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Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective.

ABSTRACT: OBJECTIVES:To explore the patient view of competencies essential for doctors to provide good collaboration at the primary-secondary care interface. DESIGN:We used a qualitative research approach. Focus groups with patients were conducted to explore their opinions of doctors' competencies to provide good collaboration between primary and secondary care doctors. Transcripts were analysed using thematic analysis. SETTING:Dutch primary-secondary care interface. PARTICIPANTS:Sixteen participants took part in five focus groups. Patients treated in both primary and secondary care, defined as having a minimum of two contacts with their general practitioner and two contacts with a medical specialty in the last 6?months, were included. Psychiatric patients and children were excluded from this study. RESULTS:Three groups of competencies were identified: (1) relationship building, both with patients and with other doctors; (2) transparent collaborating: be able to provide clarity on the process of collaboration and on roles and responsibilities of those involved and (3) reflective practising: to be willing to acknowledge mistakes, give and receive feedback and act as a lifelong learner. CONCLUSIONS:This focus group study enhances our understanding of the patient perspective on doctors' collaborative competencies at the primary-secondary care interface. With this information, doctors can improve their collaborative skills to a level that would meet their patients' needs. Patients expect doctors to be able to build relationships and act as reflective practitioners. Including patients in the collaborative process by giving them a role that is appropriate to their abilities and by making collaboration more explicit could help to improve collaboration between general practitioners and medical specialists.

SUBMITTER: Janssen M

PROVIDER: S-EPMC7332184 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective.

Janssen Marijn M Fluit Cornelia R M G CRMG Sagasser Margaretha H MH Kusters Loes H J LHJ Scherpbier-de Haan Nynke D ND de Graaf Jacqueline J

BMJ open 20200701 7

<h4>Objectives</h4>To explore the patient view of competencies essential for doctors to provide good collaboration at the primary-secondary care interface.<h4>Design</h4>We used a qualitative research approach. Focus groups with patients were conducted to explore their opinions of doctors' competencies to provide good collaboration between primary and secondary care doctors. Transcripts were analysed using thematic analysis.<h4>Setting</h4>Dutch primary-secondary care interface.<h4>Participants< ...[more]

PMID: 32611744

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Project description:BackgroundThere is a large and unexplained variation in referral rates to specialists by general practitioners, which calls for investigations regarding general practitioners' perceptions and expectations during the referral process. Our objective was to describe the decision-making process underlying referral of patients to specialists by general practitioners working in a university outpatient primary care center.MethodsTwo focus groups were conducted among general practitioners (10 residents and 8 chief residents) working in the Center for Primary Care and Public Health (Unisanté) of the University of Lausanne, in Switzerland. Focus group data were analyzed with thematic content analysis. A feedback group of general practitioners validated the results.ResultsParticipating general practitioners distinguished two kinds of situations regarding referral: a) "clear-cut situations", in which the decision to refer or not seems obvious and b) "complex cases", in which they hesitate to refer or not. Regarding the "complex cases", they reported various types of concerns: a) about the treatment, b) about the patient and the doctor-patient relationship and c) about themselves. General practitioners evoked numerous reasons for referring, including non-medical factors such as influencing patients' emotions, earning specialists' esteem or sharing responsibility. They also explained that they seek validation by colleagues and postpone referral so as to relieve some of the decision-related distress.ConclusionsGeneral practitioners' referral of patients to specialists cannot be explained in biomedical terms only. It seems necessary to take into account the fact that referral is a sensitive topic for general practitioners, involving emotionally charged interactions and relationships with patients, colleagues, specialists and supervisors. The decision to refer or not is influenced by multiple contextual, personal and clinical factors that dynamically interact and shape the decision-making process.

Project description:BackgroundIncreasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours.MethodsA descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase.ResultsThe following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts.ConclusionIn out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.

