommunicable diseases such as obesity.

scholarly journals Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016307 ◽  
Author(s):  
Natalia Calanzani ◽  
Debbie Cavers ◽  
Gabriele Vojt ◽  
Sheina Orbell ◽  
Robert J C Steele ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Feasibility Study ◽  
Occult Blood ◽  
Secondary Outcome ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Test Kit ◽  
General Practices ◽  
Primary Care Professionals

ObjectivesWe aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders.DesignThis was a feasibility study testing an intervention which comprised a brief conversation during routine consultation, provision of a patient leaflet and instructions to request a replacement faecal occult blood test kit. A mixed-methods approach to evaluation was adopted. Data were collected from proformas completed after each intervention, from the Bowel Screening Centre database and from questionnaires. Semi-structured interviews were carried out. We used descriptive statistics, content and framework analysis to determine intervention feasibility and acceptability.ParticipantsBowel screening non-responders (as defined by the Scottish Bowel Screening Centre) and primary care professionals working in five general practices in Lothian, Scotland.Primary and secondary outcome measuresSeveral predefined feasibility parameters were assessed, including numbers of patients engaging in conversation, requesting a replacement kit and returning it, and willingness of primary care professionals to deliver the intervention.ResultsThe intervention was offered to 258 patients in five general practices: 220 (87.0%) engaged with the intervention, 60 (23.3%) requested a new kit, 22 (8.5%) kits were completed and returned. Interviews and questionnaires suggest that the intervention was feasible, acceptable and consistent with an existing health prevention agenda. Reported challenges referred to work-related pressures, time constraints and practice priorities.ConclusionsThis intervention was acceptable and resulted in a modest increase in non-responders participating in bowel screening, although outlined challenges may affect sustained implementation. The strategy is also aligned with the increasing role of primary care in promoting bowel screening.

scholarly journals Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model programme in Hungary

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Cintia Katona ◽  
Éva Gutási ◽  
Magor Papp ◽  
Orsolya Varga ◽  
Karolina Kósa
Keyword(s):  
Primary Care ◽  
Personal Characteristics ◽  
Local Communities ◽  
Programme Evaluation ◽  
Care Team ◽  
Primary Care Team ◽  
Work Experiences ◽  
Care Model ◽  
Structured Interviews ◽  
Disadvantaged Population

Abstract Background A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation. Methods As part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out. Results Three themes emerged from the transcripts. The first focused on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement. Conclusions Health mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators as non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

scholarly journals Specialist Clinicians’ Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory

Pharmacy ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 25 ◽  
Author(s):  
Niamh Fingleton ◽  
Eilidh Duncan ◽  
Margaret Watson ◽  
Catriona Matheson
Keyword(s):  
Online Survey ◽  
Illicit Drugs ◽  
Theoretical Domains Framework ◽  
Mixed Methods Study ◽  
Perceived Barriers ◽  
Structured Interviews ◽  
Treatment Services ◽  
Client Group ◽  
Appropriate Care ◽  
Treatment Provision

The aim of the study was to establish how non-prescription medicine (NPM) dependence is treated by doctors in specialist substance misuse treatment services and to identify perceived barriers to providing treatment. An online survey was conducted to establish current practice and whether changes to service provision are needed to facilitate treatment (n = 83). Semi-structured interviews, based on the Theoretical Domains Framework, were conducted to derive a detailed exploration of suggested changes (n = 11). Most survey respondents had encountered cases of NPM dependence. Analgesics containing codeine were the most frequently NPMs of dependence mentioned by respondents. Most respondents were unaware of specific guidelines for the treatment of NPM dependence. The most frequently identified barriers to providing treatment identified by interviewees were limited resources or capacity and the challenges presented by this client group. There was a perception that this client group could be difficult to treat due to comorbidities, and these this client group perceived themselves to be different from people dependent on alcohol or illicit drugs. This study identified a clear need for specific clinical guidelines for the treatment of NPM dependence. Such guidance should be appropriate for specialist and generalist clinicians as the current pressure on resources may force more treatment into general practice. Appropriate care pathways need to be established and defined, and sufficient resources allocated to accommodate this client group.

scholarly journals Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Abdulrhim ◽  
Sowndramalingam Sankaralingam ◽  
Mohamed Izham Mohamed Ibrahim ◽  
Mohammed Issam Diab ◽  
Mohamed Abdelazim Mohamed Hussain ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Collaborative Care ◽  
Healthcare Professionals ◽  
Barriers And Facilitators ◽  
Easy Access ◽  
Care Model ◽  
Structured Interviews ◽  
Collaborative Care Model ◽  
Patients With Diabetes

Abstract Background Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. Methods Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. Results Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. Conclusions The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

scholarly journals Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model program in Hungary

2020 ◽  
Author(s):  
Cintia Katona ◽  
Éva Gutási ◽  
Magor Papp ◽  
Orsolya Varga ◽  
Karolina Kósa
Keyword(s):  
Primary Care ◽  
Personal Characteristics ◽  
Local Communities ◽  
Programme Evaluation ◽  
Care Team ◽  
Primary Care Team ◽  
Work Experiences ◽  
Care Model ◽  
Structured Interviews ◽  
Disadvantaged Population

Abstract Background: A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation. Methods: As part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out. Results: Three themes emerged from the transcripts. The first focused on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement. Conclusions: Health mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators as non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

scholarly journals Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101100
Author(s):  
Sharon Ann Carstairs ◽  
Rayna H Rogowsky ◽  
Kathryn B Cunningham ◽  
Frank Sullivan ◽  
Gozde Ozakinci
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Community Based ◽  
Healthcare Settings ◽  
Primary Care Patients ◽  
Exercise Programmes

BackgroundInconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.AimThis study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.Design & settingAn exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.MethodPatient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.ResultsThree methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.ConclusionFor patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

scholarly journals Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model program in Hungary

2020 ◽  
Author(s):  
Cintia Katona ◽  
Éva Gutási ◽  
Magor Papp ◽  
Orsolya Varga ◽  
Karolina Kósa
Keyword(s):  
Primary Care ◽  
Personal Characteristics ◽  
Local Communities ◽  
Programme Evaluation ◽  
Care Team ◽  
Primary Care Team ◽  
Work Experiences ◽  
Care Model ◽  
Structured Interviews ◽  
Disadvantaged Population

Abstract Background: A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation. Methods: As part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out. Results: Three themes emerged from the transcripts. The first centered on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement. Conclusions: Health mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators, non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

scholarly journals Identification and management of frailty in English primary care: a qualitative study of national policy

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101019
Author(s):  
Khulud Alharbi ◽  
Harm van Marwijk ◽  
David Reeves ◽  
Tom Blakeman
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
National Policy ◽  
Evidence Base ◽  
System Thinking ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Ageing Population ◽  
Structured Interviews ◽  
Primary Care Professionals

BackgroundPolicymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success of the programme.AimTo explore the implementation of a national policy on frailty identification and management in English primary care.Design & settingQualitative study entailing interviews with primary care professionals in the North of England.MethodSemi-structured interviews were conducted with GPs (n = 10), nurses (n = 6), practice managers (n = 3), and health advisors (n = 3). Normalisation process theory (NPT) and ‘system thinking’ provided sensitising frameworks to support data collection and analysis.ResultsPrimary care professionals were starting to use the concept of frailty to structure care within practices and across organisations; however, there was widespread concern about the challenge of providing expanded care for the identified needs with existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients.ConclusionFindings suggests that additional, focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.

scholarly journals Engaging primary care professionals in suicide prevention: A qualitative study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242540
Author(s):  
Elke Elzinga ◽  
Anja J. T. C. M. de Kruif ◽  
Derek P. de Beurs ◽  
Aartjan T. F. Beekman ◽  
Gerdien Franx ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
The Netherlands ◽  
Mental Health Care ◽  
Suicide Prevention ◽  
Implementation Process ◽  
Theory Approach ◽  
Structured Interviews ◽  
Primary Care Professionals

In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017–2018 to more effectively engage them in suicide prevention. This implementation study aimed to evaluate to what extent SUPRANET was helpful in supporting PCPs to apply suicide prevention practices. From March to May 2018, 21 semi-structured interviews have been carried out with PCPs and other non-clinical professionals from SUPRANET regions in the Netherlands. Verbatim transcripts were analysed using the grounded theory approach. Data was structured using the Consolidated Framework for Implementation Research, which enabled identifying facilitating and challenging factors for PCPs to carry out suicide prevention practices. An important challenge included difficulties in assessing suicide risk (intervention characteristics) due to PCPs’ self-perceived incompetence, burdensomeness of suicide and limited time and heavy workload of PCPs. Another important limitation was collaboration with mental health care (outer setting), whereas mental health nurses (inner setting) and SUPRANET (implementation process) were facilitating factors for applying suicide prevention practices. With regard to SUPRANET, especially the training was positively evaluated by PCPs. PCPs expressed a strong need for improving collaboration with specialized mental health care, which was not provided by SUPRANET. Educating PCPs on suicide prevention seems beneficial, but is not sufficient to improve care for suicidal patients. Effective suicide prevention also requires improved liaison between mental health services and primary care, and should therefore be the focus of future suicide prevention strategies aimed at primary care.

scholarly journals Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe

2021 ◽  
Vol 8 ◽  
Author(s):  
Marta Wanat ◽  
Melanie Hoste ◽  
Nina Gobat ◽  
Marilena Anastasaki ◽  
Femke Böhmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Individual Risk ◽  
Structured Interviews ◽  
Health Crisis ◽  
Analysis Techniques ◽  
Public Health Crisis ◽  
Personal Risk ◽  
Varied Response ◽  
Individual Risk Factors ◽  
Primary Care Professionals

Background: Minimising primary care professionals' (PCPs) risk of SARS-CoV-2 infection is crucial to ensure their safety as well as functioning health care system. PCPs' perspectives on the support they needed in the early stages of a public health crisis can inform future preparedness.Aim: To understand PCPs' experiences of providing care during the COVID-19 pandemic, with focus on personal risk from COVID-19 and testing.Design and Setting: Qualitative study using semi-structured interviews with PCPs in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020.Method: Interviews were analysed using a combination of inductive and deductive thematic analysis techniques.Results: Eighty interviews were conducted, showing that PCPs tried to make sense of their risk of both contracting and severity of COVID-19 by assessing individual risk factors and perceived effectiveness of Personal Protective Equipment (PPE). They had limited access to PPE yet continued providing care as their “duty.” Some PCPs felt that they were put in high-risk situations when patients or colleagues were not flagging symptoms of COVID-19. Not having access to testing in the initial stages of the pandemic was somewhat accepted but when available, was valued.Conclusion: Access to adequate PPE and testing, as well as training for staff and education for patients about the importance of ensuring staff safety is crucial. Given PCPs' varied response in how they appraised personal risk and their tolerance for working, PCPs may benefit from the autonomy in deciding how they want to work during health emergencies.

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