1
|
Babu D, Rowett D, Kalisch Ellett L, Marotti S, Wisdom A, Lim R, Harmon J. Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory. Res Social Adm Pharm 2024; 20:654-664. [PMID: 38627153 DOI: 10.1016/j.sapharm.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored. OBJECTIVE Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory. METHOD A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique). RESULTS Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation. CONCLUSION Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.
Collapse
Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia.
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Adelaide, SA, 5000, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Joanne Harmon
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| |
Collapse
|
2
|
Figueredo-Borda N, Ramírez-Pereira M, Gaudiano P, Cracco C, Ramos B. Experiences of miscarriage: the voice of parents and health professionals. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:777-794. [PMID: 35354387 DOI: 10.1177/00302228221085188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The death of a child in the intrauterine stage has legal, psychological, spiritual, and health-related connotations that condition the woman's experience. To understand better the processes set in motion around early pregnancy loss, this ethnographic study explores the experiences of miscarriage in a group of 15 women. The following themes are analyzed: Experience of losing the child, spirituality, health care, and the need to physically recognize the child. The study shows that the need women have to honor the child who did not live may be conditioned by the perception of an uncertain loss and by the absence of a place to honor him/her. Attitudes among professionals are revealed that could be perceived as gender-related abuse. The care of women places emphasis on physical aspects, underlining the lack of comprehensive care during the grieving process.
Collapse
Affiliation(s)
| | | | - Pedro Gaudiano
- Departamento de Humanidades y Comunicación, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Cecilia Cracco
- Departamento de Psicología, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Beatriz Ramos
- Departamento de Derecho, Universidad Católica del Uruguay, Montevideo, Uruguay
| |
Collapse
|
3
|
Sutherland AB, Phipps DL, Grant S, Hughes J, Tomlin S, Ashcroft DM. Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. ERGONOMICS 2024:1-15. [PMID: 38557363 DOI: 10.1080/00140139.2024.2333396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews. We found that a combination of the physical environment, traditional work systems and team norms were among the systemic barriers to medicines safety. The layout of wards discouraged teamworking and reinforced professional boundaries. Workspaces were inadequate, and interruptions were uncontrollable. A less experienced workforce undertook prescribing and verification while more experienced nurses undertook administration. Guidelines were inadequate, with actors muddling through together. Formal controls against ADEs included checking (of prescriptions and administration) and barcode administration systems, but these did not integrate into workflows. Families played an important part in the safe administration of medication and provision of information about their children but were isolated from other parts of the system.
Collapse
Affiliation(s)
- Adam B Sutherland
- Medicines Optimisation Research Group, School of Pharmacy & Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Pharmacy Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denham L Phipps
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | - Suzanne Grant
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Stephen Tomlin
- Children's Medicines Research & Innovation Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| |
Collapse
|
4
|
Mills S, Kaner EFS, Ramsay SE, McKinnon I. What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? A focused ethnographic approach. BMJ Open 2024; 14:e079406. [PMID: 38553050 PMCID: PMC10982710 DOI: 10.1136/bmjopen-2023-079406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients' physical and mental health. This study sought to identify the key influences and challenges around weight management in UK adult secure mental health settings. DESIGN Qualitative focused ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis. SETTING Low secure male mental health ward and associated patient activities and events, in a National Health Service Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK. PARTICIPANTS 12 males (primarily white British) on the low secure ward; additional male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a 6-month period from April 2022. RESULTS Secure mental healthcare delivered an environment predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and a ward culture that was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting. CONCLUSIONS Weight management in secure services is a complex challenge. In future, whole setting-based interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.
Collapse
Affiliation(s)
- Susanna Mills
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen F S Kaner
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Iain McKinnon
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
5
|
Assing Hvidt E. "Time work": An analysis of temporal experiences and agentic practices in the "good" doctor-patient relationship in general practice. Health (London) 2024; 28:144-160. [PMID: 35904109 DOI: 10.1177/13634593221116504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article contributes to social health research by presenting an analysis of the temporal dimensions of the "good" doctor-patient relationship as perceived and enacted by patients and general practitioners (GPs). The empirical data derive from ethnographic fieldwork comprising participant observation in four general practice clinics in Denmark, and semi-structured interviews with 27 patients and eight GPs. The analysis draws from Michael Flaherty's sociology of time: notions of temporal agency and "time work" are used as analytical tools to demonstrate that the "good" doctor-patient relationship is constructed in a tension between external temporal structures and internal temporal experiences that are the result of GPs' and patients' agentic practices of "doing time." Thus, the findings illustrate how temporal determinism and self-determinism are equally interwoven when GPs and patients talk about, enact and seek meaningful temporal experiences within the doctor-patient relationship, while resisting and avoiding others that undermine the relationship. The results challenge 1. deterministic conceptions of time demands in today's healthcare systems that are said to control healthcare providers' behavior and 2. the taken-for-granted understanding of continuity as a resource in itself.
