Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

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Promoting innovative primary care for older people in general practice using a community-oriented approach

Primary Health Care Research & Development ◽

10.1191/146342301678787012 ◽

2001 ◽

Vol 2 (2) ◽

pp. 71-79 ◽

Cited By ~ 2

Author(s):

S. Iliffe ◽

P. Lenihan

Keyword(s):

Primary Care ◽

General Practice ◽

Older People ◽

Care For Older People ◽

Oriented Approach

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Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study * Commentary: Managing time appropriately in primary care

BMJ ◽

10.1136/bmj.325.7366.687 ◽

2002 ◽

Vol 325 (7366) ◽

pp. 687-687 ◽

Cited By ~ 61

Author(s):

K. Pollock

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study

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

British Journal of General Practice ◽

10.3399/bjgp.2020.1118 ◽

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.

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GPs' perspectives on prescribing for older people in primary care: a qualitative study

British Journal of Clinical Pharmacology ◽

10.1111/bcp.13233 ◽

2017 ◽

Vol 83 (7) ◽

pp. 1521-1531 ◽

Cited By ~ 15

Author(s):

David O. Riordan ◽

Stephen Byrne ◽

Aoife Fleming ◽

Patricia M. Kearney ◽

Rose Galvin ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Older People

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The ageing population

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738021992817 ◽

2021 ◽

pp. 175573802199281

Author(s):

Jenny Walton ◽

Angus Kaye

Keyword(s):

Primary Care ◽

General Practice ◽

Older People ◽

Healthcare Professionals ◽

Ageing Population ◽

Huge Amount ◽

Older Population ◽

The World ◽

The Individual

As we all age, the demographic of the world changes. Looking after older people well can bring a huge amount of pleasure and satisfaction, not just to the individual, but also to their family, friends and indeed healthcare professionals. How we care for our elderly now is likely to set a precedent for our own care in the future. This article highlights some of the features of ageing and discusses the role of primary care in the management of the older population, within the context of the general practice curriculum.

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The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England

British Journal of General Practice ◽

10.3399/bjgp19x703877 ◽

2019 ◽

Vol 69 (685) ◽

pp. e578-e585 ◽

Cited By ~ 5

Author(s):

Sharon Spooner ◽

Louise Laverty ◽

Kath Checkland

Keyword(s):

Primary Care ◽

General Practice ◽

Qualitative Study ◽

Focus Groups ◽

Early Career ◽

Situational Analysis ◽

Career Intentions ◽

Training Programmes ◽

The Uk ◽

Gp Training

BackgroundThe capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.AimThis article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.Design and settingA qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).MethodParticipants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.ResultsFifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.ConclusionStrategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors’ early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

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Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy

The Journals of Gerontology Series A ◽

10.1093/gerona/glz260 ◽

2019 ◽

Vol 75 (6) ◽

pp. 1134-1142 ◽

Cited By ~ 6

Author(s):

Rachel C Ambagtsheer ◽

Renuka Visvanathan ◽

Elsa Dent ◽

Solomon Yu ◽

Timothy J Schultz ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Older People ◽

Diagnostic Test ◽

Community Dwelling ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Screening Instruments ◽

Residential Care Facility ◽

Index Tests

Abstract Background Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried’s Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. Methods DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility. We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. Results We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2–94.3]; Sp: 73.4% [66.5–79.6]) and REFS (Se: 87.5% [73.2–95.8]; Sp: 75.5% [68.8–81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. Conclusions Two screening instruments—the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.

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