scholarly journals Improving access to organ donor registration in general practice: a feasibility study

2020 ◽  
Vol 70 (696) ◽  
pp. e497-e504
Author(s):  
Catrin P Penn-Jones ◽  
Chris Papadopoulos ◽  
Gurch Randhawa ◽  
Zeeshan Asghar
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Mixed Methods ◽  
Focus Groups ◽  
Feasibility Study ◽  
Organ Donor ◽  
Mixed Methods Design ◽  
Waiting Room ◽  
Face To Face ◽  
The Uk

BackgroundOrgan donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting.AimTo assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice.Design and settingThe intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design.MethodStaff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups.ResultsOver 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues.ConclusionThe intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.

‘Would you like to join the NHS Organ Donor Register?’ A general practice feasibility study

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711137
Author(s):  
Catrin Pedder Jones ◽  
Chris Papadopoulos ◽  
Gurch Randhawa ◽  
Zeeshan Asghar
Keyword(s):  
General Practice ◽  
Organ Donor ◽  
Organ Donors ◽  
Practice Setting ◽  
Mixed Methods Design ◽  
Face To Face ◽  
Staff Members ◽  
The Uk ◽  
Improve Access ◽  
Family Consent

BackgroundA shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor.AimTo assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting.MethodOne general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups.ResultsThe intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked.ConclusionThis study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Intelligent Structured Intermittent Auscultation (ISIA): A Mixed Methods Evaluation of an Informed Decision-Making Framework for Fetal Heart Rate Monitoring

2021 ◽  
Author(s):  
◽  
Robyn Mary Maude
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Knowledge Translation ◽  
Focus Groups ◽  
Medical Records ◽  
Fetal Heart ◽  
Informed Decision ◽  
Low Risk ◽  
Informed Decision Making ◽  
Low Risk Women

<p>Intermittent Auscultation (IA) of the fetal heart (FH) is a screening tool for the assessment of fetal well-being during labour; the detection of changes in the FH rate and rhythm may signal fetal compromise. While the evidence reveals that IA is as effective as continuous cardiotocography (CTG) for FH monitoring for low-risk women, current practitioners favour the use of continuous CTG despite the risk of significantly increased maternal and fetal morbidity. Translating the knowledge of the effectiveness of IA into practice became the primary aim of this study. While auscultation and palpation are essential midwifery skills, the teaching of IA does not go beyond simply outlining the protocol for frequency, duration, and timing and less is understood about the underlying physiology associated with what is heard and the reassurance of fetal wellbeing that this provides. A knowledge translation intervention, in the form of an evidence-based informed decision-making framework for Intelligent Structured Intermittent Auscultation (ISIA) and a comprehensive educational intervention were developed to enhance midwives‘ knowledge and awareness of IA and to influence decision-making and practice for FH monitoring for low-risk women. A mixed methods non-experimental pre- and post - intervention study design was used to evaluate the knowledge intervention. Pre measures included a retrospective review of 511 medical records to assess existing FH monitoring practices, and focus groups with 14 midwives explored barriers and facilitators to the use of IA. The intervention was then delivered to a mix of 33 midwives and doctors three months later, followed by a second review of 422 medical records and focus groups with seven midwives to determine any changes in practice and to evaluate outcomes. The findings revealed a statistically significant increase in the use of ISIA with improved documentation, and a relative decrease of 14% in the use an admission CTG for low risk women. The ISIA framework has wide applicability in all maternity settings. This research has illuminated the effects of culture, organisation and the socio-political context on the ability for midwives to utilise their fundamental midwifery skills to promote, facilitate and protect normal physiological birth in the institutional maternity care setting. Engagement with a Knowledge Translation project and the introduction of the ISIA framework for FHR monitoring for low risk women has given midwives voice to generate change.</p>

scholarly journals Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e053099
Author(s):  
Elizabeth Rapa ◽  
Jeffrey R Hanna ◽  
Catriona R Mayland ◽  
Stephen Mason ◽  
Bettina Moltrecht ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Social Care ◽  
Psychosocial Support ◽  
Healthcare Team ◽  
Mixed Methods Design ◽  
Significant Relationships ◽  
Health And Social Care ◽  
The Uk ◽  
Parental Belief ◽  
Depth Interviews

ObjectiveThe objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative’s death during the COVID-19 pandemic.Design/settingA mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically.ParticipantsA total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals.ResultsMany children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families’ lack of understanding about their relative’s declining health; parental belief that not telling children was protecting them from becoming upset; and parents’ uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative’s relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient’s relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals’ role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult.ConclusionsProfessionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient’s significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment.

