General practitioners and decision-making capacity assessment: the experiences and educational needs of New Zealand general practitioners

2020 ◽  
Vol 37 (4) ◽  
pp. 535-540
Author(s):  
Alisha Vara ◽  
Greg Young ◽  
Alison Douglass ◽  
Frederick Sundram ◽  
Marcus Henning ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
General Practitioners ◽  
Clinical Skills ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Roles And Responsibilities ◽  
Decision Making Capacity ◽  
Training Resources ◽  
And Training

Abstract Background Assessing decision-making capacity to health care is within the scope of practice for all doctors, yet the experience of GPs in this area is unknown. Objective To explore the experiences, perspectives, approaches and challenges for GPs in New Zealand when conducting decision-making capacity assessments. Methods Qualitative study design comprising individual in-depth semi-structured interviews conducted with a convenience sample of GPs. Interview transcripts were transcribed verbatim and analysed using a thematic analysis approach. Results Twelve participants were recruited. The following themes emerged: (i) GPs’ roles and responsibilities in decision-making capacity assessments; (ii) GPs lack formal training, knowledge, and confidence in decision-making capacity assessments; (iii) the legal interface of decision-making capacity assessments; (iv) GPs’ relationships with specialists and the resulting impact on their confidence in decision-making capacity assessments; and (v) opportunities to improve GPs’ knowledge and confidence in decision-making capacity assessments. Conclusions GPs take responsibility for decision-making capacity assessments; however, assessments can be complex. There is a need to develop specific curriculum and training resources for GPs to improve their clinical skills and legal knowledge in decision-making capacity assessments.

scholarly journals Medical Decision-Making Capacity

GeroPsych ◽  
2018 ◽  
Vol 31 (2) ◽  
pp. 57-65 ◽  
Author(s):  
Dragutin Novosel ◽  
Stjepan Ljudevit Marušić ◽  
Nikola Biller-Andorno ◽  
Manuel Trachsel
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
General Practitioners ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Treatments ◽  
Decision Making Capacity ◽  
Legal Perspective ◽  
Almost All ◽  
And Training

Abstract. Decision-making capacity (DMC) is a prerequisite for informed consent to medical treatments. However, little is known about the knowledge, attitudes, and evaluation of DMC among physicians in Croatia. A survey was conducted among 180 general practitioners and psychiatrists in Croatia. Although from a legal perspective DMC is a dichotomous concept, about 90% of physicians indicated that they understand DMC to be a gradual concept. A majority of physicians considered themselves responsible and qualified to conduct DMC evaluations, though some physicians considered themselves insufficiently qualified. General practitioners considered themselves less responsible and less qualified than psychiatrists. Almost all participants indicated that they would welcome official guidelines and training.

scholarly journals An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study

2018 ◽  
Vol 20 ◽  
Author(s):  
Ratan S. Randhawa ◽  
Joht S. Chandan ◽  
Tom Thomas ◽  
Surinder Singh
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Healthcare Setting ◽  
List Type ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Telephone Consultation ◽  
Video Consultation ◽  
Mixed Feelings ◽  
The Government

AbstractBackgroundIn 2014, in the United Kingdom, the government made a commitment to spend £3.6 million on the introduction of Skype video calling consultations in general practice, however the efficacy of such technology has not yet been explored fully.AimThe study aimed to explore the views and attitudes of General Practitioners (GPs) towards video consultation in primary care; specifically, in three broad areas∙The benefits of video consultations to patients and healthcare professionals.∙Potential problems with video consultation and its implementation.∙The cost-effectiveness of video consultation in this setting.MethodA convenience sample of the views of 12 general practitioners across two primary care centres in North London were identified using topic guide based semi-structured interviews. A thematic framework approach was used to analyse the data collected to isolate main and sub-themes.FindingsThree main themes were identified1.Technology – GPs expressed concerns about the ability of patients to use technology, the availability of technology and the quality of technology available.2.Utility – encompassing GP’s ideas about the usefulness of video consultations to patients, practitioners and the doctor–patient relationship. GPs presented mixed views on the extent to which video consultation would be useful.3.Practicality – covering the views of GPs on implementation and effects on workload. GPs unanimously felt that it was not a practical substitute for face-to-face consultation. There were mixed feelings about it being used as an alternative to telephone consultation.ConclusionGPs did see potential benefits to using video consultations but also expressed concerns that need to be addressed if they are to have full confidence in the system. The views of those who are going to use video consultation as a means of increasing patient access are paramount if such tools are to be a core part of primary care.

