scholarly journals Evaluation of general practice house officer attachments in Counties Manukau: insights and benefits

2016 ◽  
Vol 8 (4) ◽  
pp. 288 ◽  
Author(s):  
Lyndsay Le Comte ◽  
Brooke Hayward ◽  
David Hughes ◽  
Luis Villa ◽  
Dominic Madell
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Clinical Skills ◽  
Care Practice ◽  
Medical Council ◽  
Structured Interviews ◽  
Quality Patient Care ◽  
Clinical Support ◽  
Number Of Patients ◽  
Community Attachments

ABSTRACT BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300–600 patients in one practice and 800–1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.

Engagement of primary care practice in Australia: learnings from a diabetes care project

2019 ◽  
Vol 25 (1) ◽  
pp. 82
Author(s):  
Rajna Ogrin ◽  
Tracy Aylen ◽  
Toni Rice ◽  
Ralph Audehm ◽  
Arti Appannah
Keyword(s):  
General Practice ◽  
Chronic Disease ◽  
Diabetes Care ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Pilot Project ◽  
Care Practice ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Practice Nurses

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

scholarly journals Acute pain management in patients with opiate maintenance treatment in primary care: a qualitative study

2020 ◽  
Author(s):  
morgane guillou landreat ◽  
Melia Baillot ◽  
Le Goff Delphine ◽  
Le Reste Jean Yves
Keyword(s):  
General Practice ◽  
Data Collection ◽  
Thematic Analysis ◽  
Acute Pain ◽  
Maintenance Treatment ◽  
Structured Interviews ◽  
Opiate Use ◽  
Number Of Patients ◽  
Data Collection Technique ◽  
Opiate Use Disorder

Abstract Background: Opiate use disorders are a worldwide disease. In the last 30 years, opiate maintenance treatment prescription changed patients’ and also changed physicians’ practice. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. Both clinically and pharmacologically, the treatment of acute pain in patients with an opiate use disorder and an OMT(opiate maintenance treatment) differs from that given to patients with other conditions. As this situation is complex, it was important to explore whether GPs recognised this problem and whether they managed it effectively.Objective: To investigate how GPs identify and manage situations of acute pain in patients with opiate use disorders and OMT. Methods: semi-structured interviews were used as a data collection technique with a purposive sample of practising GPs. Data collection continued until saturation was reached. Analysis was undertaken using a thematic analysis method. Two independent researchers, working blind and pooling data, carried out the analysis. Results: The maximal variation of the sample and saturation of data were reached with 11 GPs. The thematic analysis resulted in 4 main themes: (1) the importance and difficulties of professional links , (2) the specific clinical reasoning , (3) the importance of the doctor-patient relationship and (4) the particular characteristics of OMT patients. Conclusion: The complexity of pain and opioid dependence represents significant challenges for GPs. It is hard to achieve a balance between pain relief and opiate use disorder treatment. These questions are particularly important in general practice, where the practitioner may feel insufficiently trained, and isolated. Existing protocols do not seem to be in line with general practice. The number of patients on OMT has increased since it was first marketed; GPs will increasingly have to deal with these situations and will have to issue their own recommendations.

Learning clinical skills during bedside teaching encounters in general practice

2015 ◽  
Vol 27 (4) ◽  
pp. 298-314 ◽  
Author(s):  
Rola Ajjawi ◽  
Charlotte Rees ◽  
Lynn V Monrouxe
Keyword(s):  
General Practice ◽  
Clinical Skills ◽  
Learning Opportunities ◽  
Emergent Properties ◽  
Bedside Teaching ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Activity Systems ◽  
Content Type ◽  
Skills Learning

Purpose – This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach – An audio and/or video observational study examining seven general practice BTEs was undertaken. Additionally, audio-recorded, semi-structured interviews were conducted with participants. All data were transcribed. Data analysis comprised Framework Analysis informed by Engeström’s Cultural Historical Activity Theory. Findings – BTEs can be seen to offer many learning opportunities for clinical skills. Learning opportunities are negotiated by the participants in each BTE, with patients, doctors and students playing different roles within and across the BTEs. Tensions emerged within and between nodes and across two activity systems. Research limitations/implications – Negotiation of clinical skills learning opportunities involved shifts in the use of artefacts, roles and rules of participation, which were tacit, dynamic and changing. That learning is constituted in the activity implies that students and teachers cannot be fully prepared for BTEs due to their emergent properties. Engaging doctors, students and patients in reflecting on tensions experienced and the factors that influence judgements in BTEs may be a useful first step in helping them better manage the roles and responsibilities therein. Originality/value – The paper makes an original contribution to the literature by highlighting the tensions inherent in BTEs and how the negotiation of roles and division of labour whilst juggling two interacting activity systems create or inhibit opportunities for clinical skills learning. This has significant implications for how BTEs are conceptualised.

