Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children

BackgroundDomestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.AimTo explore how and why general practice clinicians document DVA in families with children.Design and settingA qualitative interview study using vignettes with GPs and practice nurses (PNs) in England.MethodSemi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes.ResultsMost clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians.ConclusionManaging DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.

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Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

British Journal of General Practice ◽

10.3399/bjgp18x695309 ◽

2018 ◽

Vol 68 (669) ◽

pp. e234-e244 ◽

Cited By ~ 2

Author(s):

Hilary Davies-Kershaw ◽

Irene Petersen ◽

Irwin Nazareth ◽

Fiona Stevenson

Keyword(s):

Primary Care ◽

General Practice ◽

Public Health Problem ◽

Clinical Decision ◽

Epidemiological Studies ◽

Drug Misuse ◽

Electronic Patient Records ◽

National Surveys ◽

Qualitative Interview Study ◽

Face Complex

BackgroundDrug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.AimTo explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.Design and settingA semi-structured qualitative interview study of GPs working in general practices across England.MethodPurposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs’ actions if a patient asks for the information not to be recorded, and GPs’ actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.ResultsThe complexity of asking about drug misuse preceded GPs’ decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.ConclusionWhen making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

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Exploring healthcare professionals’ views of the acceptability of delivering interventions to promote healthy infant feeding practices within primary care: a qualitative interview study

Public Health Nutrition ◽

10.1017/s1368980020004954 ◽

2020 ◽

pp. 1-24

Author(s):

Elaine Toomey ◽

Caragh Flannery ◽

Karen Matvienko-Sikar ◽

Ellinor K Olander ◽

Catherine Hayes ◽

...

Keyword(s):

Primary Care ◽

Infant Feeding ◽

Healthcare Professionals ◽

Qualitative Content Analysis ◽

Healthy Infant ◽

Valuable Insight ◽

Practice Nurses ◽

Telephone Interviews ◽

Affective Attitude ◽

Qualitative Interview Study

Abstract Objective: Early-life nutrition plays a key role in establishing healthy lifestyles and preventing chronic disease. This study aimed to 1) explore healthcare professionals’ (HCP) opinions on the acceptability of and factors influencing the delivery of interventions to promote healthy infant feeding behaviours within primary care, and 2) identify proposed barriers/enablers to delivering such interventions during vaccination visits, to inform the development of a childhood obesity prevention intervention. Design: A qualitative study design was employed using semi-structured telephone interviews. Data were analysed using qualitative content analysis; findings were also mapped to the Theoretical Framework of Acceptability (TFA). Setting: Primary care in Ireland Participants: 21 primary care-based HCPs: 5 practice nurses, 7 general practitioners, 3 public health nurses, 3 community dietitians and 3 community medical officers. Results: The acceptability of delivering interventions to promote healthy infant feeding within primary care is influenced by the availability of resources, HCPs’ roles and priorities, and factors relating to communication and relationships between HCPs and parents. Proposed barriers and enablers to delivering interventions within vaccination visits include; time constraints versus opportunistic access, existing relationships and trust between parents and practice nurses, and potential communication issues. Barriers/enablers mapped to TFA constructs of Affective Attitude, Perceived Effectiveness and Self-Efficacy. Conclusions: This study provides a valuable insight into HCPs perspectives of delivering prevention-focused infant feeding interventions within primary care settings. While promising, factors such as coordination and clarity of HCP roles and resource allocation need to be addressed to ensure acceptability of interventions to HCPs involved in delivery.

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

BMJ Open ◽

10.1136/bmjopen-2017-019970 ◽

2018 ◽

Vol 8 (2) ◽

pp. e019970 ◽

Cited By ~ 7

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.

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‘It felt like there was always someone there for us’: Supporting children affected by domestic violence and abuse who are identified by general practice

Health & Social Care in the Community ◽

10.1111/hsc.13385 ◽

2021 ◽

Author(s):

Jessica Roy ◽

Emma Williamson ◽

Katherine Pitt ◽

Nicky Stanley ◽

Mei‐See Man ◽

...

Keyword(s):

Domestic Violence ◽

General Practice ◽

Domestic Violence And Abuse

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Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study

Family Practice ◽

10.1093/fampra/cmaa044 ◽

2020 ◽

Vol 37 (5) ◽

pp. 711-718

Author(s):

Oscar James ◽

Karen Cardwell ◽

Frank Moriarty ◽

Susan M Smith ◽

Barbara Clyne

Keyword(s):

General Practice ◽

Process Evaluation ◽

Controlled Trial ◽

Qualitative Approach ◽

Structured Interviews ◽

Practice Staff ◽

Practice Nurses ◽

Practice Team ◽

Prescribing Quality ◽

Descriptive Qualitative

Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.

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