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Bonner C, Cornell S, Pickles K, Batcup C, de Wet C, Morgan M, Greaves K, O'Connor D, Hawkes AL, Crosland P, Chapman N, Doust J. Implementing decision aids for cardiovascular disease prevention: stakeholder interviews and case studies in Australian primary care. BMC Prim Care 2024; 25:49. [PMID: 38310217 PMCID: PMC10837956 DOI: 10.1186/s12875-023-02258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/23/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Australian cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk assessment, but less than half of eligible patients have the required risk factors recorded due to fragmented implementation over the last decade. Co-designed decision aids for general practitioners (GPs) and consumers have been developed that improve knowledge barriers to guideline-recommended CVD risk assessment and management. This study used a stakeholder consultation process to identify and pilot test the feasibility of implementation strategies for these decision aids in Australian primary care. METHODS This mixed methods study included: (1) stakeholder consultation to map existing implementation strategies (2018-20); (2) interviews with 29 Primary Health Network (PHN) staff from all Australian states and territories to identify new implementation opportunities (2021); (3) pilot testing the feasibility of low, medium, and high resource implementation strategies (2019-21). Framework Analysis was used for qualitative data and Google analytics provided decision support usage data over time. RESULTS Informal stakeholder discussions indicated a need to partner with existing programs delivered by the Heart Foundation and PHNs. PHN interviews identified the importance of linking decision aids with GP education resources, quality improvement activities, and consumer-focused prevention programs. Participants highlighted the importance of integration with general practice processes, such as business models, workflows, medical records and clinical audit software. Specific implementation strategies were identified as feasible to pilot during COVID-19: (1) low resource: adding website links to local health area guidelines for clinicians and a Heart Foundation toolkit for primary care providers; (2) medium resource: presenting at GP education conferences and integrating the resources into audit and feedback reports; (3) high resource: auto-populate the risk assessment and decision aids from patient records via clinical audit software. CONCLUSIONS This research identified a wide range of feasible strategies to implement decision aids for CVD risk assessment and management. The findings will inform the translation of new CVD guidelines in primary care. Future research will use economic evaluation to explore the added value of higher versus lower resource implementation strategies.
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Affiliation(s)
- Carissa Bonner
- Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27, Sydney, NSW, 2006, Australia.
| | - Samuel Cornell
- Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27, Sydney, NSW, 2006, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27, Sydney, NSW, 2006, Australia
| | - Carys Batcup
- Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27, Sydney, NSW, 2006, Australia
| | - Carl de Wet
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Mark Morgan
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD, Australia
| | - Kim Greaves
- Department of Cardiology, Sunshine Coast University Hospital, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Denise O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | - Anna L Hawkes
- School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Niamh Chapman
- Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27, Sydney, NSW, 2006, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD, Australia
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Oversby S, Hamilton EM, Ratsch A, Kitchener S. Barriers and enablers to implementation of COVID-19 vaccine programs in a rural and regional Queensland: A provider perspective. Aust J Rural Health 2023; 31:1191-1202. [PMID: 37795643 DOI: 10.1111/ajr.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Vaccines formed the core of Australia's National COVID-19 Plan in combination with other public health measures. Vaccine rates varied geographically, and lower uptake was seen in some regional and remote areas. OBJECTIVE Explore barriers and enablers to implementing COVID-19 vaccine programs and recommendations for improvement from a vaccine provider perspective in rural and regional Queensland (QLD). DESIGN Participants included eleven healthcare personnel (HCP) from rural (45%) and regional (55%) settings in the Wide Bay region, QLD, Australia. Semi-structured interviews were conducted to identify barriers and enabling factors HCP experienced implementing COVID-19 programs, in addition to their recommendations to optimise ongoing implementation of vaccine programs. Braun and Clarke's reflexive thematic analysis of interview transcripts was performed, and over-arching themes were identified. FINDINGS Four barrier themes were identified: 1. operational barriers, 2. communication issues, 3. financial constraints, and 4. leadership and coordination. Four enabler themes were also identified: 1. adaptability; 2. prior experience and knowledge; 3. collaboration and teamwork; and 4. community engagement. Recommendations for optimising ongoing vaccine rollout included reducing the administrative burden on providers, increasing involvement of primary care and the private sector in planning and decision making, improving communication methods, reviewing financial remuneration for private providers, and decentralising decision-making. DISCUSSION There were multiple barriers and enablers to implementation of COVID-19 programs experienced by rural and regional HCP in the Wide Bay region of QLD which were consistent with existing literature. CONCLUSION A range of actionable recommendations were identified that could optimise the COVID-19 vaccine program and future vaccine programs in rural and regional areas.
