Permeable boundaries? Patient perspectives on space and time in general practice waiting rooms

This paper considers an under-examined space in primary health care - the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the 'entry into the health care setting' in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood.

The care work of general practice receptionists

Abstract INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients’ journeys in many health care systems. We examine receptionists’ perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand

The place of receptionists in access to primary care: Challenges in the space between community and consultation

At the point of entry to the health care system sit general practice receptionists (GPRs), a seldom studied employment group. The place of the receptionist involves both a location within the internal geography of the clinic and a position within the primary care team. Receptionists literally 'receive' those who phone or enter the clinic, and are a critical influence in their transformation from a 'person' to a 'patient'. This process occurs in a particular space: the 'waiting room'. We explore the waiting room and its dynamics in terms of 'acceptability', an under-examined aspect of access to primary care. We ask 'How do GPRs see their role with regard to patients with complex health and social needs, in light of the spatio-temporal constraints of their working environments?' We engaged receptionists as participants to explore perceptions of their roles and their workspaces, deriving narrative data from three focus groups involving 14 GPRs from 11 practices in the Northland region of New Zealand. The study employed an adapted form of grounded theory. Our findings indicate that GPRs are on the edge of the practice team, yet carry a complex role at the frontline, in the waiting space. They are de facto managers of this space; however, they have limited agency within general practice settings, due to the constraints imposed upon them by physical and organisational structures. The agency of GPRs is most evident in their ability to shape the social dynamics of the waiting space, and to frame the health care experience as positive for people whose usual experience is marginalisation. We conclude that, if well supported, receptionists have the potential to positively influence health care acceptability, and patients' access to care.

Community participation in primary care: what does it mean 'in practice'?

INTRODUCTION

The New Zealand 2001 Primary Health Care Strategy requires primary health organisations (PHOs) to involve communities in their governance and be responsive to communities' needs. It is less clear what the implications of this policy are for general practices. This paper presents key findings from a national study undertaken in the wake of the 2001 primary care reforms on the purpose and process of involving communities in primary health care.

METHODS

A three-part qualitative process was employed. Initially, key informant interviews were undertaken with a diverse range of primary care policy makers, funders, practitioners and community stakeholders (n=42). A draft framework for involving communities in primary care was developed, and formed the basis of a consultation phase (n=26). The framework was further developed and then piloted in four PHOs around New Zealand.

FINDINGS

Views on community participation varied among different stakeholder groups in the sector. Most described it as a complex process of relationship-building over time, and one that is quite distinct from consumer feedback processes in general practice. For community representatives, it was a process of trust-building and information-sharing between communities and health professionals. These relationships enabled people to feel comfortable seeking care, and professionals to mould services to people's needs.

CONCLUSION

This research highlights that community is much more than a setting of care. As citizens, members of disadvantaged communities are partners with general practices and PHOs, working with them to improve health equity by ensuring that services are responsive to their needs.

Ethnicity, morbidity and health service utilization in two Labrador communities

This paper compares total outpatient health care utilization of residents of the Labrador community of Sheshatshit, a predominantly native Innu settlement, with those for the adjacent and predominantly caucasian community of Northwest River for 1986. In lieu of a community survey, these data provide an approximation of the morbidity patterns within the populations. Findings indicate that the native population experiences proportionately more infectious diseases (39.3% of all visits compared to 12.5% of all visits for the non-native community). While residents of the Innu community utilize health services primarily for curative care, residents of Northwest River sought services for both curative and preventive care. It is concluded that inequalities in material wellbeing may underlie the morbidity in Sheshatshit. While desirable in light of the WHO Ottawa Charter, any modification of the health services on account of these morbidity patterns will have only modest effect until policy-based initiatives to reduce material inequalities are implemented.