Collapse
|
6
|
Kaplan DB, Glazner G. Dementia Arts Mapping: observational methods for documenting impacts of poetry and recreation in care settings. Arts Health 2023:1-14. [PMID: 38007816 DOI: 10.1080/17533015.2023.2283530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Long-term care homes for older and disabled adults, including those who are living with dementia, facilitate a diversity of recreational activities and program as social interventions. The relationships between interventional elements and participant impacts are not well understood. METHODS This paper explores a poetry methodology and reports the findings from a pilot test of Dementia Arts Mapping, a novel ethnographic observational technique, to better understand impacts of poetry and recreation on people living with dementia in long-term care settings. Between 2017 and 2020, at 17 skilled nursing facilities throughout Wisconsin, researchers situated within care homes observed participants during diverse activities. RESULTS We found poetry workshops surpassed other activities in eliciting self-expression. CONCLUSIONS Dementia Arts Mapping is an effective instrument for generating insights about dementia care and may be further enhanced for future use in research to inform care provision to foster meaningful engagement with people with dementia.
Collapse
Affiliation(s)
- Daniel B Kaplan
- Adelphi University School of Social Work, Garden City, NY, USA
| | - Gary Glazner
- Alzheimer's Poetry Project LLC, Chicago, IL, USA
| |
Collapse
|
7
|
Scott S, Atkins B, Martin-Kerry JM, Pritchard M, Alldred DP, Clark AB, Colles A, Hammond A, Murphy K, Keevil VL, Kellar I, Patel M, Sims E, Taylor J, Turner D, Witham M, Wright D, Bhattacharya D. CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention. BMJ Open 2023; 13:e075795. [PMID: 37541754 PMCID: PMC10407388 DOI: 10.1136/bmjopen-2023-075795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation. METHODS AND ANALYSIS A two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken. ETHICS AND DISSEMINATION Ethics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION ISRCTN11899506.
Collapse
Affiliation(s)
- Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Bethany Atkins
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Megan Pritchard
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Antony Colles
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amber Hammond
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katherine Murphy
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Victoria L Keevil
- Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
- Older People's Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erika Sims
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
- AGE Research Group, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - David Wright
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
- School of Pharmacy, University of Bergen, Bergen, Norway
| | - Debi Bhattacharya
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
8
|
Smith J, Ellins J, Sherlaw-Johnson C, Vindrola-Padros C, Appleby J, Morris S, Sussex J, Fulop NJ. Rapid evaluation of service innovations in health and social care: key considerations. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-47. [PMID: 37796483 DOI: 10.3310/btnu5673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31).
Collapse
Affiliation(s)
- Judith Smith
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | | | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Sussex
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
9
|
Sikstrom L, Maslej MM, Findlay Z, Strudwick G, Hui K, Zaheer J, Hill SL, Buchman DZ. Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry. BMJ Open 2023; 13:e069255. [PMID: 37185650 PMCID: PMC10151964 DOI: 10.1136/bmjopen-2022-069255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML. METHODS AND ANALYSIS We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups. ETHICS AND DISSEMINATION The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.
Collapse
Affiliation(s)
- Laura Sikstrom
- The Krembil Centre for Neuroinformatics, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Marta M Maslej
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zoe Findlay
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hui
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean L Hill
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Weber F, Müller C, Bahns C, Kopkow C, Färber F, Gellert P, Otte I, Vollmar HC, Brannath W, Diederich F, Kloep S, Rothgang H, Dieter V, Krauß I, Kloek C, Veenhof C, Collisi S, Repschläger U, Böbinger H, Grüneberg C, Thiel C, Peschke D. Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial. BMC Musculoskelet Disord 2023; 24:221. [PMID: 36959595 PMCID: PMC10034894 DOI: 10.1186/s12891-023-06255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Introduction Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-023-06255-7.
