Experiences of general practice care for self-harm: a qualitative study of young people's perspectives

Background: Self-harm is a growing concern and rates of self-harm in young people presenting to general practice are rising. There is however an absence of evidence on young people’s experiences of GP care and on accessing general practice. Aim: To explore the help-seeking behaviours, experiences of GP care, and access to general practice for young people who self-harm. Design and setting: Semi-structured interviews were conducted with young people aged 16-25 from England with previous self-harm behaviour. Method: Interviews with 13 young people occurred between April and November 2019. Young people were recruited from the community, third-sector organisation, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings. Results: Young people described avenues of help-seeking they employ and reflected on mixed experiences of seeing GPs which can influence future help-seeking. Preconceptions and a lack of knowledge on accessing general practice were found to be barriers to help-seeking. GPs who attempted to understand the young person and establishing relationship-based care can facilitate young people accessing general practice care for self-harm. Conclusion: It is therefore important young people are aware how to access general practice care and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.

Continuity in general practice and hospitalization patterns: an observational study

Background High continuity of care is a key feature of strong general practice. This study aimed to assess the effect of a programme for enhancing strong general practice care on the continuity of care in Germany. The second aim was to assess the effect of continuity of care on hospitalization patterns. Methods We performed an observational study in Germany, involving patients who received a strong general practice care programme (n=1.037.075) and patients who did not receive this programme (n=723.127) in the year 2017. We extracted data from a health insurance database. The cohorts were compared with respect to three measures of continuity of care (Usual Provider Index, Herfindahl Index, and the Sequential Continuity Index), adjusted for patient characteristics. The effects of continuity in general practice on the rates of hospitalization, rehospitalization, and avoidable hospitalization were examined in multiple regression analyses. Results Compared to the control cohort, continuity in general practice was higher in patients who received the programme (continuity measures were 12.47 to 23.76% higher, P< 0.0001). Higher continuity of care was independently associated with lowered risk of hospitalization, rehospitalization, and avoidable hospitalization (relative risk reductions between 2.45 and 9.74%, P< 0.0001). Higher age, female sex, higher morbidity (Charlson-index), and home-dwelling status (not nursing home) were associated with higher rates of hospitalization. Conclusion Higher continuity of care may be one of the mechanisms underlying lower hospitalization rates in patients who received strong general practice care, but further research is needed to examine the causality underlying the associations.

Multimorbidity in General Practice: Unmet Care Needs From a Patient Perspective

Introduction: In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases. Patients with multiple chronic conditions may benefit from a more patient-tailored approach. Therefore, our objective is to explore the general practice care needs of patients with multimorbidity from a patient perspective. We also assessed their care experiences and the impact of chronic conditions on their daily functioning.Methods: We conducted a qualitative study, using semi-structured interviews complemented with self-report questionnaire assessments for triangulation, with consenting community-dwelling patients with three or more chronic conditions. Participants were identified through purposeful sampling in three general practices. Two researchers independently coded and thematically analyzed the audiotaped and anonymously transcribed interviews using the constant comparative method. The self-report questionnaire assessments were used to describe the patient characteristics and for triangulation of the data retrieved from the semi-structured interviews.Results: After 12 interviews, saturation was achieved. Overall, most participants were positive about their relationship with the general practitioner (GP) and practice nurse (PN) as well as the care they received in general practice. However, several unmet care need themes were observed: firstly, lack of a holistic approach (by the GP and PN), in particular, insufficient attention to the patient's state of functioning, their limitations in daily life, and their well-being; secondly, they mentioned that personal continuity of care was important to them and sometimes lacking; thirdly, lack of patient-tailored explanations about diseases and treatments.Conclusion: From a community-dwelling multimorbid patient perspective, general practice care could benefit from improving personal continuity of care, attention to personal circumstances and daily functioning, and patient-tailored communication.

How do patients with malignant brain tumors experience general practice care and support? Qualitative analysis of English Cancer Patient Experience Survey (CPES) data

Background English Cancer Patient Experience Survey (CPES) data show patients with brain cancer report the least-positive experiences of general practice support. We aimed to understand these findings by identifying the issues described in qualitative survey feedback and suggest how care may be improved. Methods We reviewed 2699 qualitative comments made to open questions about what was good or might be improved about National Health Service care between 2010 and 2014. We identified 84 (3%) specific comments about general practice care and used open coding and framework analysis to develop a thematic framework. Results We identified 3 key themes and 12 subthemes: first, the experience of initial diagnosis by a general practitioner (GP), including apparent complexity of making the diagnosis, apparent slowness in referral for investigation, referral made by patient or family, delay in receiving scan results, and whether the GP quickly identified the problem and referred to a specialist; second, the experience of care and support from the general practice, including lack of supportive response from the GP, lack of follow-up care from the GP, lack of family involvement by the GP, lack of GP knowledge about management, and whether the GP responded in a supportive way to the diagnosis; and third, the experience of overall coordination in care, including lack of communication between the hospital and general practice and good communication about the care plan. Conclusion Qualitative responses from patients with brain cancer reveal their needs for better emotional and practical support within primary care. Suggestions include increasing the speed of initial referral for investigation, the depth of discussion about diagnostic difficulties, and developing coordinated care plans with cancer centers.