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

2018 ◽  
Vol 68 (669) ◽  
pp. e234-e244 ◽  
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.

scholarly journals Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039674 ◽  
Author(s):  
Veronique Verhoeven ◽  
Giannoula Tsakitzidis ◽  
Hilde Philips ◽  
Paul Van Royen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Decision Making ◽  
Core Competencies ◽  
Well Being ◽  
Clinical Decision ◽  
Framework Analysis ◽  
Profound Impact ◽  
The Core ◽  
Qualitative Interview Study

ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

scholarly journals Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038398
Author(s):  
Kath Checkland ◽  
Jonathan Hammond ◽  
Lynsey Warwick-Giles ◽  
Simon Bailey
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Delivery ◽  
Service Providers ◽  
National Level ◽  
National Policy ◽  
Document Analysis ◽  
Policy Document ◽  
Qualitative Interview Study ◽  
Policy Objectives

ObjectivesEnglish general practice is suffering a workforce crisis, with general practitioners retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as primary care networks (PCNs). This study explored national policy objectives underpinning PCNs and the mechanisms expected to help achieve these, from the perspective of those driving the policy.DesignQualitative semistructured interviews and policy document analysis.Setting and participantsNational-level policy maker and stakeholder interviewees (n=16). Policy document analysis of the Network Contract Direct Enhanced Service draft service specifications.AnalysisInterviews were transcribed, coded and organised thematically according to policy objectives and mechanisms. Thematic data were organised into a matrix so prominent elements can be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.ResultsThree themes of policy objectives and associated mechanisms were identified: (1) supporting general practice, (2) place-based interorganisational collaboration and (3) primary care ‘voice’. Interviewees emphasised and sequenced themes differently, suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of theme 1. The objectives embedded in draft service delivery requirements primarily emphasised theme 2.ConclusionsThese policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

The diagnostic status of patients with conspicuous psychiatric morbidity in primary care

1984 ◽  
Vol 14 (3) ◽  
pp. 673-681 ◽  
Author(s):  
Patricia R. Casey ◽  
S. Dillon ◽  
P. J. Tyrer
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Personality Disorder ◽  
Mental State ◽  
Depressive Disorders ◽  
Psychiatric Morbidity ◽  
Epidemiological Studies ◽  
Detailed Assessment ◽  
One Year ◽  
Primary Problem

SynopsisA 7% one-year prevalence rate of conspicuous psychiatric morbidity was found in patients attending a single general practice. The nature of the morbidity was examined by a detailed assessment of mental state and personality, using interview schedules administered by a psychiatrist. Depressive disorders were presented by nearly half of the patients. The overall sex incidence of the disorders was equal, but alcohol abuse was more common in males. A personality disorder was present in 33·9% of all patients seen, although it was rarely diagnosed as the primary problem and was linked to the diagnosis of anxiety states, rather than depressive neurosis. These findings are discussed in relation to other epidemiological studies in primary care.

scholarly journals Medical professionalism: Navigating modern challenges

2021 ◽  
pp. 175573802110526
Author(s):  
Nicola Cooper-Moss ◽  
Helen Hooper ◽  
Kartina A. Choong ◽  
Umesh Chauhan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
General Practice ◽  
Professional Practice ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Clinical Decision ◽  
Medical Professionalism ◽  
The Public ◽  
General Practice Training

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.

General practice

2020 ◽  
pp. 774-841
Author(s):  
Andrew Baldwin
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Partner Violence ◽  
Sleep Problems ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Medically Unexplained Symptoms ◽  
Drug Misuse ◽  
Care Models ◽  
Physical Elements

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of general practice. It explores common reasons for seeing a general practitioner (GP), general practice in the UK, differences between GPs and specialists, pressures of primary care, primary care models, primary care teams, and the concept of universal primary care. It discusses consultation models, patient-centredness, decision-making, continuity of care, and risk management. It reviews compliance and concordance in prescribing, as well as protocols, targets, and guidelines, telephone consulting, and home visits. It describes commonly encountered chronic disease and frailty as well as minor illness, medically unexplained symptoms, time off work, and fitness to work, drive, and fly. It investigates UK benefits for disability and illness and confirmation and certification of death. It examines social class and inequalities in health as well as social, psychological, and physical elements, prevention of disease, screening, and health education. It explains cardiovascular disease risk assessment, how to manage smoking cessation, alcohol and drug misuse, obesity, sleep problems, exercise, healthy eating, alternative/holistic medicine, and the GP’s role in dealing with intimate partner violence. It discusses GPs as managers and commissioners, as well as new ways of extending primary care, and expert patients.