Collapse
Affiliation(s)
- Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carsten Müller
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Carolin Bahns
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Francesca Färber
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ina Otte
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Freya Diederich
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Stephan Kloep
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Valerie Dieter
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Inga Krauß
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Corelien Kloek
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Cindy Veenhof
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Sandra Collisi
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Ute Repschläger
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Hannes Böbinger
- grid.492243.a0000 0004 0483 0044Innovationsfonds & Produktportfolio, Techniker Krankenkasse, Hamburg, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Dirk Peschke
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| |
Collapse
|
11
|
Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
Collapse
Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
12
|
Wagner A, Tsarouha E, Ög E, Preiser C, Rieger MA, Rind E. Work-related psychosocial demands related to work organization in small sized companies (SMEs) providing health-oriented services in Germany - a qualitative analysis. BMC Public Health 2022; 22:390. [PMID: 35209852 PMCID: PMC8866918 DOI: 10.1186/s12889-022-12700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Micro, small and medium-sized enterprises (SMEs) represent the majority of businesses in the EU. Little is known about psychosocial demands faced by company owners, managers, and employees in SMEs, especially in the health and service sector. The current study aimed to identify which psychosocial demands related to work organization are reported by managers and employees in the health and service sector, and if managers and employees differ in their perspective on these psychosocial demands. METHODS We conducted nine single interviews and two focus group discussions with seven company owners and managers as well as eleven employees from six different German companies between January and February 2020. The psychosocial factors of the psychosocial risk assessment of the Joint German Occupational Safety and Health Strategy (GDA) served as a framework for data collection and analysis. The interview material was analysed using Mayring's method of qualitative content analysis. RESULTS We identified four prevailing work-related psychosocial demands related to work organization among managers and employees: (1) possibilities and time for recovery after work, (2) communication and cooperation, (3) work intensity, and (4) interruptions, and prioritization. According to the managers, they were confronted with a lack of possibilities and time for recovery after work. They report issues related to inadequate communication and cooperation affecting the entire company team, and also face high work intensity and frequent interruptions and prioritization. Employees reported a clearer division between work and private life. However, they also face periods of high work intensity, frequent interruptions and the need for prioritization. CONCLUSION Managers and employees in SMEs in the health and service sector would benefit from evidence-based and evaluated tailored interventions and approaches for improved work organization. Further studies are needed to support managers and employees in SMEs in the health and service sector in facing and handling work-related psychosocial demands like lack of possibilities and time for recovery after work, high work intensity or frequent interruptions.
Collapse
Affiliation(s)
- Anke Wagner
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Eylem Ög
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| |
Collapse
|
13
|
Disaster Risk Reduction Regime in Japan: An Analysis in the Perspective of Open Data, Open Governance. SUSTAINABILITY 2021. [DOI: 10.3390/su14010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper addresses open data, open governance, and disruptive/emerging technologies from the perspectives of disaster risk reduction (DRR). With an in-depth literature review of open governance, the paper identifies five principles for open data adopted in the disaster risk reduction field: (1) open by default, (2) accessible, licensed and documented, (3) co-created, (4) locally owned, and (5) communicated in ways that meet the needs of diverse users. The paper also analyzes the evolution of emerging technologies and their application in Japan. The four-phased evolution in the disaster risk reduction is mentioned as DRR 1.0 (Isewan typhoon, 1959), DRR 2.0 (the Great Hanshin Awaji Earthquake, 1995), DRR 3.0 (the Great East Japan Earthquake and Tsunami: GEJE, 2011) and DRR 4.0 (post GEJE). After the GEJE of 2011, different initiatives have emerged in open data, as well as collaboration/partnership with tech firms for emerging technologies in DRR. This paper analyzes the lessons from the July 2021 landslide in Atami, and draws some lessons based on the above-mentioned five principles. Some of the key lessons for open data movement include characterizing open and usable data, local governance systems, co-creating to co-delivering solutions, data democratization, and interpreting de-segregated data with community engagement. These lessons are useful for outside Japan in terms of data licensing, adaptive governance, stakeholder usage, and community engagement. However, as governance systems are rooted in local decision-making and cultural contexts, some of these lessons need to be customized based on the local conditions. Open governance is still an evolving culture in many countries, and open data is considered as an important tool for that. While there is a trend to develop open data for geo-spatial information, it emerged from the discussion in the paper that it is important to have customized open data for people, wellbeing, health care, and for keeping the balance of data privacy. The evolution of emerging technologies and their usage is proceeding at a higher speed than ever, while the governance system employed to support and use emerging technologies needs time to change and adapt. Therefore, it is very important to properly synchronize and customize open data, open governance and emerging/disruptive technologies for their effective use in disaster risk reduction.
Collapse
|
14
|
Preiser C, Tsarouha E, Weltermann B, Junne F, Seifried-Dübon T, Hartmann S, Bleckwenn M, Rieger MA, Rind E. Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany. J Occup Med Toxicol 2021; 16:47. [PMID: 34663355 PMCID: PMC8522246 DOI: 10.1186/s12995-021-00336-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team? Methods Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach. Results GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors. Conclusion We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-021-00336-w.
Collapse
Affiliation(s)
- Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany. .,Centre for Public Health and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany.
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, Faculty of Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, 72076, Tuebingen, Germany
| | - Sigrid Hartmann
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074, Tuebingen, Germany
| | | |
Collapse
|
15
|
Cubellis L, Schmid C, von Peter S. Ethnography in Health Services Research: Oscillation Between Theory and Practice. QUALITATIVE HEALTH RESEARCH 2021; 31:2029-2040. [PMID: 34286610 PMCID: PMC8552374 DOI: 10.1177/10497323211022312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The well-known divergence between what policy and protocol look like on paper, and what happens in the actual practice of daily life remains a central challenge in health services provision and research. This disparity is usually referred to as the theory-practice gap and contributes to concerns that scientific evidence fails to make substantial impacts on the processes of service delivery. In this article, we present an argument for the inclusion of ethnographic methods in health services research and show that this approach enables researchers to address this divergence by working within it. We trace how ethnography, through generative processes of oscillation, can take us beyond lamenting the gap and capture the relational dynamics of people working together in complex systemic arrangements. By moving from example to methodological reflection, to principle of research, we demonstrate how the oscillation of ethnographic research between theory and practice can productively contribute to the field of health service research.
