scholarly journals Community case managers' challenges collaborating with primary care when managing complex patients in the community: A qualitative study in Singapore

2021 ◽  
Author(s):  
Gilbert T. S. Yeo ◽  
Predeebha Kannan ◽  
Eng Sing Lee ◽  
Helen E. Smith
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Case Managers ◽  
Complex Patients

scholarly journals Community Case Managers’ (CCMs) Perspectives’ Collaborating With Primary Care Services When Managing Complex Patients in the Community: A Qualitative Study.

2021 ◽  
Author(s):  
Gilbert Yeo ◽  
Predeebha Kannan ◽  
Eng Sing Lee ◽  
Helen Smith
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Case Managers ◽  
Medical Professionals ◽  
Collaborative Culture ◽  
Self Identity ◽  
Care Services ◽  
Primary Care Services ◽  
Complex Patients ◽  
Depth Interviews

Abstract Background: Strong collaboration between community case managers (CCMs) and medical professionals are vital for the continuity of complex patients’ care in the community. Key challenges can influence or even deter successful collaboration. Objective: The objective of this qualitative study was to understand the challenges encountered by CCMs when collaborating with primary care services. Methods: This exploratory qualitative descriptive study used individual in-depth interviews. CCMs were selected using maximum variation and snowball sampling. The interviews were semi-structured, guided by a topic guide. Data were analyzed alongside ongoing data collection. Thematic content analysis was used to analyze the transcripts. Initial codes were obtained independently. These codes were then further explored, clarified and iteratively grouped into themes.Results: Fourteen individual in-depth interviews were conducted. Six themes emerged from the data i.e. self-identity, patient factor, inter-professional factor, collaborative culture, confidentiality and organizational structure. Challenges that resonated with previous studies were self-identity, inter-professional factors and confidentiality, whereas other challenges such as patient factors, collaborative culture, and organizational structure, were unique to Singapore’s health care landscape.Conclusions: Significant challenges were encountered by CCMs when collaborating with primary care services. Understanding these challenges is key to refining intervention in current models of comprehensive community care between medical and non-medical professionals.

Community Case Managers’ (CCMs) perspectives’ collaborating with primary care services when managing complex patients in the community: a qualitative study. (Preprint)

2021 ◽  
Author(s):  
Gilbert Tian Seng Yeo ◽  
Predeebha Kannan ◽  
Eng Sing Lee ◽  
Helen Elizabeth Smith
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Case Managers ◽  
Medical Professionals ◽  
Collaborative Culture ◽  
Self Identity ◽  
Care Services ◽  
Primary Care Services ◽  
Complex Patients ◽  
Depth Interviews

BACKGROUND Strong collaboration between community case managers (CCMs) and medical professionals are vital for the continuity of complex patients’ care in the community. Key challenges can influence or even deter successful collaboration. OBJECTIVE The objective of this qualitative study was to understand the challenges encountered by CCMs when collaborating with primary care services. METHODS This exploratory qualitative descriptive study used individual in-depth interviews. CCMs were selected using maximum variation and snowball sampling. The interviews were semi-structured, guided by a topic guide. Data were analyzed alongside ongoing data collection. Thematic content analysis was used to analyze the transcripts. Initial codes were obtained independently. These codes were then further explored, clarified and iteratively grouped into themes. RESULTS Fourteen individual in-depth interviews were conducted. Six themes emerged from the data i.e. self-identity, patient factor, inter-professional factor, collaborative culture, confidentiality and organizational structure. Challenges that resonated with previous studies were self-identity, inter-professional factors and confidentiality, whereas other challenges such as patient factors, collaborative culture, and organizational structure, were unique to Singapore’s health care landscape. CONCLUSIONS Significant challenges were encountered by CCMs when collaborating with primary care services. Understanding these challenges is key to refining intervention in current models of comprehensive community care between medical and non-medical professionals.

scholarly journals Nursing as a Sustainability Factor of the Health System during the COVID-19 Pandemic: A Qualitative Study

