scholarly journals Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

2021 ◽  
pp. BJGP.2020.1112
Author(s):  
Marta Wanat ◽  
Melanie Hoste ◽  
Nina Gobat ◽  
Marilena Anastasaki ◽  
Femke Boehmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Practical Training ◽  
Structured Interviews ◽  
New Ways Of Working ◽  
Primary Care Delivery ◽  
Local Primary Care ◽  
Remote Care

Background: Primary care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim: To understand the experiences of European PCPs working during the first peak of the COVID-19 pandemic. Design and Setting: An exploratory qualitative study, using semi-structured interviews in primary care in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were audio recorded, transcribed and analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance, they often lacked access to practical training. Consequently, PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care, and deal with uncertainty. Conclusion: PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions will facilitate easy and coordinated access to practical information on how to adapt services, ongoing training and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

scholarly journals Easier Said Than Done: Healthcare Professionals’ Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity

2021 ◽  
Vol 18 (11) ◽  
pp. 6057
Author(s):  
Sanne J. Kuipers ◽  
Anna P. Nieboer ◽  
Jane M. Cramm
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Time Pressure ◽  
Care Delivery ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Primary Care Delivery

Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.

scholarly journals Integrating nurse practitioners into primary care: policy considerations from a Canadian province

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stacey Black ◽  
Raad Fadaak ◽  
Myles Leslie
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care System ◽  
Structured Interviews ◽  
Primary Care Delivery ◽  
Key Stakeholders ◽  
The Status ◽  
Practice Opportunities ◽  
Care System

Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

scholarly journals The Need for Co-Creation of Care with Multi-Morbidity Patients—A Longitudinal Perspective

2020 ◽  
Vol 17 (9) ◽  
pp. 3201
Author(s):  
Sanne J. Kuipers ◽  
Anna P. Nieboer ◽  
Jane M. Cramm
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Well Being ◽  
Satisfaction With Care ◽  
Care Needs ◽  
Primary Care Delivery ◽  
Care Practices ◽  
Primary Care Practices ◽  
Multimorbid Patients

Background: Primary care delivery for multimorbid patients is complex, due to single disease–oriented guidelines, complex care needs, time constraints and the involvement of multiple healthcare professionals. Co-creation of care, based on the quality of communication and relationships between healthcare professionals and patients, may therefore be valuable. This longitudinal study investigates the relationships of co-creation of care to physical and social well-being and satisfaction with care among multimorbid patients in primary care. Methods: In 2017 and 2018, longitudinal surveys were conducted among multimorbid patients from seven primary care practices in Noord-Brabant, the Netherlands (n = 138, age = 73.50 ± 9.99). Paired sample t-tests and multivariate regression analyses were performed. (3) Results: Co-creation of care improved significantly over time (t = 2.25, p = 0.026), as did social well-being (t = 2.31, p = 0.022) and physical well-being (t = 2.72, p = 0.007) but not satisfaction with care (t = 0.18, p = 0.858). Improvements in co-creation of care from T0 to T1 were associated with social well-being (B = 0.157, p = 0.002), physical well-being (B = 0.216, p = 0.000) and satisfaction with care (B = 0.240, p = 0.000). (4) Conclusions: Thus, investment in co-creation of care by primary care practices may lead to better outcomes for multimorbid patients.

scholarly journals Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

BJGP Open ◽  
2022 ◽  
pp. BJGPO.2021.0172
Author(s):  
Marta Wanat ◽  
Melanie Eugenie Hoste ◽  
Nina Helene Gobat ◽  
Marilena Anastasaki ◽  
Femke Böhmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Respiratory Infections ◽  
Care Delivery ◽  
European Countries ◽  
Structured Interviews ◽  
Delivery Of Care ◽  
Primary Care Delivery ◽  
The Impact ◽  
Remote Consultations

BackgroundThe impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care and understanding its benefits and drawbacks may inform its implementation during this and future healthcare emergencies.AimTo explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic.Design & settingQualitative study using semi-structured interviews in primary care in eight European countriesResultsWe conducted 146 interviews with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden and Germany). Data was collected between April and July 2020 and analysed using thematic analysis. We found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns.ConclusionRemote consultations for RTI symptoms may be acceptable long-term if both groups are happy to use this format but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.

A Team-based Model of Primary Care Delivery and Physician-patient Interaction

2015 ◽  
Vol 128 (9) ◽  
pp. 1025-1028 ◽  
Author(s):  
Anita D. Misra-Hebert ◽  
Andrew Rabovsky ◽  
Chen Yan ◽  
Bo Hu ◽  
Michael B. Rothberg
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Patient Interaction ◽  
Primary Care Delivery ◽  
Physician Patient

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

Development and Implementation of a Team-Based, Primary Care Delivery Model: Challenges and Opportunities

2019 ◽  
Vol 94 (7) ◽  
pp. 1298-1303 ◽  
Author(s):  
Jay D. Mitchell ◽  
Jordan D. Haag ◽  
Eric Klavetter ◽  
Rachel Beldo ◽  
Nilay D. Shah ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Delivery Model ◽  
Primary Care Delivery ◽  
Care Delivery Model ◽  
Challenges And Opportunities
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