Collapse
Affiliation(s)
- Lauren Cubellis
- Freie Universität Berlin, Berlin, Germany
- Lauren Cubellis, Freie Universität Berlin, Ehrenbergstr. 26/28, 14195 Berlin, Germany.
| | | | | |
Collapse
|
16
|
Wong JYH, Ho JWC, Lee AM, Fong DYT, Chu N, Leung S, Chan YYW, Lam SH, Leung IPF, Macfarlane D, Cerin E, Taylor AJ, Cheng KK. Lived experience of dietary change among Chinese colorectal cancer survivors in Hong Kong: A qualitative study. BMJ Open 2021; 11:e051052. [PMID: 34433608 PMCID: PMC8388278 DOI: 10.1136/bmjopen-2021-051052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This is a qualitative study which aims to understand the lived experience of dietary changes among Chinese survivors of colorectal cancer who participated in a dietary intervention. SETTING The surgical and oncological departments of four public hospitals in Hong Kong. PARTICIPANTS Fifty-five Chinese colorectal cancer survivors who were aged 18 years or above and had received potentially curative treatment in the surgical and oncological departments in Hong Kong were examined. Participants' mean age was 64 years, with 29 (53%) males. INTERVENTION A 12-month dietary intervention delivered via face-to-face motivational interviews, fortnightly motivational phone calls, monthly electronic pamphlets, quarterly newsletters and quarterly group meeting. OUTCOME MEASURE We adopted the qualitative approach to capture participants' perspectives and to apply the understanding pragmatically in everyday life. Content analysis was conducted. RESULTS We identified themes of motives to changes of dietary practices including (1) individual commitment to dietary change; (2) adaptive strategies in interpersonal contexts and (3) working with healthcare professionals during the journey. CONCLUSIONS The findings demonstrated how Chinese custom and culture posing unique challenges to colorectal cancer survivors and the need of having dietary advice from healthcare professionals. Participants were motivated to change their eating habits by support from family, friends and healthcare professionals. Our findings could help healthcare professionals provide specific dietary advice and guidance to Chinese colorectal cancer survivors. TRIAL REGISTRATION NUMBER NCT01708824.
Collapse
Affiliation(s)
- Janet Yuen Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Judy Wai Chu Ho
- Division of Colorectal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Antoinette Marie Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Natural Chu
- Division of Colorectal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Sharron Leung
- Division of Nursing Education, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Y Y Wynnie Chan
- School of Professional and Continuing Education, University of Hong Kong, Hong Kong, Hong Kong
| | - Sharon Hs Lam
- Division of Colorectal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ivy P F Leung
- Department of Dietetics, Queen Elizabeth Hospital, Hospital Authority Kowloon Central Cluster, Kowloon, Hong Kong
| | - Duncan Macfarlane
- Institute of Human Performance, University of Hong Kong, Hong Kong, Hong Kong
| | - Ester Cerin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Aliki J Taylor
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Kar Keung Cheng
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| |
Collapse
|
17
|
Perioperative antimicrobial decision making: Focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital. Infect Control Hosp Epidemiol 2021; 41:645-652. [PMID: 32183916 DOI: 10.1017/ice.2020.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs. DESIGN In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery. SETTING This study was conducted at a public, quaternary, university-affiliated hospital. PARTICIPANTS Healthcare professionals from the 2 surgical unit teams participated in the study. METHODS We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient's journey from the preadmission clinic to the operating room to the postoperative ward. RESULTS We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient's journey, communication with the patient about antimicrobial use was limited (theme 4). CONCLUSIONS Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.
