Brief encounters: what do primary care professionals contribute to peoples' self-care support network for long-term conditions? A mixed methods study.

Anne Rogers,Anne Kennedy,Christian Blickem,Ivaylo Vassilev,Helen Brooks

doi:10.1186/s12875-016-0417-z

Abstract

BackgroundPrimary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people’s personal communities of support for long-term condition management.MethodsA mixed methods survey with nested qualitative study designed to identify relationships and social network member’s (SNM) contributions to the support work of managing a long-term condition conducted in 2010 in the North West of England. Through engagement with a concentric circles diagram three hundred participants identified 2544 network members who contributed to illness management.ResultsThe results demonstrated how primary care professionals are involved relative to others in ongoing self-care management. Primary care professionals constituted 15.5 % of overall network members involved in chronic illness work. Their contribution was identified as being related to illness specific work providing less in terms of emotional work than close family members or pets and little to everyday work. The qualitative accounts suggested that primary care professionals are valued mainly for access to medication and nurses for informational and monitoring activities. Overall primary care is perceived as providing less input in terms of extended self-management support than the current literature on policy and practice suggests. Thus primary care professionals can be described as providing ‘minimally provided support’. This sense of a ‘minimally’ provided input reinforces limited expectations and value about what primary care professionals can provide in terms of support for long-term condition management.ConclusionsPrimary care was perceived as having an essential but limited role in making a contribution to support work for long-term conditions. This coalesces with evidence of a restricted capacity of primary care to take on the work load of self-management support work. There is a need to prioritise exploring the means by which extended self-care support could be enhanced out-with primary care. Central to this is building a system capable of engaging network capacity to mobilise resources for self-management support from open settings and the broader community.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0417-z) contains supplementary material, which is available to authorized users.

Highlights

Primary care professionals are presumed to play a central role in delivering long-term condition management
In addition to being cited more frequently than secondary care professionals in making a contribution in terms of relative value primary care professionals were more likely to be viewed as being of more central importance than other professionals
Just over half of the primary care professionals were placed in the central circle and just under half in the middle and outer circle

Summary

Introduction

Primary care professionals are presumed to play a central role in delivering long-term condition management. We explore the value of primary care professionals in people’s personal communities of support for long-term condition management. Self-management support (SMS) interventions of new technologies, information provision, skills training and support from health professionals have been associated with increased patient empowerment and selfefficacy, changes in behaviour and a reduction in the utilisation of healthcare resources [1]. Primary care and general practice have been identified as having pivotal roles to play in supporting long term condition self-management based on the assumption of their organsiational capacity to offer, ready access, relevant clinical information systems, decision support, person centredness, continuity of care and behavioural interventions [4,5,6,7]. Primary health care professionals have been found to prioritise retaining control over referral and disease management and downgrading the need for connections with self-management support arrangements from external agencies [12,13,14]

Results

Discussion

Conclusion