Qualitative Study Of GPs Research Articles

Diagnosing skin disease in primary care: a qualitative study of GPs’ approaches: Table 1.

Skin diseases are a common reason for consulting a GP. This regular occurrence happens despite most GPs' lack of knowledge and training in skin disease. We aimed to explore different diagnostic approaches of GPs in patients presenting with a dermatological problem. In addition, we aimed to identify strategies used by GPs to handle diagnostic uncertainty in these patients. We conducted interviews (20-40 minutes) with 14 GPs using a semi-structured guideline. Recalling encounters with patients with skin disease, GPs described their individual diagnostic strategies. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters using a deductive-inductive approach. We identified several aspects of a complex decision-making process in GPs' diagnostic management of patients with dermatological problems. In the general diagnostic workup, GPs used a broad spectrum of different strategies such as spot diagnosis, stepwise refinement, pattern recognition trigger or test of treatment. GPs reduced diagnostic uncertainty through the identification of red flags, the application of the test of time, therapeutic trials and asking for further advice, including patient referral. GPs encounter a broad range of dermatological problems in their daily work using a variety of strategies in the workup of these patients. However, in a significant number of patients, there remains diagnostic uncertainty that is mainly reduced by specialist referral. Regular training in the diagnosis and treatment of common dermatological diseases should be offered to all GPs.

The challenges of treating women with recurrent urinary tract infections in primary care: a qualitative study of GPs' experiences of conventional management and their attitudes towards possible herbal options.

To explore GPs' experiences of managing recurrent urinary tract infections (RUTIs) and their views on the use of herbal medicines for this condition. RUTIs are an important problem commonly managed in primary care. Antibiotic prophylaxis is an effective treatment for acute infections but growing microbial resistance, adverse effects, and the lack of sustained long-term benefits mean that novel treatments are required. There are a number of promising reports of herbal medicines being used to treat RUTIs. A total of 15 GPs (seven female; aged 34-59 years; in practice from 3 to 31 years) were purposively sampled and took part in semi-structured face-to-face and telephone interviews. Interviews were digitally recorded, transcribed, and analysed using inductive thematic analysis. Data collection and analysis proceeded iteratively to allow emerging themes to inform subsequent interviews. Participants were aware of the disabling effect of RUTIs on women's lives. GPs experienced significant challenges in their management of RUTIs with decisions about the provision of antibiotics being particularly complex. While some participants were open to the possibility of herbal treatment options they required more research into effectiveness and safety, better regulation of herbal practitioners, and assurance about herbal quality control and potential herb-drug interactions.

Strategies for diagnosing leg oedema in primary care: A qualitative study of GPs’ approaches

Background: The symptom leg oedema represents a broad range of possible underlying aetiologies. The background of leg oedema is multifactorial and usually the GP is the first contact point for patients presenting with this symptom. GPs rely on patient history and physical examination as their main diagnostic tools.Objective: To identify GPs’ diagnostic approaches and heuristics in patients presenting with leg oedema.Methods: Interviews with 15 GPs (20–30 min) using a semi-structured interview-guideline were conducted. GPs described their individual diagnostic strategies concerning all patients presenting with leg oedema they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.Results: GPs applied a variety of diagnostic approaches, which can be grouped in active and passive strategies. Active strategies comprised the use of decision rules and guidelines, Bayesian arguing, problem dichotomisation and discrepancy heuristics. Passive approaches included test of time, therapy as diagnosis, and taking patient assumptions into account.Conclusion: When dealing with leg oedema, GPs use prior information of individual patients in a specific way. There is a broad variety of diagnostic approaches that can be grouped in ‘active’ and ‘passive’ behaviour. Approaches mostly match with established diagnostic strategies in primary care.

Diagnosing headache in primary care: a qualitative study of GPs' approaches.

