scholarly journals Impact of COVID-19 on Migrants’ Access to Primary Care and Implications for Vaccine Roll Out: A National Qualitative Study

2021 ◽  
pp. BJGP.2021.0028
Author(s):  
Felicity Knights ◽  
Jessica Carter ◽  
Anna Deal ◽  
Alison F Crawshaw ◽  
Sally Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Phase 1 ◽  
Vaccine Hesitancy ◽  
Administrative Staff ◽  
Foreign Born ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
The Impact ◽  
Roll Out

Background: The COVID-19 pandemic has prompted considerable changes in delivery of UK primary care, including rapid digitalisation, yet the impact upon marginalised migrant groups is unknown. Aim: To understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out. Design and Setting: Primary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings. Methods: In-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis. Results: 64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacist); Phase 2 comprised 16 administrative staff; and Phase 3, 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). Digitalisation has amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers and challenges building trust. Participants highlighted challenges registering and accessing healthcare due to physical closure of surgeries. Migrants reported specific beliefs around COVID-19 and COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. Innovative opportunities suggested included translated digital health advice using text templates and YouTube. Conclusion: Migrants risk digital exclusion and may need targeted support to access services. Solutions are urgently needed to address vaccine hesitancy and barriers to vaccination in marginalised groups (including migrants) to ensure equitable uptake of the COVID-19 vaccine.

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

scholarly journals Impact of COVID-19 on Migrants’ Access to Primary Care: A National Qualitative Study

2021 ◽  
Author(s):  
Felicity Knights ◽  
Jessica Carter ◽  
Anna Deal ◽  
Alison F Crawshaw ◽  
Sally E Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Language Barriers ◽  
Access To Healthcare ◽  
Administrative Staff ◽  
Primary Care Delivery ◽  
Increased Risk ◽  
The Impact ◽  
Migrant Groups ◽  
Roll Out

AbstractBackgroundThe COVID-19 pandemic has led to considerable changes in the delivery of primary care in the UK, including rapid digitalisation, yet the extent to which these have impacted on marginalised migrant groups – already facing existing barriers to NHS care – is unknown. Understanding the perspectives and experiences of health professionals and migrants will support initiatives to deliver more effective health services, including delivery of the COVID-19 vaccine, to marginalised groups.AimTo understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out.Design and SettingPrimary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings.MethodsIn-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis.Results64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacists); Phase 2 comprised administrative staff (11 PMs and 5 receptionists); and in Phase 3 we recruited 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). We found that digitalisation and virtual consultations (telephone, video, and online form-based) have amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers. Use of virtual consultations has resulted in concerns around building trust and the risk of missing safeguarding cues. Participants highlighted challenges around registering and accessing healthcare due to the physical closure of surgeries. Participants reported indirect discrimination, language and communication barriers, and lack of access to targeted and tailored COVID-19 information or interventions. In addition, migrants reported a range of specific beliefs around COVID-19 and on potential COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. PCPs raised concerns that migrants may have increased risk factors for poor general health and to severe illness from COVID-19, in part due to their social and economic situation. Innovative opportunities were suggested to engage migrant groups through translated digital health advice using text templates and YouTube which merit further exploration.ConclusionPandemic-related changes in primary care delivery may be here to stay, and some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. As primary care networks operationalise the delivery of the COVID-19 vaccine, these findings provide critical information on specific strategies required to support migrant population to access primary care and overcome misinformation around COVID-19 and the COVID-19 vaccine.How this fits inThe impact of pandemic-related shifts in primary care delivery on marginalised migrant groups, who may already face major disparities in accessing primary care, is poorly elucidated. We found that the rapid digitalisation of primary care services and physical closure of surgeries during the pandemic have amplified disparities in access to healthcare for specific migrant groups, with many lacking access to and capacity to use technology, compounded by language barriers. Migrants may be at increased risk of misinformation about COVID-19, which merits further consideration as COVID-19 vaccine roll out begins. Improved outreach to local migrant community organisations and places of worship, alongside co-designing with migrants more inclusive delivery approaches and creative integration of migrant ambassadors into information-sharing campaigns are needed. Primary care can maximise the opportunities of digitalisation for migrants through flexible engagement by multiple modalities (e.g. text, email, letter and YouTube videos) to provide targeted, translated advice and information, virtual group consultations for patients with a specific condition, and working with local leaders and NGOs to access and disseminate information through informal communication channels.