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Affiliation(s)
- Shannen Oversby
- Wide Bay Hospital and Health Service, Hervey Bay, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
| | - Elizabeth M Hamilton
- Wide Bay Hospital and Health Service, Hervey Bay, Queensland, Australia
- The University of Queensland, Rural Clinical School, St Lucia, Queensland, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Hervey Bay, Queensland, Australia
- The University of Queensland, Rural Clinical School, St Lucia, Queensland, Australia
| | - Scott Kitchener
- Wide Bay Hospital and Health Service, Hervey Bay, Queensland, Australia
- The University of Queensland, Rural Clinical School, St Lucia, Queensland, Australia
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Yong FR, Naicker S, Uebel K, Agaliotis M, Chan C, Nguyen JDT, Pathirana T, Hawkey A, Vuong K. "We're trained to trust our patients": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care. Fam Pract 2023:cmad095. [PMID: 37797167 DOI: 10.1093/fampra/cmad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. AIM To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. METHODS GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. RESULTS Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. CONCLUSIONS Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.
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Affiliation(s)
- Faith R Yong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Safe and Effective Medication Research Collaborative, School of Pharmacy, Faculty of Health and Behavioural Science, University of Queensland, Brisbane, Australia
- Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kerry Uebel
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maria Agaliotis
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Rozelle, Australia
| | - Christopher Chan
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - John D T Nguyen
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Kylie Vuong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
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Kraus M, Stegner C, Reiss M, Riedel M, Børsch AS, Vrangbaek K, Michel M, Turmaine K, Cseh B, Dózsa CL, Dandi R, Mori AR, Czypionka T. The role of primary care during the pandemic: shared experiences from providers in five European countries. BMC Health Serv Res 2023; 23:1054. [PMID: 37784101 PMCID: PMC10546726 DOI: 10.1186/s12913-023-09998-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.
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Affiliation(s)
- Markus Kraus
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria.
| | - Christoph Stegner
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Miriam Reiss
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Monika Riedel
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
| | - Anne Sofie Børsch
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Karsten Vrangbaek
- University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Morgane Michel
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
- Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, Paris, 75019, France
| | - Kathleen Turmaine
- Université Paris Cité, ECEVE, UMR 1123, 10 avenue de Verdun, Inserm, Paris, 75010, France
| | - Borbála Cseh
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Csaba László Dózsa
- University of Miskolc, Egyetem út 1, Miskolc-Egyetemváros, 3515, Hungary
| | - Roberto Dandi
- Luiss Business School, Via Nomentana 216, Roma, 00162, RM, Italy
| | - Angelo Rossi Mori
- Institute for Research on Population and Social Policies, Via Palestro 32, Roma, 00185, Italy
| | - Thomas Czypionka
- Institute for Advanced Studies (IHS), Josefstädter Straße 39, Vienna, 1080, Austria
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Sturgiss E, Advocat J, Lam T, Nielsen S, Ball L, Gunatillaka N, Martin C, Barton C, Tam CWM, Skouteris H, Mazza D, Russell G. Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysis. Br J Gen Pract 2023; 73:e778-e788. [PMID: 37666514 PMCID: PMC10498380 DOI: 10.3399/bjgp.2022.0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Brief interventions (BIs) are effective for reducing harmful alcohol consumption, but their use in primary care is less frequent than clinically indicated. The REducing AlCohol- related Harm (REACH) project aimed to increase the delivery of BIs in primary care. AIM To assess the effectiveness of the REACH programme in increasing alcohol BIs in general practice and explore the implementation factors that improve or reduce uptake by clinicians. DESIGN AND SETTING This article reports on a sequential, explanatory mixed-methods study of the implementation of the REACH project in six general practice clinics serving low-income communities in Melbourne, Australia. METHOD Time-series analyses were conducted using routinely collected patient records and semi-structured interviews, guided by the consolidated framework for implementation research. RESULTS The six intervention sites significantly increased their rate of recorded alcohol status (56.7% to 60.4%), whereas there was no significant change in the non-intervention practices (344 sites, 55.2% to 56.4%). CONCLUSION REACH resources were seen as useful and acceptable by clinicians and staff. National policies that support the involvement of primary care in alcohol harm reduction helped promote ongoing intervention sustainability.