Primary care

2016 ◽  
pp. 466-533
Author(s):  
Andrew Baldwin ◽  
Nina Hjelde ◽  
Charlotte Goumalatsou ◽  
Gil Myers
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Social Class ◽  
Sleep Problems ◽  
Care Home ◽  
Medically Unexplained Symptoms ◽  
Drug Misuse ◽  
Independent Practice ◽  
And Performance ◽  
The Uk

This chapter explores primary care and general practice. It outlines primary care (general practice in the UK and worldwide, primary care, intermediate care and self-care, primary health care teams, and pressures of primary care), consulting and certifying (the consultation and patient centred care, consultation models, complex decision making, managing uncertainty, what to do for the best, continuity of care, home visits, telephone consulting, chronic disease, approaching minor illness, medically unexplained symptoms, time off work and fit notes, fitness to drive, fitness to fly, UK benefits, certification of death) health and healthy living (health and social class, social class and health inequalities, prevention, screening, health education, smoking cessation, managing alcohol and drug misuse, managing obesity, managing sleep problems, exercise, healthy eating and alternative medicine, domestic violence), and practice management and performance (GPs as business managers and commissioners, independent practice vs commercial companies, clinical governance, significant events, audit and complaints, appraisal, revalidation and performance, prescribing and referring, patient groups).

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

2017 ◽  
Vol 67 (659) ◽  
pp. e437-e444 ◽  
Author(s):  
Jessica Drinkwater ◽  
Nicky Stanley ◽  
Eszter Szilassy ◽  
Cath Larkins ◽  
Marianne Hester ◽  
...  
Keyword(s):  
Domestic Violence ◽  
General Practice ◽  
Current Evidence ◽  
Electronic Patient Records ◽  
Practice Nurses ◽  
Telephone Interviews ◽  
Hide Information ◽  
Qualitative Interview Study ◽  
Legal Document ◽  
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.

scholarly journals The implementation, use and sustainability of a clinical decision support system for medication optimisation in primary care: A qualitative evaluation

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250946
Author(s):  
Mark Jeffries ◽  
Nde-Eshimuni Salema ◽  
Libby Laing ◽  
Azwa Shamsuddin ◽  
Aziz Sheikh ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Medication Safety ◽  
Qualitative Evaluation ◽  
Clinical Decision ◽  
Population Characteristics ◽  
Successful Implementation ◽  
General Practices

