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Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences.

ABSTRACT: BACKGROUND:Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs' expectations of and experiences with IMEs. METHODS:We conducted three focus group interviews with a convenience sample of 14 GPs who had had 2-9 (mean 5) of their long-term sick-listed patients summoned to an IME. We asked them to recollect and describe their concrete expectations of and experiences with patients assigned to an IME. Systematic text condensation, a method for thematic cross-case analysis, was applied for analysis. RESULTS:To care for and to reassure their assigned sick-listed patients, the participants had spent time and applied different strategies before their patients had attended an IME. The participants welcomed a second opinion from an experienced GP colleague as a way of obtaining constructive advice for further sick-leave measures and/or medical advice. However, they mainly described the IME reports in negative terms, as these were either too categorical or provided unusable advice for further follow-up of their sick-listed patients. The participants did not agree with the proposed routine use of IMEs but instead suggested that GPs should be able to select particularly challenging sick-listed patients for an IME, which should be performed by a peer. CONCLUSION:Our participants showed positive attitudes towards second opinions but found the regular IMEs to be unsuitable. The participants did however welcome IMEs if they themselves could select particularly challenging patients for a mandatory second opinion by a peer but emphasized that IME-doctors should not be able to overrule a GP's sick-leave recommendation. These findings, together with other evaluations, will serve as a basis for the Norwegian government's decision on whether or not to implement IMEs for long-term sick-listed patients. TRIAL REGISTRATION:ClinicalTrials.gov NCT02524392 . Registered 23 June, 2015.

SUBMITTER: Aamland A

PROVIDER: S-EPMC6114176 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences.

Aamland Aase A Husabo Elisabeth E Maeland Silje S

BMC health services research 20180829 1

<h4>Background</h4>Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs' expectations of and experiences with IMEs.<h4>Met ...[more]

PMID: 30157844

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Project description:ObjectivesThe study was designed to examine the sufficiency of general practitioners' (GPs) follow-up of patients on sick leave, assessed by independent medical evaluators.DesignCross-sectional study SETTING: Primary health care in the Western part of Norway. The study reuses data from a randomised controlled trial-the Norwegian independent medical evaluation trial (NIME trial).ParticipantsThe intervention group in the NIME trial: Sick-listed workers having undergone an independent medical evaluation by an experienced GP at 6 months of unremitting sick leave (n=937; 57% women). In the current study, the participants were distributed into six exposure groups defined by gender and main sick leave diagnoses (women/musculoskeletal, men/musculoskeletal, women/mental, men/mental, women/all other diagnoses and men/all other diagnoses).Outcome measureThe independent medical evaluators assessment (yes/no) of the sufficiency of the regular GPs follow-up of their sick-listed patients.ResultsEstimates from generalised linear models demonstrate a robust association between men with mental sick leave diagnoses and insufficient follow-up by their regular GP first 6 months of sick leave (adjusted relative risk (RR)=1.8, 95% CI=1.15-1.68). Compared with the reference group, women with musculoskeletal sick leave diagnoses, this was the only significant finding. Men with musculoskeletal diagnoses (adjusted RR=1.4, 95% CI=0.92-2.09); men with other diagnoses (adjusted RR=1.0, 95% CI=0.58-1.73); women with mental diagnoses (adjusted RR=1.2, 95% CI=0.75-1.77) and women with other diagnoses (adjusted RR=1.3, 95% CI=0.58-1.73).ConclusionsAssessment by an independent medical evaluator showed that men with mental sick leave diagnoses may be at risk of insufficient follow-up by their GP. Efforts should be made to clarify unmet needs to initiate relevant actions in healthcare and work life. Avoiding marginalisation in work life is of the utmost importance.Trial registration numberNCT02524392; Post-results.

Project description:BACKGROUND:This study aimed to use marketing theory to examine the views of patients, pharmacists and general practitioners (GPs) on how community pharmacies are currently used and to identify how community pharmacy services may be better integrated within the primary care pathway for people with long-term conditions (LTCs). METHODS:A qualitative research design was used. Two focus groups were conducted with respiratory patients (n?=?6, 5) and two with type 2 diabetes patients (both n?=?5). Two focus groups were held with pharmacists (n?=?7, 5) and two with GPs (both n?=?5). The "7Ps marketing mix" ("product", "price", "place", "promotion", "people", "process", "physical evidence") was used to frame data collection and analysis. Data was analysed using thematic analysis. RESULTS:Due to the access and convenience of community pharmacies ("place"), all stakeholder groups recommended using community pharmacies over GP practices for services such as management of minor ailments, medication reviews and routine check-ups for well managed LTCs ("product"). All stakeholder groups preferred pharmacy services with clear specifications which focused on specific interventions to reduce variability in service delivery and quality ("process"). However, all stressed the importance of having an appropriate system to share relevant information, allowing pharmacists and GPs two-way flow ("process"). Pharmacists and GPs mentioned difficulties in collaborating with each other due to inter-professional tensions arising from funding conflicts, which leads to duplication of services and inefficient workflow within the primary care pathway ("people"). Patients and GPs were sometimes doubtful of community pharmacies' potential to expand services due to limited space, size and poor quality consultation rooms ("physical evidence"). However, all stakeholder groups recommended promoting community pharmacy services locally and nationally ("promotion"). Patients felt the most effective form of promotion was first-hand experience of high quality pharmacy services and peer word-of-mouth. The added value of using pharmacy services was faster access and convenience for patients, and freeing up GPs' time to focus on more complex patients ("value"). CONCLUSIONS:Using the 7Ps marketing mix highlighted factors which could influence utilisation and integration of community pharmacy services within the primary care pathway for patients with LTCs. Further research is needed to identify their relative importance.