Project description:BackgroundCollaborative practice in primary health care increases care quality and security. In France, primary health care professionals increasingly work together. The link between general practitioners (GPs) and community pharmacists (CPs) is an important element. Nevertheless, effective collaboration between GPs and CPs is difficult to develop and formalize. Interprofessional education has been identified as a necessary step to prepare "collaborative practice-ready professionals". We aimed to identify the interprofessional training needs of last-year GP and CP students to develop interprofessional collaborations.MethodWe conducted an analysis of training needs using a method inspired by occupational didactics. We collected data through individual semidirective interviews with CPs and GPs in 2022. At each stage we aimed to identify the elements of the occupational didactics to deduce the training needs in the form of a frame of reference: apparent competencies, emblematic situations and acting characteristics. We conducted an initial deductive thematic analysis to identify the apparent competencies of the two professions, the emblematic situations in which these competencies are used, and the acting characteristics used in these situations. We made an inductive categorization to define the collaborative competence and the families of situations and to model the actions of this GP-CP collaboration.ResultsWe defined the competency "to collaborate effectively in an interprofessional setting in order to respond to care issues in one's territory" expressed in various professional situations. We described it by three capacities based on two interacting dynamics: one-off exchanges and structured collaborations. Various communication tools facilitate the implementation of these interactions. We modeled the actions of the GP-CP collaboration in the form of a conceptual map.ConclusionThe collaboration between the CP and the GP implements a competency that could be integrated into their professional referential. This competency, entitled "collaborating effectively in interprofessional settings to respond to care issues in one's territory", is expressed in a variety of professional situations. It is based on two parallel and interacting dynamics: one-off exchanges and a dynamic of lasting collaboration. This study thus lays the groundwork for the development of this collaborative skill among general practice and pharmacy residents.

Project description:BACKGROUND:Wearables, fitness apps, and patient home monitoring devices are used increasingly by patients and other individuals with lifestyle challenges. All Danish general practitioners (GPs) use digital health records and electronic health (eHealth) consultations on a daily basis, but how they perceive the increasing demand for lifestyle advice and whether they see eHealth as part of their lifestyle support should be explored further. OBJECTIVE:This study aimed to explore GPs' perspectives on eHealth devices and apps and the use of eHealth in supporting healthy lifestyle behavior for their patients and themselves. METHODS:A total of 10 (5 female and 5 male) GPs were recruited by purposive sampling, aged 38 to 69 years (mean 51 years), of which 4 had an urban uptake of patients and 6 a rural uptake. All of them worked in the region of Southern Denmark where GPs typically work alone or in partnership with 1 to 4 colleagues and all use electronic patient health records for prescription, referral, and asynchronous electronic consultations. We performed qualitative, semistructured, individual in-depth interviews with the GPs in their own office about how they used eHealth and mHealth devices to help patients challenged with lifestyle issues and themselves. We also interviewed how they treated lifestyle-challenged patients in general and how they imagined eHealth could be used in the future. RESULTS:All GPs had smartphones or tablets, and everyone communicated on a daily basis with patients about disease and medicine via their electronic health record and the internet. We identified 3 themes concerning the use of eHealth: (1) how eHealth is used for patients; (2) general practitioners' own experience with improving lifestyle and eHealth support; and (3) relevant coaching techniques for transformation into eHealth. CONCLUSIONS:GPs used eHealth frequently for themselves but only infrequently for their patients. GPs are familiar with behavioral change techniques and are ready to use them in eHealth if they are used to optimize processes and not hinder other treatments. Looking ahead, education of GPs and recognizing patients' ability and preference to use eHealth with regard to a healthy living are needed.