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Affiliation(s)
- Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jenny Advocat
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Lauren Ball
- Grad Dip Health Economics and Health Policy, chair of community health and wellbeing, University of Queensland, Brisbane, Australia; Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia; conjoint senior lecturer, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Warwick Business School, University of Warwick, Coventry, UK
| | | | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ovington S, Anderson K, Choy M, Haesler E. Reflections of Australian general practitioners during the first year of the COVID-19 pandemic: a qualitative study. Aust J Prim Health 2023; 29:395-402. [PMID: 36716751 DOI: 10.1071/py22047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. METHODS A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. RESULTS Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government-GP relationship; impacts on the patient-doctor relationship; and teamwork within practices and among GPs. CONCLUSIONS The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care.
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Affiliation(s)
- Seren Ovington
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Katrina Anderson
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Melinda Choy
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian National University, Canberra, ACT 2605, Australia; and Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6102, Australia; and Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Vic. 3086, Australia
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Schrimpf A, Bleckwenn M, Braesigk A. COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11. [PMID: 36766895 DOI: 10.3390/healthcare11030320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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Yi Y, Chiu DK. Public information needs during the COVID-19 outbreak: a qualitative study in mainland China. LHT 2023. [DOI: 10.1108/lht-08-2022-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PurposeThe impact of COVID-19 has led to a surge in the public’s reliance on the Internet for pandemic information, and the policy of home isolation has exacerbated this. This study aimed to investigate public information needs and ways of accessing and disseminating information during COVID-19 in mainland China.Design/methodology/approachThis study used a qualitative research approach to conduct semi-structured interviews with 15 participants from 9 cities in mainland China about information needs and access behaviors during the COVID-19 outbreak. All interview recordings were converted into text and proofread, then coded and summarised in correspondence with the research questions using the grounded theory.FindingsThis study summarized the dynamics of public information needs during the 2.5-year pandemic and identified the difficulties in accessing certain information.Originality/valueAlthough information needs of public health emergencies have been a hot topic during COVID-19, scant studies focus on information needs in specific countries in Asia, especially in mainland China, the first country with a major outbreak and stringent lockdown mandates. Therefore, the current study is well enriched by focusing on information demand behavior in the context of COVID-19. Possible measures for improvement were also given to existing and potential problems, taking into account the participants’ views.
