scholarly journals Factors affecting primary care practitioners’ alcohol-related discussions with older adults: Qualitative study

2021 ◽  
pp. BJGP.2020.1118
Author(s):  
Bethany Kate Bareham ◽  
Jemma Stewart ◽  
Eileen Kaner ◽  
Barbara Hanratty
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Older People ◽  
Focus Groups ◽  
Old Age ◽  
Later Life ◽  
Long Term Conditions ◽  
Age Related ◽  
Comparison Results ◽  
Primary Care Practitioners

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

scholarly journals Managing older people’s perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

2020 ◽  
Vol 70 (701) ◽  
pp. e916-e926
Author(s):  
Bethany Kate Bareham ◽  
Eileen Kaner ◽  
Barbara Hanratty
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Alcohol Use ◽  
Older People ◽  
Focus Groups ◽  
Later Life ◽  
Structured Interviews ◽  
Primary Care Practitioners ◽  
Types Of Information ◽  
People’S Perceptions

BackgroundRisk of harm from drinking increases with age as alcohol affects health conditions and medications that are common in later life. Different types of information and experiences affect older people’s perceptions of alcohol’s effects, which must be navigated when supporting healthier decisions on alcohol consumption.AimTo explore how older people understand the effects of alcohol on their health; and how these perspectives are navigated in supportive discussions in primary care to promote healthier alcohol use.Design and settingA qualitative study consisting of semi-structured interviews and focus groups with older, non-dependent drinkers and primary care practitioners in Northern England.MethodA total of 24 older adults aged ≥65 years and 35 primary care practitioners participated in interviews and focus groups. Data were analysed thematically, applying principles of constant comparison.ResultsOlder adults were motivated to make changes to their alcohol use when they experienced symptoms, and if they felt that limiting consumption would enable them to maintain their quality of life. The results of alcohol-related screening were useful in providing insights into potential effects for individuals. Primary care practitioners motivated older people to make healthier decisions by highlighting individual risks of drinking, and potential gains of limiting intake.ConclusionLater life is a time when older people may be open to making changes to their alcohol use, particularly when suggested by practitioners. Older people can struggle to recognise potential risks or perceive little gain in acting on perceived risks. Such perceptions may be challenging to navigate in supportive discussions.

scholarly journals Developing a recovery-focused therapy for older people with bipolar disorder: a qualitative focus group study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e049829
Author(s):  
Elizabeth Tyler ◽  
Fiona Lobban ◽  
Rita Long ◽  
Steven H Jones
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Focus Group ◽  
Older People ◽  
Focus Groups ◽  
Later Life ◽  
Focus Group Study ◽  
Age Related ◽  
Health Related ◽  
Age Related Changes

ObjectivesAs awareness of bipolar disorder (BD) increases and the world experiences a rapid ageing of the population, the number of people living with BD in later life is expected to rise substantially. There is no current evidence base for the effectiveness of psychological interventions for older adults with BD. This focus group study explored a number of topics to inform the development and delivery of a recovery-focused therapy (RfT) for older adults with BD.DesignA qualitative focus group study.SettingThree focus groups were conducted at a university in the North West of England.ParticipantsEight people took part in the focus groups; six older adults with BD, one carer and one friend.ResultsParticipant’s responses clustered into six themes: (1) health-related and age-related changes in later life, (2) the experience of BD in later life, (3) managing and coping with BD in later life, (4) recovery in later life, (5) seeking helping in the future and (6) adapting RfT for older people.ConclusionsParticipants reported a range of health-related and age-related changes and strategies to manage their BD. Participants held mixed views about using the term ‘recovery’ in later life. Participants were in agreement that certain adaptations were needed for delivering RfT for older adults, based on their experience of living with BD in later life. The data collected as part of the focus groups have led to a number of recommendations for delivering RfT for older adults with BD in a randomised controlled trial (Clinical Trial Registration: ISRCTN13875321).

Dementia in the community: Challenges for primary care development

2002 ◽  
Vol 12 (3) ◽  
pp. 243-252 ◽  
Author(s):  
Steve Iliffe ◽  
Jill Manthorpe
Keyword(s):  
Primary Care ◽  
Older People ◽  
Old Age ◽  
National Service ◽  
Specialist Services ◽  
Quality Of Primary Care ◽  
Old Age Psychiatry ◽  
Primary Care Practitioners ◽  
Care Development

The National Service Frameworks for Older People and for Mental Health are setting standards for services in areas where problems are complex and solutions limited. Primary Care Trusts seeking to raise the quality of primary care for older people and commission specialist services rationally face many challenges. Specialists in old age medicine and old age psychiatry will find themselves working closely with primary care practitioners to develop services and extend professional skills, for it is uncertain that specialist services will be able to deal with the scale of the clinical and social problems unaided.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