Abstract 172: Early Impact of a Technology Solution to Transform Care for Cardiometabolic Conditions: Physician Experience and Patient-Centered Outcomes

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Joshua Liberman ◽  
J.B. Jones ◽  
Xiaowei (Sherry) Yan ◽  
Hannah Husby ◽  
Gary Takher ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Digital Health ◽  
Early Experience ◽  
Routine Care ◽  
Cardiometabolic Health ◽  
Structured Interviews ◽  
Disease Case ◽  
The Impact

Objectives: To assess early experience with a digital health solution introduced to primary care. Background: Managing cardiometabolic conditions (diabetes, hypertension, and dyslipidemia) is challenging for patients and physicians. Patients often lack the understanding and motivation to adopt healthy behaviors and adhere to treatment plans. Physicians face the challenge of having limited time to engage and educate patients at the point-of-care. Electronic health records (EHRs) have not solved this problem; in fact, reports suggest that EHRs increase administrative tasks, reducing time with patients and contributing to burnout. To address these issues we developed CM-SHARE, a web-based application that provides physicians and patients a dashboard of critical health information needed at the point of care, actionable cues to address guideline-based care and quality gaps, and visual tools to educate patients. Methods: CM-SHARE was designed with input from practicing primary care physicians (PCPs) and launched in two clinics in April 2016. Physician use of CM-SHARE is voluntary, and regular feedback is elicited for ongoing development. Both quantitative and qualitative measures assess the impact of CM-SHARE. Quantitative measures included use (e.g., number of launches, duration of use, clicks on specific features and functions) and measures of physician efficiency based on the EHR audit file logs. Semi-structured interviews were conducted with both physicians and patients to assess perceptions of CM-SHARE’s impact on physician-patient communication, patients’ knowledge of their conditions and motivations to change health behaviors, as well as value, barriers/facilitators of use, and desired improvements. A pre-post, matched control design was used to assess early experience and impact. Results: From April 27, 2016 to November 1, 2017, CM-SHARE was used in 7,900 encounters for 3,712 patients by 6 PCPs. CM-SHARE was launched in 30% of all encounters, a rate that nearly doubled (to 59%) if cardiometabolic health issues were addressed in the visit. Use of CM-SHARE was associated with a 25%-35% reduction in time spent in the EHR during an encounter and an 11%-20% reduction in the number of EHR clicks during the encounter. Both patients and physicians reported that CM-SHARE enhanced the patient-physician communication, particularly for patients for whom behavior change is necessary to improve clinical measures (e.g., A1c). Following this early experience, CM-SHARE adoption has expanded to 30+ providers, including physicians and an expanded user base of chronic disease case managers and diabetes educators. Conclusions: Digital health solutions such as CM--SHARE can be successfully integrated into routine care settings and favorably influence physician efficiency and patient experience. Further research will explore the impact of CM-SHARE on longer-term health outcomes.

scholarly journals Women’s lives in times of Zika: mosquito-controlled lives?

2018 ◽  
Vol 34 (5) ◽  
Author(s):  
Ana Rosa Linde ◽  
Carlos Eduardo Siqueira
Keyword(s):  
Coping Strategies ◽  
Sampling Technique ◽  
Well Being ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
International Agencies ◽  
The Us ◽  
Women's Lives ◽  
Heavy Burden ◽  
The Impact

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it to shed light on the social repercussions of Zika. Women were recruited through the snowball sampling technique and data was collected through semi-structured interviews. We describe the effects in mental health and the coping strategies that women use to deal with the Zika epidemic. Zika is taking a heavy toll on women’s emotional well-being. They are coping with feelings of fear, helplessness, and uncertainty by taking drastic precautions to avoid infection that affect all areas of their lives. Coping strategies pose obstacles in professional life, lead to social isolation, including from family and partner, and threaten the emotional and physical well-being of women. Our findings suggest that the impacts of the Zika epidemic on women may be universal and global. Zika infection is a silent and heavy burden on women’s shoulders.

scholarly journals Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees

2021 ◽  
Author(s):  
Anna Deal ◽  
Sally E Hayward ◽  
Mashal Huda ◽  
Felicity Knights ◽  
Alison F Crawshaw ◽  
...  
Keyword(s):  
Primary Care ◽  
Asylum Seekers ◽  
Qualitative Interview ◽  
Vaccine Hesitancy ◽  
Undocumented Migrants ◽  
Accessible Information ◽  
Qualitative Interview Study ◽  
The Uk ◽  
Asylum Seekers And Refugees ◽  
Roll Out