Headache is one of the most common symptoms in primary care. Most headaches are due to primary headaches and many headache sufferers do not receive a specific diagnosis. There is still a gap in research on how GPs diagnose and treat patients with headache. To identify GPs' diagnostic approaches in patients presenting with headache. Qualitative study with 15 GPs in urban and rural practices. Interviews (20-40 minutes) were conducted using a semi-structured interview guideline. GPs described their individual diagnostic strategies by means of patients presenting with headache that they had prospectively identified during the previous 4 weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters. Regarding GPs' general diagnostic approach to patients with headache, four broad themes emerged during the interviews: 'knowing the patient and their background', 'first impression during consultation', 'intuition and personal experience' and 'application of the test of time'. Four further themes were identified regarding the management of diagnostic uncertainty: 'identification of red flags', 'use of the familiarity heuristic', 'therapeutic trial', and 'triggers for patient referral'. GPs apply different strategies in the early diagnostic phase when managing patients with headache. Identification of potential adverse outcomes accompanied by other strategies for handling uncertainty seem to be more important than an exact diagnosis. Established guidelines do not play a role in the diagnostic workup.

‘On the surface’: a qualitative study of GPs’ and patients’ perspectives on psoriasis

BackgroundPsoriasis is a chronic, inflammatory skin disease affecting approximately 2% of the UK population and is currently incurable. It produces profound effects on psychological wellbeing and social functioning and has significant associated co-morbidities. The majority of patients with psoriasis are managed in primary care, however in-depth patient and GP perspectives about psoriasis management in this setting are absent from the literature. This article reports an in-depth study which compares and contrasts the perspectives of people with psoriasis and of GPs on the challenges of managing psoriasis in primary care.MethodsIn-depth, qualitative semi-structured interviews were conducted with a diverse sample of 29 people with psoriasis and 14 GPs. Interviews were coded using principles of Framework Analysis to enable a comparison of patient and practitioner perspectives on key issues and concepts arising from the data.ResultsPatients perceived GPs to be lacking in confidence in the assessment and management of psoriasis and both groups felt lacking in knowledge and understanding about the condition. While practitioners recognised that psoriasis has physical, emotional and social impact, they assumed patients had expertise in the condition and may not address these issues in consultations. This resulted in patient dissatisfaction and sub-optimal assessment of severity and impact of psoriasis by GPs. Patients and GPs recognised that psoriasis was not being managed as a complex long-term condition, however this appeared less problematic for GPs than for patients who desired a shared management with their GP incorporating appropriate monitoring and timely reviews.ConclusionsThe research suggests that current routine practice for psoriasis management in primary care is mismatched with the expressed needs of patients. To address these needs, psoriasis must be recognised as a complex long-term condition involving exacting physical, psychological and social demands, co-morbidity and the development of new treatments.General practitioners need to improve both their knowledge and skills in the assessment and management of psoriasis. This in turn will facilitate management of the condition in partnership with patients. Commissioning multi-disciplinary services, which focus on long-term impacts on wellbeing and quality of life, might address current deficits in care.

Causes of death certification of adults: an exploratory cross-sectional study at a university hospital in Riyadh, Saudi Arabia

BACKGROUND AND AIMSSaudi Arabia has no precise data on causes of death. We sought to ascertain the commonest causes of death as stated in death certificates of adults and evaluate the completeness of death certificates at a teaching hospital in Riyadh.DESIGN AND SETTINGA cross-sectional study carried out at King Khalid University Hospital in Riyadh, Saudi Arabia, during the year 2008.METHODSAll death certificates that were issued in 2008 were reviewed and data were checked by two reviewers. Causes of death were coded according to specially-designed codes.RESULTSThe mean (SD) age of death was 63.9 (20.7) years. More than 80% arrived alive at the hospital. Among the 410 certificates, 62.2% had the first reported cause of death being classified as “inappropriate” and this tended to be slightly, but significantly more frequent among women. The first most common appropriately reported cause of death was malignancy of any type (7.3%) followed by ischemic heart diseases (4.9%). Accidents and fractures were more common in the younger age groups and among men.CONCLUSIONSThis is the first study that documents the possible gaps among healthcare professionals in Saudi Arabia in their understanding of death and its certification based on the clinical assessment of the deceased. The findings needs to be validated by similar studies from other health care sectors. It is clear, however, that proven educational, system-related and legal interventions to improve the accuracy of death certification are strongly needed if the health care priorities are to be properly identified.

