scholarly journals Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviours in Primary Care for the Elderly—Protocol for a Qualitative Study

2021 ◽  
Vol 18 (14) ◽  
pp. 7656
Author(s):  
Najwa Taghy ◽  
Linda Cambon ◽  
Caroline Boulliat ◽  
Olivier Aromatario ◽  
Claude Dussart
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Qualitative Data ◽  
Geographic Location ◽  
Community Pharmacists ◽  
The Elderly ◽  
Structured Interviews ◽  
Care For The Elderly ◽  
Key Stakeholders ◽  
Negative Connotation

Polypharmacy is becoming increasingly common, especially among the elderly. It often has a negative connotation, but is sometimes necessary or even desirable, and needed to categorize polypharmacy as appropriate or inappropriate. The challenge is in ensuring that this is considered appropriate when necessary. We aimed to develop an evidence-based intervention to reduce the risks associated with using a systematic approach, involving key stakeholders in prescribing and dispensing drugs to the elderly in primary care. The purpose of this study is to identify the key components which are perceived as influencing these behaviours. It is a qualitative study of general practitioners (GPS) and community pharmacists involved in the care of the elderly. The main inclusion criterion is the geographic location. Qualitative data will be generated from one-on-one, semi-structured interviews and processed for thematic content analysis. Our approach integrates the patient pathway in primary care. It considers the fact that GP and pharmacist behaviours are far from being independent. This study represents the first step in the process of developing an intervention theory which involves a crossover between data from the literature and the knowledge of experts, allowing us to interrogate hypotheses about the influences and mechanisms associated with prescribing and dispensing drugs to the elderly in primary care.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing

2017 ◽  
Vol 9 (2) ◽  
pp. 145 ◽  
Author(s):  
Katharine Wallis ◽  
Rebecca Tuckey
Keyword(s):  
General Practice ◽  
High Risk ◽  
The Elderly ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Medicines Information ◽  
Care For The Elderly ◽  
Increased Risk ◽  
Information Brochure ◽  
Practice Methods

ABSTRACT INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

scholarly journals Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

2020 ◽  
pp. 1-15
Author(s):  
Gary Lamph ◽  
John Baker ◽  
Tommy Dickinson ◽  
Karina Lovell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Personality Disorder ◽  
Qualitative Study ◽  
Patient Group ◽  
Stepped Care ◽  
Research Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

scholarly journals Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

2020 ◽  
Vol 70 (691) ◽  
pp. e102-e110 ◽  
Author(s):  
Verity Wainwright ◽  
Lis Cordingley ◽  
Carolyn A Chew-Graham ◽  
Nav Kapur ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Support Needs ◽  
Structured Interviews ◽  
Perceived Needs ◽  
The North ◽  
Suicide Bereavement ◽  
Additional Support ◽  
The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

scholarly journals Training of nursing students in integrated care for the elderly

2018 ◽  
Vol 21 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Wanderson Carneiro Moreira ◽  
Ana Raquel Batista de Carvalho ◽  
Eliana Campêlo Lago ◽  
Fernanda Cláudia Miranda Amorim ◽  
Delmo de Carvalho Alencar ◽  
...  
Keyword(s):  
Nursing Students ◽  
Integrated Care ◽  
Exploratory Study ◽  
Holistic Approach ◽  
The Elderly ◽  
Qualitative Approach ◽  
Training Process ◽  
Structured Interviews ◽  
University Center ◽  
Care For The Elderly

Abstract Objective: To analyze training in integrated health care for the elderly from the perspective of nursing students. Method: A descriptive and exploratory study with a qualitative approach was carried out using the action research method with the participation of 24 nursing students from a university center in Piauí, Brazil. Data were obtained through semi-structured interviews and submitted to content analysis. Results: Two thematic categories emerged: Perspectives on aging, violence and sexuality and A holistic approach to the elderly: integrating training and care. Conclusion: The perspective of the students on integrated care for the elderly is fragmented, stemming from the limitations of the training process for such care.

scholarly journals Public, private or hybrid? Providing care services under austerity: the case of Italy