Collapse
|
18
|
Geffroy M, Pagès N, Chavernac D, Dereeper A, Aubert L, Herrmann-Storck C, Vega-Rúa A, Lecollinet S, Pradel J. Shifting From Sectoral to Integrated Surveillance by Changing Collaborative Practices: Application to West Nile Virus Surveillance in a Small Island State of the Caribbean. Front Public Health 2021; 9:649190. [PMID: 34178915 PMCID: PMC8222804 DOI: 10.3389/fpubh.2021.649190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
After spreading in the Americas, West Nile virus was detected in Guadeloupe (French West Indies) for the first time in 2002. Ever since, several organizations have conducted research, serological surveys, and surveillance activities to detect the virus in horses, birds, mosquitoes, and humans. Organizations often carried them out independently, leading to knowledge gaps within the current virus' situation. Nearly 20 years after the first evidence of West Nile virus in the archipelago, it has not yet been isolated, its impact on human and animal populations is unknown, and its local epidemiological cycle is still poorly understood. Within the framework of a pilot project started in Guadeloupe in 2019, West Nile virus was chosen as a federative model to apply the "One Health" approach for zoonotic epidemiological surveillance and shift from a sectorial to an integrated surveillance system. Human, animal, and environmental health actors involved in both research and surveillance were considered. Semi-directed interviews and a Social Network Analysis were carried out to learn about the surveillance network structure and actors, analyze information flows, and identify communication challenges. An information system was developed to fill major gaps: users' needs and main functionalities were defined through a participatory process where actors also tested and validated the tool. Additionally, all actors shared their data, which were digitized, cataloged, and centralized, to be analyzed later. An R Shiny server was integrated into the information system, allowing an accessible and dynamic display of data showcasing all of the partners' information. Finally, a series of virtual workshops were organized among actors to discuss preliminary results and plan the next steps to improve West Nile Virus and vector-borne or emerging zoonosis surveillance. The actors are willing to build a more resilient and cooperative network in Guadeloupe with improved relevance, efficiency, and effectiveness of their work.
Collapse
Affiliation(s)
- Mariana Geffroy
- CIRAD, UMR, ASTRE, Petit-Bourg, France.,ASTRE, CIRAD, INRAE. Univ Montpellier, Montpellier, France
| | - Nonito Pagès
- ASTRE, CIRAD, INRAE. Univ Montpellier, Montpellier, France
| | | | - Alexis Dereeper
- CIRAD, UMR, ASTRE, Petit-Bourg, France.,ASTRE, CIRAD, INRAE. Univ Montpellier, Montpellier, France
| | - Lydéric Aubert
- CIRE Antilles, Santé Publique France, Pointe-à-Pitre, France
| | - Cecile Herrmann-Storck
- Centre Hospitalier Universitaire, Department of Bacteriology, Virology and Parasitology, Pointe-à-Pitre, France
| | - Anubis Vega-Rúa
- Institut Pasteur de Guadeloupe, Laboratory of Vector Control Research, Unit Transmission, Reservoirs and Pathogen Diversity, Les Abymes, France
| | - Sylvie Lecollinet
- Anses, Laboratory for Animal Health, UMR1161 Virology, INRAE, Anses, ENVA, Maisons-Alfort, France
| | - Jennifer Pradel
- CIRAD, UMR, ASTRE, Petit-Bourg, France.,ASTRE, CIRAD, INRAE. Univ Montpellier, Montpellier, France
| |
Collapse
|
19
|
Rankl F, Johnson GA, Vindrola-Padros C. Examining What We Know in Relation to How We Know It: A Team-Based Reflexivity Model for Rapid Qualitative Health Research. QUALITATIVE HEALTH RESEARCH 2021; 31:1358-1370. [PMID: 33745367 PMCID: PMC8182295 DOI: 10.1177/1049732321998062] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Reflexivity constitutes a core component of qualitative research and has been actively integrated into long-term and "lone ranger" approaches to qualitative research. However, its application to team-based approaches and particularly to rapid qualitative team-based approaches continues to lag behind. In this article, we introduce a reflexivity model we developed for teams undertaking rapid qualitative studies. Utilizing our most recent application of this model to a rapid qualitative appraisal of health care workers' experiences delivering care during the COVID-19 pandemic as a case study, we identify the steps to put this model into practice and its main outcomes. Our application of the model revealed that the team's practices could be grouped along four dimensions: design assumptions, data collection and analysis processes, multidisciplinary collaboration, and responsible dissemination. Reflexivity can improve the relations within the team and the quality of the research output, if it is implemented as a continuous and iterative process.
Collapse
Affiliation(s)
- Felicia Rankl
- University College London, London,
United Kingdom
- Nuffield College, University of
Oxford, Oxford, United Kingdom
- Felicia Rankl, Nuffield College,
University of Oxford, New Road, Oxford OX1 1NF, UK.
| | | | | |
Collapse
|
20
|
Dong KA, Lavergne KJ, Salvalaggio G, Weber SM, Xue CJ, Kestler A, Kaczorowski J, Orkin AM, Pugh A, Hyshka E. Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study. J Am Coll Emerg Physicians Open 2021; 2:e12409. [PMID: 33969340 PMCID: PMC8082712 DOI: 10.1002/emp2.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the perspectives of Canadian emergency physicians on the care of patients with opioid use disorders in the emergency department (ED), in particular the real-world facilitators to prescribing buprenorphine/naloxone (BUP) in the ED. METHODS We conducted semistructured qualitative interviews using a multi-site-focused ethnographic design. Purposive sampling via an existing national research network was used to recruit ED physicians. Interviews were conducted by phone using an interview guide and continued until theoretical data saturation was reached. Interviews were transcribed and analyzed using latent content analysis. Interviews took place between June 21, 2019, and February 11, 2020. RESULTS A total of 32 physicians were included in the analysis. Participants had a median of 10 years of experience, and most (29/32) worked in urban settings. Clinical care of patients with opioid use disorder was found to be variable and physician dependent. Although some physicians reported routinely prescribing BUP, others felt that this was outside the clinical scope of emergency medicine. Access to clinical pathways, incentivized training, dedicated human resources, and follow-up care were identified as critical facilitators for supporting BUP prescribing. Participants also identified a shared responsibility between patients and the ED, including the importance of a patient-centered approach that enhanced patient autonomy. ED BUP prescribing became self-reinforcing over time. CONCLUSIONS Although there remains practice variability among Canadian emergency physicians, successful implementation of ED BUP prescribing has occurred in some locations. Jurisdictions wanting to facilitate BUP uptake should consider providing incentivized training, treatment protocols, dedicated human resources, and streamlined access to follow-up care.
