Navigating possible endometriosis in primary care: a qualitative study of GP perspectives

Background: Endometriosis affects approximately 10% of women, with well-documented delays between initial presentation with symptoms and diagnosis. In England, women typically seek help first in primary care, making this setting pivotal in women’s pathways to diagnosis and treatment. English General Practitioner (GP) perspectives on managing possible endometriosis have not been previously reported. Aim: To explore what GPs identify as important considerations when caring for women with symptoms that raise the possibility of endometriosis. Design and Setting: English primary care. Method: Semi-structured scenario-based telephone interviews with 42 GPs based around a fictional scenario of a woman presenting to primary care with symptoms suggesting possible endometriosis. Interviews were thematically coded and analysed. Results: Managing possible endometriosis in primary care brings challenges. While knowledge and awareness were pre-requisites for considering endometriosis, other important considerations were raised. Symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. GPs move through a diagnostic hierarchy to exclude sinister causes and utilise trials of treatment as both therapeutic interventions and diagnostic tools – processes which take time. An endometriosis label or diagnosis has advantages and risks. GPs reported sharing decisions about investigation and referral whilst holding women’s priorities as pivotal. These conversations were underpinned by their knowledge of uncertainties and unknowns, including the wide spectrum and unpredictability of endometriosis. Conclusion: GPs considerations are more complex than simply lacking awareness. The unknowns surrounding endometriosis matter to GPs. Further research and tailored resources for primary care, where women present with undifferentiated symptoms, are needed.

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How to decide adequately? Qualitative study of GPs’ view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany

BMJ Open ◽

10.1136/bmjopen-2018-026786 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026786 ◽

Cited By ~ 3

Author(s):

Sarah Oslislo ◽

Christoph Heintze ◽

Martina Schmiedhofer ◽

Martin Möckel ◽

Liane Schenk ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Qualitative Study ◽

Qualitative Content Analysis ◽

Wide Spectrum ◽

Influencing Factor ◽

Primary Care Providers ◽

Ambulatory Setting ◽

Care Providers ◽

Registration Number

ObjectivesPatients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients’ decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs’ perception of such patients. This qualitative study explores the GPs’ view regarding motives and competences of patients self-referring to EDs, and also GPs’ rationale for or against physician-initiated ED referrals.DesignQualitative study with semi-structured, face-to-face interviews; qualitative content analysis.SettingGP practices in Berlin, Germany.Participants15 GPs (female/male: 9/6; mean age 53.6 years).ResultsThe interviewed GPs related a wide spectrum of factors potentially influencing their patients’ decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients’ surmised rationale corresponded to GPs’ reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients’ health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy.ConclusionsHealth education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals.Trial registration numberDRKS00011930.

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A strategy for improvement in diagnosis and treatment of bronchial asthma in primary care

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-4-457-467 ◽

2019 ◽

Vol 29 (4) ◽

pp. 457-467

Author(s):

S. N. Avdeev ◽

S. R. Aisanov ◽

A. S. Belevskiy ◽

A. V. Emel’yanov ◽

O. M. Kurbacheva ◽

...

Keyword(s):

Primary Care ◽

Bronchial Asthma ◽

Primary Care Physicians ◽

Respiratory Symptoms ◽

Respiratory Diseases ◽

Diagnosis And Treatment ◽

Diagnostic Tools ◽

Chronic Obstructive ◽

Asthma Diagnosis ◽

Chronic Respiratory Diseases

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

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The Allied Health Professions Health and Work Report and the fit note: Perspectives of patients and stakeholders

British Journal of Occupational Therapy ◽

10.1177/0308022620948763 ◽

2020 ◽

pp. 030802262094876

Author(s):

Fiona Nouri ◽

Carol Coole ◽

Genevieve Smyth ◽

Avril Drummond

Keyword(s):

Primary Care ◽

General Practitioner ◽

Allied Health ◽

Occupational Therapists ◽

Health Professions ◽

Allied Health Professions ◽

Telephone Interviews ◽

Potential Value ◽

Vocational Support

Introduction Although the role of occupational therapists in the provision of vocational support is established, there has been little research into their role in issuing Allied Health Professions Health and Work Reports or their potential to complete fit notes. Method Employed patients ( n = 14) and stakeholders ( n = 12) took part in semi-structured telephone interviews and were questioned about occupational therapy-run vocational clinics, experiences of the Allied Health Professions Health and Work Reports and their views of occupational therapists completing fit notes. Results Most interviewees saw the Allied Health Professions Health and Work Report as a valuable tool in affecting return to work and even employers with access to in-house occupational health predominantly found it useful in corroborating recommendations. There was consensus, amongst patients and stakeholders, that completion of the fit note by the occupational therapist could reduce the burden on the general practitioner, and potentially provide more in-depth advice via the ‘may be fit’ option. However, stakeholders strongly believed that the profile of the Allied Health Professions Health and Work Report needed to be raised nationally. Conclusion The potential value of Allied Health Professions Health and Work Reports in primary care is recognised. However, in order to maximise this, its profile and utility needs to be raised nationally as a matter of urgency. There was also support for occupational therapists completing fit notes.