2020 ◽  
Vol 40 (11/12) ◽  
pp. 1279-1300
Author(s):  
Lisa Dorigatti ◽  
Anna Mori ◽  
Stefano Neri
Keyword(s):  
Trade Unions ◽  
Local Governments ◽  
Industrial Relations ◽  
The Elderly ◽  
Educational Services ◽  
Structured Interviews ◽  
Term Care ◽  
Content Type ◽  
Care For The Elderly ◽  
Market Factors

PurposeThe paper examines the different trajectories of externalisation and the development of different kinds of welfare mix in three different sub-sectors of socio-educational services: long-term care for the elderly, early childhood services and kindergartens. By integrating the industrial relations and comparative public administration literatures, it analyses the different rationales underpinning contracting-out decisions of Italian local governments.Design/methodology/approachThe paper adopts a multi-method, multi-level approach: quantitative data on the provision of socio-educational services and the nature of the providers are combined with the analysis of 12 case studies of municipalities through 80 semi-structured interviews and documentary analysis.FindingsThe paper argues that differentials in labour regulation across the public/private divide and the consequent possibility to access labour markets characterised by cheaper labour and higher organisational flexibility are a key explanation in local governments' decisions to outsource. Despite labour market factors playing a prominent role, their relevance is significantly tempered by political and social factors and particularly by the strong opposition of citizens, personnel and trade unions to pure market solutions in the provision of such services. However, the centrality of these factors depends on the nature of the services: political sensibility against privatisation proved to be stronger in kindergartens, while services for the elderly were more frequently and less contentiously privatised.Originality/valueThe main contribution is the integration of the two research traditions to analyse patterns of outsourcing in the socio-educational services in Italy, showing that neither of them is able, alone, to explain the different private/public mix characterising different social and educational services.

scholarly journals Emergency care units and dimensions of accessibility to health care for the elderly

2018 ◽  
Vol 71 (suppl 2) ◽  
pp. 811-817 ◽  
Author(s):  
Giovana Aparecida de Souza Scolari ◽  
Leidyani Karina Rissardo ◽  
Vanessa Denardi Antoniassi Baldissera ◽  
Lígia Carreira
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Of Care ◽  
Elderly Patients ◽  
Emergency Care ◽  
Elderly Population ◽  
The Elderly ◽  
Care For The Elderly ◽  
Emergency Care Units

ABSTRACT Objective: to understand the conception of the elderly and their caregivers about the accessibility to health mediated by the service in Emergency Care Units. Methodo: a qualitative study conducted with 25 elderly patients and caregivers at Emergency Care Units in a city of Paraná, using Grounded Theory as a methodological reference. Results: According to the participants, the resources available in these services guarantee medical consultation and provide access to exams and medicines. Such resources have attracted patients and caused excess demand, which implies a set of compromising factors for the quality of care in these services. Final considerations: Investments in the restructuring of the care network, especially in primary care, with an increase in the number of consultations and the creation of a bond, can contribute to the emergency care units achieving the goal of access to qualified assistance to the elderly population.

scholarly journals Therapeutic itinerary of people with tuberculosis in face with their health needs

2019 ◽  
Vol 23 (3) ◽  
Author(s):  
Aliéren Honório Oliveira ◽  
Antonio Germane Alves Pinto ◽  
Maria do Socorro Vieira Lopes ◽  
Tânia Maria Ribeiro Monteiro de Figueiredo ◽  
Edilma Gomes Rocha Cavalcante
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Qualitative Study ◽  
Health Needs ◽  
Smear Microscopy ◽  
Structured Interviews ◽  
X Ray ◽  
Entrance Door ◽  
One Year ◽  
The Impact

Abstract Objective: To describe the therapeutic itinerary of people with tuberculosis in face of their health needs. Method: Descriptive, qualitative study. Semi-structured interviews were carried out with ten patients. Hermeneutic-dialectic method of analysis and concept of therapeutic itinerary as driver of the analysis. Results: Most had classic symptoms at the beginning, however there was a case with coughing for more than one year. Entrance door, access to diagnosis and treatment were predominant in Primary Care, through smear microscopy and X-ray; patients had to pay for exams. Decentralization of treatment for other services when necessary or by link with the professional. The patient followed the decisions of the professionals and the support of relatives; prejudice regarding the disease was noted. Conclusions and implications for practice: Fragility in disease management, importance of bonding and family. It should be considered the impact of the disease and the need to support patients to ensure continuity of care.

