scholarly journals Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care

2021 ◽  
Author(s):  
Andrew Turner ◽  
Anne Scott ◽  
Jeremy Horwood ◽  
Chris Salisbury ◽  
Rachel Denholm ◽  
...  
Keyword(s):  
Infection Risk ◽  
Qualitative Investigation ◽  
Structured Interviews ◽  
Practice Staff ◽  
Face To Face ◽  
Outdoor Spaces ◽  
National Guidance ◽  
General Practices ◽  
Increased Pressure ◽  
Indoor And Outdoor

Abstract BackgroundIn March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.AimTo examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19 infection risk. Design and SettingQualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire.MethodLongitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020.ResultsPractices worked flexibly within general national guidance to determine when face-to-face contact with patients was necessary, influenced by knowledge of the patient, experience, and practice resilience. For example, practices prioritised patients according to clinical need using face-to-face contact to resolve clinician uncertainty or provide adequate reassurance to patients. To make face-to-face contact as safe as possible and keep patients separated, practices introduced a heterogeneous range of measures that exploited features of their indoor and outdoor spaces and altered their appointment processes. As national restrictions eased in June and July, the number and proportion of patients seen face-to-face generally increased. However, the reconfiguration of buildings and processes reduced the available capacity and put increased pressure on practices.ConclusionPractices responded rapidly and creatively to the initial lockdown restrictions. The variety of ways practices organised face-to-face contact to minimise infection highlights the need for flexibility in guidance.

scholarly journals Maintaining face-to-face contact during the COVID-19 pandemic: a longitudinal qualitative investigation in UK primary care

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0036
Author(s):  
Andrew Turner ◽  
Anne Scott ◽  
Jeremy Horwood ◽  
Chris Salisbury ◽  
Rachel Denholm ◽  
...  
Keyword(s):  
Qualitative Interview ◽  
Infection Risk ◽  
Qualitative Investigation ◽  
Structured Interviews ◽  
Face To Face ◽  
Outdoor Spaces ◽  
National Guidance ◽  
Qualitative Interview Study ◽  
General Practices ◽  
Indoor And Outdoor

BackgroundIn March 2020 the COVID-19 pandemic required a rapid reconfiguration of UK general practice to minimise face-to-face contact with patients to reduce infection risk. However, some face-to-face contact remained necessary and practices needed to ensure such contact could continue safely.AimTo examine how practices determined when face-to-face contact was necessary and how face-to-face consultations were reconfigured to reduce COVID-19 infection risk.Design & settingQualitative interview study in general practices in Bristol, North Somerset and South Gloucestershire.MethodLongitudinal semi-structured interviews with clinical and managerial practice staff at four timepoints between May and July 2020.ResultsPractices worked flexibly within general national guidance to determine when face-to-face contact with patients was necessary, influenced by knowledge of the patient, experience, and practice resilience. For example, practices prioritised patients according to clinical need using face-to-face contact to resolve clinician uncertainty or provide adequate reassurance to patients. To make face-to-face contact as safe as possible and keep patients separated, practices introduced a heterogeneous range of measures that exploited features of their indoor and outdoor spaces and altered their appointment processes. As national restrictions eased in June and July, the number and proportion of patients seen face-to-face generally increased. However, the reconfiguration of buildings and processes reduced the available capacity and put increased pressure on practices.ConclusionPractices responded rapidly and creatively to the initial lockdown restrictions. The variety of ways practices organised face-to-face contact to minimise infection highlights the need for flexibility in guidance.

Are Young Adults Talking about Their Family Health History? A Qualitative Investigation

2017 ◽  
Vol 32 (2) ◽  
Author(s):  
Lei Xu ◽  
Wura Jacobs ◽  
Mary Odum ◽  
Caitlin Melton ◽  
Lindsey Holland ◽  
...  
Keyword(s):  
Young Adults ◽  
Essential Role ◽  
Family Health ◽  
Family Health History ◽  
Qualitative Investigation ◽  
Structured Interviews ◽  
Face To Face ◽  
Health History ◽  
Culturally Tailored ◽  
Proactive Care

Family Health History (FHH) plays an essential role in risk assessment for a variety of hereditaryconditions. However, little is known about how young adults communicate with their family membersabout FHH. We conducted face-to-face, semi-structured interviews with 30 college students to gatherinformation about their FHH communications with family members. Our sample was diverse and halfof our participants were international young adults. Our findings indicated that none of the intervieweeshad initiated conversations about their FHH. Our findings highlight the need to provide culturally-tailored educational programs for young adults on the importance of collecting FHH for proactive care.