Introduction Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. Methods We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old; <10 years in the UK) to the UK with precarious immigration status between September 2020 and March 2021, seeking their input into strategies to strengthen COVID-19 vaccine delivery and uptake. We used the Three Cs model (confidence, complacency and convenience) to explore COVID-19 vaccine hesitancy, barriers and access. Data were analysed using a thematic framework approach. Data collection continued until data saturation was reached, and no novel concepts were arising. The study was approved by the University of London ethics committee (REC 2020.00630). Results We approached 20 migrant support groups nationwide, recruiting 32 migrants (mean age 37.1 years; 21 [66%] female; mean time in the UK 5.6 years [SD 3.7 years]), including refugees (n = 3), asylum seekers (n = 19), undocumented migrants (n = 8) and migrants with limited leave to remain (n = 2) from 15 different countries (5 WHO regions). 23 (72%) of 32 migrants reported being hesitant about accepting a COVID-19 vaccine and communicated concerns over vaccine content, side-effects, lack of accessible information in an appropriate language, lack of trust in the health system and low perceived need. Participants reported a range of barriers to accessing the COVID-19 vaccine and expressed concerns that their communities would be excluded from or de-prioritised in the roll-out. Undocumented migrants described fears over being charged and facing immigration checks if they present for a vaccine. All participants (n = 10) interviewed after recent government announcements that COVID-19 vaccines can be accessed without facing immigration checks remained unaware of this. Participants stated that convenience of access would be a key factor in their decision around whether to accept a vaccine and proposed alternative access points to primary care services (for example, walk-in centres in trusted places such as foodbanks, community centres and charities), alongside promoting registration with primary care for all, and working closely with communities to produce accessible information on COVID-19 vaccination. Conclusions Precarious migrants may be hesitant about accepting a COVID-19 vaccine and face multiple and unique barriers to access, requiring simple but innovative solutions to ensure equitable access and uptake. Vaccine hesitancy and low awareness around entitlement and relevant access points could be easily addressed with clear, accessible, and tailored information campaigns, co-produced and delivered by trusted sources within marginalised migrant communities. These findings have immediate relevance to the COVID-19 vaccination initiatives in the UK and in other European and high-income countries with diverse migrant populations.

scholarly journals Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248339
Author(s):  
Megan A. Lewis ◽  
Laura K. Wagner ◽  
Lisa G. Rosas ◽  
Nan Lv ◽  
Elizabeth M. Venditti ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Collaborative Care ◽  
Health Impact ◽  
Public Health Impact ◽  
Integrative Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Care Intervention ◽  
The Impact

Background An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential. Methods The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance. Conclusions RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

scholarly journals Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

2020 ◽  
Vol 70 (698) ◽  
pp. e668-e675
Author(s):  
Hajira Dambha-Miller ◽  
Simon J Griffin ◽  
Ann Louise Kinmonth ◽  
Jenni Burt
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Provision ◽  
Structured Interviews ◽  
High Quality ◽  
Face To Face ◽  
Healthcare Experiences ◽  
Provision Of Services ◽  
The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

Vaccine Hesitancy in Pediatric Primary Care Practices

2018 ◽  
Vol 28 (13) ◽  
pp. 2071-2080 ◽  
Author(s):  
Salini Mohanty ◽  
Amy Carroll-Scott ◽  
Marissa Wheeler ◽  
Cecilia Davis-Hayes ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Vaccine Hesitancy ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Multiple Strategies ◽  
Efficiency And Effectiveness ◽  
Care Practices ◽  
Barriers And Challenges ◽  
Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

The journey to radiographer advanced practice: a methodological reflection on the use of interpretative phenomenological analysis to explore perceptions and experiences

2019 ◽  
Vol 19 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Lynn M. Cuthbertson
Keyword(s):  
Qualitative Research ◽  
Interpretative Phenomenological Analysis ◽  
Phase 1 ◽  
Phenomenological Analysis ◽  
Advanced Practice ◽  
Structured Interviews ◽  
Two Phase ◽  
Oncology Research ◽  
The Impact ◽  
Methodological Reflection

AbstractIntroduction:This paper is a methodological reflection on the use of interpretative phenomenological analysis (IPA) utilised in the context of a qualitative research project that explored perceptions and experiences of the journey to radiographer advanced practice.Methods and materials:A two-phase qualitative research explored the perceptions and experiences. Phase 1 reviewed reflective diaries (n = 12) kept during the educational phase of the practitioner journeys. Phase 2 included one-to-one, semi-structured interviews (n = 6) which were recorded, transcribed verbatim and reviewed using the IPA six-stage thematic analysis for practitioners embedded in the advanced practice role.Findings:Key themes arising from reflective diary analysis informed the interview content; and following interview transcription, data immersion and IPA, 12 emergent sub-themes generated 3 superordinate themes.Discussion:Theoretical perspectives and application of the methodology are discussed. The phenomenological and interpretative qualities of IPA have the potential to provide unique and valuable insights into lived experiences of individuals. It is hoped that this researchers’ reflections are transferrable for those interested in employing a qualitative methodology for radiotherapy and oncology research.Conclusion:Therapeutic radiographers work within rapidly changing environments from technological, treatment and care perspectives. With continued development and change, the impact of research utilising an IPA methodology may allow exploration of perceptions and experiences from a range of key stakeholders with the potential to increase the research base.

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