scholarly journals Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

2021 ◽  
Vol 13 (4) ◽  
pp. 340
Author(s):  
Chloë Campbell ◽  
Caroline Morris ◽  
Lynn McBain
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
General Practitioners ◽  
Community Pharmacists ◽  
Unintended Consequences ◽  
Structured Interviews ◽  
Interprofessional Communication ◽  
Potential Benefits ◽  
Handwritten Signature ◽  
Purposive Sample

ABSTRACTINTRODUCTIONDuring the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy.AIMThe purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy.METHODSSemi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants’ perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach.RESULTSFour themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs).DISCUSSIONBoth general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.

scholarly journals Integrating nurse practitioners into primary care: policy considerations from a Canadian province

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stacey Black ◽  
Raad Fadaak ◽  
Myles Leslie
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care System ◽  
Structured Interviews ◽  
Primary Care Delivery ◽  
Key Stakeholders ◽  
The Status ◽  
Practice Opportunities ◽  
Care System

Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

FEATURES OF THE FORMATION OF CARE FOR THE OLDERLY IN NON-STATE RESIDENTIAL HOMES

2021 ◽  
pp. 870-878
Author(s):  
К. А. Галкин
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Rural Areas ◽  
Large City ◽  
The Elderly ◽  
Structured Interviews ◽  
Personalized Care ◽  
Care For The Elderly ◽  
Informal Rules ◽  
Care For Older People

В статье рассматриваются особенности заботы и ухода за пожилыми людьми в двух кейсах, которые представляют собой частные дома-интернаты для людей старше 60 лет. В частности, рассматривается создание заботы в условиях альтернативных возможностей, организация альтернативной заботы о пожилых людях в таких учреждениях и особенности формирования подобной заботы. В исследовании рассмотрены вопросы о соотношении формальных (институциональных) норм заботы о пожилых людях и неформальных правил, которые создаются сотрудниками частных домов-интернатов для пожилых людей, имеющих ограниченную профессионализацию в сфере работы с людьми старше 60 лет. Роль неформальных правил в рамках создания заботы о пожилых людях важна с точки зрения расширения агентности пожилых людей и их инклюзии в социум. В исследовании проанализировано сочетание особенностей формальных и неформальных правил по осуществлению заботы. На примере двух кейсов, полуструктурированных интервью с сотрудниками и администрацией, волонтёрами частных домовинтернатов ( n =30) автор показывает, что забота, которая формируется в частных домах-интернатах для пожилых людей, может достаточно сильно отличаться в зависимости от расположения учреждения, особенностей сотрудников и их профессионализации. Для более глобального пространства крупного города регионального значения забота о пожилых людях оказывается чётко регламентированной различными нормами и стандартами. Особенности заботы частного дома-интерната в сельской местности заключаются в персонифицированной заботе и создании больших возможностей для активности пожилых людей. The article discusses the features of care and care for the older in two cases, which are private nursing homes for people over sixty years of age. In particular, is the creation of concern in terms of great opportunities, the organization of alternative care for older people in such institutions and how such concerns. The study examines the relationship between formal (institutional) norms of social care for the older and informal rules that are created by employees of private nursing homes for the older who have limited professionalization in the field of work with people over sixty years of age. The role of informal rules in creating care for older people is important in terms of including the agency of older people and their inclusion in society. The study analyzes the combination of features of formal and informal rules for the implementation of care. Using the example of two cases, semi-structured interviews with employees and administration, volunteers of private nursing homes ( n =30), the author shows that the care that is formed in private nursing homes for the older can differ quite significantly depending on the location of the institution, the characteristics of employees and their professionalization For a more global space of a large city of regional significance care for the elderly is clearly regulated by various norms and standards. Features of care of a private nursing homes in rural areas consist in personalized care and creating greater opportunities for the activities of older people.

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