General practitioners' perceptions of their role and their collaboration with district nurses in wound care.

Anne Friman,Samuel Edelbring,Desiree Wiegleb Edström

doi:10.1017/s1463423618000464

Abstract

To explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare. Earlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs' understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP's perspective. Semi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data. Four themes were identified. The first theme: 'role as consultant and coordinator' shows how the GPs perceived their role in wound care. In the second theme: 'responsibility for diagnosis' the GPs' views on responsibility for wound diagnosis is presented. The third theme: 'desire for continuity' is based on the GPs' desire for continuity concerning various aspects. In the fourth theme: 'collaboration within the organisation' the importance of the organisation for collaboration between GPs and DNs is presented. The GP's often work on a consultation-like basis and feel that they become involved late in the patients' wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.

Highlights

People with multiple diagnoses require collaboration and interplay between different competences in today’s healthcare (Moore et al, 2014; Swedish Agency for Health Technology Assessment and Assessment of Social Services [SBU], 2014)
The general practitioners (GPs) perceived their role in wound care as being secondary; they were primarily consulted when wound healing did not proceed as expected and when it was necessary to involve other healthcare professionals
The district nurses (DNs) was seen as taking the main responsibility for wound care: ‘I guess it’s because we are not responsible for the management of leg ulcers, it is in some way the nurses who are

Summary

Introduction

People with multiple diagnoses require collaboration and interplay between different competences in today’s healthcare (Moore et al, 2014; Swedish Agency for Health Technology Assessment and Assessment of Social Services [SBU], 2014). One such arena is management of patients suffering from chronic leg ulcers in which general practitioners (GPs) and district nurses (DNs) are prominent actors in primary care (Sadler et al, 2006; Mooij and Huisman, 2016). Significant amounts of time and resources are invested in the healing of leg ulcers, with developed countries spending approximately 2–5% of their total healthcare costs on the condition (Ragnarson Tennvall et al, 2004; Öien and Ragnarson Tennvall, 2006; Edwards et al, 2013; Phillips et al, 2015)

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