scholarly journals General practitioner perceptions of telehealth services in Australia: a qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0182
Author(s):  
Keshia R De Guzman ◽  
Centaine Snoswell ◽  
Chantelle M Giles ◽  
Anthony C Smith ◽  
Helen H Haydon
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Qualitative Study ◽  
Quality Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Telephone Consultation ◽  
Practitioner Perceptions ◽  
New Research

BackgroundPrimary care providers have been rapidly transitioning from in-person to telehealth care during the 2019 coronavirus (COVID-19) pandemic. There is an opportunity for new research in a rapidly evolving area, where evidence for telehealth services in primary care in the Australian setting remains limited.AimTo explore general practitioner (GP) perceptions on providing telehealth (telephone and videoconsultation) services in primary care in Australia.Design & settingA qualitative study using semi-structured interviews to gain an understanding of GP perceptions on telehealth use in Australia.MethodsGPs across Australia were purposively sampled. Semi-structured interviews were conducted, recorded, and transcribed verbatim for analysis. Transcripts were analysed using inductive thematic analysis to identify initial codes, which were then organised into themes.ResultsFourteen GPs were interviewed. Two major themes that described GP perceptions of telehealth were 1) Existence of business and financial pressures in general practice and 2) providing quality of care in Australia. These two themes interacted with four minor themes: 3) consumer-led care, 4) COVID-19 as a driver for telehealth reimbursement and adoption, 5) refining logistical processes and 6) GP experiences shape telehealth use.ConclusionThis study found that multiple considerations influence GP choice of in-person, videoconference, or telephone consultation mode. For telehealth to be used routinely within primary care settings, evidence that supports the delivery of higher quality care to patients through telehealth and sustainable funding models will be required.

scholarly journals Strategies to reach marginalized women for cervical cancer screening: A qualitative study of stakeholder perspectives

2018 ◽  
Vol 25 (1) ◽  
pp. 8 ◽  
Author(s):  
B. Wood ◽  
A. Lofters ◽  
M. Vahabi
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Qualitative Study ◽  
Cervical Cancer Screening ◽  
Health Care Providers ◽  
Cervical Screening ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Primary Screening

Background Self-sampling for human papillomavirus (hpv) has the potential to reach marginalized populations that are underserved for cervical cancer screening. However, before implementing an alternative screening strategy such as self-sampling for under- and never-screened women, the key processes, facilitators, and barriers to reform need to be understood.Methods A descriptive qualitative study was conducted that involved semi-structured interviews with Canadian and international cancer screening health care providers and policy-makers. Respondents were purposively selected from a list of thirty stakeholders generated through an environmental scan. The interviews were transcribed verbatim and analyzed using directed content analysis.Results Nineteen stakeholders participated in the interviews. Most respondents thought that self-sampling was an appropriate cervical screening alternative for hard-to-reach populations, as it addressed barriers to cervical screening related to various social determinants of health. All respondents emphasized that transitioning to hpv primary screening would catalyze a policy shift towards self-sampling. Clinician respondents were less enthusiastic about self-sampling strategies since that discouraged women’s appointments with primary care providers, because cervical screening offered an opportunity to discuss other preventive health topics. There also was little consensus between respondents on whether the state of evidence was satisfactory to integrate a self-sampling option into policy, or whether more Canadian research was needed.Conclusion Canadian cervical cancer screening stakeholders should collaborate to identify the knowledge gaps that researchers should address and leverage the existing literature to implement tailored, patient-centred alternative cervical screening strategies. The transition to hpv primary screening would be a key first step in the broad implementation of hpv self-sampling in Canada.

scholarly journals Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study

2019 ◽  
Vol 35 (4) ◽  
pp. 1044-1051 ◽  
Author(s):  
Andrea L. Nevedal ◽  
Eleanor T. Lewis ◽  
Justina Wu ◽  
Josephine Jacobs ◽  
Jeffrey G. Jarvik ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Qualitative Study ◽  
Primary Care Providers ◽  
Utilization Review ◽  
Low Back ◽  
Care Providers ◽  
Review Management

Abstract Background Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood. Objective To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain. Design Qualitative study using semi-structured interviews. Participants Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016. Approach Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI. Key Results Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns. Conclusions Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.

scholarly journals How to decide adequately? Qualitative study of GPs’ view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026786 ◽  
Author(s):  
Sarah Oslislo ◽  
Christoph Heintze ◽  
Martina Schmiedhofer ◽  
Martin Möckel ◽  
Liane Schenk ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Qualitative Content Analysis ◽  
Wide Spectrum ◽  
Influencing Factor ◽  
Primary Care Providers ◽  
Ambulatory Setting ◽  
Care Providers ◽  
Registration Number

ObjectivesPatients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients’ decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs’ perception of such patients. This qualitative study explores the GPs’ view regarding motives and competences of patients self-referring to EDs, and also GPs’ rationale for or against physician-initiated ED referrals.DesignQualitative study with semi-structured, face-to-face interviews; qualitative content analysis.SettingGP practices in Berlin, Germany.Participants15 GPs (female/male: 9/6; mean age 53.6 years).ResultsThe interviewed GPs related a wide spectrum of factors potentially influencing their patients’ decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients’ surmised rationale corresponded to GPs’ reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients’ health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy.ConclusionsHealth education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals.Trial registration numberDRKS00011930.

Understanding Adolescent Expressions of Sadness: A Qualitative Exploration

2020 ◽  
Vol 34 (4) ◽  
pp. 321-339
Author(s):  
Daniela A. Terrizzi ◽  
Huma A. Khan ◽  
Allison Paulson ◽  
Zach Abuwalla ◽  
Nitza Solis ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Depressive Disorder ◽  
Primary Care Providers ◽  
Epidemiologic Studies ◽  
Empirical Literature ◽  
Subthreshold Depression ◽  
Care Providers ◽  
Structured Interviews ◽  
Risk For Depression

PurposePrimary care providers are positioned to identify adolescents at risk for depression and prevent major depressive disorder. To identify subthreshold depression, we examined the language adolescents use to describe their symptoms.MethodsAdolescents ages 13–18 with elevated levels on the Center for Epidemiologic Studies Depression (CES-D) scale and/or a history of depression who were part of a large randomized clinical trial to prevent depressive disorder were included. We used content analysis to analyze transcripts of semi-structured interviews.ResultsSaturation was reached at 37 interviews. Adolescents self-identified as African American (N = 15), Hispanic (N = 10), and White (N = 21). Three domains were revealed; external sources of stress, adolescent expressions of sadness, and seeking help and care. Within these domains, 12 distinct themes emerged contextualizing these domains. No variations in the expression of the themes identified for subthreshold depression were found between the three ethno-cultural groups.Implications for PracticeOur study identifies, in adolescents' own words, how adolescents with subthreshold depression express feelings and cope with symptoms, and may guide primary care providers to recognize subthreshold depression early. These findings are a step toward filling the gap in the empirical literature needed to improve identification of adolescents at risk for depression in nonspecialist settings.

scholarly journals Primary care providers’ experiences caring for complex patients in primary care: a qualitative study

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Danielle F. Loeb ◽  
Elizabeth A. Bayliss ◽  
Carey Candrian ◽  
Frank V. deGruy ◽  
Ingrid A. Binswanger
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Providers ◽  
Care Providers ◽  
Complex Patients
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