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Larrabee Sonderlund A, Quirina Bang Van Sas T, Wehberg S, Huibers L, Nielsen JB, Søndergaard J, Assing Hvidt E. Development of a Video Consultation Patient-Satisfaction Questionnaire (vCare-PSQ): A Cross-Sectional Explorative Study. JMIR Form Res 2024; 8:e58928. [PMID: 39094110 DOI: 10.2196/58928] [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: 04/03/2024] [Revised: 05/25/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Since the COVID-19 pandemic, the use of video consultation (VC) in primary care has expanded considerably in many countries. VC and other telehealth formats are often touted as a solution to improved health care access, with numerous studies showing high satisfaction with this care format among health professionals and patients. However, operationalization and measurement of patient satisfaction with VC varies across studies and often lacks consideration of dynamic contextual factors (eg, convenience, ease-of-use, or privacy) and doctor-patient relational variables that may influence patient satisfaction. OBJECTIVE We aim to develop a comprehensive and evidence-based questionnaire for assessing patient satisfaction with VC in general practice. METHODS The vCare Patient-Satisfaction Questionnaire (the vCare-PSQ) was developed according to the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. To achieve our overall objective, we pursued three aims: (1) a validation analysis of an existing patient-satisfaction scale (the PS-14), (2) an assessment of extrinsic contextual factors that may impact patient satisfaction, and (3) an assessment of pertinent intrinsic and relational satisfaction correlates (eg, health anxiety, information technology literacy, trust in the general practitioner, or convenience). For validation purposes, the questionnaire was filled out by a convenience sample of 188 Danish adults who had attended at least 1 VC. RESULTS Our validation analysis of the PS-14 in a Danish population produced reliable results, indicating that the PS-14 is an appropriate measure of patient satisfaction with VC in Danish patient populations. Regressing situational and doctor-patient relational factors onto patient satisfaction further suggested that patient satisfaction is contingent on several factors not measured by the PS-14. These include information technology literacy and patient trust in the general practitioner, as well as several contextual pros and cons. CONCLUSIONS Supplementing the PS-14 with dynamic measures of situational and doctor-patient relational factors may provide a more comprehensive understanding of patient satisfaction with VC. The vCare-PSQ may thus contribute to an enhanced methodological approach to assessing patient satisfaction with VC. We hope that the vCare-PSQ format may be useful for future research and implementation efforts regarding VC in a general practice setting.
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Affiliation(s)
- Anders Larrabee Sonderlund
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tessa Quirina Bang Van Sas
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jesper Bo Nielsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Ferguson J, Stringer G, Walshe K, Donnelly A, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. 'None of Them Know Me': A Qualitative Study of the Implications of Locum Doctor Working for Patient Experience. Health Expect 2024; 27:e14156. [PMID: 39087726 PMCID: PMC11292670 DOI: 10.1111/hex.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION There have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience. METHODS A qualitative semi-structured interview study was conducted with 130 participants including locums, people working with locums and patients with experience of being seen or treated by locums. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge. RESULTS Three main themes were constructed through analysis: (1) Awareness and disclosure; patients were not always aware if their doctor was a locum, and there was some debate about whether patients had a right to know, particularly if locum working presented quality and safety risks. (2) Continuity and accessibility of care; access was regarded as priority for acute conditions, but for long-term or serious conditions, patients preferred to see a permanent doctor who knew their history, although it was acknowledged that locums could provide fresh perspectives. (3) Communication and practice; locums and patients described how consultations were approached differently when doctors worked as locums. Patients evaluated their interactions based on how safe they felt with practitioners. CONCLUSION Patients reported that they were unlikely to have continuity of care with any doctors delivering care, regardless of their contractual status. Locums sometimes provided new perspectives on care which could be beneficial for patient outcomes, but for patients with long-term, complex or serious conditions continuity of care was important, and these patients may avoid or delay seeking care when locums are the only available option. PATIENT OR PUBLIC CONTRIBUTION Patients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., study protocol, participant information sheets, survey tools, interview schedules, emerging findings). Our PPI forum co-produced our patient interview schedule, two members of our PPI forum led the patient focus groups and all were involved in analysis of patient interviews. Our PPI Chair was involved in the preparation of this manuscript.