scholarly journals Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

2018 ◽  
Vol 68 (669) ◽  
pp. e293-e300 ◽  
Author(s):  
Helen Atherton ◽  
Heather Brant ◽  
Sue Ziebland ◽  
Annemieke Bikker ◽  
John Campbell ◽  
...  
Keyword(s):  
General Practice ◽  
Participant Observation ◽  
Health Issues ◽  
Ethnographic Case Study ◽  
Structured Interviews ◽  
Face To Face ◽  
The Face ◽  
General Practices ◽  
The One

BackgroundNHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.AimTo understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.Design and settingFocused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.MethodNon-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report.ResultsCase study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.ConclusionExperience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

scholarly journals GPs’ and practice staff’s views of a telephone first approach to demand management: a qualitative study in primary care

2019 ◽  
Vol 69 (682) ◽  
pp. e321-e328 ◽  
Author(s):  
Jennifer Newbould ◽  
Josephine Exley ◽  
Sarah Ball ◽  
Jennie Corbett ◽  
Emma Pitchforth ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Negative Impact ◽  
Demand Management ◽  
Qualitative Interviews ◽  
New Approach ◽  
Practice Staff ◽  
Face To Face ◽  
General Practices ◽  
Better Than

BackgroundTo better manage patient demand, some general practices have implemented a ‘telephone first’ approach in which all patients seeking a face-to-face appointment first have to speak to a GP on the telephone. Previous studies have suggested that there is considerable scope for this new approach, but there remain significant concerns.AimTo understand the views of GPs and practice staff of the telephone first approach, and to identify enablers and barriers to successful adoption of the approach.Design and settingA qualitative study of the telephone first approach in 12 general practices that have adopted it, and two general practices that have tried the approach but reverted to their previous system.MethodA total of 53 qualitative interviews with GPs and practice staff were conducted. Transcriptions of the interviews were systematically analysed.ResultsStaff in the majority of practices reported that the approach was an improvement on their previous system, but all practices experienced challenges; for example, where practices did not have the capacity to meet the increase in demand for telephone consultations. Staff were also aware that the new system suited some patients better than others. Adoption of the telephone first approach could be very stressful, with a negative impact on morale, especially reported in interviews with the two practices that had tried but stopped the approach. Interviewees identified enablers and barriers to the successful adoption of a telephone first approach in primary care. Enablers to successful adoption were: understanding demand, practice staff as pivotal, making modifications to the approach, and educating patients.ConclusionPractices considering adopting or clinical commissioning groups considering funding a telephone first approach should consider carefully a practice’s capacity and capability before launching.

scholarly journals The Friends and Family Test in general practice in England: a qualitative study of the views of staff and patients

2017 ◽  
Vol 67 (658) ◽  
pp. e370-e376 ◽  
Author(s):  
Tommaso Manacorda ◽  
Bob Erens ◽  
Nick Black ◽  
Nicholas Mays
Keyword(s):  
Quality Improvement ◽  
Qualitative Study ◽  
Representative Sample ◽  
Quality Care ◽  
Poor Quality ◽  
Structured Interviews ◽  
Practice Staff ◽  
Minimal Impact ◽  
Local Quality ◽  
General Practices

BackgroundThe Friends and Family Test (FFT) was introduced into general practices in England in 2015 to provide staff with information on patients’ views of their experience of care.AimTo examine the views of practice staff and patients of the FFT, how the results are used, and to recommend improvements.Design and settingA qualitative study of a national representative sample of 42 general practices.MethodSemi-structured interviews with 43 clinicians, 48 practice managers, and 27 patient representatives. Interviews were audiotaped, transcribed, and analysed thematically.ResultsAlthough the FFT imposed little extra work on practices, it was judged to provide little additional insight over existing methods and to have had minimal impact on improving quality. Staff lacked confidence in the accuracy of the results given the lack of a representative sample and the risk of bias. The FFT question was judged to be inappropriate as in many areas there was no alternative practice for patients to choose, patients’ individual needs would not be the same as those of their friends and relatives, and an overall assessment failed to identify any specific aspects of good- or poor-quality care. Despite being intended to support local quality improvement, there was widespread unease about the FFT, with many responders perceiving it as a tool for national bodies to monitor general practices.ConclusionIf the use of a single-item questionnaire is to continue, changes should be made to the wording. It should be focused on stimulating local quality improvement, and practice staff should be supported to use the results effectively.

