scholarly journals GP views on strategies to cope with increasing workload: a qualitative interview study

2017 ◽  
Vol 67 (655) ◽  
pp. e148-e156 ◽  
Author(s):  
Rebecca FR Fisher ◽  
Caroline HD Croxson ◽  
Helen F Ashdown ◽  
FD Richard Hobbs
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Self Management ◽  
Telephone Triage ◽  
Workload Management ◽  
Qualitative Interview Study ◽  
Data Saturation ◽  
The Uk ◽  
Maximum Variation Sample

BackgroundThe existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.AimTo explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.Design and settingSemi-structured, qualitative interviews with GPs working within NHS England.MethodAll GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.ResultsResponses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.ConclusionThis in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.

scholarly journals Knowledge mobilisation: an exploratory qualitative interview study to confirm and envision modification of lay and practitioner eczema mindlines to improve consultation experiences and self-management in primary care in the UK

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028225 ◽  
Author(s):  
Fiona Cowdell
Keyword(s):  
Primary Care ◽  
Qualitative Interviews ◽  
Virtual Space ◽  
Self Management ◽  
Core Content ◽  
Qualitative Interview Study ◽  
Primary Care Practitioners ◽  
The Uk ◽  
Consistent Information ◽  
Constant Comparative Analysis

ObjectivesTo investigate whether initial eczema mindlines, ‘collectively reinforced, internalised, tacit guidelines’, are an accurate representation of the experiences of lay people and practitioners in primary care and to explore how these mindlines may best be revised to improve eczema care.DesignExploratory qualitative interviews with constant comparative analysis and data mining.SettingUK, primary care.ParticipantsPeople with eczema or parents of children with eczema (n=19) and primary care practitioners (n=13).ResultsInterview data were analysed using constant comparison of new data with existing initial eczema mindlines to identify areas of agreement and disagreement. Data were mined for participant’s thoughts aboutwhosemindlines should be modified,howthis may be achieved andwhatcore content is essential. Eczema mindlines and the spiral of knowledge creation, from which they evolved, intuitively made sense. Participants offered examples of how their eczema knowledge is continually produced and transformed as they interact with others. They reported diverse and wide-ranging influences on their thinking and recognised the critical relationship between lay and practitioner mindlines. For this reason they advocated modifying lay and practitioner mindlines in parallel. Participants advised amendment based on consistent information directed to all who influence eczema care. Information should come from trusted sources and be easy to access, distilled, practical, contextually relevant and amenable to assimilation.ConclusionsThe purpose here is to improve primary care consultation experiences and self-management in eczema. The remaining challenge is to find novel, simple and pragmatic methods of modifying eczema mindlines to instil shared and consistent understanding. Given the prevalence of eczema and the scope of people who influence self-care, interventions should transcend patient-practitioner boundaries and address the wider community. One conceptually congruent approach is to create aBa, which in this case would be a virtual space for generating and sharing eczema knowledge.

scholarly journals GPs’ perceptions of workload in England: a qualitative interview study

2017 ◽  
Vol 67 (655) ◽  
pp. e138-e147 ◽  
Author(s):  
Caroline HD Croxson ◽  
Helen F Ashdown ◽  
FD Richard Hobbs
Keyword(s):  
General Practice ◽  
Qualitative Interviews ◽  
Full Time ◽  
Social Media Networks ◽  
Perceptions And Attitudes ◽  
Qualitative Interview Study ◽  
Data Saturation ◽  
Key Issues ◽  
E Mail ◽  
Maximum Variation Sample

BackgroundGPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.ConclusionThis study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.

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 Development and implementation of a nurse-led allergy clinic model in primary care: feasibility trial protocol

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Margaret Kelman ◽  
Victoria Hammersley ◽  
Marilyn Kendall ◽  
Mome Mukherjee ◽  
Lynn Morrice ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Retention Rates ◽  
Feasibility Trial ◽  
Allergy Clinic ◽  
Randomised Controlled

AbstractIn the United Kingdom, there are acknowledged short comings in allergy care provision for patients seen in primary care. There is a lack of allergy training for healthcare professionals and this leads to inappropriate referrals to the limited number of allergy specialists. The primary aims of this study are to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and quality of life. This is a single arm feasibility trial in which up to 250 participants referred to the nurse-led allergy clinic will receive the intervention and complete 6–12 weeks follow-up before being referred back to their usual care. Primary outcomes for this study will be establishment of clinics, recruitment and retention rates, and estimates of change in disease-specific quality of life measures. Secondary outcomes will be acceptability of the new service to participants/carers and healthcare professionals. A sample of participants and professional stakeholders will take part in more in-depth semi-structured qualitative interviews. Data from this feasibility trial will be used to inform plans for a pilot randomised controlled trial of nurse-led allergy clinics.