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Affiliation(s)
- Jane Ferguson
- Health Services Management CentreThe University of BirminghamBirminghamUK
| | - Gemma Stringer
- Alliance Manchester Business SchoolThe University of ManchesterManchesterUK
| | - Kieran Walshe
- Alliance Manchester Business SchoolThe University of ManchesterManchesterUK
| | - Ailsa Donnelly
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services ResearchUniversity of ManchesterManchesterUK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
- Danish Centre for Health EconomicsUniversity of Southern DenmarkOdenseDenmark
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
- Division of Informatics, Imaging and Data ScienceUniversity of ManchesterManchesterUK
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration, Division of Pharmacy and Optometry, Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK
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Holdroyd I, Chadwick W, Harvey-Sullivan A, Bartholomew T, Massou E, Tzortziou Brown V, Ford J. Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England. J Health Serv Res Policy 2024; 29:201-209. [PMID: 38091626 PMCID: PMC11151703 DOI: 10.1177/13558196231218830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. METHODS Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. RESULTS Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. CONCLUSIONS We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.
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Affiliation(s)
- Ian Holdroyd
- Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - William Chadwick
- Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adam Harvey-Sullivan
- Academic Clinical Fellow, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
| | - Theodore Bartholomew
- GP Registrar, General Practice, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Efthalia Massou
- Research Associate, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Victoria Tzortziou Brown
- Senior Clinical Lecturer, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
| | - John Ford
- Senior Clinical Lecturer in Health Equity, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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White SJ, Nguyen AD, Roger P, Tse T, Cartmill JA, Hatem S, Willcock SM. Tailoring communication practices to support effective delivery of telehealth in general practice. BMC PRIMARY CARE 2024; 25:232. [PMID: 38937674 PMCID: PMC11210157 DOI: 10.1186/s12875-024-02441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. METHODS This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. RESULTS Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. CONCLUSIONS Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice.
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Affiliation(s)
- Sarah J White
- Centre for Social Impact, UNSW Sydney, 704, Level 7, Science Engineering Building (E8), Kensington, NSW, 2052, Australia.
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- St Vincent's Clinical Campus, UNSW Sydney, Darlinghurst, NSW, Australia
| | - Peter Roger
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Tim Tse
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - John A Cartmill
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Simon M Willcock
- Department of Primary Care, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Kollmann J, Sana S, Magnée T, Boer S, Merkelbach I, Kocken PL, Denktaș S. Patients' and professionals' experiences with remote care during COVID-19: a qualitative study in general practices in low-income neighborhoods. Prim Health Care Res Dev 2024; 25:e32. [PMID: 38826073 DOI: 10.1017/s1463423624000240] [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: 06/04/2024] Open
Abstract
AIM To explore how patients and general practice professionals in low-income neighborhoods experienced the increase of remote care during COVID-19. BACKGROUND As the GP (general practitioner) is the first point of contact in Dutch health care, there are concerns about access to remote care for patients from low-income neighborhoods. Now that general practice professionals have returned to the pre-pandemic ways of healthcare delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care and their satisfaction. METHODS In this qualitative study, 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals were interviewed. Interviews were held on the phone and face-to-face in the native language of the participants. FINDINGS Remote care, especially telephone consultation, was generally well-approachable for patients from low-income neighborhoods. Contrarily, video calling was rarely used. This was partly because patients did not know how to use it. The majority of patients thought remote care was possible for minor ailments but would also still like to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care. In conclusion, it is important to take the opinions and barriers of patients and care providers into account and to increase patient-centered care elements and care provider satisfaction in remote care. Integrating remote care is not only important in times of crisis but also for future care that is becoming increasingly digitalized.