Collapse
Affiliation(s)
- Kathryn A. Dong
- Department of Emergency MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Karine J. Lavergne
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
- Employment and Social Development CanadaGatineauQuébecCanada
| | | | | | - Cindy Jiaxin Xue
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrew Kestler
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Janusz Kaczorowski
- Department of Family and Emergency MedicineUniversity of Montreal and University of Montreal Hospital Research CentreMontrealQuebecCanada
| | - Aaron M. Orkin
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Arlanna Pugh
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
- CASA Child, Adolescent and Family Mental HealthEdmontonAlbertaCanada
| | - Elaine Hyshka
- School of Public HealthUniversity of AlbertaEdmontonAlbertaCanada
| |
Collapse
|
21
|
Gertner AK, Franklin J, Roth I, Cruden GH, Haley AD, Finley EP, Hamilton AB, Palinkas LA, Powell BJ. A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34056611 PMCID: PMC8153409 DOI: 10.1177/2633489521992743] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Researchers have argued for the value of ethnographic approaches to implementation science (IS). The contested meanings of ethnography pose challenges and possibilities to its use in IS. The goal of this study was to identify sources of commonality and variation, and to distill a set of recommendations for reporting ethnographic approaches in IS. Methods: We included in our scoping review English-language academic journal articles meeting two criteria: (1) IS articles in the healthcare field and (2) articles that described their approach as ethnographic. In March 2019, we implemented our search criteria in four academic databases and one academic journal. Abstracts were screened for inclusion by at least two authors. We iteratively develop a codebook for full-text analysis and double-coded included articles. We summarized the findings and developed reporting recommendations through discussion. Results: Of the 210 articles whose abstracts were screened, 73 were included in full-text analysis. The number of articles increased in recent years. Ethnographic approaches were used within a wide variety of theoretical approaches and research designs. Articles primarily described using interviews and observational methods as part of their ethnographic approaches, though numerous other methods were also employed. The most cited rationales for using ethnographic approaches were to capture context-specific phenomena, understand insiders’ perspective, and study complex interactions. In reporting on ethnographic approaches, we recommend that researchers provide information on researcher training and position, reflect on researchers’ positionality, describe observational methods in detail, and report results from all the methods used. Conclusion: The number of IS studies using ethnography has increased in recent years. Ethnography holds great potential for contributing further to IS, particularly to studying implementation strategy mechanisms and understanding complex adaptive systems. Researchers have proposed that ethnographic methods may be valuable to implementation research and practice. Ethnographic approaches have their roots in the field of anthropology, but they are now used in many fields. These approaches often involve a researcher spending time in “real-world” settings, conducting interviews and observation to understand a group of people. That said, researchers disagree on the meaning of ethnography, which presents a challenge to its use in implementation science (IS). We searched for articles in the field of IS that described their methods as ethnographic. We then reviewed the articles, looking for similarities and differences in how and why ethnographic approaches were used. Many of these articles said they used ethnographic methods because they were interested in issues like context, research participants’ views, and complex interactions. We found a large amount of variation in how ethnographic methods were used. We developed recommendations for describing ethnographic methods in a way that readers can clearly understand. We also made several observations of the value ethnographic approaches can bring to IS. Ethnographic methods may be especially useful to studying unplanned and unexpected changes that take place during implementation. These recommendations and observations could be helpful to implementation researchers wishing to use ethnographic methods.
