scholarly journals Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges

2018 ◽  
Vol 68 (672) ◽  
pp. e487-e494 ◽  
Author(s):  
Kathryn Skivington ◽  
Mathew Smith ◽  
Nai Rui Chng ◽  
Mhairi Mackenzie ◽  
Sally Wyke ◽  
...  
Keyword(s):  
Primary Care ◽  
Case Management ◽  
Case Manager ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Community Organisation ◽  
Health Goals ◽  
Community Organisations ◽  
Ability To Act ◽  
Qualitative Interview Study

BackgroundSocial prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health.AimTo investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals.Design and settingQualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas.MethodAudiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically.ResultsParticipants identified some benefits of collaborative working, particularly the CLPs’ ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management.ConclusionAlthough the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as ‘magic bullets’. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care.

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

scholarly journals Operational failures and how they influence the work of GPs: a qualitative study in primary care

2020 ◽  
Vol 70 (700) ◽  
pp. e825-e832
Author(s):  
Carol Sinnott ◽  
Alexandros Georgiadis ◽  
Mary Dixon-Woods
Keyword(s):  
Primary Care ◽  
Work Environment ◽  
Information Transfer ◽  
Healthcare Providers ◽  
Comparison Method ◽  
Care Work ◽  
System Level ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Operational Failures

BackgroundOperational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs’ experiences of work, they remain under-explored in primary care.AimTo identify operational failures in the primary care work environment and to examine how they influence GPs’ work.Design and settingQualitative interview study in the East of England.MethodSemi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.ResultsGPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook ‘compensatory labour’ to fulfil their duties of coordinating and safeguarding patients’ care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.ConclusionOperational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.

scholarly journals Nasal balloon autoinflation for glue ear in primary care: a qualitative interview study

2018 ◽  
Vol 69 (678) ◽  
pp. e24-e32
Author(s):  
Jane Vennik ◽  
Ian Williamson ◽  
Caroline Eyles ◽  
Hazel Everitt ◽  
Michael Moore
Keyword(s):  
Primary Care ◽  
Low Cost ◽  
Daily Routine ◽  
Structured Interviews ◽  
Early Management ◽  
Practice Nurses ◽  
Holistic Treatment ◽  
Qualitative Interview Study ◽  
Cost Treatment ◽  
Glue Ear

BackgroundNasal balloon autoinflation is an effective, non-surgical treatment for symptomatic children with glue ear, although uptake is variable and evidence about acceptability and feasibility is limited.AimTo explore parent and healthcare professional views and experiences of nasal balloon autoinflation for children with glue ear in primary care.Design and settingQualitative study using semi-structured interviews with a maximum-variety sample of parents, GPs, and practice nurses. The study took place between February 2013 and September 2014.MethodSemi-structured face-to-face and telephone interviews were audiorecorded, transcribed verbatim, and analysed using inductive thematic analysis.ResultsIn all, 14 parents, 31 GPs, and 19 nurses were included in the study. Parents described the nasal balloon as a natural, holistic treatment that was both acceptable and appealing to children. GPs and nurses perceived the method to be a low-cost, low-risk strategy, applicable to the primary care setting. Good instruction and demonstration ensured children mastered the technique and engaged with the treatment, but uncertainties were raised about training provision and potential impact on the GP consultation. Making nasal balloon autoinflation part of a child’s daily routine enhances compliance, but difficulties can arise if children are unwell or refuse to cooperate.ConclusionNasal balloon autoinflation is an acceptable, low-cost treatment option for children with glue ear in primary care. Provision of educational materials and demonstration of the method are likely to promote uptake and compliance. Wider use of the nasal balloon has the potential to enhance early management, and may help to fill the management gap arising from forthcoming changes to care pathways.

scholarly journals General practitioners’ perceptions towards the use of digital health services for citizens in primary care: a qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028251 ◽  
Author(s):  
Asbjørn Johansen Fagerlund ◽  
Inger Marie Holm ◽  
Paolo Zanaboni
Keyword(s):  
Primary Care ◽  
Health Services ◽  
General Practitioners ◽  
Computer Literacy ◽  
Large Scale ◽  
Digital Health ◽  
The Elderly ◽  
Structured Interviews ◽  
Electronic Prescription ◽  
Qualitative Interview Study

ObjectivesTo explore general practitioners’ (GPs) perceptions towards use of four digital health services for citizens: an electronic booking service to make reservations with the GP; an electronic prescription service to request renewal of maintenance drugs; a service for text-based non-clinical enquiries to the GP office and a service for text-based electronic consultation (e-consultation) with the GP.DesignA qualitative study based on semi-structured interviews.SettingPrimary care.ParticipantsNine GPs who were early adopters of the four services were interviewed.MethodOne moderator presented topics using open-ended questions, facilitated the discussion and followed up with further questions. Phone interviews were conducted, audio recorded and transcribed verbatim. Qualitative data were analysed using the framework method.ResultsThe use of digital services in primary care in Norway is growing, although the use of text-based e-consultations is still limited. Most GPs were positive about all four services, but there was still some scepticism regarding their effects. Advantages for GP offices included reduced phone load, increased efficiency, released time for medical assessments, less crowded waiting rooms and more precise communication. Benefits for patients were increased flexibility, autonomy and time and money savings. Children, the elderly and people with low computer literacy might still need traditional alternatives.ConclusionsMore defined and standardised routines, as well as more evidence of the effects, are necessary for large-scale adoption.