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Affiliation(s)
- Jelena Kollmann
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Shakib Sana
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tessa Magnée
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sarah Boer
- Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Inge Merkelbach
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Paul L Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Semiha Denktaș
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Cohen E, Lindman I. Importance of continuity of care from a patient perspective - a cross-sectional study in Swedish health care. Scand J Prim Health Care 2024; 42:195-200. [PMID: 38189945 PMCID: PMC10851828 DOI: 10.1080/02813432.2023.2299119] [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: 06/08/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE The primary objective of this study was to evaluate the patients' view on continuity of care (CoC), including preference for a certain general practitioner (GP) and importance and access to a regular general practitioner (RGP). DESIGN Cross-sectional study. SETTING Primary care center in Halland County, in the western part of Sweden. SUBJECTS Patients ≥18 years old and having at least one appointment at the primary care center during October-December 2022. MAIN OUTCOME MEASURES Preference for a certain GP and importance of and accessibility for an RGP. RESULTS The study included 404 patients. Importance of having an RGP was considered by 86% of the patients. Preference for a certain GP was thought by 73% of the patients, and when asked as a bivariate question, 69% considered having an RGP. Both the importance of an RGP and preference for a certain GP were more often considered by patients ≥65 years (p < .0001). Regarding accessibility, 67% of the patients reported having access to their RGP 'always/most of the time or a lot of the time' and 62% reported seeing their RGP at last visit. CONCLUSIONS In conclusion, this study showed that the majority of patients value CoC in terms of importance of having an RGP. Older patients were more likely to have a preference for a certain GP. Two-third of the patients succeeded in seeing their RGP always or a lot of the time. The results in this study provide evidence that CoC is important for most patients, regardless of age and gender.Key pointsPrevious studies have showed that continuity of care (CoC) is important regarding mortality and morbidity. In primary care, there is a current debate regarding CoC, accessibility and the strive for CoC. This study showed that the majority of patients, regardless of age and gender, value CoC and consider it being important. However, there was a statistically significant difference regarding age, where patients above 65 years old thought it was more important to have a regular general practitioner and more often had a preference for a certain GP.
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Affiliation(s)
- Ebba Cohen
- Säröledens Familjeläkare, Billdal, Sweden
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Abelsen B, Pedersen K, Løyland HI, Aandahl E. Expanding general practice with interprofessional teams: a mixed-methods patient perspective study. BMC Health Serv Res 2023; 23:1327. [PMID: 38037165 PMCID: PMC10691031 DOI: 10.1186/s12913-023-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Across healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care. METHODS Qualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot. RESULTS The interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery. CONCLUSION From the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.
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Affiliation(s)
- Birgit Abelsen
- Department of Community Medicine, National Centre for Rural Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway
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Parry W, Fraser C, Crellin E, Hughes J, Vestesson E, Clarke GM. Continuity of care and consultation mode in general practice: a cross-sectional and longitudinal study using patient-level and practice-level data from before and during the COVID-19 pandemic in England. BMJ Open 2023; 13:e075152. [PMID: 37968008 PMCID: PMC10660661 DOI: 10.1136/bmjopen-2023-075152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Investigate trends in continuity of care with a general practitioner (GP) before and during the COVID-19 pandemic. Identify whether continuity of care is associated with consultation mode, controlling for other patient and practice characteristics. DESIGN Retrospective cross-sectional and longitudinal observational studies. SETTING Primary care records from 389 general practices participating in Clinical Practice Research Datalink Aurum in England. PARTICIPANTS In the descriptive analysis, 100 000+ patients were included each month between April 2018 and April 2021. Modelling of the association between continuity of care and consultation mode focused on 153 475 and 125 298 patients in index months of February 2020 (before the pandemic) and February 2021 (during the pandemic) respectively, and 76 281 patients in both index months. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome measure was the Usual Provider of Care index. Secondary outcomes included the Bice-Boxerman index and count of consultations with the most frequently seen GP. RESULTS Continuity of care was gradually declining before the pandemic but stabilised during it. There were consistent demographic, socioeconomic and regional differences in continuity of care. An average of 23% of consultations were delivered remotely in the year to February 2020 compared with 76% in February 2021. We found little evidence consultation mode was associated with continuity at the patient level, controlling for a range of covariates. In contrast, patient characteristics and practice-level supply and demand were associated with continuity. CONCLUSIONS We set out to examine the association of consultation mode with continuity of care but found that GP supply and patient demand were much more important. To improve continuity for patients, primary care capacity needs to increase. This requires sufficient, long-term investment in clinicians, staff, facilities and digital infrastructure. General practice also needs to transform ways of working to ensure continuity for those that need it, even in a capacity-constrained environment.