scholarly journals DECISION-MAKING AT THE FIRST MANAGEMENT LEVEL: THE INTERFERENCE OF THE ORGANIZATIONAL CULTURE

2018 ◽  
Vol 19 (3) ◽  
Author(s):  
GUSTAVO G. MARCHISOTTI ◽  
MARIA DE L. C. DOMINGOS ◽  
RODRIGO L. DE ALMEIDA
Keyword(s):  
Decision Making ◽  
Organizational Culture ◽  
Treatment Technique ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Management Level ◽  
Decision Making Capacity ◽  
Practical Usefulness ◽  
The One ◽  
Different Origins

ABSTRACT Purpose: This article aims at explaining how a decision is made in the first management level, within five different organizations, from different origins - American, Brazilian and Chinese - in different branches of activity. Originality/value: This is an original work, since it goes beyond the frontiers of knowledge about the subject researched, both for its approach and for its practical usefulness in the day-to-day of the decision makers, being useful for both professionals - and decision making - and for companies - on how to improve the decision-making capacity of their managers. Design/methodology/approach: Fifty managers were interviewed, through the application of a qualitative exploratory research, with the collection of data through semi-structured interviews and content analysis as data analysis and treatment technique. Findings: One may conclude that the decision-making of the first level decision-making managers is more rational. Also, the organizational culture, among the studied variables is the one with the greater impact in the way this management level makes the decisions. This influence of the organizational culture contains three important elements: 1. the need of the manager to act procedurally, using the rules and standards of the company, 2. the use of supporting tools for the decision-making and 3. the learning from the current relationship - or from the past one - with their peers. To go deeper in the theme, we suggest the analysis of the influence of gender in decision-making, under the focus of rationality or intuition, in the first level of the managerial function of the organizations.

scholarly journals The incorporation of Māori environmental values as part of the Ruamāhanga Whaitua Implementation Programme in the Wellington Region, Aotearoa New Zealand

2021 ◽  
Author(s):  
◽  
Bryn Cal Hickson Rowden
Keyword(s):  
Environmental Management ◽  
Decision Making ◽  
New Zealand ◽  
Theory Approach ◽  
Structured Interviews ◽  
Environmental Decision Making ◽  
Aotearoa New Zealand ◽  
Management Processes ◽  
Local Government Level ◽  
Implementation Programme

<p>In recent years, there has been significant efforts to create frameworks in which Māori values are incorporated as part of environmental management processes in Aotearoa New Zealand(Forster, 2014; Harmsworth et al., 2016). This research explores the factors that influence the incorporation of Māori values at the local government level, and what barriers Māori values face to being incorporated in environmental management. This research focused on a case study of the Ruamāhanga Whaitua Committe Implementation Programme process in the Wellington region. Semi-structured interviews were used to collect information on the opinions of members of the Ruamāhanga Whaitua Committee. The interviews were analysed using a critical theory approach. The research found that there was a clear discrepancy between the values and behaviours expressed by some non-Māori members of the Committee. The result of such a discrepancy was that Māori values were not sufficiently part of environmental decision making. Such a discrepancy was a result of the political structures of the Regional Council’s Whaitua Implementation Programme process. The majority of the decision-making power was found to be situated ‘higher’ up in the organisation, outside of the Committee. Overall this research found that there are important opportunities to make sure iwi values are not only included, but form the basis of decisions.</p>

General Practitioners’ Roles in Disaster Health Management: Perspectives of Disaster Managers

2021 ◽  
pp. 1-8
Author(s):  
Penelope L. Burns ◽  
Gerard J. FitzGerald ◽  
Wendy C. Hu ◽  
Peter Aitken ◽  
Kirsty A. Douglas
Keyword(s):  
Health Care ◽  
New Zealand ◽  
General Practitioners ◽  
Health Management ◽  
Health Care Systems ◽  
Health Resources ◽  
Local Health ◽  
Structured Interviews ◽  
Care Needs ◽  
Study Objective

Abstract Introduction: General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. Study Objective: The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. Methods: A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. Results: These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs’ ability to facilitate GP integration; and (2) DMs’ difficulty engaging with GPs as a single group. Other considerations included GPs’ limited DHM knowledge, limited preparedness, and their heightened vulnerability. Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. Conclusion: Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

scholarly journals General practitioners’ views of pharmacists’ current and potential contributions to medication review and prescribing in New Zealand

