Experience In General Practice Research Articles

General practice is 'different': qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees.

Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training. To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future. Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role. Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas. Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger's social learning model, which may have useful practical implications.

Online patient feedback as a measure of quality in primary care: a multimethod study using correlation and qualitative analysis

ObjectivesTo ascertain the relationship between online patient feedback and the General Practice Patient Survey (GPPS) and the Friends and Family Test (FFT). To consider the potential benefit it may add...

Lenox Jardine Millar

After working in Nottingham City Hospital, Lenox Jardine Millar gained his first experience of general practice in Australia, with his wife, Jo, also a doctor . He started in practice in Worksop in 1974, …

General practitioners' experiences of patients with eating disorders.

General practitioners play a key role in assessing, diagnosing and treating eating disorders. This role is challenged by clinical features of the patient group, the doctors' everyday work and issues related to collaboration with the specialist health service. The objective of this study was to obtain more knowledge about the ways in which GPs meet such challenges. Five GPs from Nordland county participated in the study, all of whom had at least three years' experience of general practice and relevant clinical experience with this patient group. The participants were interviewed about their experience of patients with eating disorders, especially with regard to identification and follow-up. The interviews entailed no risk of the doctors breaching their duty of confidentiality. The interviews were recorded on an audio device, transcribed and analysed with the aid of systematic text condensation. The GPs had few patients with eating disorders. None reported any specific problems in identifying patients, but called for both competence development and screening tools. It was challenging to talk to patients who attended for consultations due to reports of concern by others, as well as to make time for longer consultations in general. The experience from collaboration with the specialist health service varied somewhat. The results must be seen in light of the limitations stemming from sample size and contextual dependency, but the experiences reflect challenges that can be linked to both clinical issues and framework conditions in general practice. The participants called for initiatives to enhance clinical competence among GPs in the field of eating disorders.

Factors affecting recruitment into General Practice: a double binary choice approach

Recruitment to General Practice (GP) is currently low in many countries. Here we focus on two binary choices for junior doctors: first, whether to apply to GP; second, whether to accept a GP training place if offered. Previous attitudinal studies have indicated factors claimed to affect recruitment. The current study goes further by quantifying the relative impact of different factors on the propensity of candidates to apply to GP and accept a training place. An online questionnaire was sent to candidates applying to United Kingdom (UK) specialty training in 2015. Descriptive statistics and a path analysis evaluated the importance of various factors on GP applications. Our results were synthesised with an analysis of data from the online applications portal. With 3838 candidates responding to the survey, the path analysis showed that personality and previous GP experiences were strongly associated with the decision to apply. There was some evidence that it was easier to enter GP than other specialties; in terms of deciding whether to accept, the evidence suggests GP was a backup plan for around 9% of candidates who accepted a GP post. Our results indicate that recruitment initiatives should focus on candidates who apply to GP but not as first choice or consider GP but do not apply, particularly by providing substantial experience of GP and accentuating the positives of the specialty such as work-life balance and the intellectual challenge of working with patients in primary care. Acceptance of a GP place may also depend on competition for places in other specialties.

The acceptance and applicability of a patient-reported experience measurement tool in oncological care: a descriptive feasibility study in northern Germany

BackgroundPatient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes of and experiences with health care from the patient’s perspective. In Germany, PROMs are widely used in research for evaluating patient outcomes and quality of care. However, the application of PREMs is rather scant, especially in oncology. The study aimed to assess the feasibility of patient-centred quality evaluation in oncological care in Germany using the German adaptation of the Danish National Cancer Patient Questionnaire. This questionnaire is a PREM/PROM-tool addressing patients of all cancer sites and covering the entire cancer patient pathway.MethodsThe Danish National Cancer Patient Questionnaire was translated into German via forward-backward translation. Face-validity was tested among three cancer patients in a conventional pre-test. The German adaptation contains 99 questions. A pilot test was carried out among 245 newly diagnosed breast and colorectal cancer patients in the German federal state Schleswig-Holstein. Patients were recruited via clinics participating in the Oncological Care Registry (12 specialised units in seven hospitals) and contacted six to nine months after diagnosis. Response behaviour and response patterns were compared to the Danish study population (n = 1964).ResultsThe willingness among clinicians to support patient recruitment as well as the response rate of patients to the questionnaire was high (65%). Moreover, response behaviour and response patterns of German and Danish patients were consistent. Despite the generally good response behaviour of patients to the single items, the authors observed that questions assessing the diagnostic process did not fully capture German pathways. Only 19.3% of the German patients stated that their diagnostic process was initiated by a visit to a general practitioner (GP) in contrast to 52% in Denmark. The assessment of patient experiences in the diagnostic phase heavily focuses on experiences in general practice, which does not seem appropriate in the German health care setting.ConclusionThe translation was successful, and the feasibility of a future large-scale study within existing structures is given. However, some modifications of questions heavily related to the Danish health care system, especially referring to the diagnostic phase, are necessary.

293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study

Abstract Background The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs. Methods Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection. Results 12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care. Conclusion GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.