Greater clarity in roles needed

British Journal of Healthcare AssistantsVol. 5, No. 8 Health MattersGreater clarity in roles neededFelicity Hasson, Hugh McKennaFelicity HassonSearch for more papers by this author, Hugh McKennaSearch for more papers by this authorFelicity Hasson; Hugh McKennaPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2011.5.8.408AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bach S, Kessler I, Heron P (2008) Role redesign in a modernised NHS: the case of health care assistants. Human Resource Management Journal 18(2): 171–87 Crossref, Google ScholarDepartment of Health (1999) Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. The Stationery Office, London Google ScholarDepartment of Health (2000) The NHS Plan: a Plan for Investment: a Plan for Reform. The Stationery Office, London Google ScholarDepartment of Health (2004) European Working Time Directive. The Stationery Office, London Google ScholarHall P (2005) Interprofessional teamwork: professional cultures as barriers. Journal of Interprofessional Care 19(1): S188–96 Crossref, Google ScholarHoban V (2008) HCAs in nursing: what role should they play? Nurs Times 104(20): 18–9 Google ScholarKessler I, Heron P, Dopson S, Magee H, Swain D, Askham J (2010) The nature and consequences of support workers in a hospital setting. Final report. NIHR Service Delivery and Organisation, London Google ScholarMcKenna HP (2004) ‘‘Role drift'' to unlicensed assistants: risks to quality and safety. Editorial, quality and safety in health care. Quality and Safety in Health Care 13(6): 410–1 Crossref, Google ScholarOldfield A (2009) Healthcare assistants and their role in tissue viability. Wounds UK 5(1): 67–71 Google ScholarPetrova M, Vail L, Bosley S, Dale J (2010) Benefits and challenges of employing health care assistants in general practice: a qualitative study of GPs and practice nurses' perspectives. Fam Pract 27(3): 303–11 Crossref, Google ScholarRoyal College of Nursing (2003) The future nurse: interim report. RCN, London Google ScholarSpilsbury K, Meyer J (2005) Making claims on nursing research. Exploring the work of healthcare assistants and the implications for registered nurses' roles. Journal of Research in Nursing 10(1): 65–83 Crossref, Google ScholarStokes J, Warden A (2004) The changing role of the Healthcare assistant. Nurs Stand 18(51): 33–7 Crossref, Google ScholarThornley C (2000) A question of competence? Re-evaluating the roles of the nursing auxiliary and health care assistant in the NGS. J Clin Nurs 9(3): 451–8 Crossref, Google ScholarUnited Kingdom Central Council for Nursing, Midwifery and Health Visiting (1986) Project 2000: a new preparation for practice. United Kingdom. Central Council for Nursing, Midwifery and Health Visiting, London Google ScholarWakefield A (2000) Tensions experience by student nurses in a changed NHS culture. Nurse Educ Today 20(7): 571–8 Crossref, Google ScholarWatson R (2007) Do HCAs deskill nurses? Yes. British Journal of Healthcare Assistants 1(2): 58 Link, Google Scholar FiguresReferencesRelatedDetailsCited byOrganising through compassion: The introduction of meta‐virtue management in the NHS24 April 2019 | Sociology of Health & Illness, Vol. 107 1 August 2011Volume 5Issue 8ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 August 2011 Information© MA Healthcare LimitedPDF download

Obstacles to colorectal screening in general practice: a qualitative study of GPs and patients

The faecal occult blood test (FOBT) has proven efficiency at screening populations for an average risk of colorectal cancer. Mortality related to this cancer decreases by 15-18% among adults, 50-74 years old, tested every 2 years. A participation rate of at least 50% is desirable. This rate has not yet been reached in most French regions. To explore the obstacles to mass colorectal screening in France. In 2009, five focus groups were conducted in different areas to explore physicians' obstacles to FOBT screening. The patients' obstacles were assessed in semi-structured interviews. A purposive sampling had been carried out for both GPs and patients. The focus groups were coded using Nvivo 8(®) software by three researchers; the interviews manually coded by two researchers. GPs reported insufficient training and some doubted the relevance of screening. They expressed concern of having insufficient time for the test during a consultation, as well as practical and administrative obstacles. Some GPs experienced difficulty persuading patients who had no signs of colorectal disease. Obstacles for patients were mainly difficulties in doing screening themselves and a perception of health care that didn't match with screening. Information and organization were also important points to improve. The screening process was considered complex both by GPs and by patients. Numerous obstacles to colorectal screening, from both the physicians' and the patients' perspectives, were found. The major goal to improve mass screening may be to increase awareness and understanding of both physicians and patients regarding this process.