2020 ◽  
Vol 12 (19) ◽  
pp. 8099
Author(s):  
María Jesús Rojas-Ocaña ◽  
Miriam Araujo-Hernández ◽  
Rocío Romero-Castillo ◽  
Silvia San Román-Mata ◽  
E. Begoña García-Navarro
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Phenomenological Approach ◽  
Total Sample ◽  
Case Managers ◽  
Service Users ◽  
Health Crisis ◽  
Key Informants ◽  
Specialized Care ◽  
Nursing Professionals

Earlier this year, Spain took center stage in the emerging health crisis due to the SARS-CoV-2 pandemic. On 14 March 2020, a state of alarm was declared to manage this health crisis. The contribution of nursing professionals to sustainability of the system during this health crisis has been vital, not only in specialized care but, in a more understated way, in primary care. The objective of the present study was to describe the perceptions and lived experiences of primary care nurses during the COVID-19 health emergency. A qualitative study taking a phenomenological approach was carried out, triangulating data collected through non-participant observations, eight in-depth interviews, and two discussion groups with community nurses and case managers. A total sample of 20 key informants was obtained during the month of May, 2020. The key informants expressed strong positive perceptions of the recognition received from service users and satisfaction when acknowledging that they have been an important source of emotional support. Informants identify the importance of their work in sustaining the system, particularly outlining team cohesion and communication, whilst also evaluating the empowering position in which service users and society itself has put them.

scholarly journals Primary care providers’ experiences caring for complex patients in primary care: a qualitative study

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Danielle F. Loeb ◽  
Elizabeth A. Bayliss ◽  
Carey Candrian ◽  
Frank V. deGruy ◽  
Ingrid A. Binswanger
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Providers ◽  
Care Providers ◽  
Complex Patients

Factors Affecting Primary Care Physician Decision-Making for Patients with Complex Multimorbidity: A Qualitative Study

2021 ◽  
Author(s):  
Linnaea Schuttner ◽  
Stacey Hockett Sherlock ◽  
Carol Simons ◽  
James D Ralston ◽  
Ann-Marie Rosland ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Multiple Chronic Conditions ◽  
Care Planning ◽  
Health Administration ◽  
Factors Affecting ◽  
Care Plans ◽  
Physician Decision Making ◽  
Complex Patients

Abstract Background Patients with multiple chronic conditions (multimorbidity) and additional psychosocial complexity are at higher risk of adverse outcomes. Establishing treatment or care plans for these patients must account for their disease interactions, finite self-management abilities, and even conflicting treatment recommendations from clinical practice guidelines. Despite existing insight into how primary care physicians (PCPs) approach care decisions for their patients in general, less is known about how PCPs make care planning decisions for more complex populations. We therefore sought to describe factors affecting physician decision-making when care planning for complex patients with multimorbidity Methods This was a qualitative study involving semi-structured telephone interviews with PCPs working ≥ 40% time in a team-based, patient-centered medical home setting in the integrated healthcare system of the U.S. Department of Veterans Affairs, the Veterans Health Administration (VHA). Interviews were conducted from April to July, 2020. Content was analyzed with inductive thematic analysis. Results 25 physicians participated in interviews; most were MDs (n = 21) and worked in hospital-affiliated clinics (n = 14) across all regions of the VHA’s national clinic network. Seven major themes emerged for factors affecting decision-making for complex patients with multimorbidity. Physicians described collaborating on care plans with their care team; considering impacts from patient access and resources on care plans; the boundaries provided by organizational structures; tailoring decisions to individual patients; making decisions in keeping with an underlying internal style or habit; working towards an overarching goal for care; and impacts on decisions from their own emotions and relationship with patient. Conclusions PCPs described individual, relationship-based, and environmental factors affecting their care planning for high-risk and complex patients with multimorbidity in the VHA. Findings offer useful strategies employed by physicians to effectively conduct care planning for complex patients, such as delegation of follow-up within care teams, optimizing visit time vs frequency, and deliberate investment in patient relationship building to gain buy-in to care plans.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

scholarly journals Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033061
Author(s):  
Mark Lown ◽  
Christopher R Wilcox ◽  
Stephanie Hughes ◽  
Miriam Santer ◽  
George Lewith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Qualitative Study ◽  
Decision Aids ◽  
Care Practice ◽  
Semistructured Interview ◽  
Interview Guide ◽  
Registration Number ◽  
The Cost ◽  
Inductive Thematic Analysis

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

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