scholarly journals Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: A qualitative interview study using vignettes

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0014
Author(s):  
Emily Lyness ◽  
Jane Louise Vennik ◽  
Felicity Bishop ◽  
Pranati Misurya ◽  
Jeremy Howick ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Structured Interviews ◽  
Knee Oa ◽  
Qualitative Interview Study ◽  
Empathic Communication ◽  
Case Vignettes ◽  
Digital Training ◽  
Improve Patient

BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews.SettingPurposefully sampled patients (n=33) aged 45+ with hip/knee OA from Wessex GP practices.MethodFifteen participants watched two filmed OA consultations with a GP, and eighteen participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.ResultsPatients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.ConclusionPatients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.

Ulcerative colitis

2019 ◽  
Vol 12 (9) ◽  
pp. 501-506
Author(s):  
Charlie Andrews
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Primary Care ◽  
Patient Outcomes ◽  
Colon And Rectum ◽  
Inflammatory Bowel ◽  
Primary Care Clinicians ◽  
Improve Patient ◽  
Prompt Diagnosis

Ulcerative colitis is a form of inflammatory bowel disease. It is a chronic relapsing condition affecting the colon and rectum and can cause a variety of symptoms, the commonest of which is bloody diarrhoea. Prompt diagnosis, as well as flare identification and management by primary care clinicians can improve patient outcomes such as disease progression and effects on quality of life.

Addressing the Scottish burden of wounds through the Lens of Profound Knowledge

2021 ◽  
Vol 30 (Sup20) ◽  
pp. S34-S40
Author(s):  
Jenni MacDonald
Keyword(s):  
Patient Outcomes ◽  
Wound Care ◽  
Cost Effective ◽  
Theory Of Knowledge ◽  
Care Needs ◽  
Profound Knowledge ◽  
The Cost ◽  
Improve Patient ◽  
Growing Population

The prevalence of wounds and the cost of treating them are increasing year on year. Improving the quality of wound care will improve patient outcomes and is a financial necessity. The Lens of Profound Knowledge is a tool that can be used to support quality improvement and identify where action is needed. It allows exploration of an organisation through four aspects—appreciate the system, understanding variation, psychology, and theory of knowledge—and working on all four aspects simultaneously is believed to increase the likelihood of achieving improvement. Improvements at and between all levels—microsystem (such as frontline services), mesosystem (health boards) and macrosystem (NHS Scotland)—would reduce variation in practice and prove to be both clinically and cost-effective. Given the rapidly growing population of people with unhealed wounds, wound care needs to be valued at all system levels and be adequately resourced.

scholarly journals Operational failures and how they influence the work of GPs: a qualitative study in primary care

2020 ◽  
Vol 70 (700) ◽  
pp. e825-e832
Author(s):  
Carol Sinnott ◽  
Alexandros Georgiadis ◽  
Mary Dixon-Woods
Keyword(s):  
Primary Care ◽  
Work Environment ◽  
Information Transfer ◽  
Healthcare Providers ◽  
Comparison Method ◽  
Care Work ◽  
System Level ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Operational Failures

BackgroundOperational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs’ experiences of work, they remain under-explored in primary care.AimTo identify operational failures in the primary care work environment and to examine how they influence GPs’ work.Design and settingQualitative interview study in the East of England.MethodSemi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.ResultsGPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook ‘compensatory labour’ to fulfil their duties of coordinating and safeguarding patients’ care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.ConclusionOperational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.

scholarly journals Gout in primary care: Can we improve patient outcomes?

2017 ◽  
Vol 6 (1) ◽  
pp. u210130.w4918 ◽  
Author(s):  
Jacqueline Callear ◽  
Georgina Blakey ◽  
Alexandra Callear ◽  
Linda Sloan
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Improve Patient

scholarly journals Patient-reported outcomes in clinical practice

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 501-506 ◽  
Author(s):  
Sarah Dobrozsi ◽  
Julie Panepinto
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Physician Communication ◽  
Valuable Data ◽  
Patient Reported ◽  
Improve Patient

Abstract Patient-reported outcome (PRO) measurement plays an increasingly important role in health care and understanding health outcomes. PROs are any report of a patient's health status that comes directly from the patient, and can measure patient symptoms, patient function, and quality-of-life. PROs have been used successfully to assess impairment in a clinical setting. Use of PROs to systematically quantify the patient experience provides valuable data to assist with clinical care; however, initiating use of PROs in clinical practice can be daunting. Here we provide suggestions for implementation of PROs and examples of opportunities to use PROs to tailor individual patient therapy to improve patient outcomes, patient–physician communication, and the quality of care for hematology/oncology patients.

scholarly journals Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

2018 ◽  
Vol 6 (4) ◽  
pp. 1-260 ◽  
Author(s):  
Elaine Hay ◽  
Krysia Dziedzic ◽  
Nadine Foster ◽  
George Peat ◽  
Danielle van der Windt ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Research Programme ◽  
Anxiety And Depression ◽  
Knee Oa ◽  
Randomised Controlled

BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8689
Author(s):  
Claire Norman ◽  
Josephine M. Wildman ◽  
Sarah Sowden
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Care Staff ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Social Prescribing ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Primary Care Staff ◽  
Deprived Areas

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

scholarly journals An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

2020 ◽  
Author(s):  
Danielle Lobena Couch ◽  
Belinda O’Sullivan ◽  
Deborah Russell ◽  
Matthew McGrail ◽  
Glen Wallace ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Clinical Care ◽  
Scope Of Practice ◽  
Structured Interviews ◽  
Training Systems ◽  
Access To Primary Care ◽  
Registrar Training ◽  
Improve Patient

Abstract Background: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. In particular rural over regional GP placements are important for developing future GPs with broader skills because the rural scope of practice is wider. Having enough GP supervisors in smaller rural communities is essential such training. We aimed to explore what makes rural GPs’ based outside of major regional centres, participate in supervising or not, their experiences of supervising, and impact of their practice context. Methods: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania (outside of major regions - Hobart and Launceston), in towns of <25,000 population, to explore the GPs’ professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. Results: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors impacted the decision to participate in supervision and the experience of participating: including uncertainty and discontinuity of registrar supply (rotational training systems), registrar competence and generating income. Conclusions: Supervising is strongly positive for rural GPs and related to job satisfaction but increasing supervision capacity in rural areas may depend on better policies to assure continuity of rural registrars as well as policies and systems that enable viable supervision models tailored to the context.

scholarly journals 002 Gout in primary care: can we improve patient outcomes?

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_3) ◽  
Author(s):  
Georgina Blakey ◽  
Jacqueline Callear
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Improve Patient

scholarly journals A TEAM APPROACH TO THE IMPLEMENTATION OF THE ANNUAL WELLNESS VISIT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S393-S393
Author(s):  
Lucy Guerra
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Practice Change ◽  
Team Approach ◽  
Change Initiative ◽  
Virtual Training ◽  
Highly Effective ◽  
To Come ◽  
Improve Patient

Abstract The success of any practice change initiative is dependent upon a highly effective team. This presentation will focus on the “secret sauce” of our implementation of the AWV in collaboration with the Dartmouth GWEP. Participating in both asynchronous and live virtual training enabled our team to come together to successfully implement the AWV using a team based model. Using the principles of highly effective teaming and a rapid cycle QI approach we have been able to improve patient outcomes in primary care.

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