Prostate cancer awareness

British Journal of Healthcare AssistantsVol. 5, No. 3 In FocusProstate cancer awarenessGeorgia DiebelGeorgia DiebelSearch for more papers by this authorGeorgia DiebelPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2011.5.3.148AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ben-Shlomo Y, Evans S, Metcalfe C, Ibrahim F, Patel B, Gillatt D, Anson K et al. (2008) The Risk of Prostate Cancer amongst Black men in the United Kingdom: The PROCESS Cohort Study. European Urology 53(1): 99–105 Crossref, Google ScholarCancer Research UK (2011) Source of incidence. http:// info.cancerresearchuk.org/cancerstats/types/prostate/ incidence/ (accessed 1 March 2011) Google ScholarCourtenay W (2004) Making health manly: social marketing and men’s health. Journal of Men’s Health and Gender 1(2) 275–276 Crossref, Google ScholarCourtenay W (2006) Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci & Medi 50(10): 1385–1401 Crossref, Google ScholarEngstrom G (2009) Distress from lower urinary tract symptoms and its effect on the quality of life in Swedish men. Journal of Men’s Health 6(2): 114–22 Crossref, Google ScholarMen’s Health Forum (2009) Challenges and Choices – Improving health services to save men’s lives. A policy briefing paper. Men’s Health Forum, London Google ScholarNational Institute of Health and Clinical Excellence (2010) The Management of Lower Urinary Tract Symptoms in Men CG97. National Institute of Clinical Excellence, London Google ScholarNorcross WA, Ramirez C, Palinkas LA (1996). The influence of women on the health care-seeking behaviour of men. J Fam Pract 43(5): 475–480 Google ScholarOffice for National Statistics (2007) General Household Survey 2007. Office for National Statistics, 2007 Google ScholarPetrova M, Vail L, Bosley S, Dale J (2010) Benefits and challenges of employing health care assistants in general practice: a qualitative study of GPs’ and practice nurses’ perspectives. Fam Pract 27(3): 303–11 Crossref, Google ScholarRobb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Waller J, Hiom S, Wardle J (2009) Public awareness of cancer in Britain: a population-based survey of adults. Bri J Cancer 101: S18–S23 Crossref, Google ScholarSchone BS, Weinick RM (1998) Health-related behaviours and the benefits of marriage for elderly persons. Gerontologist 38(5): 618–627 Crossref, Google ScholarSmith LK, Pope C, Botha JL (2005) Patients’ help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 366(9488): 825–31 Crossref, Google ScholarThe Prostate Cancer Charity (2008) 2008 Prostate Cancer Survey Results. Prostate Cancer Charity, London Google ScholarThe Prostate Cancer Charity (2010a) 2010 Prostate Cancer Survey Results. Prostate Cancer Charity, London Google ScholarThe Prostate Cancer Charity (2010b) Prostate Cancer Research. http://tinyurl.com/BJHCAprostate (accessed 3 March 2011) Google ScholarThe Prostate Cancer Charity (2011a) Know your prostate. http://tinyurl.com/BJHCAprostate2 (accessed 3 March 2011) Google ScholarThe Prostate Cancer Charity (2011b) Did you know? http://tinyurl.com/BJHCAprostate3 (accessed 3 March 2011) Google Scholar FiguresReferencesRelatedDetails 1 March 2011Volume 5Issue 3ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 March 2011 Information© MA Healthcare LimitedPDF download

Delayed prescribing for upper respiratory tract infections: a qualitative study of GPs' views and experiences