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Exploring GPs’ experiences of using diagnostic tools for cancer: a qualitative study in primary care

Family Practice ◽

10.1093/fampra/cmu081 ◽

2014 ◽

Vol 32 (1) ◽

pp. 101-105 ◽

Cited By ~ 16

Author(s):

Trish Green ◽

Tanimola Martins ◽

William Hamilton ◽

Greg Rubin ◽

Kathy Elliott ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Diagnostic Tools

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Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives

Chronic Illness ◽

10.1177/1742395320983871 ◽

2021 ◽

pp. 174239532098387

Author(s):

Muhammad Z Hossain ◽

Carolyn A Chew-Graham ◽

Emma Sowden ◽

Tom Blakeman ◽

Ian Wellwood ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Qualitative Study ◽

Ejection Fraction ◽

Minority Groups ◽

Learning Needs ◽

Preserved Ejection Fraction ◽

Framework Analysis ◽

Long Term Conditions ◽

Telephone Interviews

Objectives To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). Methods Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. Results Themes presented reflect four inter-related challenges: GPs’ 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. Discussion HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.

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67. Diagnosis and Treatment of Gout in Primary Care: A Qualitative Study of Patient Experience

Rheumatology ◽

10.1093/rheumatology/keu099.007 ◽

2014 ◽

Vol 53 (suppl_1) ◽

pp. i80-i81

Author(s):

Jane Richardson ◽

Jennifer Liddle ◽

Samantha Hider ◽

Christian Mallen ◽

Edward Roddy

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Patient Experience ◽

Diagnosis And Treatment

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Integrating primary and secondary care for children and young people: sharing practice

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308558 ◽

2015 ◽

Vol 101 (9) ◽

pp. 792-797 ◽

Cited By ~ 11

Author(s):

Jenny Woodman ◽

Hannah Lewis ◽

Ronny Cheung ◽

Ruth Gilbert ◽

Linda PMM Wijlaars

Keyword(s):

Primary Care ◽

General Practitioner ◽

Young People ◽

Healthcare Professionals ◽

Shared Responsibility ◽

Specialist Care ◽

Children And Young People ◽

Telephone Interviews ◽

Hospital At Home ◽

Primary Care Professionals

ObjectiveTo share innovative practice with enough detail to be useful for paediatricians involved in planning services.DesignA review of practice, adopting a realist approach.SettingWe collected detailed information about five initiatives which were presented at two meetings in July and October 2014 and telephone interviews between July and November 2014 with key informants, updating information again in February 2015.ResultsThe five case studies involved three clinical commissioning groups (CCGs): Islington CCG and Southwark and Lambeth CCG in London and Taunton CCG in the Southwest. All five initiatives involved acute paediatric units. We heard about four distinct types of services designed to bring paediatric expertise into primary care and/or improve joint working between paediatricians and primary care professionals: telephone multidisciplinary team, hospital at home, general practitioner (GP) outreach clinics, and advice and guidance. We defined four common ways that initiatives might work: promoting shared responsibility; upskilling GPs; establishing relationships between paediatricians and primary healthcare professionals; and by taking specialist care to the patient.ConclusionsWe derived common aims and mechanisms and generated programme (mid-level) theory for each integrated care initiative about how they might work. These descriptions of what is being done can inform debate about which interventions should be prioritised for wider implementation. There is an urgent need for evaluation of these interventions and more indepth research into how mechanisms and their effectiveness could be assessed.

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General practitioner perceptions of telehealth services in Australia: a qualitative study

BJGP Open ◽

10.3399/bjgpo.2021.0182 ◽

2021 ◽

pp. BJGPO.2021.0182

Author(s):

Keshia R De Guzman ◽

Centaine Snoswell ◽

Chantelle M Giles ◽

Anthony C Smith ◽

Helen H Haydon

Keyword(s):

Primary Care ◽

General Practitioner ◽

Qualitative Study ◽

Quality Care ◽

Primary Care Providers ◽

Care Providers ◽

Structured Interviews ◽

Telephone Consultation ◽

Practitioner Perceptions ◽

New Research

BackgroundPrimary care providers have been rapidly transitioning from in-person to telehealth care during the 2019 coronavirus (COVID-19) pandemic. There is an opportunity for new research in a rapidly evolving area, where evidence for telehealth services in primary care in the Australian setting remains limited.AimTo explore general practitioner (GP) perceptions on providing telehealth (telephone and videoconsultation) services in primary care in Australia.Design & settingA qualitative study using semi-structured interviews to gain an understanding of GP perceptions on telehealth use in Australia.MethodsGPs across Australia were purposively sampled. Semi-structured interviews were conducted, recorded, and transcribed verbatim for analysis. Transcripts were analysed using inductive thematic analysis to identify initial codes, which were then organised into themes.ResultsFourteen GPs were interviewed. Two major themes that described GP perceptions of telehealth were 1) Existence of business and financial pressures in general practice and 2) providing quality of care in Australia. These two themes interacted with four minor themes: 3) consumer-led care, 4) COVID-19 as a driver for telehealth reimbursement and adoption, 5) refining logistical processes and 6) GP experiences shape telehealth use.ConclusionThis study found that multiple considerations influence GP choice of in-person, videoconference, or telephone consultation mode. For telehealth to be used routinely within primary care settings, evidence that supports the delivery of higher quality care to patients through telehealth and sustainable funding models will be required.

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Diagnosing renal disease

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211053030 ◽

2021 ◽

pp. 175573802110530

Author(s):

Ikenna Anderson Aneke

Keyword(s):

Primary Care ◽

General Practitioner ◽

Renal Disease ◽

Physical Examination ◽

Secondary Care ◽

Diagnostic Tools ◽

Or Management ◽

Detailed History ◽

Diagnostic Pathway ◽

High Index Of Suspicion

Making clear diagnoses of renal disease can prove challenging for the general practitioner considering the limitations in consulting time and diagnostic tools in primary care. In addition, many of these diseases are asymptomatic and a high index of suspicion is needed to make a diagnosis. As always, the diagnostic pathway begins with a detailed history, physical examination and relevant investigations. This will help determine whether the patient requires emergency referral to secondary care, referral on the cancer pathway or management within the community.

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