Research activity and quality indicators in primary care - An explorative qualitative interview study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697445
Author(s):  
Helen Riding ◽  
S Haining ◽  
L Robinson
Keyword(s):  
Primary Care ◽  
Quality Indicators ◽  
Quantitative Research ◽  
Sampling Strategy ◽  
Care Staff ◽  
Current Evidence ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Research Activity ◽  
Qualitative Interview Study

BackgroundEmerging evidence suggests that research activity improves healthcare performance in secondary care. Staff who contribute and participate in research studies, tend to have a greater understanding, and use, of current evidence and guidelines. The engagement in research in primary care and correlation with quality indicators (QIs) is unclear.AimThe aim of this study is exploring the link between research activity and quality indicators in primary care.Method4 GPs and 4 practice managers consented and participated in semi-structured interviews conducted in spring 2017. A purposive sampling strategy was adopted until data saturation was achieved. The interviews were digitally recorded, transcribed verbatim and analysed using thematic framework analysis.ResultsPractices with a GP research champion were more likely to undertake research. Staff directly participating in the recruitment and follow-up and the research teams adopting a participatory and active research methodology is more likely to lead to improvement in quality. Including research as Enhanced Service may influence increased participation. The QOF is most likely to reflect improvement related to research, but opinions were mixed.ConclusionClinical Commissioning Groups and NHS England should be encouraged to develop QIs for research. As the landscape changes with the creation of Accountable Care Systems, there is an opportunity address the inclusion of research into practice contracts. This paper is the first to explore this topic in primary care and the findings will contribute towards developing quantitative research to expand the findings of this exploratory study.

scholarly journals Exploring commissioners’ understandings of early Primary Care Network development: qualitative interview study

2021 ◽  
pp. BJGP.2020.0917
Author(s):  
Lynsey Warwick-Giles ◽  
Jonathan Hammond ◽  
Simon Bailey ◽  
Katherine Checkland
Keyword(s):  
Primary Care ◽  
Structured Interviews ◽  
Telephone Interviews ◽  
Similar Work ◽  
Policy Goals ◽  
Establishment Method ◽  
Qualitative Interview Study ◽  
Geographical Populations ◽  
Early Primary ◽  
Blank Slate

Background: Primary Care Networks (PCNs) are financially incentivised groupings of General Practices (GP) in the English NHS. Their purpose is to deliver a number of policy goals set out in the NHS Long Term Plan. Clinical Commissioning Groups (CCGs) have a role in their establishment, support, and oversight. Aim: Explore commissioner’s perspectives on the early development of PCNs. Design and Setting: Qualitative study of CCGs using telephone interviews. Semi-structured interviews (n=37) with CCG employees involved in PCN establishment. Method: Interviewees were asked about local PCNs’ characteristics, factors shaping development and form, activities to date, challenges and benefits, and their CCGs’ relationship with PCNs. Interviewee responses were summarised within a matrix and analysed thematically. Results: Three meta-themes were identified: the multifaceted role of the commissioner; uneven advantages; engaging the broader system. Interviewees reported that the policy potentially favours PCNs working from a ‘blank slate’ and does not sufficiently account for the fact some GP practices and wider system organisations have been doing similar work already. The prescriptive, contractual nature of the policy has led to local challenges, trying to ensure local good practices are not lost during implementation. Interviewees also considered an important part of their work to be protecting PCNs from the weight of expectations placed upon them. Conclusion: CCGs are well placed to understand the complexities of local systems and facilitate PCNs and working practices between wider system partners. It is important that this local role is not lost as CCGs continue to merge and cover larger geographical populations.

scholarly journals Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: A qualitative interview study using vignettes

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0014
Author(s):  
Emily Lyness ◽  
Jane Louise Vennik ◽  
Felicity Bishop ◽  
Pranati Misurya ◽  
Jeremy Howick ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Structured Interviews ◽  
Knee Oa ◽  
Qualitative Interview Study ◽  
Empathic Communication ◽  
Case Vignettes ◽  
Digital Training ◽  
Improve Patient

BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews.SettingPurposefully sampled patients (n=33) aged 45+ with hip/knee OA from Wessex GP practices.MethodFifteen participants watched two filmed OA consultations with a GP, and eighteen participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.ResultsPatients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.ConclusionPatients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.

scholarly journals Swedish primary healthcare practitioners’ perspectives on the impact of arts on prescription for patients and the wider society: a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anita Jensen ◽  
Hilary Bungay
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Healthcare ◽  
Social Issues ◽  
Care Pathway ◽  
Medical Model ◽  
Structured Interviews ◽  
Care Services ◽  
Qualitative Interview Study ◽  
The Impact

Abstract Background There is growing evidence that participating in arts activities are beneficial for mental health and wellbeing. Many patients attending primary care services have mental ill-health or social issues that healthcare practitioners currently do not have adequate ways of supporting. This study set out to explore the perspectives of primary healthcare practitioners on Arts on Prescription (AoP) as an additional referral pathway. Methods A qualitative exploratory descriptive approach within an interpretive framework using semi-structured interviews was used to explore healthcare practitioners’ perspectives and experiences of AoP programmes in Sweden. Ten interviews were conducted with healthcare practitioners in primary care. Data were analysed using an inductive thematic approach. Results The healthcare practitioners interviewed, recognised the need for more holistic approaches to care for those with mental health issues. They perceived that AoP is beneficial for patients in terms of motivation, creating routines, providing social interactions, and increasing self-esteem. In addition, AoP was felt to have the potential to impact upon current service provision and wider society. However, whilst the opportunity to refer patients to AoP in conjunction with conventional treatments was valued, participants reported that time pressures on practitioners and the continuing dominance of the medical model of care were barriers to wider acceptance amongst practitioners at the present time. Conclusions AoP enabled primary healthcare practitioners to offer an additional pathway for patients that is an adjunct to the traditional care pathway. However, the programmes tend to be project-based and often time limited. For programmes to be sustainable and be included as part of a wider range of interventions available to healthcare practitioners’ suitable levels of funding would be required.

scholarly journals Developing and implementing a social prescribing initiative in primary care: insights into the possibility of normalisation and sustainability from a UK case study

2016 ◽  
Vol 18 (02) ◽  
pp. 112-121 ◽  
Author(s):  
Sandy Whitelaw ◽  
Claire Thirlwall ◽  
Amy Morrison ◽  
Jill Osborne ◽  
Lisa Tattum ◽  
...  
Keyword(s):  
Primary Care ◽  
Well Being ◽  
Care Staff ◽  
Data Sets ◽  
Structured Interviews ◽  
Related Data ◽  
Social Prescribing ◽  
Barriers To Change ◽  
Early Implementation

Aim To conduct a process-based evaluation of the inception and early implementation of a social prescribing initiative (Healthy Connections Stewartry) in two UK General Practices. Background Prescribing a range of social, cultural, arts and educational activities to clients in primary care (known as ‘social prescribing’ or ‘community linking schemes’) as a means of addressing long-term physical health conditions and promoting mental health and well-being is becoming increasingly prominent and popular. However, concerns exist over a lack of evidence of effectiveness and formalised insights into how such initiatives may be optimally implemented. Methods Within a case study design and using 1–1 semi-structured interviews, three related data sets were developed over a 12-month period from 30 purposively sampled informants: the project steering group; the wider primary care team; and various community groups. Data analysis drew on various theoretical resources, particularly those pertaining to nurturing sufficient capacity for the organisational ‘normalisation’ of this practice and understanding the dynamic flows and linkages between potential clients, ‘prescribing’ primary care staff and the available community resources. Findings The inception and implementation of the initiative had been broadly successful and that more generally, there were grounds to suggest that these practices were becoming ‘normalised’ into the day-to-day cultures and routines of the primary care organisations. A series of procedural features are considered significant in achieving such ends. Some specific barriers to change are identified and ultimately in the context of potential ‘transferability’, a wider reflection is undertaken of the potential for such innovative practice to become established in less advantageous organisational circumstances. Fundamental difficulties are recognised and thus the need for formally implemented ‘change’ processes. Furthermore, for social prescribing to become a pervasive feature of health-care provision, the need for necessary capacity and resources is stressed.

scholarly journals Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

2015 ◽  
Vol 23 (1) ◽  
pp. 137-143 ◽  
Author(s):  
Jing Zhang ◽  
Yunan Chen ◽  
Shazia Ashfaq ◽  
Kristin Bell ◽  
Alan Calvitti ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Patient Centered Care ◽  
Theory Approach ◽  
Care Providers ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Qualitative Interview Study ◽  
Centered Care

Abstract Objective Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish “patient-centeredness” in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Methods and Materials Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. Results The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. Discussion and Conclusion This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing “best” practices to improve patient-centered care in today’s highly “wired” health environment. These findings also show that more user-centered EHR design is needed to improve system usability.

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