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Affiliation(s)
| | | | | | - Jay Hughes
- Data Analytics, The Health Foundation, London EC4Y 8AP, UK
| | - Emma Vestesson
- Data Analytics, The Health Foundation, London EC4Y 8AP, UK
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Čáp J, Miertová M, Bóriková I, Žiaková K, Tomagová M, Gurková E. Trust in healthcare professionals of people with chronic cardiovascular disease. Nurs Ethics 2023:9697330231209285. [PMID: 37889675 DOI: 10.1177/09697330231209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. RESEARCH AIM The purpose of the qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. RESEARCH DESIGN Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. PARTICIPANTS AND RESEARCH CONTEXT Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. ETHICAL CONSIDERATIONS The study was approved by the faculty ethics committee. Participants gave their written informed consent. FINDINGS FOUR INTERRELATED GROUP EXPERIENTIAL THEMES Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants' vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. CONCLUSION Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care.
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Affiliation(s)
- Juraj Čáp
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Michaela Miertová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Ivana Bóriková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Martina Tomagová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Elena Gurková
- Department of Nursing, Faculty of Health Care, University of Prešov, Slovakia
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Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. Locum doctors in English general practices: evidence from a national survey. Br J Gen Pract 2023; 73:e667-e676. [PMID: 37604697 PMCID: PMC10471140 DOI: 10.3399/bjgp.2023.0039] [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: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost. AIM To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, supported, perceived, and managed. DESIGN AND SETTING An online survey was sent to 3745 practices. METHOD Quantitative responses were analysed using frequency tables, t-tests, and correlations. Free-text responses were analysed using thematic analysis. RESULTS In total, 605 (16.2%) responses were returned between June and December 2021. Practices made frequent use of locums, preferring regular locums familiar with processes and patients. Disadvantages of agency locums included cost, lack of patient familiarity, and impact on continuity of care. Care provided by locums was generally viewed as the same but sometimes worse compared with permanent GPs. Some practices reported that locums did not always perform the full range of duties, resulting in increased workload for other staff. Practices were largely unfamiliar with national guidance for organisations engaging locums, and, although processes such as verifying documentation were conducted, far fewer responders reported providing feedback, support for revalidation, or professional development. CONCLUSION Locum working is an essential part of English general practice, but this research raises some concerns about the robustness of arrangements for locum working and the impact on quality and safety of care. Further research is needed about the clinical practice and performance of locums, and to explore how locum working can be organised in ways that assure safe and high-quality care.