Project description:BackgroundVulnerable pregnant women, defined as women threatened by social, psychological, or physical risk factors, need special support during pregnancy to prevent complications in pregnancy, birth, and childhood. Proper cross-sectoral collaboration in antenatal care is paramount to delivering sufficient supportive care to these women. General practitioners (GPs) often face barriers when assessing vulnerable pregnant women and may; as a result, under-identify and underreport child abuse. Little is known about how the cross-sectoral collaboration in antenatal care affects the GP's opportunities of managing vulnerable pregnant women. This study explores GPs' perceived barriers and facilitators in the antenatal care collaboration on vulnerable pregnant women and in the reporting of these women to social services.MethodsA qualitative study with semi-structured focus group interviews among twenty GPs from the Region of Southern Denmark. A mixed inductive and deductive analytic strategy was applied, structured according to the Theoretical Domains Framework (TDF).ResultsThree themes emerged: I) collaborative experience, II) motivation, and III) organizational working conditions. Barriers were lacking experience, i.e. knowledge, skills, and attention to antenatal care collaboration and reporting, inadequate organizational working contexts, i.e. insufficient pathways for communication between health care and social care systems, and laws restricting feedback on the consequences of reporting. This decreased the GPs motivation, i.e. poor confidence in navigating the system, fear of breaking the patient alliance when collaborating in antenatal care and reporting with the social services. GPs motivation to collaborate and report was increased by knowing the working contexts of their collaborative partners in the antenatal care and social services system and by a strong doctor-patient relationship enabling them to describe the vulnerability to collaborators.ConclusionsGPs experience system-related barriers to collaborating and reporting on vulnerable pregnant women within the health care sector and in the interplay with the social services sector. Organizational development of cross-sectoral antenatal care collaboration should imply user involvement of all collaborative partners. Results suggest that health authorities should consider establishing accessible communication pathways between the GPs and the social services to improve options for proper cross-sectoral communication and feedback to GPs, thereby improving care trajectories of vulnerable pregnant women.

Project description:BackgroundIn Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients' complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation.MethodsThirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support. The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology.ResultsThe results of this paper predominantly focus on GPs' perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option.ConclusionsThe cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.

Project description:Medical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention).We used the qualitative Grounded Theory approach. Theoretical sampling was carried out to recruit GPs in Bavaria, Germany. We accessed the field of research through GPs with academic affiliation, recommendations by interview partners and personal contacts. They differed in terms of primary care experience, gender, region, work experience abroad, academic affiliation, type of specialist training, practice organisation and position. Qualitative in-depth face-to-face interviews with a semi-structured interview guide were conducted (n =?13). The interviews were audiotaped and transcribed verbatim. Data analysis was carried out using open and axial coding.GPs defined medical overuse as unnecessary investigations and treatment that lack patient benefit or bear the potential to cause harm. They observed that medical overuse takes place in all three German reimbursement categories: statutory health insurance, private insurance and individual health services (direct payment). GPs criticised the poor acceptance of gate-keeping in German primary care. They referred to a low-threshold referral policy and direct patient access to outpatient secondary care, leading to specialist treatment without clear medical indication. The GPs described various direct drivers of medical overuse within their direct area of influence. They also emphasised indirect drivers related to system or societal processes. The proposed strategies for reducing medical overuse included a well-founded wait-and-see approach, medical education, a trustful doctor-patient relationship, the improvement of primary/health care structures and the involvement of patients and society.GPs are frequently located at the starting point of the diagnostic and treatment process. They have the potential to play a vital role in quaternary prevention. This requires a debate going beyond the medical profession and involving society as a whole.

Project description:BACKGROUND:An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners' perspective on long-term care after myocardial infarction focussing on medical prevention. METHODS:In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners' prescribing and patients' non-adherence was performed. RESULTS:Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital; however, they described deviating from guidelines because of drugs' side effects or patients' intolerances. Some questioned the benefits of medical secondary prevention for the oldest of patients. General practitioners perceived good adherence among their patients who had had an MI while they regarded their methods for assessing medical non-adherence as limited. They perceived diverse reasons for non-adherence, particularly side effects, patients' freedom from symptoms and patients' indifference to health. They attributed mainly negative characteristics, like lack of knowledge and understanding, to non-adherent patients. These characteristics contribute to the difficulty of convincing these patients to take medications as prescribed. General practitioners improved adherence by preventing side effects, explaining the medication's necessity, facilitating intake and involving patients in decision-making. However, about half of the general practitioners reported threatening their patients with negative consequences of non-adherence. CONCLUSIONS:General practitioners should be aware that discharge medication can be insufficient and thus, should always check hospital recommendations for accordance with guideline recommendations. Improving physicians' communication skills and informing and motivating patients in an adequate manner, for example in simple language, should be an important goal in the hospital and the general practitioner setting. General practitioners should assess patients' motivations through motivational interviewing, which no general practitioner mentioned during the interviews, and talk with them about adherence and long-term treatment goals regularly.

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Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective.

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Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective.

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