Background The quality and safety of prescribing in general practice is important, Clinical decision support (CDS) systems can be used which present alerts to health professionals when prescribing in order to identify patients at risk of potentially hazardous prescribing. It is known that such computerised alerts may improve the safety of prescribing in hospitals but their implementation and sustainable use in general practice is less well understood. We aimed to understand the factors that influenced the successful implementation and sustained use in primary care of a CDS system. Methods Participants were purposively recruited from Clinical Commissioning Groups (CCGs) and general practices in the North West and East Midlands regions of England and from the CDS developers. We conducted face-to-face and telephone-based semi-structured qualitative interviews with staff stakeholders. A selection of participants was interviewed longitudinally to explore the further sustainability 1–2 years after implementation of the CDS system. The analysis, informed by Normalisation Process Theory (NPT), was thematic, iterative and conducted alongside data collection. Results Thirty-nine interviews were conducted either individually or in groups, with 33 stakeholders, including 11 follow-up interviews. Eight themes were interpreted in alignment with the four NPT constructs: Coherence (The purpose of the CDS: Enhancing medication safety and improving cost effectiveness; Relationship of users to the technology; Engagement and communication between different stakeholders); Cognitive Participation (Management of the profile of alerts); Collective Action (Prescribing in general practice, patient and population characteristics and engagement with patients; Knowledge);and Reflexive Monitoring (Sustaining the use of the CDS through maintenance and customisation; Learning and behaviour change. Participants saw that the CDS could have a role in enhancing medication safety and in the quality of care. Engagement through communication and support for local primary care providers and management leaders was considered important for successful implementation. Management of prescribing alert profiles for general practices was a dynamic process evolving over time. At regional management levels, work was required to adapt, and modify the system to optimise its use in practice and fulfil local priorities. Contextual factors, including patient and population characteristics, could impact upon the decision-making processes of prescribers influencing the response to alerts. The CDS could operate as a knowledge base allowing prescribers access to evidence-based information that they otherwise would not have. Conclusions This qualitative evaluation utilised NPT to understand the implementation, use and sustainability of a widely deployed CDS system offering prescribing alerts in general practice. The system was understood as having a role in medication safety in providing relevant patient specific information to prescribers in a timely manner. Engagement between stakeholders was considered important for the intervention in ensuring prescribers continued to utilise its functionality. Sustained implementation might be enhanced by careful profile management of the suite of alerts in the system. Our findings suggest that the use and sustainability of the CDS was related to prescribers’ perceptions of the relevance of alerts. Shared understanding of the purpose of the CDS between CCGS and general practices particularly in balancing cost saving and safety messages could be beneficial.

scholarly journals Understanding people who self-referred in an emergency department with primary care problems during office hours: a qualitative interview study at a Daytime General Practice Cooperative in two hospitals in The Hague, The Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e029853 ◽  
Author(s):  
Rosa Naomi Minderhout ◽  
Pien Venema ◽  
Hedwig M M Vos ◽  
Jojanneke Kant ◽  
Marc Abraham Bruijnzeels ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practice ◽  
The Netherlands ◽  
Motivational Factors ◽  
Lack Of Information ◽  
Qualitative Interview Study ◽  
The Hague ◽  
Straightforward Solution ◽  
The Right

ObjectiveTo provide insight into the motives for hospital self-referral during office hours and the barriers deterring general practitioner (GP) consultation with a primary care request.SettingPeople who self-referred at a Daytime General Practice Cooperative (GPC) in two hospitals in The Hague, The Netherlands.ParticipantsA total of 44 people who self-referred were interviewed in two hospitals. The average age of interviewees was 35 years (range 19 months to 83 years), a parent of a young patient was interviewed, but the age of patients is shown here. There were more male patients (66%) than female patients (34%). Patients were recruited using a sampling method after triage. Triage was the responsibility of an emergency department (ED) nurse in one hospital and of a GP in the other. Those excluded from participation included (a) children under the age of 18 years and not accompanied by a parent or legal guardian, (b) foreign patients not resident in the Netherlands, (c) patients unable to communicate in Dutch or English and (d) patients directly referred to the ED after triage by the GP (in one hospital).ResultsPeople who self-referred generally reported several motives for going to the hospital directly. Information and awareness factors played an important role, often related to a lack of information regarding where to go with a medical complaint. Furthermore, many people who self-referred mentioned hospital facilities, convenience and perceived medical necessity as motivational factors. Barriers deterring a visit to the own GP were mainly logistical, including not being registered with a GP, the GP was too far away, poor GP telephone accessibility or a waiting list for an appointment.ConclusionInformation and awareness factors contribute to misperceptions among people who self-referred concerning the complaint, the GP and the hospital. As a range of motivational factors are involved, there is no straightforward solution. However, better dissemination of information might alleviate misconceptions and contribute to providing the right care to the right patient in the right setting.

scholarly journals Measuring quality in primary healthcare – opportunities and weaknesses

2019 ◽  
Vol 58 (3) ◽  
pp. 101-103
Author(s):  
Eva Arvidsson ◽  
Rob Dijkstra ◽  
Zalika Klemenc-Ketiš
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Indicators ◽  
Pay For Performance ◽  
Easy Access ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Local Improvement ◽  
Quality And Patient Safety ◽  
Access To Data

Abstract The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.

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