2015 ◽  
pp. 1-2
Author(s):  
A. SINCLAIR
Keyword(s):  
Primary Care ◽  
Target Population ◽  
Population Based ◽  
Care Staff ◽  
Long Term Conditions ◽  
Primary Care Research ◽  
Wide Range ◽  
Primary Care Practitioners ◽  
Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

scholarly journals Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study

2010 ◽  
Vol 11 (1) ◽  
Author(s):  
Linda McGowan ◽  
Diane Escott ◽  
Karen Luker ◽  
Francis Creed ◽  
Carolyn Chew-Graham
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Primary Care Practitioners

scholarly journals Cardiovascular disease risk prediction in older people: a qualitative study

2021 ◽  
pp. BJGP.2020.1038
Author(s):  
Denise Ann Taylor ◽  
Katharine Wallis ◽  
Sione Feki ◽  
Sione Segili Moala ◽  
Manusiu He-Naua Esther Latu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Qualitative Study ◽  
Older People ◽  
Focus Groups ◽  
Risk Prediction ◽  
Heart Attack ◽  
Clinical Decision Making ◽  
Community Dwelling ◽  
Cvd Risk

Background: Despite cardiovascular disease (CVD) risk prediction equations becoming more widely available for people aged 75 years and over, views of older people on CVD risk assessment are unknown. Aim: To explore older people’s views on CVD risk prediction and its assessment. Design and Setting: Qualitative study of community dwelling older New Zealanders. Methods: We purposively recruited a diverse group of older people. Semi-structured interviews and focus groups were conducted, transcribed verbatim and thematically analysed. Results: Thirty-nine participants (mean age 74 years) of Māori, Pacific, South Asian and European ethnicities participated in one of 26 interviews or three focus groups. Three key themes emerged, (1) Poor knowledge and understanding of cardiovascular disease and its risk assessment, (2) Acceptability and perceived benefit of knowing and receiving advice on managing personal cardiovascular risk; and (3) Distinguishing between CVD outcomes; stroke and heart attack are not the same. Most participants did not understand CVD terms but were familiar with ‘heart attack,’ ‘stroke’ and understood lifestyle risk factors for these events. Participants valued CVD outcomes differently, fearing stroke and disability which might adversely affect independence and quality of life, but being less concerned about a heart attack, perceived as causing less disability and swifter death. These findings and preferences were similar across ethnic groups. Conclusion: Older people want to know their CVD risk and how to manage it, but distinguish between CVD outcomes. To inform clinical decision making for older people, risk prediction tools should provide separate event types rather than just composite outcomes.

scholarly journals What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703505
Author(s):  
Joseph Clark ◽  
Elvis Amoakwa ◽  
John Blenkinsopp ◽  
Florence Reedy ◽  
Miriam Johnson
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cancer Care ◽  
Information Needs ◽  
Controlled Trial ◽  
Unmet Need ◽  
Care Staff ◽  
Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

scholarly journals ‘I’ve never drunk very much water and I still don’t, and I see no reason to do so’: a qualitative study of the views of community-dwelling older people and carers on hydration in later life

2019 ◽  
Vol 49 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Cini Bhanu ◽  
Christina Avgerinou ◽  
Kalpa Kharicha ◽  
Yehudit Bauernfreund ◽  
Helen Croker ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
Later Life ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Drinking Patterns ◽  
Adequate Hydration ◽  
Perceived Importance ◽  
Community Dwelling Older People ◽  
Informal Carers

Abstract Background dehydration is associated with significant adverse outcomes in older people despite being largely preventable and treatable. Little research has focused on the views of community-dwelling older people on hydration, healthy drinking and the perceived importance of drinking well in later life. Objectives to understand community-dwelling older people and informal carers’ views on hydration in later life and how older people can be supported to drink well. Methods qualitative study using interviews and a focus group exploring hydration and nutrition in later life (24 older people at risk of malnutrition and dehydration, 9 informal carers) and thematic analysis. Results this article presents the findings on hydration alone. Four themes are presented: perceptions of healthy drinking, barriers to and facilitators of drinking in later life and supporting older people to drink well. The perceived importance of adequate hydration in later life was polarised. Concerns about urinary incontinence and knowledge gaps were significant barriers. Consideration of individual taste preference and functional capacity acted as facilitators. Distinct habitual drinking patterns with medications and meals exist within individuals. Many relied on thirst at other times or when fluid demands are greater (such as hot weather), a known unreliable prompt in later life. Conclusions older people could be supported to drink well by building upon existing habitual drinking patterns. Primary care and public health should consider individual barriers, facilitators and tailored education. A multidisciplinary approach to promote hydration should be incorporated into care for older people with more complex needs.

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