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Affiliation(s)
- Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK; Danish Centre for Health Economics, University of Southern Denmark, Denmark
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research School for Primary Care Research, Centre for Primary Care and Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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Coombs C, Cohen T, Duddy C, Mahtani KR, Owen E, Roberts N, Saini A, Foster AS, Park S. Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives. Br J Gen Pract 2023; 73:e651-e658. [PMID: 37549994 PMCID: PMC10428005 DOI: 10.3399/bjgp.2022.0545] [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: 11/03/2022] [Accepted: 04/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND International trends have shifted to creating large general practices. There is an assumption that interdisciplinary teams will increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate for some potential challenges of practice expansion, including continuity of care. AIM To review available literature and examine how micro-teams are described, and identify opportunities and limitations for patients and practice staff. DESIGN AND SETTING This was an international systematic review of studies published in English. METHOD Databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus) and grey literature were searched. Studies were included if they provided evidence about implementation of primary care micro-teams. Framework analysis was used to synthesise identified literature. The research team included a public contributor co-applicant. The authors conducted stakeholder discussions with those with and without experience of micro-team implementation. RESULTS Of the 462 studies identified, 24 documents met the inclusion criteria. Most included empirical data from healthcare professionals, describing micro-team implementation. Results included characteristics of the literature; micro-team description; range of ways micro-teams have been implemented; reported outcomes; and experiences of patients and staff. CONCLUSION The organisation of primary care has potential impact on the nature and quality of patient care, safety, and outcomes. This review contributes to current debate about care delivery and how this can impact on the experiences and outcomes of patients and staff. This analysis identifies several key opportunities and challenges for future research, policy, and practice.
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Dickson JM, Hilton A, Kelsall C, Cormack L. Primary care: the sleeping giant of research delivery. Br J Gen Pract 2023; 73:198-199. [PMID: 37105738 PMCID: PMC10147423 DOI: 10.3399/bjgp23x732573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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Williams S, Barnard A, Collis P, Correia de Sousa J, Ghimire S, Habib M, Jelen T, Kanniess F, Mak V, Martins S, Paulino E, Pinnock H, Roman M, Sandelowsky H, Tsiligianni I, van der Steen L, Weber Donatelli F. Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery. J Health Serv Res Policy 2022:13558196221140318. [PMID: 36484225 PMCID: PMC10363957 DOI: 10.1177/13558196221140318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.
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Affiliation(s)
- Siân Williams
- International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - Amanda Barnard
- School of General Practice, Rural and Indigenous Health, 2219The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Phil Collis
- 441760European Lung Foundation, Leamington Spa, UK
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, 56059University of Minho, Braga, Portugal
| | - Suraj Ghimire
- Institute of Medicine, 92959Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Monsur Habib
- 588669Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | - Tessa Jelen
- British Lung Foundation Support Group, Westminster, London, UK
| | - Frank Kanniess
- Practice for Family Medicine and Allergy, Reinfeld, Germany
| | - Vince Mak
- 8946Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Hilary Pinnock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Hanna Sandelowsky
- Department of Family Medicine and Primary Care, Inst. NVS, 27106Karolinska Institute, Stockholm, Sweden
| | - Ioanna Tsiligianni
- Faculty of Medicine, Department of Social Medicine, University of Crete, Greece
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Murphy M, Salisbury C, Scott A, Sollazzi-Davies L, Wong G. The person-based development and realist evaluation of a pre-consultation form for GP consultations. NIHR OPEN RESEARCH 2022; 2:19. [PMID: 37601950 PMCID: PMC7614962 DOI: 10.3310/nihropenres.13249.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 08/22/2023]
Abstract
Background Use of telephone, video and e-consultations is increasing. These can make consultations more transactional, potentially missing patients' concerns. This study aimed to develop a complex intervention to address patients' concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework.The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the pre-consultation questionnaire. Methods A person-based approach was used to develop the pre-consultation form. An online questionnaire system was designed to allow patient self-completion of a form which could be shared with GPs. This was tested with 45 patients in three rounds, with iterative adjustments made based on feedback after each round.Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results Intervention Development: 15 patients were recruited per practice. Twelve patients, six GPs and three administrators were interviewed and 32 changes were made iteratively in three rounds. Recruitment rates (proportion of patients responding to the text) increased from 15% in round one to 50% in round three.Realist evaluation: The pre-consultation form was most useful for people comfortable with technology and with hidden concerns or anxiety about the consultation. It resulted in more issues being discussed and support provided, more effective use of time and greater patient satisfaction. Conclusions The person-based approach was successful. The pre-consultation form uncovers more depth and improves satisfaction in certain consultations and patients. Technological improvements are required before this could be rolled out more widely.