Predicting no return to sports after three months in patients with traumatic knee complaints in general practice by combining patient characteristics, trauma characteristics and knee complaints

Background: It remains unclear to what extent patients with traumatic knee complaints aged 18–45 years seen in general practice experience difficulties with return to sports.Objectives: This study aims to determine the proportion of patients with a knee trauma that return to sports at six weeks and three months follow-up. Also examined were associations between no return to sports and baseline patient/trauma characteristics, knee complaints and MR (magnetic resonance) findings, as well as the additive value of MR findings.Methods: Included were patients with traumatic knee complaints participating in a randomized controlled trial assessing the cost-effectiveness of an MR scan in general practice. Patients were classified as ‘no return to sports’ or ‘return to sports’ (sports on pre-injury or adapted level). Potential baseline predictors for no return to sports were assessed using logistic regression analyses. The area under the curves (AUC) was compared.Results: At six weeks and three months follow-up, 147 (59%) and 175 (74%) patients, respectively, reported return to sports. Combining patient characteristics, trauma characteristics and knee complaints predicted no return to sports with an AUC of 0.86 (95%CI: 0.81–0.90) at six weeks and of 0.82 (95%CI: 0.76–0.88) at three months follow-up. After adding MR findings, the AUC was 0.79 (95%CI: 0.71–0.87) at six weeks and 0.79 (95%CI: 0.70–0.88) at three months follow-up.Conclusion: Three out of four patients with a knee trauma in general practice reported return to sports at three months follow-up. A combination of patient/trauma characteristics and knee complaints predicted no return to sports, whereas MR findings had no additive value. Trial registration: Dutch trial registration: registration number: NTR3689. registration date: 7 November 2012.

Proliferation of the WReN spider, an instrument to measure health professionals\u2019 experience of research: a bibliographic study

BackgroundIn 1997 the “Wessex Research Network (WReN) Spider” was developed and validated to assess the research experience of general practice based researchers. This bibliometric study traces the use and development of this instrument over 15 years.MethodsWe performed a bibliographic search to identify all the citations of the original article since 2002.ResultsThirty one relevant papers were found. Publications were classified according to whether they used (N = 18) or cited (N = 13) the WReN Spider. The majority of these papers came from Australia (N = 18) and 10 papers focussed on the research training of Allied Health Professionals. The WReN Spider was used in 12 studies to assess baseline experience before a training intervention or to compare before and after training scores. The WReN Spider was often (N = 9) modified to additionally assess interest, confidence or interest in up-skilling in each of its 10 limbs. It was also often (N = 14) used in tandem with open ended questions to gain a more detailed understanding of people’s research skills, or with additional questions focussing on the research context, culture and team. None of the papers confirmed the validation of the WReN Spider, although it was applied in contexts that differed from the one in which it was developed.ConclusionsThe WReN Spider continues to be used to measure the research experience of health care practitioners, but it is frequently enhanced with other questions to look at the wider issues of research success, including collaborators, resource and environment.

Luck or Strategy? Some Insights Into Successful New Ventures

Utilizing Nobel Laureate, Daniel Kahneman's views on decision-making psychology and the general practice experience of Amazon's founder, Jeff Bezos, the authors formulate an approach to understand strategy and entrepreneurship. A hypothetical a priori probability model of a successful entrepreneurial venture is introduced in this paper. The model clarifies why the “prior to launch” probability of success is normally exceptionally low. But, low probability does not imply insignificance as free-market-driven new ventures with low probabilities of success can have a substantial impact on strategic planning within competitive firms. As a venture progresses through start-up phases and the probabilities of achieving individual critical single-events rise, the probability of venture success also increases as a function resembling the shape of a “hockey stick.” Entrepreneurially, the results show how a new venture's start-up can be quantitatively managed and analyzed with improved outcomes. The results provide some strategic insights on the difficulty of assessing competition as markets evolve.

Young bisexual women's sexual health care experiences in Australian rural general practice.

To examine how young bisexual women in rural Tasmania experience routine sexual health care in general practice settings. Semi-structured interviews with bisexual women were used for this study. Self-selected and purposive sampling were used to recruit women in 2015. Participants were recruited via community social media pages and a not-for-profit organisation supporting same-sex attracted rural youth. Data were analysed thematically. Regional and rural areas in the north and south of Tasmania, Australia. Fifteen bisexual women, 18-26years of age, with experience seeking sexual health care in Tasmania. Semi-structured interviews explored women's experiences of inclusive sexual health care. Four key themes emerged from the thematic analysis: (a) issues of health care accessibility in rural Tasmania; (b) the importance of visual signs of inclusivity in rural clinics; (c) practitioner attitudes; and (d) use of inclusive, gender-neutral language. Rural bisexual women prefer practitioners who make meaningful efforts to be inclusive and take a non-judgmental approach to sexual health care. Additional resources are needed to support rural communities and their health care providers to prioritise inclusive health practices.

Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years...

The two-year longitudinal dental foundation training programme: an option worth revisiting.