scholarly journals Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018688 ◽  
Author(s):  
Mary Carter ◽  
Emily Fletcher ◽  
Anna Sansom ◽  
Fiona C Warren ◽  
John L Campbell
Keyword(s):  
Mixed Methods ◽  
Case Reports ◽  
Postal Survey ◽  
Full Potential ◽  
Cross Sectional ◽  
Practice Staff ◽  
Good Communication ◽  
Face To Face ◽  
General Practices ◽  
The Impact

ObjectivesTo evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices.MethodsMixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews.SettingGeneral practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group’s area approximately 6 months after implementing webGP (February–July 2016).ParticipantsSix practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed.Outcome measuresAttitudes and experiences of practice staff and patients regarding webGP.ResultsWebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices.GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients.81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them.From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems.ConclusionsThere is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload.

scholarly journals Clinicians’ Perspectives on Self-Harm in Pakistan: A Qualitative Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Tayyeba Kiran ◽  
Nasim Chaudhry ◽  
Penny Bee ◽  
Sehrish Tofique ◽  
Sana Farooque ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Public Health Problem ◽  
Public Hospitals ◽  
Structured Interviews ◽  
Face To Face ◽  
Self Harm ◽  
General Practices ◽  
Illegal Acts

Background: Suicide is a serious public health problem, ranked amongst the leading causes of death worldwide. There are no official data on self-harm and suicide in Pakistan; both are illegal acts, and are socially and religiously condemned. This study explored the views of clinicians, including general practitioners (GPs) and hospital physicians (HPs) on self-harm, about their management of people who self-harm and what interventions might be appropriate in Pakistan.Methods: This qualitative study, generating data using semi-structured interviews, was nested within a Randomized Controlled Trial (RCT) of a psychosocial intervention for people following self-harm. Clinicians (n = 18) with experience of treating people who self-harm were recruited from public hospitals and general practices.Results: Face-to-face interviews were conducted in Urdu and digitally recorded with consent, transcribed and translated into English. Transcripts were checked for cultural and interpretive interpretations by the research team, then analyzed thematically using the principles of constant comparison. The following themes will be presented: encountering people with self-harming behaviors; challenges encountered in managing people who self-harm; barriers to accessing care, and what ideal care might look like. Participants identified their lack of training and expertise in the management of people with self-harm behavior.Conclusions: This is the first study to explore clinicians’ perspectives on self-harm in Pakistan. The study highlighted the need for training for doctors in the identification and management of mental health problems, including the management of people who self-harm.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals Telling Our Stories: Resilience during Resettlement for African Skilled Migrants in Australia

2021 ◽  
Vol 18 (8) ◽  
pp. 3954
Author(s):  
Lillian Mwanri ◽  
Leticia Anderson ◽  
Kathomi Gatwiri
Keyword(s):  
Cultural Values ◽  
South Australia ◽  
Qualitative Inquiry ◽  
Structured Interviews ◽  
Face To Face ◽  
Health And Wellbeing ◽  
African Migrants ◽  
Cultural Expectations ◽  
The Social ◽  
Resilience Factors

Background: Emigration to Australia by people from Africa has grown steadily in the past two decades, with skilled migration an increasingly significant component of migration streams. Challenges to resettlement in Australia by African migrants have been identified, including difficulties securing employment, experiences of racism, discrimination and social isolation. These challenges can negatively impact resettlement outcomes, including health and wellbeing. There has been limited research that has examined protective and resilience factors that help highly skilled African migrants mitigate the aforementioned challenges in Australia. This paper discusses how individual and community resilience factors supported successful resettlement Africans in Australia. The paper is contextualised within a larger study which sought to investigate how belonging and identity inform Afrodiasporic experiences of Africans in Australia. Methods: A qualitative inquiry was conducted with twenty-seven (n = 27) skilled African migrants based in South Australia, using face-to-face semi-structured interviews. Participants were not directly questioned about ‘resilience,’ but were encouraged to reflect critically on how they navigated the transition to living in Australia, and to identify factors that facilitated a successful resettlement. Results: The study findings revealed a mixture of settlement experiences for participants. Resettlement challenges were observed as barriers to fully meeting expectations of emigration. However, there were significant protective factors reported that supported resilience, including participants’ capacities for excellence and willingness to work hard; the social capital vested in community and family support networks; and African religious and cultural values and traditions. Many participants emphasised their pride in their contributions to Australian society as well as their desire to contribute to changing narratives of what it means to be African in Australia. Conclusions: The findings demonstrate that despite challenges, skilled African migrants’ resilience, ambition and determination were significant enablers to a healthy resettlement in Australia, contributing effectively to social, economic and cultural expectations, and subsequently meeting most of their own migration intentions. These findings suggest that resilience factors identified in the study are key elements of integration.

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