A mixed-methods study describing behavioral factors that influenced general practitioners' experiences using triage during the COVID-19 pandemic

Impact of the clinically oriented roles of a general practice receptionist: a systematic review with narrative synthesis

BACKGROUND

Modern general practice is characterised by increased demand and growing multidisciplinarity, including ring-fenced funding for additional non-clinical roles. For practice receptionists, however, training has remained unchanged for decades despite primary care being under greater pressure than ever, with receptionists becoming a growing focal point for abuse and unprecedented numbers leaving the role.

AIM

To present the evidence of the range of tasks that receptionists continue to perform, describing their impact on primary care delivery and how the role might be better supported.

DESIGN AND SETTING

Systematic review of research conducted in the UK.

METHOD

A systematic review of evidence contained in the major medical databases (MEDLINE/PubMed, CINAHL, ASSIA, Cochrane Library, and Embase) from January 2000 to March 2024 was conducted, including hand searches of the bibliographies of included studies.

RESULTS

In total, 29 studies were identified that grouped into three themes: service delivery, patient attitudes, and receptionist experience. The theme 'service delivery' confirms the continuing role of receptionists in providing administrative support alongside the clinical tasks of prioritising patients for consultations, facilitating repeat prescriptions, and communicating blood test results. The theme 'patient attitudes' describes how patients lacked trust in receptionists, who were viewed as unqualified and unnecessarily obstructive. Finally, in considering receptionist experience, the contrast between their confidence in performing administrative roles and the anxiety induced from the clinically related tasks was described, particularly the mounting pressure from patients to meet their preferences for clinician appointments.

CONCLUSION

Although confident performing administrative tasks, receptionists described uncertainty and anxiety when providing clinically oriented support or managing patients when their requests for appointments could not be met. More appropriate training or professionalisation might improve staff retainment.

What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel

OBJECTIVE

Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF).

DESIGN

Online survey informed by the TDF and BCW.

SETTING

UK trauma rehabilitation pathway.

POPULATION

Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78).

ANALYSIS

Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies.

RESULTS

Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs.

CONCLUSIONS

Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.

The Concept of Health Debt Incurred during the COVID-19 Pandemic on the Example of Basal Cell Skin Cancer Diagnosis in Lower Silesia

Introduction: This study explores the impact of the COVID-19 pandemic on the diagnosis of basal cell carcinoma (BCC) in Lower Silesia, Poland, comparing pre-pandemic, pandemic, and post-pandemic periods. It investigates how different medical facilities adapted to the pandemic's challenges and the subsequent implications for cancer diagnosis. Methods: Data from histopathology and cytology laboratories were analyzed, focusing on BCC diagnoses from 2018 to 2022. This study included various medical centers categorized by size and source of implementation. Statistical analyses were conducted to compare diagnoses before, during, and after the pandemic. Results: During the initial wave of the pandemic, there was a significant reduction in newly diagnosed BCC cases, followed by a surge post-pandemic. Larger medical centers adapted more effectively, while district hospitals faced challenges. Private practices maintained stable diagnosis rates. The increase in diagnoses post-pandemic suggests a backlog of undiagnosed cases during the pandemic. Discussion: Challenges in accessing healthcare during the pandemic led to delayed cancer diagnoses. Larger medical centers were better equipped to handle the crisis, while district hospitals struggled. Private practices maintained stability, possibly due to pre-scheduled appointments. Recommendations include public education on symptom recognition and standardizing histopathological evaluation protocols. Conclusions: Despite data limitations, this study provides valuable insights into the pandemic's impact on cancer diagnosis, highlighting the need for proactive measures in future health crises to ensure timely detection and treatment of cancer cases.

Digital First Primary Care for those with multiple long-term conditions: a rapid review of the views of stakeholders

Background

General practices are facing challenges such as rising patient demand and difficulties recruiting and retaining general practitioners. Greater use of digital technology has been advocated as a way of mitigating some of these challenges and improving patient access. This includes Digital First Primary Care, when a patient's first contact with primary care is through a digital route, either through a laptop or smartphone. The use of Digital First Primary Care has been expedited since COVID-19. There is little evidence of staff experiences of using Digital First Primary Care with more complex patients, such as those with multiple long-term conditions.

Objective

To understand the experiences of those with multiple long-term conditions of Digital First Primary Care from the perspectives of healthcare professionals and stakeholders.