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Budrevičiūtė A, Raila G, Paukštaitienė R, Valius L, Argyrides M. Consultation Management during the COVID-19 Pandemic: The Experience of Lithuanian Physicians. Healthcare (Basel) 2022; 10. [PMID: 36553996 DOI: 10.3390/healthcare10122472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Crises in the medicine sector such as the COVID-19 pandemic encourage the search for effective solutions for the provision of health care services, when conventional face-to-face consultations may be difficult to deliver effectively due to contact restrictions. The main objective of this study was to investigate consultation management provided by physicians during the COVID-19 pandemic in Lithuania. The dependence of diagnostic testing and vaccination of patients on the socio-demographic characteristics of physicians was also assessed. An anonymous survey was carried out during the COVID-19 pandemic, between 21 June 2021 and 17 September 2021, involving 191 physicians (9% of the total population) working in family physician teams in Lithuania. Thirty-nine Lithuanian Primary Health Care Institutions (PHCIs) were selected for this study, of which 11 were public and 28 were private. Private and public PHCIs employed 31% and 63% of the respondents, respectively, and 6% of respondents worked at both types of institutions. Concerning telemedicine, the physician-respondents frequently provided consultations over the telephone (79.6%) and in-person (63.9%), but less so via the Internet, with the latter option never being used at all by 57.1% of the respondents. Whilst telephone consultations were frequently provided by Lithuanian physicians, only half of the respondents chose to provide services over the Internet. Private, smaller, and rural-based PHCIs should more actively offer viral diagnostics and vaccination services.
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Dreher A, Mambrey V, Loerbroks A. Changes of working conditions and job-related challenges due to the SARS-CoV-2 pandemic for medical assistants in general practices in Germany: a qualitative study. BMC Prim Care 2022; 23:273. [PMID: 36329407 PMCID: PMC9632591 DOI: 10.1186/s12875-022-01880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Background In Germany, general practices are usually contacted first by patients with health complaints, including symptoms characteristic of SARS-CoV-2. Within general practices, medical assistants (MAs) are the first contact person for patients and perform various tasks in close physical patient contact. Working conditions of MAs have been characterized as challenging, e.g., due to low salaries, a high workload, time pressure and frequent interruptions. The potential changes of working conditions and job-related challenges experienced by MAs due to the SARS-CoV-2 pandemic have not been fully explored. We aimed to address this knowledge gap among MAs working in general practices in Germany. Methods Semi-structured telephone interviews were conducted between March and April 2021 with 24 MAs. Medical assistants of legal age, who worked in general practices in Germany, and who were continuously employed and without change of employer in 2020 were eligible for participation. Interview recordings were transcribed verbatim and content-analyzed using MAXQDA, using deductive and inductive coding. Results The SARS-CoV-2 pandemic posed great challenges for MAs, including a dramatic increase in workload, changes in occupational tasks, increased hygiene measures, rearrangements of work organization, childcare issues, and structural and personnel challenges within their practice. Participants described both improved but also worsened collaboration with their employers and colleagues due to the pandemic. Many MAs complained about issues regarding SARS-CoV-2-related billing processes and an increase in unpleasant patient behavior, including disregard of practice rules or frequent verbal insults. Many also did not feel adequately appreciated by politics, media, or society for their efforts during the pandemic. Positive changes were perceived to be the expansion of digital communication channels and a growing social cohesiveness of practice teams. Conclusions Our study suggests that the SARS-CoV-2 pandemic posed great challenges for MAs. The pandemic seems to have worsened MAs’ working conditions, which had been described as challenging already prior to the pandemic. In order to improve job satisfaction and to prevent loss of healthcare personnel, measures must be taken to improve working conditions of MAs in general practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01880-y.