Collapse
Affiliation(s)
- Alex K Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua Franklin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin P Finley
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, University of Southern California, Los Angeles, CA, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
22
|
Bogaert B, Petit J. Patient empowerment as capabilities: The perspective of patients with epilepsy at a medical-social center in France. Epilepsy Behav 2021; 116:107795. [PMID: 33545653 DOI: 10.1016/j.yebeh.2021.107795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
The aim of the study was to develop a new conceptual framework of empowerment based upon the perspective of patients with refractory epilepsy at the medical-social center of La Teppe (France). A qualitative research methodology was used, which consisted of focused ethnography and in-depth interviews. The 19 patients interviewed came from three hospital services and were in the age range of 20-60. Ten interviews were also conducted with healthcare providers, which included neurologists, psychiatrists, nurses, and social educators. Results were analyzed via an intuitive process of thematic analysis. The researcher also constructed narrative cases of the patient interview to better understand patient responses in context. The results show that patients understood empowerment as the ability to develop and take advantage of opportunities in their overall lives. This included searching to be healthy by reducing their seizures, developing their practical reason in order to be able to make more autonomous life choices, and living with and toward others in positive social relationships. The patient's perspective on empowerment encompasses but also goes beyond their medical care. We therefore propose a novel conceptual framework for empowerment as the patient's capabilities to develop and make their life choices, with help as needed from their support network. In order to help patients toward empowerment, clinical care can include discussions and dedicate resources that help patients work toward their overall life projects. Several methodologies, including the use of a personalized project and therapeutic patient education, are elaborated to give ideas for empowerment programming in epilepsy care.
Collapse
Affiliation(s)
- Brenda Bogaert
- Institute of Philosophical Research, University Jean Moulin Lyon III, 18 rue Chevreul, 69007 Lyon, France; University Lyon I, Laboratory of Science, Society, History, Education and Practice (S2HEP), Lyon, France.
| | - Jérôme Petit
- Medical Center of La Teppe, 25 Avenue de la Bouterne, 26600 Tain-l'Hermitage, France.
| |
Collapse
|
23
|
Tsarouha E, Preiser C, Weltermann B, Junne F, Seifried-Dübon T, Stuber F, Hartmann S, Wittich A, Rieger MA, Rind E. Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197114. [PMID: 32998397 PMCID: PMC7579545 DOI: 10.3390/ijerph17197114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
General practices are established microenterprises in Germany providing a variety of preventive and therapeutic health care services and procedures in a challenging working environment. For example, general practice teams are confronted increasingly with work-related demands, which have been associated with poor psychological and physical outcomes. It is therefore important to gain a better understanding of issues related to occupational health and safety for personnel working in the primary care setting. This study aims to gain an in-depth understanding of psychosocial demands and resources in the primary care setting. We applied an ethnographic design, comprising a combination of participating observations, individual interviews with general practitioners (GPs) (N = 6), and focus group discussion with practice assistants and administrative staff (N = 19) in five general practices in Germany. A grounded theory approach was applied to analyze all data. Our results identified psychosocial demands and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial demands included factors related to work content and tasks, organization of work, and the working environment. For example, daily routines across all practices were characterized by a very high work intensity including disturbances, interruptions, delegation, and the division of labor between GPs and practice staff. Work-related resources comprised the staff’s influence on aspects related to work organization and social support. The triangulation of methods and data formats allowed the disclosure of interconnectedness between these factors. Although work processes in general practices are complex and required to comply with legal regulations, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.
Collapse
Affiliation(s)
- Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, Faculty of Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany;
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Sigrid Hartmann
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Andrea Wittich
- Occupational Psychologist and Psychotherapist, Tuebingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Correspondence:
| |
Collapse
|
24
|
Bogaert B. Untangling fear and eudaimonia in the healthcare provider-patient relationship. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:457-469. [PMID: 32436140 DOI: 10.1007/s11019-020-09956-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ensuring patient participation in healthcare decision making remains a difficult task. Factors such as a lack of time in the consultation, medical objectivation, or the difficulties of translating individual patient experience into the treatment plan have been shown to limit patient contributions. Little research attention has focused however on how emotions experienced by both the patient and the healthcare provider may affect the ability of the patient to participate. In this research, patient's and healthcare provider's emotions were identified and analysed. The research method showed fear as a prominent emotion experienced. This included patient's fears both inside and outside the consultation, as well as the healthcare provider's fears in their professional practice. Using Martha Nussbaum's cognitive-evaluative theory of emotions as an additional means of analysis, the research looked at what this emotion could show about the importance of the object of this fear to the person's eudaimonia (flourishing). At the end of the article, several solutions were proposed to help mitigate this fear to keep it from becoming a destructive force in the healthcare provider-patient relationship.
Collapse
Affiliation(s)
- Brenda Bogaert
- Healthcare Values Chair, Institut de Recherches Philosophiques de Lyon, Université Jean Moulin, 18 rue Chevreul, 69007, Lyon, France.
- Laboratory of Sciences, Société, Historicité, Éducation et Pratiques (S2HEP), Université Lyon 1, Villeurbanne, France.
| |
Collapse
|
25
|
Rodriguez K, Hallas D. Quadangulation: A New Methodology Combining Ethnographic Research and Quality Improvement Projects in Health Science Research. J Pediatr Health Care 2020; 34:273-278. [PMID: 32059819 DOI: 10.1016/j.pedhc.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
Abstract
The purpose of this paper is to describe quadangulation as a methodology for conducting and analyzing combined ethnographic studies and quality improvement (QI) projects into one comprehensive investigation to improve the quality of health care. A comprehensive base of cultural influences in all health-care delivery settings, obtained from the design, implementation, and interpretation of a rigorous ethnographic investigation, and a QI project is new proposed methodology, called quadangulation. This new methodology has the potential to influence transformational cultural change, quality whole-person patient-centered care, and improved population health, through in-depth qualitative and quantitative analysis of cultural influences and clinical problems.