Design

This was a qualitative evaluation, comprised of four distinct work packages: Work package 1: Locating the study within the wider context, engaging with literature, and co-designing the study approach and research questions with patients. Work package 2: Interviews with health professionals working across general practice and key expert topic stakeholders, including academics and policy-makers. Work package 3: Analysis of data and generation of themes, and testing findings with patients. Work package 4: Synthesis, reporting and dissemination.

Results

The study commenced in January 2021 and in total 28 interviews were conducted with 14 health professionals and 15 stakeholders between January and August 2022. From the perspective of health professionals, Digital First Primary Care approaches could enable patients to speak with a clinician more quickly than traditional approaches. Those with multiple long-term conditions could submit healthcare readings from home, though health professionals felt patients may struggle navigating digital systems not designed to capture the nuances associated with living with multiple conditions. Clinicians expressed preferences for seeing patients face-to-face, particularly those with multiple long-term conditions, to identify non-verbal cues about a patient's health. Digital First Primary Care approaches provided an opportunity for clinicians to engage with the carers of patients living with multiple long-term conditions, yet there were concerns around obtaining consent and confidentiality. There remain debates among stakeholders about the nature and extent to which Digital First Primary Care impacts on staff workload.

Limitations

At the time of data collection, general practices were facing considerable pressure to deliver care and respond to the COVID-19 pandemic. While it was originally intended that the study would include interviews with patients with multiple long-term conditions and their carers, none of the general practices that took part in the study were willing and/or able to recruit patients and carers in the time available.

Conclusions

The rapid implementation of Digital First Primary Care, at a time of immense pressures, meant there has been little time for considering the impact on patients, including those with multiple long-term conditions. The impacts on care continuity depended largely on how surgeries implemented their approaches. Staff and stakeholders felt that Digital First Primary Care, as an additional route for accessing primary care, could be useful for patients with multiple long-term conditions but not at the expense of face-to-face consultations.

Future work

Future research obtaining patient and carer views of digital-first approaches, understanding the impacts on carers and how approaches are designed with patients with more complex conditions in mind, is essential.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/31) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 21. See the NIHR Funding and Awards website for further award information.

Triage of patients and remote consultations in primary care facilities during the COVID-19 pandemic in France (PRICOV-19 study)

Introduction

PRICOV-19 is a European cross-sectional study based on an online questionnaire, describing the impact of the pandemic on primary care structures (PCS). In France, PCS are solo practices (SP), single or multi-professional group practices (GP), coordinated practice structures (CPS): health houses and health centers. Triage, whether it is digital (TD), by telephone (TT) or at the reception (TR), is essential to reduce the risk of infection, and is part of recommended organizational practices.

Purpose of research

Based on French data from the PRICOV-19 study, the objective is to describe the frequency and factors associated with triage in PCSs during the COVID 19 pandemic.

Results

1100 structures responded to the survey. The TD was implemented in 64% of PCSs (53.3% of SPs, 64.9% of GPs, 73.2% of CPSs). The TT was implemented in 76% of structures (72.7% of SPs, 75.4% of GPs and 81% of CPSs). Finally, TR was implemented in 52% of structures (37.7% of SPs, 52% of GPs and 67% of CPSs). The other positively associated factors are the urban territory and the lower workload for the TD, and the presence of a receptionist for the TR.

Conclusions

Triage practices seem to be clearly associated with the organization and working conditions in the PCSs, and first and foremost with the type of structure.

The Limitation of Accessing Hospital Services Due to COVID-19 Pandemic: A Pilot Study of the Telephone Triage to Re-Organize the Access to a Center for Sexual Health in Northwest Italy

BACKGROUND

The COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many sexually transmitted infection (STI) clinics to book appointments by telephone. In this work, we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients.

METHODS

From January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage. Symptoms suggestive of STIs were further classified into four syndromic presentations: cutaneous neoformations, genital and oral ulcers, anogenital discharge, and finally other dermatological manifestations. All other clinical pictures were properly managed and eventually referred to other centers and not considered in the analysis. During the following medical examinations, the concordance between presumptive syndromic diagnosis and confirmed clinical diagnosis were recorded. Cohen k test was used to assess concordance.

RESULTS

According to the Cohen k test, a good concordance between telephone presumptive diagnoses and medical clinical assessment was found (73.79% with a k = 0.611), whereas only a scarcely acceptable concordance between expected and real waiting time was established (75.51%, k = 0.34).