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Affiliation(s)
- Mairead Murphy
- Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Chris Salisbury
- Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Anne Scott
- Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6HT, UK
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Pinaka O, Gioulekas F, Routa E, Delliou A, Stamatiadis E, Dratsiou I, Romanopoulou E, Billinis C. Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults. Healthcare (Basel) 2022; 10:healthcare10071230. [PMID: 35885757 PMCID: PMC9320876 DOI: 10.3390/healthcare10071230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults.
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Affiliation(s)
- Ourania Pinaka
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece;
- Correspondence: ; Tel.: +30-241-0534-235
| | - Fotios Gioulekas
- 5th Regional Health Authority of Thessaly & Sterea, Mezourlo Area, 41110 Larissa, Greece; (F.G.); (E.S.)
| | - Evlampia Routa
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
| | - Aikaterini Delliou
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
| | - Evangelos Stamatiadis
- 5th Regional Health Authority of Thessaly & Sterea, Mezourlo Area, 41110 Larissa, Greece; (F.G.); (E.S.)
| | - Ioanna Dratsiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.D.); (E.R.)
| | - Evangelia Romanopoulou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.D.); (E.R.)
| | - Charalambos Billinis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece;
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Affiliation(s)
| | - Rebecca Rosen
- Nuffield Trust, London, UK
- Correspondence to: C A M Paddison
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Knottnerus B, Heijmans M, Rademakers J. The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study. BMC PRIMARY CARE 2022; 23:115. [PMID: 35546226 PMCID: PMC9091153 DOI: 10.1186/s12875-022-01723-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, people have been confronted with a large amount of information about the virus and the governmental measures against its spreading. However, more than a quarter of individuals have limited health literacy (HL), meaning that they have difficulty finding, understanding, and applying health information. The purpose of this interview study was to investigate how individuals with limited HL acquire information about COVID-19 and governmental measures, what difficulties they experience in understanding and applying it, and what may be needed to overcome these difficulties. We also addressed other problems that they might face as a result of the pandemic. Using our findings, we aimed to make recommendations on the possible role of primary care in informing and supporting patients with limited HL during the pandemic. METHODS Between June and October 2020, 28 individuals with limited HL were interviewed by phone (age range 20-84). The interviews were semi-structured and focused on the first months of the pandemic in the Netherlands (March/April/May 2020). RESULTS The participants generally found COVID-19-related information abundant and complicated, and sometimes contradictory. Information provision by their own health care professionals was highly appreciated, especially in the context of chronic illnesses. General health care problems resulting from COVID-19 measures were postponement of regular care and difficulty with digital contacts. CONCLUSIONS Individuals with limited HL may benefit from provision of COVID-19-related information and support by their own health care providers. This applies in particular to patients with chronic illnesses. Primary care professionals are in the ideal position to take this role.
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Affiliation(s)
- Bart Knottnerus
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- CAPHRI (Care and Public Health Research Institute), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Lillis S. The end of general practice as we know it. J Prim Health Care 2022; 14:10-12. [PMID: 35417329 DOI: 10.1071/hc21157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Among the many changes in general practice over the last 30 years, loss of continuity of relationship between a health professional and patient in the general practice context has occurred in many areas. There has been little discussion or consultation over this change, yet the consequences on people working in general practice and patients who come for the services is significant. Without continuity of relationship, general practice will evolve into something quite different from what it has traditionally represented.