2013 ◽  
Vol 5 (3) ◽  
pp. 223 ◽  
Author(s):  
Ernieda Hatah ◽  
Rhiannon Braund ◽  
Stephen Duffull ◽  
June Tordoff
Keyword(s):  
New Zealand ◽  
General Practitioners ◽  
Medication Review ◽  
Skills Training ◽  
Structured Interviews ◽  
Medical Practitioners ◽  
Pharmacist Prescribing ◽  
Adherence Support ◽  
Primary Health Care Professional ◽  
Medication Reviews

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs’ perceptions of pharmacists’ contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists’ provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs’ major strengths. GPs’ perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists’ strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. KEYWORDS: Community pharmacy services; general practitioners; New Zealand; primary health care; professional role

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 Decision-making through the grapevine: Winegrowers' perceptions on climate change and the barriers to adaptation planning in New Zealand

2021 ◽  
Author(s):  
◽  
Alyssa Ryan
Keyword(s):  
Climate Change ◽  
Decision Making ◽  
New Zealand ◽  
Climate Science ◽  
Wine Industry ◽  
Adaptation Planning ◽  
Climate Projections ◽  
Structured Interviews ◽  
Wine Production ◽  
Climate Change Research

<p>New Zealand wine is cultivated in cool climates that produce distinctive flavours and wine-styles, which are representative of the terroir of the region. The effects of climate change can impact the quality and quantity of winegrapes, and the production of premium wine. The aim of this research was to investigate adaptation planning in the New Zealand wine industry by evaluating winegrowers’ decision-making and perceptions of climate change. Research was conducted using primary survey data from New Zealand winegrowers and semi-structured interviews with winegrowers from three case study regions of Marlborough, Central Otago, and Hawke’s Bay. The study was designed to assess how climate change is understood throughout the industry, whether adaptation plans are being developed or employed and the barriers hindering winegrowers’ implementation of adaptation strategies. The results show that winegrowers are somewhat informed about climate change with some adaptation planning occurring. However, the majority of winegrowers have no plans to adapt to climate change. The uncertainty in the climate science and the availability of information were indicated as a barrier to adaptation planning. Winegrowers convey the need for regional information with a focus on reliable forecasting and climate projections for the next few years. The New Zealand wine industry is in a positive position to undertake adaptation with the opportunity to exploit the benefits of climate change for wine production.</p>

scholarly journals The incorporation of Māori environmental values as part of the Ruamāhanga Whaitua Implementation Programme in the Wellington Region, Aotearoa New Zealand

2021 ◽  
Author(s):  
◽  
Bryn Cal Hickson Rowden
Keyword(s):  
Environmental Management ◽  
Decision Making ◽  
New Zealand ◽  
Theory Approach ◽  
Structured Interviews ◽  
Environmental Decision Making ◽  
Aotearoa New Zealand ◽  
Management Processes ◽  
Local Government Level ◽  
Implementation Programme

<p>In recent years, there has been significant efforts to create frameworks in which Māori values are incorporated as part of environmental management processes in Aotearoa New Zealand(Forster, 2014; Harmsworth et al., 2016). This research explores the factors that influence the incorporation of Māori values at the local government level, and what barriers Māori values face to being incorporated in environmental management. This research focused on a case study of the Ruamāhanga Whaitua Committe Implementation Programme process in the Wellington region. Semi-structured interviews were used to collect information on the opinions of members of the Ruamāhanga Whaitua Committee. The interviews were analysed using a critical theory approach. The research found that there was a clear discrepancy between the values and behaviours expressed by some non-Māori members of the Committee. The result of such a discrepancy was that Māori values were not sufficiently part of environmental decision making. Such a discrepancy was a result of the political structures of the Regional Council’s Whaitua Implementation Programme process. The majority of the decision-making power was found to be situated ‘higher’ up in the organisation, outside of the Committee. Overall this research found that there are important opportunities to make sure iwi values are not only included, but form the basis of decisions.</p>

scholarly journals General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study

2018 ◽  
Vol 36 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Abigail Moore ◽  
Caroline Croxson ◽  
Sara McKelvie ◽  
Dan Lasserson ◽  
Gail Hayward
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
General Practitioners ◽  
Older Patients ◽  
Ageing Population ◽  
Structured Interviews ◽  
Suspected Infection ◽  
Qualitative Interview Study ◽  
System Factors ◽  
The Uk

Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.

Sign in / Sign up

Export Citation Format

Share Document