The influence of women's cognitive status on their understanding of Down syndrome screening

2020 ◽  
Vol 28 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Sophie John ◽  
Maggie Kirk ◽  
Emma Tonkin ◽  
Ian Stuart-Hamilton
Keyword(s):  
Down Syndrome ◽  
Mixed Methods ◽  
Need For Cognition ◽  
Cognitive Status ◽  
Informed Decision ◽  
Abstract Reasoning ◽  
Mixed Methods Design ◽  
Midwifery Education ◽  
The Uk ◽  
Down Syndrome Screening

Aim To establish whether women's cognitive status influenced their understanding of Down syndrome screening information, and to determine whether midwives offer the same oral explanation of Down syndrome screening to all women or if information was tailored to each woman based on their cognitive status. Methods Midwives (n=16) and women (n=100) were recruited from a regional NHS unit in the UK. A mixed-methods design encompassed two components; audio-recorded antenatal consultations and quantitative surveys to assess women's cognitive status and their understanding of Down syndrome screening information. Findings While women with abstract reasoning skills and high need for cognition (NfC) could understand information sufficiently, women with more concrete skills and low NfC require further explanation from the midwife to reach an informed decision. Conclusion Midwives did not tailor their communication based on women's cognitive status. This has implications for midwifery education programmes to train midwives to communicate Down syndrome screening information effectively.

scholarly journals A Mixed Methods Design to Detect Adolescent and Young Adults' Impulsiveness on Decision-Making and Motor Performance

2019 ◽  
Vol 10 ◽  
Author(s):  
Queralt Prat ◽  
Juan Andueza ◽  
Berta Echávarri ◽  
Oleguer Camerino ◽  
Tiago Fernandes ◽  
...  
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Mixed Methods ◽  
Motor Performance ◽  
Mixed Methods Design ◽  
Adolescent And Young Adults

PP24 Lay understanding of head injury and when an ambulance might be needed: a mixed methods study

2019 ◽  
Vol 36 (10) ◽  
pp. e11.1-e11
Author(s):  
Mary Halter ◽  
Stefan Tino Kulnik ◽  
Ann Hilton ◽  
Aidan Baron ◽  
Stuart Garner ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Head Injury ◽  
Focus Groups ◽  
Emergency Services ◽  
Life Experience ◽  
Head Injuries ◽  
Signs And Symptoms ◽  
Lower Percentage ◽  
Lay Understanding ◽  
The Uk

BackgroundHead injury results in a high use of emergency services, although most people with head injuries do not require hospitalisation. Conversely, some evidence suggests that lay recognition of the seriousness of head injury can be problematic, for example in sports settings.AimTo investigate how members of the public - parents of young children, school staff, sports coaches, informal carers of older adults, young adults and other adults - understood head injury terminology and when an emergency ambulance/999 call was required for head injury, against UK public guidance.MethodsA mixed methods exploratory study, comprising of electronic and paper self-completion surveys across the UK and focus groups or interviews. Survey data were analysed statistically against the outcomes of understanding of terms and selection of the correct action by symptom. Focus group/interview data were analysed thematically.ResultsWe received 520 survey responses, with respondents from across gender, age group, ethnicity and first aid experience. Out of 19 given signs and symptoms of head injury, participants could differentiate the most serious (e.g. unconsciousness 92% call 999) from those that could be observed (e.g. nausea 5%, and altered behaviour 5–30% call 999). The proportion of ‘correct’ actions ranged from just below half to almost 100%. Those aged 18–24 had a lower percentage of correct answers. Focus groups and/or interviews were held with 44 participants. Hypothetical scenarios elicited a range of responses, from calling 999 in any instance, to not calling in serious situations. Participants described ‘life experience’ as influential in the decision whether to call 999 or feel confident to observe.ConclusionDistinguishing severity of head injury was reported as difficult and confidence about the best course of action was low. The study was limited by regional recruitment biases, but supports the need for public health guidance in head injury.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

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