Two-year longitudinal dental foundation training (LDFT) programmes are available for dental graduates through a national recruitment process. These two-year schemes have been around for many years and enable foundation dentists to gain valuable experiences in general practice as well as the hospital and community services. However, the LDFT schemes have closed in Northern Ireland, Scotland and Wales in recent years, leaving the North East England General Professional Training (GPT) scheme and the Yorkshire and Humberside LDFT scheme as the only two LDFT/GPT schemes left. With the Health Education England (HEE) 'Advancing Dental Care' project in progress, HEE are looking at reforming dental education and training to meet new and continued expectations. LDFT/GPT has been highlighted already in stage one of the project and will be considered further in stage two. Following frequent discussions in the project, this could offer an opportunity to expand and develop future LDFT/GPT schemes around the UK.

Changes in Australian Early-Career General Practitioners’ Benzodiazepine Prescribing: a Longitudinal Analysis

Australian and international guidelines recommend benzodiazepines and related drugs (hereafter "benzodiazepines") as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars ("trainees" or "residents" participating in a post-hospital training, apprenticeship-like, practice-based vocational training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiazepine prescribing. To establish if registrars' prescribing of benzodiazepines decreases with time within a GP training program DESIGN: Longitudinal analysis from the Registrar Clinical Encounters in Training multi-site cohort study PARTICIPANTS: Registrars of five of Australia's 17 Regional Training Providers. Analyses were restricted to patients ≥ 16years. The main outcome factor was prescription of a benzodiazepine. Conditional logistic regression was used, with registrar included as a fixed effect, to assess within-registrar changes in benzodiazepine-prescribing rates. The "time" predictor variable was "training term" (6-month duration Terms 1-4). To contextualize these "within-registrar" changes, a mixed effects logistic regression model was used, including a random effect for registrar, to assess within-program changes in benzodiazepine-prescribing rates over time. The "time" predictor variable was "year" (2010-2015). Over 12 terms of data collection, 2010-2015, 1161 registrars (response rate 96%) provided data on 136,809 face-to-face office-based consultations. Two thousand six hundred thirty-two benzodiazepines were prescribed (for 1.2% of all problems managed). In the multivariable model, there was a significant reduction in within-program benzodiazepine prescribing over time (year) (p = < 0.001, OR = 0.94, CI = 0.90, 0.97). However, there was no significant change in 'within-registrar' prescribing over time (registrar Term) (p = 0.92, OR = 1.00 [95% CI = 0.94-1.06]). Despite a welcome temporal trend for reductions in overall benzodiazepine prescribing from 2010 to 2015, there is still room for improvement and our findings suggest a lack of effect of specific GP vocational training program education and, thus, an opportunity for targeted education.

Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey.

The UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients' overall experiences of general practice. To examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours. Analysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011-2012 until 2013-2014. These covered 8289 general practice surgeries in England. Data from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression. In total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices. Patient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients' overall experience of general practice.

High-performing general practice registrars, the gifted and the talented: Helping them to reach their potential.

This article was migrated. The article was marked as recommended. The under-performing medical student or trainee in difficulty, is the subject of extensive discussion in the medical education literature. In contrast, literature on the high-performing medical student or trainee is limited, possibly because high-performers are considered the 'quiet achievers' requiring little assistance. High-performers however are diverse and they may also have difficulties with their learning and face particular impediments. Whether quiet achievers or otherwise, high-performers provide challenges to the educator and educational institution alike. This is a discussion paper based largely on the author's broad experiences in General Practice (GP) training. It references educational theories of giftedness and knowledge management theory in order to provide an understanding of high-performing GP Registrars (GPRs) and the gifted, their attributes, particular challenges and needs. It argues that high-performing GPRs, those having talent or showing potential, should be supported and encouraged to excel. This requires striking the right balance between challenge and support as well as the optimization of: learning, experience, self-reflection and self-actualization. In addition, impediments to learning should be addressed, psychosocial needs met and assistance provided to surmount any disabilities. This is important, not only that high-performing GPRs will aim higher and attain their ultimate potential but also to give impetus to the gifted amongst them, who have special abilities and the potential to make new discoveries, challenge extant ideas and create new paradigms.

Does patients’ experience of general practice affect the use of emergency departments? Evidence from Australia

AS Emergency Department (ED) attendances have been growing rapidly, various strategies have been employed in Australia to improve access to General Practitioner (GP) care, particularly after normal working hours, in order to reduce the demand for ED. However, there has been little attention paid to the quality of GP care and whether that influences ED attendances. This paper investigates whether ED use is affected by patients’ experience of GP care, using the logit model to analyse data from a survey of Australian consumers (1758 individuals). Not surprisingly, we find that people with poor health status and a greater number of chronic conditions are more likely to visit the ED. We also find that, after correcting for health status and sociodemographic factors, patients with a better GP experience are less likely to visit the ED. This suggests that policies aimed at improving the quality of primary care are also important in reducing unplanned hospital use.

‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK

ObjectivesFailure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor....

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study

ObjectivesGeneral practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs....

Factors associated with professional satisfaction in primary care: Results from EUprimecare project

Background: Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine.Objectives: This study explored factors associated with professional satisfaction in seven European countries.Methods: A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians.Results: A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8).Conclusion: Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.