Delayed prescribing has been promoted as a strategy that meets patients' expectations and helps to avoid unnecessary use of antibiotics in upper respiratory tract infections. To explore GPs' views on and experiences with delayed prescribing in patients with acute upper respiratory tract infections. Qualitative study involving focus groups. Setting Norwegian general practice. Qualitative analysis of data collected from five focus groups comprising 33 GPs who took part in a quality-improvement programme of antibiotic prescribing. The views of GPs differed on the usefulness of delayed prescribing. GPs who endorsed the strategy emphasised shared decision making and the creation of opportunities for educating patients, whereas GPs who were negative applied the strategy mainly when being pressed to prescribe. Mild and mainly harmless conditions of a possible bacterial origin, such as acute sinusitis and acute otitis, were considered most suitable for delayed prescribing. A key argument for issuing a wait-and-see prescription was that it helped patients avoid seeking after-hours care. For issuing a wait-and-see prescription, the GPs required that the patient was 'knowledgeable', able to understand the indications for antibiotics, and motivated for shared decision making. GPs emphasised that patients should be informed thoroughly when receiving a wait-and-see prescription. Not all GPs endorse delayed prescribing; however, it appears to be a feasible approach for managing patients with early symptoms of mild upper respiratory tract infections of a possible bacterial origin. Informing the patients properly while issuing wait-and-see prescriptions is essential.

Benefits and challenges of employing health care assistants in general practice: a qualitative study of GPs' and practice nurses' perspectives

Estimates suggest that over half of general practices in England currently employ a health care assistant (HCA) but there is little evidence of their impact, effectiveness and acceptability to patients and primary care team members. To explore the role of HCAs in general practice and the benefits and challenges associated with their employment. Semi-structured interviews were performed with 6 GPs and 13 practice nurses as part of a larger qualitative study that also included HCAs. Interviewees were from 16 general practices from two Primary Care Trusts in the West Midlands. Transcripts were analyzed using thematic and framework analysis. HCAs were seen as a valuable addition to the primary care team. They were reported to accelerate, rather than extend services, allow more appropriate use of nurses' skills and enable cost containment. Their training and supervision were felt as time intensive, demanding of time and commitment. Patient safety was raised as a concern, although no specific experience of it being compromised was reported. Nurses recognized the usefulness of HCAs, helped to make the role work, but were often anxious about the impact on their own roles and professional identity. Patients were perceived as being generally neutral or positive. Cost-effectiveness, patient safety, quality of care, potentially contested role boundaries and patient attitudes are among the issues that policy-makers, commissioners and those responsible for workforce development and training need to consider in relation to HCAs in general practice. There is also a need for more in-depth evaluation of this role.

The present state and future direction of primary care: a qualitative study of GPs' views

Over the past decade there has been a sharp increase in the number of non-profit-sharing salaried doctors employed by practices. This has been accompanied by the introduction of mechanisms to facilitate the entry of other providers into the primary care market.To explore the views of GP principals and salaried doctors on current working practices and the future direction of primary care in England.Qualitative study using semi-structured interviews.Twenty-two nationally representative practices across England, between February and August 2007.Interviews were conducted with 22 principals and seven salaried doctors. A topic guide included questions on motivations for working in primary care, descriptions of working lives, the way in which clinical time was spent, and predictions for future working conditions.Significant changes to GP working arrangements were identified, including increasing pursuit of specialist clinical interests by GP principals and increasing employment of salaried GPs. These developments were reported as improving the working lives of principals but also creating a hierarchical structure at practice level that led to resentment among salaried doctors. Many of the salaried GPs felt disenfranchised and disillusioned by the difference in status and autonomy in decision making and the type of work they performed in the practice. Almost all GPs felt uncertain about the future of primary care and were concerned about the potential threat of private providers delivering primary care within the NHS through a largely salaried workforce.By failing to recognise the problems of employing an increasingly disenfranchised salaried labour force, GP principals may be undermining the very ethos of general practice they otherwise advocate and recreating smaller versions of the private provider organisations they suggest threaten to corrode NHS primary care.

Our debt to those who are dying: the UK medical establishment should reconsider its stance on assisted suicide

Just when you thought it had gone away, the debate on assisted suicide is back. Debbie Purdy, who has multiple sclerosis, took her case to the House of Lords to seek assurance that her husband would not be prosecuted for assisting her to commit suicide, and the House of Lords referred it to the Director of Public Prosecutions (DPP). The DPP has now issued an interim statement and invited consultations (the closing date for responses is 16 December 2009).1 The judicial decision was at least in part a response to the wholly unsatisfactory position that the authorities in the UK seemed to be condoning acts carried out by UK citizens abroad that would be illegal here. The medical profession in the UK is in general opposed to legalising assisted dying, and those working in palliative medicine are more opposed than any other group.2 The Royal College of General Practitioners debated the subject 4 years ago, and agreed a policy that there should be no change in the existing law.3 In this issue of the BJGP , Hussain and White report on a qualitative study of GPs' attitudes.4 They found a range of opinions, with some taking the view that involving doctors in euthanasia would always be wrong, and others seeing it as a potentially useful service to patients suffering intolerably. It should not …

