Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN)

Introduction The Indonesian government has been implementing Jaminan Kesehatan Nasional (JKN) as the national universal coverage scheme to help Indonesian citizens affording medical care since 2014. However, after a few years of its implementation, a very limited study has been conducted to explore general practitioners’ (GPs) views and experiences of practicing in primary care under JKN implementation. Methods The study applied semi-structured interviews with GPs from January to February 2016, guided by a phenomenology approach in Yogyakarta province, Indonesia. The GPs were recruited using a maximum variation sample design. The interviews were recorded and transcribed, and the data were analyzed thematically. Result A total of 19 GPs were interviewed. Three major themes emerged, namely: powerlessness, clinical resources, and administration. Transition to the JKN system has improved patient access to primary care without significant economic barrier, however, GP participants experienced a sense of powerless practice during JKN implementation. They also commented on limited clinical resources and claimed that JKN administration was complicated and burdened their practice. Conclusion This study identifies various perspectives from GPs practicing in primary care under JKN implementation. The JKN improves access to primary care practice, but there are limited supports for GPs to practice optimally and maintain their relationships with patients. Extensive improvements are needed to upgrade the GP practice in primary care.

A Study of One State’s School District Physical Restraint and Seclusion Policies

This descriptive analysis of policy content examined local school district policies on physical restraint and seclusion in one Midwestern state that did not have state legislation on these topics to determine whether districts had policies and, if so, whether their content included recommended principles from the U.S. Department of Education. No previous research has addressed district policies. A maximum variation sample of 90 districts was examined to determine whether policies were in place, whether recommended principles were included, and whether policies varied based on student enrollment. Although almost all districts had policies, many of the federally recommended principles were not addressed across the sample and less than 10% of the district policies indicated that these procedures should only be used in the case of imminent danger of serious injury to self or others. District enrollment size did not affect policy, but the substance of the policy was determined by the districts’ policy source from advising attorneys.

Trust initiation and development in SME-university collaborations: implications for enabling engaged scholarship

Purpose The purpose of this study is to explore trust initiation and development in collaborations between universities and small- and medium-sized enterprises (SMEs) and the implications for enabling engaged scholarship (ES). Design/methodology/approach Adopting a qualitative inductive approach, semi-structured interviews were conducted with a purposive maximum variation sample comprising 14 SMEs and 12 university stakeholders. Findings The authors highlight the role of calculus-based trust in the initiation of collaborations emphasising the key roles of networking and referrals. As collaborations develop, reciprocal insights regarding stakeholders’ competencies and integrity and the development of knowledge-based trust can support engagement, in particular, knowledge application. Although relationships have a common sense of purpose, a fully engaged campus remains absent. Research limitations/implications This study is based on a collaborative research between eight SMEs and one university business school and does not reflect ES fully as conceptualised. It provides few insights into the role of trust (or distrust) in such collaborations where things go wrong. Practical implications Universities looking to enable ES collaborations with SMEs need to develop and enact strategies which support ongoing engagement and enable identification-based trust (IBT). Recommendations for universities and human resource development regarding interventions to support trust initiation and development to enable knowledge application ES are outlined and suggestions are offered for future research. Social implications University strategies to support the development of trust and, in particular, IBT are likely to benefit longer-term relationships and the development of ES between SMEs and universities. Originality/value Little research has been undertaken on trust initiation and development between academic and SME stakeholders or the associated implications for ES.

Diet and weight management by people with nonmetastatic colorectal cancer during chemotherapy: mixed methods research

Aim: To investigate self-management of dietary intake by colorectal cancer patients receiving chemotherapy. Methods: A questionnaire was administered to 92 patients with nonmetastatic colorectal cancer receiving chemotherapy treatment at a UK cancer center in 2018–19. A maximum variation sample of 20 patients who completed the questionnaire were interviewed. Results: More than three in five patients were at nutritional risk but fewer than one in five were concerned about dietary intake or weight. Self-management of diet and weight was inconsistent with achieving the nutritional intake recommended by clinical guidelines on nutrition in cancer. Conclusion: There is potential for psychoeducation to support change in self-management of nutritional risk, with implications for better treatment tolerance and outcomes including quality of life.

GP views on strategies to cope with increasing workload: a qualitative interview study

BackgroundThe existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.AimTo explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.Design and settingSemi-structured, qualitative interviews with GPs working within NHS England.MethodAll GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.ResultsResponses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.ConclusionThis in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.

GPs’ perceptions of workload in England: a qualitative interview study

BackgroundGPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.ConclusionThis study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.