scholarly journals Understanding the benefits and limitations of continuous, risk-based, consultation peer-review in out-of-hours general practice: A qualitative interview study

2021 ◽  
pp. BJGP.2021.0076
Author(s):  
Ian Bennett-Britton ◽  
Jonathan Banks ◽  
Andrew Carson-Stevens ◽  
Chris Salisbury
Keyword(s):  
General Practice ◽  
Peer Review ◽  
Qualitative Interview ◽  
Interview Study ◽  
Learning Culture ◽  
Learning Needs ◽  
Full Potential ◽  
Programme Theory ◽  
Out Of Hours ◽  
Qualitative Interview Study

Background: Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim: To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting: A qualitative interview study in South-West England. Method: Semi-structured interviews with intervention users (clinicians, peer-reviewers and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results: 20 clinicians were interviewed between September 2018 - January 2019. Interviewees indicated the intervention supported clinician learning through improved peer-feedback; highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence; supporting standardisation of supervision, clinical governance and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation and organisational learning culture influenced the perception of the intervention as a support or stressor. Conclusion: Our findings demonstrate the potential of this methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practice to their full potential. Our programme theory provides a theoretical basis to maximise its benefits and accommodate its potential limitations.

scholarly journals Contact to the out-of-hours service among Danish parents of small children – a qualitative interview study

2018 ◽  
Vol 36 (2) ◽  
pp. 216-223 ◽  
Author(s):  
Marie Lass ◽  
Camilla Rahr Tatari ◽  
Camilla Hoffmann Merrild ◽  
Linda Huibers ◽  
Helle Terkildsen Maindal
Keyword(s):  
Qualitative Interview ◽  
Interview Study ◽  
Small Children ◽  
Out Of Hours ◽  
Qualitative Interview Study

scholarly journals Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019970 ◽  
Author(s):  
Rosie Dew ◽  
Kathryn King ◽  
Onyebuchi E Okosieme ◽  
Simon H Pearce ◽  
Gemma Donovan ◽  
...  
Keyword(s):  
General Practice ◽  
Continuity Of Care ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Interview Study ◽  
Theory Approach ◽  
Practice Nurses ◽  
Blood Tests ◽  
Qualitative Interview Study ◽  
Attitudes And Perceptions

ObjectiveTo explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice.DesignA qualitative interview study using semistructured interviews.ParticipantsSixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner.SettingGeneral practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stockton-on-Tees and North Cumbria, North of England, UK.MethodA grounded-theory approach was used to generate themes from interviews, which were underpinned by the theory of planned behaviour to give explanation to the data.ResultsAlthough health professionals felt that hypothyroidism was easy to manage, GPs and nurses generally revealed inadequate knowledge of medication interactions and levothyroxine pharmacokinetics. Pharmacists felt limited in the advice that they provide to patients due to lack of access to patient records. Most GPs and nurses followed local guidelines, and relied on blood tests over clinical symptoms to adjust levothyroxine dose. The information exchanged between professional and patient was usually restricted by time and often centred on symptoms rather than patient education. Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned. Enablers perceived by health professionals to improve the management of hypothyroidism included continuity of care, blood test reminders, system alerts for interfering medications and prescription renewal, and accessible blood tests and levothyroxine prescriptions for patients.ConclusionThere is a significant health professional behavioural component to the management of hypothyroidism. Addressing the differences in patient and professional knowledge and perceptions could reduce the barriers to optimal treatment, while continuity of care and increased involvement of pharmacists and practice nurses would help to promote optimal thyroid replacement.

scholarly journals Pharmacists’ perceptions of their emerging general practice roles in UK primary care: a qualitative interview study

2017 ◽  
Vol 67 (662) ◽  
pp. e650-e658 ◽  
Author(s):  
Jo Butterworth ◽  
Anna Sansom ◽  
Laura Sims ◽  
Mark Healey ◽  
Ellie Kingsland ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Skills ◽  
Action Plan ◽  
Geographical Location ◽  
Qualitative Interview ◽  
Training Programme ◽  
Interview Study ◽  
Qualitative Interview Study ◽  
Primary Care Practitioners

BackgroundUK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative ‘10-point GP workforce action plan’.AimTo explore pharmacists’ perceptions of primary care roles including the potential for greater integration of their profession into general practice.Design and settingA qualitative interview study in UK primary care carried out between October 2015 and July 2016.MethodPharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted — one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used.ResultsSixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants’ experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role.ConclusionThere is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.

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