CONCLUSIONS

Concordance between nursing syndromic diagnosis and syndromic medically confirmed diagnosis is good from a clinical point of view but there is a limitation when considering a public health perspective. An optimal training of nurses may improve the method of telephone triage. For future ongoing emergencies, the implementation of telemedicine with accurate patient management systems is mandatory.

Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study

OBJECTIVES

In order to provide a deeper understanding of family functioning, the aim of this study was to identify, describe and conceptualise the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit, with the impact of a pandemic.

RESEARCH METHODOLOGY/DESIGN

The study has a grounded theory design including interviews with eight families.

SETTING

Former adult intensive care patients cared for Covid-19 infection and their family. Eight patients and twelve family members from three different intensive care units.

MAIN OUTCOME MEASURES

The results presented are grounded in data and identified in the core category "Existential issues" and the categories "Value considerateness; Anxiety and insecurity in life; Insight into the unpredictability of life."

FINDINGS

The core category could be found in all data and its relationship and impact on the categories and each other. The core is a theoretical construction, whereas the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit was identified, described, and conceptualised. Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life.

CONCLUSION

There is awareness about the love that exists within the family. A willing to supporting each other in the family even if the critical illness made the family anxious and afraid.

IMPLICATIONS FOR CLINICAL PRACTICE

Even if the pandemic Covid-19 led to restrictions inhibiting family focused nursing, it is important to confirm the family as a part of the caring of the ICU patient. The patients are not alone, their family are fighting together for the future.

The experiences of district public health officers during the COVID-19 crisis and its management in the upper southern region of Thailand: A mixed methods approach

District public health officers (DPHO) are the major health care providers and vital resources for tackling the coronavirus disease 2019 (COVID-19) outbreak in Thailand. No studies have been published on their experiences of combating COVID-19 in Thailand. To guide and improve COVID-19 control efforts, we aimed to describe their experiences and analyze associated factors for tackling the outbreak. This mixed-methods design involved providing structured questionnaires to selected DPHOs across 52 districts of seven provinces in the upper southern region Thailand. We performed data analysis using descriptive and multivariate statistics. The quantitative approach used questionnaires that demonstrated the content validity and reliability. Data collection involved Google forms, analyzed by multivariate statistics. The qualitative approach comprised an online in-depth interview of 11 DPHOs and a thematic analysis. Results found of the 52 DPHOs, 41 were men (78.8%), and the mean age was 50.02 years (SD = 8.52 years). Their proactive experiences were significantly associated with sex (OR_adj = 2.38, 95% CI = 1.11-3.30), age (OR_adj = 1.73, 95% CI = 1.09-2.76), the length of experience in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63), and working time in the current position (OR_adj = 2.27, 95% CI = 1.43-3.63). There was no significant association between marital status, knowledge, understanding, opinion, proactive practice, and participation experiences. These results were related to six themes of the qualitative approach as follows: High morbidity and mortality of COVID-19, COVID-19 concomitant with several problems, Reaching out to the community for better COVID-19 solutions, The importance of regular reports and feedback, Solution planning based on the situation, and Providing relief to all stakeholders from COVID-19 issue. Proactive experiences of district public health officers are important for sustainable COVID-19 solutions. Disseminating relevant equipment, guidelines, policy, and government regulations is necessary to promote preparedness and efficacy in the crisis management of COVID-19.

Remote Consultations in General Practice - A Systematic Review

INTRODUCTION

Remote consultations in general practice can be very useful form of telemedicine, which is basically a way to exchange medical information to improve the clinical health of patients when the patient and their general practitioner (GP) are not on the same place at the same time. This concept was developed in the 1980s to provide health care to patients who lived in remote areas.

METHODS

We were interested in researching what kind of remote consultations are available in general practice and what is the usage of these methods. We used four keywords - remote consultation and general practice or family medicine or primary care - and we searched in four different scientific databases: Medline-PubMed, Scopus, Web of Science and IEEX Xplore.

RESULTS

We used a PRISMA diagram to identify studies and search the four main databases, we investigated 48 full text articles and when we applied our inclusion and exclusion criteria, 12 studies were included in this systematic review.

CONCLUSIONS

This systematic review covers the topics of remote consultation versus a traditional or classic physical consultation. Studies have shown its importance prior to the COVID-19 pandemic, and its value while in the mist of the pandemic then caring for infected patients. We have found that remote consultation is necessary, but it must be an improvement on the previous system. Teleconsultations can reduce the number of visits, especially during lockdown situations, with both patients and GPs satisfied with the method, but we should not forget that a physical consultation cannot be fully replaced by a remote consultation due to the limitations of the latter.