scholarly journals Enhancing intrinsic motivation for physical activity among adolescents with cystic fibrosis: a qualitative study of the views of healthcare professionals

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028996
Author(s):  
Sarah Denford ◽  
Kelly A Mackintosh ◽  
Melitta A McNarry ◽  
Alan R Barker ◽  
Craig Anthony Williams
Keyword(s):  
Physical Activity ◽  
Cystic Fibrosis ◽  
Intrinsic Motivation ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Physical Activity Promotion ◽  
Multidisciplinary Teams ◽  
Activity Promotion ◽  
The Uk ◽  
Views Of Healthcare Professionals

ObjectiveTo explore the views of healthcare professionals from cystic fibrosis (CF) multidisciplinary teams (MDT) on physical activity for adolescents with CF, the specific strategies used for physical activity promotion and associated challenges.DesignIn this exploratory study, in-depth qualitative interviews were conducted with 15 healthcare professionals from CF MDTs to explore their views surrounding physical activity promotion for adolescents with CF.ParticipantsEleven physiotherapists (nine female), two consultants (both male) and two dieticians (both female) provided written informed consent and participated in the study.SettingCF clinics in the UK.ResultsWhile healthcare professionals highlighted the importance of physical activity in the management of CF, they noted that very few patients were motivated solely by (CF or general) health reasons. Healthcare professionals discussed the need for physical activity to be an enjoyable and routine part of their life, undertaken with significant others, outside the clinic whenever possible. Adopted approaches for physical activity promotion focused on providing individualised recommendations that suit the patients’ individual needs and goals and enhance intrinsic motivation for physical activity.ConclusionOur research offers valuable information for those seeking to develop interventions to promote physical activity among adolescents with CF. Specifically, intervention developers should focus on developing individualised interventions that focus on enhancing intrinsic motivation and support the integration of physical activity into everyday life.

scholarly journals When Values Get in the Way of Conversations: Reflections on Dealing With Discriminatory Remarks and Behaviors in Qualitative Interviewing

2020 ◽  
Vol 19 ◽  
pp. 160940692096540
Author(s):  
S. T. Kulnik ◽  
J. Egbunike ◽  
J. Francois
Keyword(s):  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Qualitative Interview ◽  
Critical Discussion ◽  
Critical Examination ◽  
Qualitative Interviewing ◽  
Qualitative Interview Study ◽  
Practical Guidance ◽  
And Behaviors ◽  
Legal Frameworks

As healthcare researchers conducting qualitative interviews, we might encounter participants who make remarks or display behaviors which go against principles of valuing diversity, equality and human rights; in other words, remarks and behaviors which could indicate racist, homophobic, xenophobic, islamophobic, sexist, misogynist, classist, etc. views and attitudes. In this article, we offer our reflections on how as researchers we might deal with such situations. We draw on methodological literature and on our own experiences as researchers, educators and practitioners in healthcare, to provide a critical discussion around researcher awareness and anticipation of emotional triggers, management and leadership of research, and understanding of ethics and legal frameworks of equality. We summarize and signpost toward methodological views under which such instances might be considered, including interpretivist and constructivist interpretations, and the concepts of positionality and adversarial discourse. Lastly, we offer practical suggestions for dealing with such occurrences in the context of qualitative research studies in healthcare, and for using researcher reflexivity as a strategy to surface and work through these situations. We hope that this article will provide accessible theoretical and practical guidance, for example to healthcare professionals who embark on their first qualitative interview study as part of a postgraduate course. Equally, we hope that this article will be of interest to more experienced researchers and invite further critical examination of the issues we highlight.

scholarly journals Is simulation-based team training performed by personnel in accordance with the INACSL Standards of Best Practice: SimulationSM?—a qualitative interview study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Anne Strand Finstad ◽  
Randi Ballangrud ◽  
Ingunn Aase ◽  
Torben Wisborg ◽  
Luis Georg Romundstad ◽  
...  
Keyword(s):  
Best Practice ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Team Training ◽  
Public Hospitals ◽  
Clinical Simulation ◽  
International Nursing ◽  
Qualitative Interview Study ◽  
Simulation Based ◽  
Almost All