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Affiliation(s)
- Annegret Dreher
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Viola Mambrey
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
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Hardie RA, Thomas J, Li J, Pearce C, Georgiou A. General practice perspective on the use of telehealth during the COVID-19 pandemic in Australia using an Action Research approach: a qualitative study. BMJ Open 2022; 12:e063179. [PMID: 36302573 PMCID: PMC9620525 DOI: 10.1136/bmjopen-2022-063179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Telehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode, which we hypothesise may be due to potential barriers impacting on quality of care. We aimed to identify the benefits and barriers of telehealth use in general practice, using an 'Action Research' approach involving general practitioners (GPs) and general practice stakeholders. DESIGN Qualitative focus group performed within a broader Action Research methodology. SETTING A focus group was held in August 2021, with general practice participants from Victoria, Australia. PARTICIPANTS The study consisted of a purposive sample of 11 participants, including GPs (n=4), representatives from three primary health networks (n=4) and data custodian representatives (n=3) who were part of a project stakeholder group guided by an Action Research approach. METHODS Semistructured interview questions were used to guide focus group discussions via videoconference, which were recorded and transcribed verbatim for analysis. The transcript was analysed using an inductive thematic approach. RESULTS Emerging themes included evolution of telehealth, barriers to telehealth (privacy, eligibility, technology, quality of care, sociodemographic and residential aged care barriers) and benefits of telehealth (practice, quality of care, sociodemographic and residential aged care benefits). CONCLUSION The findings highlight a range of barriers to telehealth that impact general practice, but also provide justification for the continuation and development of telehealth. These results provide important context to support data-driven population-based findings on telehealth uptake. They also highlight areas of quality improvement for the enhancement of telehealth as a valuable tool for routine general practice patient care.
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Affiliation(s)
- Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
| | - Christopher Pearce
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
- Outcome Health, Blackburn, Victoria, Australia
- General Practice, Monash University, Clayton, Victoria, Australia
| | - A Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
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Parkinson A, Matenge S, Desborough J, Hall Dykgraaf S, Ball L, Wright M, Sturgiss EA, Kidd M. The impact of
COVID
‐19 on chronic disease management in primary care: lessons for Australia from the international experience. Med J Aust 2022; 216:445-448. [PMID: 35403236 PMCID: PMC9114997 DOI: 10.5694/mja2.51497] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Anne Parkinson
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Sethunya Matenge
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Jane Desborough
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | | | - Lauren Ball
- Centre for Health Practice Innovation Griffith University Brisbane QLD
| | - Michael Wright
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney NSW
| | | | - Michael Kidd
- Australian National University Canberra ACT
- COVID‐19 Primary Care Response Group Australian Government Department of Health Canberra ACT
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13
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Deml MJ, Minnema J, Dubois J, Senn O, Streit S, Rachamin Y, Jungo KT. The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: A mixed-methods study. Soc Sci Med 2022; 298:114858. [PMID: 35247784 PMCID: PMC8868005 DOI: 10.1016/j.socscimed.2022.114858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Abstract
Continuity of care is important for the health of aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision of non-urgent care, at-risk patients depending upon regular consultations with general practitioners (GPs) faced confusion about the possibility of seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting of a quantitative component followed by a qualitative component, to understand at-risk patients' health services use during the COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs and 266,796 patients. Based on pre-pandemic data, we predicted weekly consultation counts as well as weekly measurement counts (blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol) per 100 patients that would be expected in 2020 in absence of a pandemic and compared those to actual observed values. Qualitatively, we conducted 23 semi-structured interviews with 24 GPs (∼45 min) and 37 interviews with at-risk patients (∼35 min). Quantitative results demonstrate a significant decrease in consultation and measurement counts during the first shutdown period, with consultation counts quickly returning to normal and moving within expected values for the rest of 2020. Qualitative data contextualize these findings with GPs describing constantly implementing material, administrative, and communication changes. GPs reported communication gaps with the authorities and noted a lack of clear guidelines delineating how to define "at-risk patients" and what cases were "urgent" to treat during shutdowns. Patient interviews show that patient-level factors, such as fear of contracting coronavirus, perceptions that GPs were overburdened, and a sense of solidarity, influenced patients' decisions to consult less at the beginning of the pandemic. Findings demonstrate communication gaps during pandemic periods and provide valuable lessons for future pandemic preparedness, particularly the need for contingency plans for the overall healthcare system instead of plans focusing only on the infectious agent itself.
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Affiliation(s)
- Michael J Deml
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland; Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Julia Minnema
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Julie Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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