scholarly journals Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0168
Author(s):  
Pieter C Barnhoorn ◽  
Geurt TJM Essers ◽  
Vera Nierkens ◽  
Mattijs E Numans ◽  
Walther NKA van Mook ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Waiting Times ◽  
Retrospective Observational Study ◽  
Exact Nature ◽  
Out Of Hours ◽  
Face To Face ◽  
Patient Complaints ◽  
Rich Diversity ◽  
Open Coding

BackgroundProfessionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited.AimTo characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist.Design & settingA retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019).MethodComplaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding.ResultsOut of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where 'not being taken seriously' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints.ConclusionMost unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.

scholarly journals Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019233 ◽  
Author(s):  
Martine W J Huygens ◽  
Ilse C S Swinkels ◽  
Robert A Verheij ◽  
Roland D Friele ◽  
Onno C P van Schayck ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Patient Characteristics ◽  
Retrospective Observational Study ◽  
Electronic Health Record Data ◽  
Face To Face ◽  
Patients With Diabetes ◽  
General Practices ◽  
Electronic Health

ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

scholarly journals Trends in suicidal behaviour in Dutch general practice 1983–2013: a retrospective observational study

BMJ Open ◽  
2016 ◽  
Vol 6 (5) ◽  
pp. e010868 ◽  
Author(s):  
Derek P de Beurs ◽  
Mariette Hooiveld ◽  
Ad J F M Kerkhof ◽  
Joke C Korevaar ◽  
Gé A Donker
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Suicidal Behaviour ◽  
Retrospective Observational Study

scholarly journals Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Ramon PG Ottenheijm ◽  
Inge GM van’t Klooster ◽  
Laurens MM Starmans ◽  
Kurt Vanderdood ◽  
Rob A de Bie ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Retrospective Observational Study

scholarly journals Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016901 ◽  
Author(s):  
Hannah B Edwards ◽  
Elsa Marques ◽  
William Hollingworth ◽  
Jeremy Horwood ◽  
Michelle Farr ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Waiting Times ◽  
Telephone Consultation ◽  
Face To Face ◽  
Online Consultation ◽  
South West ◽  
Consultation System ◽  
General Practices ◽  
South West England

ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

scholarly journals Fifty years of longitudinal continuity in general practice: a retrospective observational study

2016 ◽  
Vol 33 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Eleanor S White ◽  
Denis Pereira Gray ◽  
Peter Langley ◽  
Philip H Evans
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Retrospective Observational Study

scholarly journals Discharge against medical advice and premature leave of neurological patients from an interdisciplinary emergency department: a retrospective observational study.

2019 ◽  
Author(s):  
Carolin Hoyer ◽  
Patrick Stein ◽  
Angelika Alonso ◽  
Michael Platten ◽  
Kristina Szabo
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Patient Flow ◽  
Waiting Times ◽  
Medical Advice ◽  
Retrospective Observational Study ◽  
Against Medical Advice ◽  
Presenting Symptoms ◽  
Neurological Patients ◽  
Discharge Against Medical Advice

Abstract Background: Discharge against medical advice (DAMA) or premature leave (PL) from the emergency department represent relevant medical problems with impact on patient safety and potential medicolegal consequences. They may also indicate structural or procedural problems in the ED. To date, no dedicated analysis of DAMA/PL exists for neurological patients presenting to the ED. Methods: A retrospective observational study was performed of all patients with neurological complaints presenting to a German interdisciplinary emergency department between January and December 2017. DAMA/PL patients were compared to the total of patients who were admitted or discharged regularly (non-DAMA/PL). Results: Of all neurological cases, 3% left against medical advice and 2.2% left prematurely. DAMA/PL patients were younger (p<.001), and their presentation was more frequently self-motivated (p<0.001. Waiting times did not differ between DAMA/PL and non-DAMA/PL patients (p=.166) but treatment duration was significantly shorter in the former (p<.001) Headaches, seizures and sensory deficits were the most frequent presenting symptoms in DAMA/PL patients, and in 56.1% of those presenting with a seizure had a history of epilepsy. The most common documented reason for leaving was the length of waiting time. Conclusions: Both individual and structural/systemic reasons contribute to DAMA/PL in neurological patients. Optimization of pre-hospital assessment and the development of alternative models of care for patients with non-urgent conditions appear to be promising targets for future improvements regarding demand management and the direction of patient flow.

scholarly journals An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Ruth A. Barragry ◽  
Leo E. Varadkar ◽  
David K. Hanlon ◽  
Ken F. Bailey ◽  
Tom C. O’Dowd ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Care Setting ◽  
Out Of Hours ◽  
Out Of Hours Care

scholarly journals Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0123
Author(s):  
Rae-Anne Hardie ◽  
Gorkem Sezgin ◽  
Chisato Imai ◽  
Emma Gault ◽  
Precious McGuire ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Diagnostic Testing ◽  
World Health Organisation ◽  
Estimating Equation ◽  
World Health ◽  
Test Collection ◽  
Face To Face ◽  
Health Technologies

BackgroundSince the World Health Organisation declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis.AimTo undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019-2020; and quantify any change in pathology test collection and follow-up patterns.Design and SettingRetrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales and Victoria, Australia.MethodMultivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for: overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range (IQR)) time.ResultsPathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face. Median time between referral and test collection was 3 days (IQR 1–14) for telehealth and 1 day (IQR 0–7) for face-to-face.ConclusionFor telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians’ workflows are supported and patients receive diagnostic testing.

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