What happens when doctors are patients? Qualitative study of GPs

Current evidence about the experiences of doctors who are unwell is limited to poor quality data. To investigate GPs' experiences of significant illness, and how this affects their own subsequent practice. Qualitative study using interpretative phenomenological analysis to conduct and analyse semi-structured interviews with GPs who have experienced significant illness. Two primary care trusts in the West of England. A total of 17 GPs were recruited to take part in semi-structured interviews which were conducted and analysed using interpretative phenomenological analysis Results: Four main categories emerged from the data. The category, 'Who cares when doctors are ill?' embodies the tension between perceptions of medicine as a 'caring profession' and as a 'system'. 'Being a doctor-patient' covers the role ambiguity experienced by doctors who experience significant illness. The category 'Treating doctor-patients' reveals the fragility of negotiating shared medical care. 'Impact on practice' highlights ways in which personal illness can inform GPs' understanding of being a patient and their own consultation style. Challenging the culture of immunity to illness among GPs may require interventions at both individual and organisational levels. Training and development of doctors should include opportunities to consider personal health issues as well as how to cope with role ambiguity when being a patient and when treating doctor-patients. Guidelines about being and treating doctor-patients need to be developed, and GPs need easy access to an occupational health service.

Socially responsible antibiotic choices in primary care: a qualitative study of GPs' decisions to prescribe broad-spectrum and fluroquinolone antibiotics

There is considerable variation within and between countries in general medical practitioners' (GPs') prescribing of broad-spectrum antibiotics such as fluroquinolones, and resistance to these agents is increasing worldwide. Urgently promoting cautious fluroquinolone prescribing in primary care may limit increase in resistance. We therefore interviewed 40 GPs in order to explore the reasons for their choice of prescribed antibiotic, in particular their decision to prescribe fluroquinolones. We used a grounded theory approach to data collection and analysis, incorporating purposive and theoretical sampling, based on high and average fluroquinolone prescribing. Interviews were conducted with 26 GPs from practices known to be high prescribers of fluroquinolone antibiotics and 14 from average fluroquinolone prescribing practices. Chosing to prescribe a broad-spectrum antibiotic such as a fluroquinolone, rather than a narrow-spectrum antibiotic, related to a number of clinical considerations, perceptions of patient expectations and organizational influences. GPs from high fluroquinolone prescribing practices were more likely to prioritize patients' immediate needs, whereas GPs from average prescribing practices were more likely to consider longer term issues. GPs from both high and average fluroquinolone prescribing practices justified their antibiotic choices on the basis of a desire to do their best for their patients and society. Choosing to prescribe powerful, broad-spectrum antibiotics such as fluroquinolones, as well as choosing to keep these agents in reserve, was justified on the basis of social responsibility. Strategies to change fluroquinolone and broad-spectrum antibiotic prescribing will need to take into account clinicians' perceptions of social responsibility.

Bowel cancer screening in England: a qualitative study of GPs' attitudes and information needs

BackgroundThe National Health Service Bowel Cancer Screening Programme is to be introduced in England during 2006. General Practitioners are a potentially important point of contact for participants throughout the screening process. The aims of the study were to examine GPs' attitudes and information needs with regard to bowel cancer screening, with a view to developing an information pack for primary care teams that will be circulated prior to the introduction of the programme.Methods32 GPs participated in semi-structured telephone interviews. 18 of these had participated in the English Bowel Screening Pilot, and 14 had not. Interviews covered attitudes towards the introduction of the Bowel Cancer Screening Programme, expected or actual increases in workload, confidence in promoting informed choice, and preferences for receiving information about the programme.ResultsGPs in the study were generally positive about the introduction of the Bowel Cancer Screening Programme. A number of concerns were identified by GPs who had not taken part in the pilot programme, particularly relating to patient welfare, patient participation, and increased workload. GPs who had taken part in the pilot reported holding similar concerns prior to their involvement. However, in many cases these concerns were not confirmed through GPs experiences with the pilot. A number of specific information needs were identified by GPs to enable them to provide a supportive role to participants in the programme.ConclusionThe study has found considerable GP support for the introduction of the new Bowel Cancer Screening Programme. Nonetheless, GPs hold some significant reservations regarding the programme. It is important that the information needs of GPs and other members of the primary care team are addressed prior to the roll-out of the programme so they are equipped to promote informed choice and provide support to patients who consult them with queries regarding screening.

