Understanding patient experience of out-of-hours general practitioner services in South Wales: a qualitative study

ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

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OUT‐OF‐HOURS DEPUTIZING SERVICES IN NEW SOUTH WALES

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1970.tb116854.x ◽

1970 ◽

Vol 1 (15) ◽

pp. 775-775

Keyword(s):

New South ◽

New South Wales ◽

Out Of Hours ◽

South Wales

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Off‐label prescribing of stimulant medication to students: a qualitative study on the general practitioner perspective

Sociology of Health & Illness ◽

10.1111/1467-9566.13166 ◽

2020 ◽

Vol 42 (7) ◽

pp. 1657-1672

Author(s):

Sara De Bruyn ◽

Edwin Wouters ◽

Koen Ponnet ◽

Robert Tholen ◽

Caroline Masquillier ◽

...

Keyword(s):

General Practitioner ◽

Qualitative Study ◽

Stimulant Medication ◽

Off Label

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PATIENTS’ JOURNEY THROUGH INFLAMMATORY BOWEL DISEASE (IBD): A QUALITATIVE STUDY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.127 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S53-S54

Author(s):

Tina Aswani Omprakash ◽

Norelle Reilly ◽

Jan Bhagwakar ◽

Jeanette Carrell ◽

Kristina Woodburn ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Qualitative Study ◽

Patient Experience ◽

Bowel Disease ◽

Quality Care ◽

Diagnostic Testing ◽

Healthcare Providers ◽

Indeterminate Colitis ◽

Patient Journey ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is a debilitating intestinal condition, manifesting as Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC). The patient experience is impacted by a lack of awareness from other stakeholders despite growing global disease prevalence. To gain deeper insight of the patient experience, promote quality care, and enhance quality of life, we performed a qualitative study of the patient journey starting from pre-diagnosis through treatment. Methods U.S. patients with IBD were recruited via UC/CD support groups and organizations, social media platforms, blog followers, and personal networks. Participants were screened via an emailed survey and asked to self-identify as medically diagnosed on the basis of reported diagnostic testing. Interviews were conducted by qualitative researchers by phone or web conferencing. Open-ended questions were developed to support and gather information about our learning objectives—primarily, our desire to understand the unique experiences of UC/CD patients in their journey from symptom onset through diagnosis, treatment and maintenance (e.g. “Upon diagnosis, what were your immediate thoughts about the condition?”). This qualitative data were analyzed using Human-Centered Design methodology, including patient typologies (personas), forced temporal zoom (journey maps), forced semantic zoom (stakeholder system mapping), and affinity mapping for pattern recognition of unmet needs. Results A total of 32 patients were interviewed: N=17 CD patients, N=13 UC patients and N=2 IC patients. The interviewed population reflected regional, demographic, and disease-related diversity (Table 1). Five unique, mutually exclusive journeys were identified to understand and classify patient experiences: (1) Journey of Independence, (2) Journey of Acceptance, (3) Journey of Recognition, (4) Journey of Passion and (5) Journey of Determination (Figure 1). Patients with IBD expressed a need for increased awareness, education, and training for providers to shorten the path to diagnosis. Mental health support was found to be a critical gap in care, particularly for major treatment decisions (e.g., surgery). The inclusion of emotional support into the treatment paradigm was perceived as essential to long-term wellness. Patient attitudes and self-advocacy varied on their individual journeys; understanding these journeys may accelerate time to diagnosis and treatment. Conclusion Better understanding of patient journeys can help healthcare providers improve their approach to patient care and coordination.

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Performance of a new guideline for telephone triage in out-of-hours services in Belgium: A pilot study using simulated patients

Health Services Management Research ◽

10.1177/0951484820921809 ◽

2020 ◽

Vol 33 (4) ◽

pp. 166-171

Author(s):

Stefan Morreel ◽

Hilde Philips ◽

Annelies Colliers ◽

Veronique Verhoeven

Keyword(s):

General Practitioner ◽

Primary Objective ◽

Phone Call ◽

Simulated Patients ◽

Telephone Triage ◽

Out Of Hours ◽

Important Variation ◽

Phone Calls ◽

The Right ◽

Urgency Level

Background Patients in Belgium needing out-of-hours care have two options: the emergency department or the general practitioner on call often organised in a general practitioner cooperative. Currently, there is no triage system in Belgium so patients do not know where to go. Methods Our primary objective was to examine the ability of a newly developed telephone guideline, called 1733, to adequately estimate the urgency of health problems presented by simulated patients. Ten clinical vignettes were presented to 12 operators in a simulated phone call. The operators had to assign a protocol, urgency level and resource to dispatch (ambulance, general practitioner house visit, etc.) to each case. Results A total of 120 phone calls were analysed. The operators chose the right protocol in 69% and the correct urgency level in 35% of the cases. The proportion of under- and over-triage was 26% and 39%, respectively. There was important variation in between the operators. The sensitivity for detecting highly urgent cases was 0.42, the specificity 0.92. Conclusion Using the new Belgian 1733 guideline for telephone triage, operators mostly chose the appropriate protocol but only chose the correct urgency in one out of three cases. In this phase of development, the studied telephone guideline is not ready for implementation.

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“I Can’t Go Far”: Perceptions and Experiences of Heart Failure Patients Regarding Physical Activity: A Qualitative Study Using Semistructured Face-to-Face Interviews

Health Education & Behavior ◽

10.1177/10901981211053247 ◽

2021 ◽

pp. 109019812110532

Author(s):

Elodie Charuel ◽

Martial Bernard ◽

Hélène Vaillant Roussel ◽

Benoit Cambon ◽

Thibault Ménini ◽

...

Keyword(s):

Physical Activity ◽

Heart Failure ◽

New York ◽

General Practitioner ◽

Qualitative Study ◽

Heart Association ◽

Enabling Factors ◽

Face To Face ◽

New York Heart Association

Background Participation in regular physical activity (RPA) is beneficial to the quality of life and life expectancy of patients with chronic heart failure (CHF). However, it is inadequate in many patients. Aims To determine the factors that influence the practice of RPA in patients with CHF managed in general practice. Method This was a qualitative study using semistructured, individual face-to-face interviews. Patients with CHF (New York Heart Association Stages 1–3) capable of participating in RPA were enrolled by their general practitioner. A longitudinal and transversal inductive thematic analysis was performed by two researchers. Results Five themes emerged from the 19 interviews that were conducted. Poor knowledge of the disease and the benefits of participating in RPA, as well as the lack of motivation or enjoyment, in particular due to the absence of previous participation, were considered significant obstacles. Fear associated with CHF or other comorbidities was also an obstacle. Attendance at a rehabilitation center, family and social circles, and having a pet all appeared to be beneficial. Family and friends were important for motivating the patient to participate in an activity but could also be an obstacle when they were overprotective. Conclusion This study helps highlight the difficulties for patients with CHF associated with participation in RPA. Despite the obstacles, there are enabling factors on which the general practitioner may rely to motivate their patients.

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