Abstract
BackgroundPrevious research has highlighted that many GPs lack the confidence and knowledge to diagnose and manage people with CFS/ME. Following the development of an online training module for GPs, and an information pack and DVD for patients, this study explored the extent to which these resources can be implemented in routine primary care.MethodsSemi structured qualitative interviews were completed with patients and GPs across North West England. All interviews were transcribed and analysed using open exploratory thematic coding. Following this thematic analysis, the authors conducted a further theory-driven analysis of the data guided by Normalisation Process Theory.ResultsWhen used in line with advice from the research team, the information resource and training were perceived as beneficial to both patients and GPs in the diagnosis and management of CFS/ME. However, 47 % of patients in this study did not receive the information pack from their GP. When the information pack was used, it was often incomplete, sent in the post, and GPs did not work with patients to discuss the materials. Only13 out of 21 practices completed the training module due to time pressures and the low priority placed on low prevalence, contentious, hard to manage conditions. When the module was completed, many GPs stated that it was not feasible to retain the key messages as they saw so few patients with the condition. Due to the complexity of the condition, GPs also believed that the diagnosis and management of CFS/ME should take place in a specialist care setting.ConclusionWhile barriers to the implementation of training and resources for CFS/ME remain, there is a need to support CFS/ME patients to access reliable, evidence based information outside primary care. Our findings suggest that future research should develop an online resource for patients to support self-management.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0453-8) contains supplementary material, which is available to authorized users.
Highlights
Previous research has highlighted that many GPs lack the confidence and knowledge to diagnose and manage people with Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME)
Reasons given for a lack of engagement included a level of scepticism about CFS/ME, and the complexity of managing the condition and working with patients and their families: Table 2 Normalization Process Theory (NPT) constructs (May and Finch, 2009)
Integrating new training and resources for a complex, low prevalence, medically unexplained condition into routine practice can clash with existing norms and beliefs, including scepticism around CFS/ME and the belief that this condition should be managed in secondary care [3, 18]
Summary
Previous research has highlighted that many GPs lack the confidence and knowledge to diagnose and manage people with CFS/ME. Some GPs see CFS/ ME as a contentious illness while others report a lack of confidence and knowledge in how to diagnose and manage the condition, and how to refer patients to specialist services [2,3,4,5]. The condition is of low prevalence and low priority as it is not within the Quality and Outcome Framework (QOF) [6]. This has led to dissatisfaction with current practice among patients who tend to disengage from primary care [7, 8]
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