Closer supervision in Australian general practice training: planning major system change

2020 ◽  
Vol 26 (2) ◽  
pp. 184
Author(s):  
Gerard Ingham ◽  
Kayty Plastow ◽  
Rebecca Kippen ◽  
Nicky White
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Strong Support ◽  
System Change ◽  
Active Role ◽  
Structured Interviews ◽  
Management Guidelines ◽  
Barriers To Change ◽  
Australian General Practice ◽  
General Practice Training

Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored. Semi-structured interviews were conducted with a lead medical educator from nine Australian regions. Focus groups were conducted with GP supervisors and GP registrars. Transcripts from the interviews and focus groups were analysed using conventional content analysis, with themes emerging inductively from the data. The findings were that over 1–3 months, a registrar could progress from their supervisor observing all consultations through to the registrar only calling when they identify the need for help. There is strong support from registrars for this change to closer supervision, but less support from supervisors and educators. Barriers to the proposed change include high clinical demand competing with teaching capacity, inadequate payment for closer supervision and supervisors lacking skills or motivation to have a more active role in registrar supervision. If funding and logistic barriers to change are addressed, a change to a closer level of supervision is possible. A pilot study to further refine the change is indicated.

scholarly journals Opportunities and Challenges for Family-Centered Postpartum Care During the COVID-19 Pandemic: A Qualitative Study of Nurse Perspectives

2021 ◽  
Author(s):  
Katharine W. Buek ◽  
Molly O’Neil ◽  
Dorothy J. Mandell
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Father Involvement ◽  
Nursing Practice ◽  
Care Practice ◽  
Perceived Benefits ◽  
Structured Interviews ◽  
Number Of Patients ◽  
Family Bonding ◽  
Family Centered

Abstract Background The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered models, including perinatal and maternity care. Research conducted in prenatal, childbirth and postpartum settings during the pandemic has shown that some of these restrictions have negatively impacted health care practice and outcomes, while others have been beneficial to both providers and patients. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth.MethodsStructured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses’ attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 30 to 45 minutes. Data were analyzed using a qualitative descriptive approach. ResultsParticipants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for nursing practice as well as patient outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding.ConclusionsStudy findings suggests that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

scholarly journals A cross-sectional survey of general practitioners’ experiences with, views of, and attitudes towards, practice-based pharmacists

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i24-i25
Author(s):  
A H Ibrahim ◽  
H Barry ◽  
C M Hughes
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Northern Ireland ◽  
General Practitioners ◽  
Response Rate ◽  
Clinical Skills ◽  
Community Pharmacists ◽  
Care Practice ◽  
Full Time ◽  
General Practices

Abstract Introduction Five-year pilot schemes were announced in both England and Northern Ireland (NI) to integrate practice-based pharmacists (PBPs) into general practices. The NI scheme anticipates that there will be 300 whole time equivalent PBPs in post by the end of the pilot (2020/2021).[1] There is little existing UK literature on PBPs’ role evolution and few studies have explored general practitioners’ (GPs) experiences of pharmacist integration into primary care practice. Aim To investigate GPs’ experiences with PBPs, their views about the PBP role and its impact upon patients and GPs, and their attitudes towards collaboration with PBPs. Methods A paper-based self-administered questionnaire was mailed to all general practices (n=329) across Northern Ireland (NI) on two occasions during September and October 2019, and was completed by one GP in every practice who had most contact with the PBP. The questionnaire was developed following a comprehensive literature review and comprised four sections (Table 1). Descriptive analyses were conducted using SPSS v26 and responses to open-ended questions were analysed thematically. Results The response rate was 61.7% (203/329). Respondents had a median age of 52.0 years and there was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n=159) meeting with the PBP more than once a week. GPs reported that two-thirds of PBPs (62.4%, n=126) were qualified as independent prescribers, with 76.2% of prescribers (n=96) currently prescribing for patients. The most common PBP activities were medication reconciliation and medication reviews. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n=162) and knowledge (87.0%, n=167) to provide safe and effective care for patients. However, only 31.1% (n=61) stated that PBPs sometimes had the confidence to make clinical decisions. The majority of GPs (>85%) displayed largely positive attitudes towards collaboration with PBPs. Most respondents agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n=192) and can provide a better link between general practices and community pharmacists (96.1%, n=194). However, 24.8% of GPs (n=50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. Thematic analysis of the open comments indicated that GPs were in favour of more PBP sessions and full-time posts. Conclusion This study has revealed that the majority of GPs had positive views and attitudes about the PBP role, its impact in primary care and collaboration with PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Our target sample included all general practices within NI and the response rate enhanced generalisability at the practice level. However, the study sample was limited to NI, and some findings may not be relevant to other parts of the UK. Further work is required to explore PBPs’, community pharmacists’ and patients’ views of this role in general practice to corroborate study findings. References 1. Strategic Leadership Group for Pharmacy. Practice-based pharmacists' statement. 2016. (Online) Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/practice-based-pharmacists.pdf (accessed 06 Oct 2020). 2. Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists. Res Soc Adm Pharm. 2013; 9(6): 688–699.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Judy Brook ◽  
Leanne M. Aitken ◽  
Julie-Ann MacLaren ◽  
Debra Salmon
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Focus Groups ◽  
Academic Staff ◽  
Skills Training ◽  
Early Career ◽  
Mixed Methods Study ◽  
Healthcare Organisation ◽  
Structured Interviews ◽  
Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

scholarly journals Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention

2020 ◽  
Vol 41 (S1) ◽  
pp. s279-s280
Author(s):  
Nicole Lamont ◽  
Lauren Bresee ◽  
Kathryn Bush ◽  
Blanda Chow ◽  
Bruce Dalton ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Groups ◽  
Clinical Decision Support ◽  
Implementation Strategy ◽  
Clinical Decision ◽  
Medication Administration ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Clostridioides Difficile ◽  
Number Of Patients

Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: AwardDisclosures: None

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