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

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.

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‘It’s a real fine balancing act’: directly employed care workers’ experiences of engaging with health services

International Journal of Care and Caring ◽

10.1332/239788221x16099486601224 ◽

2021 ◽

Author(s):

Jane Wilcock ◽

Jill Manthorpe ◽

Jo Moriarty ◽

Steve Iliffe

Keyword(s):

Health Services ◽

Healthcare Professionals ◽

Healthcare Providers ◽

Well Being ◽

Care Work ◽

Structured Interviews ◽

Care Workers ◽

The Impact ◽

Health And Well Being

Little is known of the experiences of directly employed care workers communicating with healthcare providers about the situations of their employers. We report findings from 30 in-depth semi-structured interviews with directly employed care workers in England undertaken in 2018–19. Findings relate to role content, communication with healthcare professionals and their own well-being. Directly employed care workers need to be flexible about the tasks they perform and the changing needs of those whom they support. Having to take on health liaison roles can be problematic, and the impact of care work on directly employed workers’ own health and well-being needs further investigation.

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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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168689 ◽

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.

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Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

BMC Primary Care ◽

10.1186/s12875-021-01610-w ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Julien A. M. Vos ◽

Robin de Best ◽

Laura A. M. Duineveld ◽

Henk C. P. M. van Weert ◽

Kristel M. van Asselt

Keyword(s):

Primary Care ◽

Colon Cancer ◽

Cancer Survivorship ◽

Daily Practice ◽

System Level ◽

Normalisation Process Theory ◽

Survivorship Care ◽

Structured Interviews ◽

Delivery Of Care ◽

Roles And Responsibilities

Abstract Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

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Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

Medicine Access Point of Care ◽

10.1177/2399202620922507 ◽

2020 ◽

Vol 4 ◽

pp. 239920262092250

Author(s):

Natalie Kennie-Kaulbach ◽

Rachel Cormier ◽

Olga Kits ◽

Emily Reeve ◽

Anne Marie Whelan ◽

...

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Behavior Change ◽

Primary Healthcare ◽

Healthcare Providers ◽

Primary Care Providers ◽

System Level ◽

Care Providers ◽

Behavior Change Wheel ◽

Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

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

British Journal of General Practice ◽

10.3399/bjgp18x700217 ◽

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.

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Implementing International Board-Certified Lactation Consultants Intervention into Routine Care: Barriers and Recommendations

Clinical Lactation ◽

10.1891/215805312807003799 ◽

2012 ◽

Vol 3 (4) ◽

pp. 131-137 ◽

Cited By ~ 1

Author(s):

Scott Hartman ◽

Josephine Barnett ◽

Karen A. Bonuck

Keyword(s):

Primary Care ◽

Low Income ◽

Healthcare Providers ◽

Routine Care ◽

System Level ◽

Healthcare Team ◽

Call To Action ◽

Department Of Health ◽

Lactation Consultants ◽

Breastfeeding Education

The Surgeon General’s 2011 Call to Action on Breastfeeding (U. S. Department of Health and Human Services, 2011) encourages greater use of International Board-Certified Lactation Consultants (IBCLCs) to increase breastfeeding rates. The objective was to examine IBCLCs’ experiences as part of a routine, primary-care based team serving low income, minority populations, and to elicit their recommendations for implementing IBCLC support as routine in prenatal care. Using a predesigned interview guide, a debriefing session was held with three IBCLCs who served as interventionists in two NIH-funded randomized controlled trials (RCTs) of breastfeeding promotion interventions. Themes were identified through coding and analysis of the session transcript. The results indicated that healthcare provider (HCP) support for breastfeeding was undermined by inadequate education and experience, often resulting in support "in name only." In addition, IBCLCs rapport and expertise—with both women and the healthcare team—helped overcome individual- and system-level barriers to breastfeeding. IBCLCs’ acceptance and integration into the primary-care team validated their work and increased their effectiveness. IBCLCs comments suggest that mothers cannot rely solely upon their healthcare providers for breastfeeding education and support. IBCLCs integrated into routine antenatal and postpartum care are pivotal to encouraging and reinforcing a woman’s choice to breastfeed through education, as well as emotional and skill-based support.

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

BMJ Open ◽

10.1136/bmjopen-2018-028251 ◽

2019 ◽

Vol 9 (5) ◽

pp. e028251 ◽

Cited By ~ 14

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.

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Digital consultations in Swedish primary health care: a qualitative study of physicians’ job control, demand and support

BMC Family Practice ◽

10.1186/s12875-020-01321-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Hanna Fernemark ◽

Janna Skagerström ◽

Ida Seing ◽

Carin Ericsson ◽

Per Nilsen

Keyword(s):

Primary Care ◽

Health Care ◽

Work Environment ◽

Primary Care Physicians ◽

Psychosocial Work Environment ◽

Mobile Telephone ◽

Full Time ◽

Psychosocial Work ◽

Structured Interviews ◽

Demand Control

Abstract Background Digital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians’ psychosocial work environment. Previous research has focused primarily on the patients’ point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians’ perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients. Methods The study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians’ perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data. Results Analysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care. Conclusions This study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.

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

British Journal of General Practice ◽

10.3399/bjgp18x696617 ◽

2018 ◽

Vol 68 (672) ◽

pp. e487-e494 ◽

Cited By ~ 14

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.

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Access to CKD Care in Rural Communities of India: A Qualitative Study Exploring the Barriers and Facilitators

10.21203/rs.2.16182/v1 ◽

2019 ◽

Author(s):

Tazeen Jafar ◽

Chandrika Ramakrishnan ◽

Oommen John ◽

Abha Tewari ◽

Benjamin Cobb ◽

...

Keyword(s):

Primary Care ◽

Rural Communities ◽

Primary Care Physicians ◽

Group Discussion ◽

Healthcare Providers ◽

Primary Care Providers ◽

System Level ◽

Rural India ◽

Care Providers ◽

Timely Initiation

Abstract Introduction Chronic kidney disease (CKD) has become a public health challenge globally, especially in lower- and middle- income countries. The implications of adverse social and economic consequences of CKD are particularly grave in a populous country like India where CKD risk factors like diabetes and hypertension are widely prevalent. Although with early detection and timely initiation of interventions CKD progression can be slowed, huge knowledge-practice gap exists. Moreover, factors that influence access to CKD care at the community level have not been studied previously. This study aimed to explore the experiences and views of key stakeholders to identify factors that influence access to CKD care in rural India. We also sought to discern the current practices and preparedness for CKD, understand the facilitators and barriers to CKD care, and feasibility and acceptability of mobile-technology based clinical decision support system (mCDSS) for CKD care in primary care.Methods Using 15 in-depth interviews and one focus group discussion (n=6), we aimed to explore the experiences and views of different stakeholdres from primary healthcare system in rural India. We employed Lévesque’s framework for access to care, and inductive and deductive approaches in the analysis. The interviews were audio-recorded and transcribed verbatim. Using QSR nVivio 11, coding and thematic analysis was undertaken.Results Our study identified barriers in relation to access to CKD care in rural India. Fore most among them was poor knowledge and lack of awareness to CKD among patients as well as primary care physicians. Health system-level barriers like shortages of skilled healthcare professionals and medicines, fragmented referrals pathways with inadequate follow up care were identified. Increasing awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a system-level approach to care coordination were key facilitators.Conclusions Lack of awareness and knowledge on CKD among primary care providers and patients, and unprepared primary care infrastructure are key barriers for access to CKD care in rural India. There is an urgent need to raise CKD awareness among primary care physicians and patients, improve supplies for diagnostics and medications, and create efficient referral pathways for CKD in primary care.

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