Project description:BackgroundThe environment for medical education in Iraq has been difficult for many years. The 2003 invasion of Iraq accelerated a steady emigration of faculty and graduates. Kidnappings and deaths of doctors became commonplace. To understand current career plans, expectations and perceptions of medical students, three Baghdad medical schools were surveyed.MethodsWritten questionnaires were completed by 418 medical students variously in their 4th, 5th and 6th (final)years of training. We asked about perceptions of the quality of their medical education, the quality of health services in Iraq generally, and about deaths, injuries and migration of faculty, classmates and family.ResultsThe average age of students was 22 years, with 59% women. Most students (90%) were originally from Baghdad. Although there were some positive responses, many students (59%) rated the overall quality of their medical education as fair or poor. Three-fourths of students believed the quality of hospital care in Iraq to be only fair or poor. A majority of students (57%) stated they were thinking frequently or all the time about leaving Iraq after graduation. Reasons given for leaving included the desire for further education, seeking a better lifestyle and fleeing conflict. Leading reasons for staying included the pull of friends and family, familiarity with the health system, and a sense of responsibility to the country. Nearly one in five (18%) students reported the death of a family member attributable to intentional violence, and 15% reported the violent death of a medical school classmate or faculty member since the 2003 invasion. Half the students reported at least one school faculty members had left Iraq because of the war.ConclusionMedical students hold a mediocre view of the quality of their medical education and of Iraq's health system. Many of their faculty members have left the country. The majority of students may leave Iraq after graduation, afforded the opportunity. This poses a significant problem for staffing an already demoralized and stressed health system. Current circumstances suggest the situation will continue to deteriorate.

Project description:Purpose:To describe the experiences of non-medical discipline staff of difficulties and possibilities in inter-professional communication within the radiology department and remitting departments. Materials and Methods:Three focus group interviews were conducted with 16 non-medical discipline staff in a radiology department at a university hospital in Sweden. Data were analysed using qualitative content analysis. Results:The experiences of inter-professional communication by non-medical discipline staff within the radiology department and with remitting departments can be described in three categories, and six sub categories. The informants experienced difficulties in both oral and written inter-professional communication. Inadequate structures, incorrect information and unclear language in the referral forms, lack of feedback from clinicians and radiologists, and reduced face-to-face communication were described as factors that negatively influenced communication. Other difficulties were time shortage, inadequate routines and economy issues. The possibilities described were use of face-to-face communication, interpreters, and clear and well-structured referral forms. Conclusion:Non-medical staff experience that quality in inter-professional communication has a significant impact on health outcomes and patient safety. They expressed a number of difficulties in both written and oral inter-professional communication. For example inadequate written and oral communication, as well as practical issues such as routine could negatively influence the quality of the outcome of inter-professional communication. Lack of feedback from clinicians and radiologists and reduced face-to-face communication were also mentioned as factors that influence oral communication. Possibilities described to improve inter-professional communication quality and thus patient safety were professional contact on both professional and personal levels, use of interpreters, and clear and well-structured referral forms. The results of this study add to our knowledge of the difficulties and possibilities in non-medical inter-professional communication, which may enhance both safety and health outcomes for patients if implemented. Future studies in interprofessional communication is needed.

Project description:BackgroundWe report on a multidisciplinary focus group project related to the appropriate care of chiropractic patients who present with chest pain. The prevalence and clinical management, both diagnosis and treatment, of musculoskeletal chest pain in ambulatory medical settings, was explored as the second dimension of the focus group project reported here.MethodsThis project collected observational data from a multidisciplinary focus group composed of both chiropractic and medical professionals. The goals of the focus group were to explore the attitudes and experiences of medical and chiropractic clinicians regarding their patients with chest pain who receive care from both medical and chiropractic providers, to identify important clinical or research questions that may inform the development of 'best practices' for coordinating or managing care of chest pain patients between medical and chiropractic providers, to identify important clinical or research questions regarding the diagnosis and treatment of chest pain of musculoskeletal origin, to explore various methods that might be used to answer those questions, and to discuss the feasibility of conducting or coordinating a multidisciplinary research effort along this line of inquiry. The convenience-sample of five focus group participants included two chiropractors, two medical cardiologists, and one dual-degreed chiropractor/medical physician. The focus group was audiotaped and transcripts were prepared of the focus group interaction. Content analysis of the focus group transcripts were performed to identify key themes and concepts, using categories of narratives.ResultsSix key themes emerged from the analysis of the focus group interaction, including issues surrounding (1) Diagnosis; (2) Treatment and prognosis; (3) Chest pain as a chronic, multifactorial, or comorbid condition; (4) Inter-professional coordination of care; (5) Best practices and standardization of care; and (6) Training and education.ConclusionThis study carries implications for chiropractic clinical training relative to enhancing diagnostic competencies in chest pain, as well as the need to ascertain and improve those skills, competencies, and standards for referrals and sharing of clinical information that may improve cross-disciplinary coordination of care for chest pain patients.

Project description:BACKGROUND:Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. METHODS:A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method. RESULTS:Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. CONCLUSION:Key obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.

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Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences.

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Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences.

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