Abstract Background Anesthesia personnel was among the first to implement simulation and team training including non-technical skills (NTS) in the field of healthcare. Within anesthesia practice, NTS are critically important in preventing harmful undesirable events. To our best knowledge, there has been little documentation of the extent to which anesthesia personnel uses recommended frameworks like the Standards of Best Practice: SimulationSM to guide simulation and thereby optimize learning. The aim of our study was to explore how anesthesia personnel in Norway conduct simulation-based team training (SBTT) with respect to outcomes and objectives, facilitation, debriefing, and participant evaluation. Methods Individual qualitative interviews with healthcare professionals, with experience and responsible for SBTT in anesthesia, from 51 Norwegian public hospitals were conducted from August 2016 to October 2017. A qualitative deductive content analysis was performed. Results The use of objectives and educated facilitators was common. All participants participated in debriefings, and almost all conducted evaluations, mainly formative. Preparedness, structure, and time available were pointed out as issues affecting SBTT. Conclusions Anesthesia personnel’s SBTT in this study met the International Nursing Association for Clinical Simulation and Learning (INACSL) Standard of Best Practice: SimulationSM framework to a certain extent with regard to objectives, facilitators’ education and skills, debriefing, and participant evaluation.

scholarly journals Healthcare professionals’ perspectives on lung cancer screening in the UK: a qualitative study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101035
Author(s):  
Charikleia Margariti ◽  
Maria Kordowicz ◽  
Gillian Selman ◽  
Arjun Nair ◽  
Yvonne Akande ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Smoking Cessation ◽  
Cancer Screening ◽  
Healthcare Professionals ◽  
Lung Cancer Screening ◽  
Case Finding ◽  
Smoking Cessation Services ◽  
Potential Impact ◽  
The Uk

BackgroundLung cancer screening with low-dose computed tomography (LDCT) has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes, such as pharmacies, smoking cessation services, and respiratory clinics, have not been fully explored.AimTo explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.Design & settingA qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists, staff from smoking cessation services within Southwark and Lambeth in London, and staff from respiratory clinics in Guys’ and St Thomas’ NHS Foundation Trust in London between April 2018 and December 2018.MethodSixteen participants were interviewed and the interview transcripts were analysed thematically.ResultsParticipants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, and the potential impact on their patients and workload.ConclusionStudy participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.

scholarly journals GP and parent dissonance about the assessment and treatment of childhood eczema in primary care: a qualitative study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019633 ◽  
Author(s):  
Kingsley Powell ◽  
Emma Le Roux ◽  
Jonathan Banks ◽  
Matthew J Ridd
Keyword(s):  
Primary Care ◽  
Topical Therapy ◽  
Complementary Therapy ◽  
Treatment Decisions ◽  
Snowball Sampling ◽  
Qualitative Interview Study ◽  
Assessment And Treatment ◽  
Incurable Condition ◽  
Poor Outcomes ◽  
The Uk

ObjectivesTo compare parents’ and clinicians’ perspectives on the assessment and treatment of children with eczema in primary care.DesignQualitative interview study with purposive and snowball sampling and thematic analysis.Setting14 general practices in the UK.Participants11 parents of children with eczema and 15 general practitioners (GPs) took part in semistructured individual interviews.ResultsWe identified several areas of dissonance between parents and GPs. First, parents sought a ‘cause’ of eczema, such as an underlying allergy, whereas GPs looked to manage the symptoms of an incurable condition. Second, parents often judged eczema severity in terms of psychosocial impact, while GPs tended to focus on the appearance of the child’s skin. Third, parents sought ‘more natural’ over-the-counter treatments or complementary medicine, which GPs felt unable to endorse because of their unknown effectiveness and potential harm. Fourth, GPs linked poor outcomes to unrealistic expectations of treatment and low adherence to topical therapy, whereas parents reported persisting with treatment and despondency with its ineffectiveness. Consultations were commonly described by parents as being dominated by the GP, with a lack of involvement in treatment decisions. GPs’ management of divergent views varied, but avoidance strategies were often employed.ConclusionsDivergent views between parents and clinicians regarding the cause and treatment of childhood eczema can probably only be bridged by clinicians actively seeking out opinions and sharing rationale for their approach to treatment. Together with assessing the psychosocial as well as the physical impact of eczema, asking about current or intended use of complementary therapy and involving parents in treatment decisions, the management of eczema and patient outcomes could be improved.

scholarly journals Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative study in primary care

BJGP Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. bjgpopen18X101638 ◽  
Author(s):  
Aidan Searle ◽  
Emma Ranger ◽  
Jez Zahra ◽  
Byron Tibbitts ◽  
Angie Page ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
The Self ◽  
Self Management ◽  
Post Intervention ◽  
Practice Nurses ◽  
Qualitative Interview Study ◽  
Primary Care Health ◽  
Care Health

BackgroundPhysical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression.AimTo explore engagement with an e-cycling intervention conducted with adults with T2DM.Design & settingProspective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care.MethodInterviews were conducted with 20 individuals with T2DM (42–70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken.ResultsParticipants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA.ConclusionE-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.

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