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Radl-Karimi C, Nielsen DS, Sodemann M, Batalden P, Von Plessen C. “What it really takes” – a qualitative study of how professionals coproduce healthcare service with immigrant patients. J Migr Health 2022; 5:100101. [PMID: 35480876 PMCID: PMC9036136 DOI: 10.1016/j.jmh.2022.100101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 10/27/2022] Open
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Why do GPs rarely do video consultations? Qualitative study in UK. Br J Gen Pract 2022; 72:e351-e360. [DOI: 10.3399/bjgp.2021.0658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 10/31/2022] Open
Abstract
Background: Fewer than 1% of UK general practice consultations occur by video. Aim: To explain why video consultations are not more widely used in general practice. Design and setting: Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings 2019-2021. Methods: The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, 9 managers, 4 support staff, 4 national policymakers, 5 technology industry). Data were transcribed, coded thematically and then analysed using the Planning and Evaluating Remote Consultations (PERCS) Framework. Results: With few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers and advances in functionality, dependability and usability of video technologies (though some products remained “fiddly” and unreliable). The relative advantage of video was perceived as minimal for most of the case load of general practice, since many presenting problems could be sorted adequately and safely by telephone and in-person assessment was considered necessary for the remainder. Some patients found video appointments convenient, appropriate and reassuring but others found therapeutic presence was only achieved in person. Video sometimes added value for out-of-hours and nursing home consultations and statutory functions (e.g. death certification). Conclusion: Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage (e.g. strong patient or clinician preference, remote localities, out-of-hours services, nursing homes).
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Is continuity of primary care declining in England? Practice-level longitudinal study from 2012 to 2017. Br J Gen Pract 2021; 71:e432-e440. [PMID: 33947666 PMCID: PMC8103927 DOI: 10.3399/bjgp.2020.0935] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/03/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Continuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care in England is declining. AIM To confirm reports of declining continuity of care, explore differences in decline according to practice characteristics, and examine associations between practice populations or appointment provision and changes in continuity of care. DESIGN AND SETTING Longitudinal design on GP Patient Survey data reported annually in June or July from 2012 to 2017, whereby the unit of analysis was English general practices that existed in 2012. METHOD Linear univariable and bivariable multilevel models were used to determine decline in average annual percentage of patients having a preferred GP and seeing this GP 'usually' according to practicelevel continuity of care, rural/urban location, and deprivation. Associations between percentage of patients having a preferred GP or seeing this GP usually and patients' experiences with the appointment system and practice population characteristics were modelled. RESULTS In 2012, 56.7% of patients had a preferred GP, which had declined by 9.4 percentage points (pp) (95% CI = -9.6 to -9.2) by 2017. Of patients with a preferred GP, 66.4% saw that GP 'usually' in 2012; this had declined by 9.7 pp (95% CI = -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or level of deprivation. At practice level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP and those able to see that GP 'usually'. CONCLUSION Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. Ability of practices to offer patients a satisfactory appointment system could partly counteract this decline.
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Experiences of general practice care for self-harm: a qualitative study of young people's perspectives. Br J Gen Pract 2021; 71:e744-e752. [PMID: 33950851 PMCID: PMC8340729 DOI: 10.3399/bjgp.2021.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Self-harm is a growing concern and rates of self-harm in young people (aged 12-25 years) presenting to general practice are rising. There is, however, little evidence about young people's experiences of GP care and on accessing general practice. AIM To explore the help-seeking behaviours, experiences of GP care, and access to general practice of young people who self-harm. DESIGN AND SETTING In this qualitative study, semi-structured interviews were conducted with young people aged 16-25 years from England with previous self-harm behaviour. METHOD Interviews with 13 young people took place between April and November 2019. Young people were recruited from the community, third-sector organisations, and Twitter. Data were analysed using reflexive thematic analysis with principles of constant comparison. A patient and public involvement advisory group informed recruitment strategies and supported interpretation of findings. RESULTS Young people described the avenues of help-seeking they employ and reflected on the mixed experiences of seeing GPs that can influence future help-seeking. Preconceptions and a lack of knowledge about accessing general practice were found to be barriers to help-seeking. GPs who attempt to understand the young person and establish relationship-based care can facilitate young people accessing general practice for self-harm. CONCLUSION It is important young people are aware of how to access general practice and that GPs listen, understand, and proactively follow-up young people who self-harm. Supporting young people with self-harm behaviour requires continuity of care.