After hours care: a qualitative study of GPs’ perceptions of risk of violence and effect on service provision

After hours care: a qualitative study of GPs’ perceptions of risk of violence and effect on service provision

Barriers to the adoption of computerised decision support systems in general practice consultations: a qualitative study of GPs’ perspectives

Introduction: Computerised decision support systems are increasingly important in primary care for the practice of evidence-based medicine and the development of shared GP-patient decision making. However, despite their emergence, such systems have not been entirely embraced by GPs. There is little qualitative research exploring practical barriers to the adoption of decision support systems in this setting. Method: Qualitative interviews with 15 GPs in the West Midlands. Results: Several practical barriers were identified to the use of computerised support systems in primary care consultations. These included limitations of practitioners’ IT skills, problems for GPs in understanding the risk output of systems and GP concerns about communicating risk sufficiently well to patients. Concerns over the time implications of using a system in a consultation was also identified as a barrier. Conclusion: Designers of decision support systems for use in primary care consultations must account for the practical needs of users when developing computerised support systems. Systems must be acceptable to the format of a consultation, include definitions of what output means, and help facilitate dialogue between the GP and the patient.

Binners, fillers and filers: A qualitative study of GPs who don't return postal questionnaires

Background and Objectives: Postal questionnaires are a frequently used method of obtaining information from general practitioners. However, getting GPs to return questionnaires or participate in research can be challenging. We wanted to ascertain reasons why GPs, identified as ‘routine non-responders’ to postal questionnaires, do not to participate in this type of research.Methods: Qualitative study using semi-structured interviews of 14 GPs who had returned only one or none of five questionnaires sent to them during a five-year period between 1994 and 1999.Results: Participants were classified into one of three groups-binners, filers, and fillers-according to their behaviour when faced with a questionnaire. Each group had slightly different attitudes toward research in general practice. Although standard strategies such as incentives and good design could influence the decision to complete a questionnaire, poor research experiences or a poor relationship between the participant and researchers were also very important.Conclusion: The decision not to return a postal questionnaire is multifactorial and reflects personal and professional attitudes, experiences and organisation of individual GPs as well as time pressure and interest. The development of a positive relationship with a researcher or academic department may be influential in encouraging the return of postal questionnaires and when trying to enhance response rates amongst ‘routine non-responders’ researchers should take into account the broader values and practices GPs bring to their work.

A qualitative study of GPs' attitudes to drug misusers and drug misuse services in primary care.

Due to a growing drug misuse problem in Scotland, GPs increasingly are being called upon to deal with and treat misusers. With the publication of government guidelines in 1999, debate on this subject has intensified, with some GPs questioning their role in the treatment of drug misuse. This study explored, in depth, GPs' views and experiences of providing services for drug misusers such as methadone maintenance, use of guidelines and shared care schemes. Factors influencing their treatment of drug misusers were covered. Forty-eight semi-structured GP telephone interviews were conducted and their responses recorded, transcribed and analysed using qualitative content analysis. The sample was purposive and included a spread of individuals from varying age groups, levels of involvement with drug misuse and training, as well as gender and health board. Transcripts were validated with a 50% sample of interviewees, allowing them to correct any opinions they felt were not represented accurately. GPs increasingly accept a role in the treatment of drug dependency, although a shared care model was preferred due to the workload implications of this patient group. A drawback of shared care was long waiting lists. Patient behaviour emerged as a strong theme influencing treatment, and safety concerns were evident. Views of methadone maintenance were mixed, and it was considered as the only real option available. Themes identified from the interviews reinforced the patterns of past research. GPs are becoming more confident and comfortable with misusers, and more positive towards methadone and methadone maintenance treatment, but still feel that they lack the necessary knowledge and skills.