Collapse
|
26
|
Orton L, Ponsford R, Egan M, Halliday E, Whitehead M, Popay J. Capturing complexity in the evaluation of a major area-based initiative in community empowerment: what can a multi-site, multi team, ethnographic approach offer? Anthropol Med 2019; 26:48-64. [DOI: 10.1080/13648470.2018.1508639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lois Orton
- University of Liverpool, Public Health and Policy, Whelan Building, The Qudrangle, Liverpool L69 3GB, UK
| | - Ruth Ponsford
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Matt Egan
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Emma Halliday
- Department of Health Research; Furness Building, Lancaster University, Bailrigg, Lancaster LA1 4YG, UK
| | - Margaret Whitehead
- University of Liverpool, Public Health and Policy, Whelan Building, The Qudrangle, Liverpool L69 3GB, UK
| | - Jennie Popay
- Department of Health Research; Furness Building, Lancaster University, Bailrigg, Lancaster LA1 4YG, UK
| |
Collapse
|
27
|
Receptionists' role in new approaches to consultations in primary care: a focused ethnographic study. Br J Gen Pract 2018; 68:e478-e486. [PMID: 29866710 PMCID: PMC6014429 DOI: 10.3399/bjgp18x697505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background The receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments. Aim The authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care. Design and setting The authors conducted a team-based focused ethnography. Three researchers observed eight general practices across England and Scotland between June 2015 and May 2016. Method Interviews were conducted with 39 patients and 45 staff in the practices, all of which had adopted one or more methods (telephone, email, e-consultation, or internet video) for providing an alternative to face-to-face consultation. Results Receptionists have a key role in facilitating patient awareness regarding new approaches to consultations in primary care, while at the same time ensuring that patients receive a consultation appropriate to their needs. In this study, receptionists’ involvement in implementation and planning for the introduction of alternative approaches to face-to-face consultations was minimal, despite the expectation that they would be involved in delivery. Conclusion A shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery. Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations.
Collapse
|
28
|
Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06200] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundThere is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood about how, under what conditions, for which patients and in what ways these approaches may offer benefits to patients and practitioners in general practice.ObjectivesOur objectives were to review existing evidence about alternatives to face-to-face consultation; conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives; recruit eight general practices as case studies for focused ethnographic research, exploring how practice context, patient characteristics, type of technology and the purpose of the consultation interact to determine the impact of these alternatives; and synthesise the findings in order to develop a website resource about the implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.DesignMixed-methods case study.SettingGeneral practices in England and Scotland with varied experience of implementing alternatives to face-to-face consultations.ParticipantsPatients and practice staff.InterventionsAlternatives to face-to-face consultations include telephone consultations, e-mail, e-consultations and internet video.Main outcome measuresHow context influenced the implementation and impact of alternatives to the face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of consultation by different patient groups; and the intended benefits/outcomes.Review methodsThe conceptual review used an approach informed by realist review, a method for synthesising research evidence regarding complex interventions.ResultsAlternatives to the face-to-face consultation are not in mainstream use in general practice, with low uptake in our case study practices. We identified the underlying rationales for the use of these alternatives and have shown that different stakeholders have different perspectives on what they hope to achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life use of different forms of alternative, we have a clearer understanding of how, under what circumstances and for which patients alternatives might have a range of intended benefits and potential unintended adverse consequences. We have also developed a framework for future evaluation.LimitationsThe low uptake of alternatives to the face-to-face consultation means that our research participants might be deemed to be early adopters. The case study approach provides an in-depth examination of a small number of sites, each using alternatives in different ways. The findings are therefore hypothesis-generating, rather than hypothesis-testing.ConclusionsThe current low uptake of alternatives, lack of clarity about purpose and limited evidence of benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted key issues for practices and policy-makers to consider and have made recommendations about priorities for further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face consultation, such as telephone consulting, e-consultation, e-mail and video consulting.Future workWe have synthesised our findings to develop a framework and recommendations about future evaluation of the use of alternatives to face-to-face consultations.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| |
Collapse
|
29
|
Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. Alternatives to the face-to-face consultation in general practice: focused ethnographic case study. Br J Gen Pract 2018; 68:e293-e300. [PMID: 29378697 PMCID: PMC5863684 DOI: 10.3399/bjgp18x694853] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. AIM To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. DESIGN AND SETTING Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. METHOD Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. RESULTS Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. CONCLUSION Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.
Collapse
Affiliation(s)
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - John Campbell
- University of Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol
| |
Collapse
|