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What is Wise GP? The intellectual and scholarly challenge of general practice. Br J Gen Pract 2021; 71:225. [PMID: 33926879 DOI: 10.3399/bjgp21x715853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Hibberd J, Carter J, McCoy M, Rafiq M, Varma A, Sanghera R, Matthews P, Rait G. General Practice in the Time of COVID-19: A Mixed-Methods Service Evaluation of a Primary Care COVID-19 Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062895. [PMID: 33809000 PMCID: PMC7998968 DOI: 10.3390/ijerph18062895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/10/2023]
Abstract
Primary care coronavirus disease 2019 (COVID-19) clinics were rapidly introduced across the UK to review potentially infectious patients. Evaluation of these services is needed to guide future implementation. This mixed-methods study evaluates patient demographics, clinical presentation, co-morbidities, service usage, and outcomes for the Islington COVID-19 service (London, UK) and from April to May 2020 and thematically analyses survey responses from 29 service clinicians and 41 GP referrers on their service experience. Of the 237 patients booked into the service, a significant number of referrals (n = 91; 38.6%) were made after the presumed infectious period of 14 days. Almost half of all adult referrals (49%) were dealt with remotely (via telephone/video consultation +/− remote oxygen saturation monitoring). The service was perceived to provide a safe way to see patients; it developed local expertise, learning, and empowerment; and it was a positive teamworking experience. These findings suggest that the management of many patients with COVID-19 symptoms is possible in routine general practice with minimal risk through the implementation of remote consultation methods and in patients who present after the post-infectious period. Additionally, the use of remote saturation monitoring and local GP COVID-19 “experts” can support practices to manage COVID-19 patients. Future primary care COVID-19 services should act as empowerment tools to assist GPs to safely manage their own patients and provide support for GPs in this process.
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Affiliation(s)
- James Hibberd
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
| | - Jessica Carter
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
- Institute for Infection and Immunity, St George’s University, London SW17 0RE, UK
| | - Michaella McCoy
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
| | - Meena Rafiq
- Epidemiology of Cancer and Healthcare Outcomes (ECHO) University College, London WC1E 6BT, UK;
- RM Partners, London SW1H 0QS, UK
| | - Amita Varma
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
| | - Rita Sanghera
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
| | - Philippa Matthews
- Islington GP Federation, London N7 8EG, UK; (J.H.); (J.C.); (M.M.); (A.V.); (R.S.); (P.M.)
| | - Greta Rait
- Primary Care and Population Health Department University College, London NW3 2QG, UK
- Correspondence:
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Avery AJ, Sheehan C, Bell B, Armstrong S, Ashcroft DM, Boyd MJ, Chuter A, Cooper A, Donnelly A, Edwards A, Evans HP, Hellard S, Lymn J, Mehta R, Rodgers S, Sheikh A, Smith P, Williams H, Campbell SM, Carson-Stevens A. Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review. BMJ Qual Saf 2020; 30:961-976. [PMID: 33172907 PMCID: PMC8606464 DOI: 10.1136/bmjqs-2020-011405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. DESIGN Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded. SETTING Primary care. PARTICIPANTS Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients). MAIN OUTCOME MEASURES The incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents. RESULTS The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines. CONCLUSION There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.
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Affiliation(s)
- Anthony J Avery
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK .,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
| | - Christina Sheehan
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Brian Bell
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Armstrong
- NIHR RDS for the East Midlands, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Sciences, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ailsa Donnelly
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Huw Prosser Evans
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Joanne Lymn
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rajnikant Mehta
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sarah Rodgers
- PRIMIS, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Pam Smith
- School of Health and Social Sciences, Edinburgh University, Edinburgh, UK
| | - Huw Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.,Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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