Source Of Frustration Research Articles

The client experience of psychiatric medication: A qualitative study

This qualitative study examined the client experience of psychiatric medication among an unusual and under-studied subpopulation, individuals diagnosed with SMI who eventually experienced functional recovery. Four themes emerged from in-depth qualitative interviews with 16 such individuals: (1) primacy of medication, (2) informed consent, (3) self-determination, and (4) clinical engagement. Participants reported that psychiatric medication was the primary, and sometimes the only, intervention offered to them. Some described substantial delays in receiving psychosocial services, or that they were not informed of their availability. Participants also identified deficiencies in the process of informed consent, with some receiving information on adverse effects belatedly, or not at all. Coercive medication practices (e.g., court-ordered medication) were described negatively. Good clinical engagement from prescribers (e.g., good listening and a respectful relationship) was highly appreciated by the participants and seen as an essential component of their recovery process. Poor clinical engagement on the part of prescribers was a source of frustration. In some cases this resulted from poor micro-level skills; in others, it was more reflective of systemic problems (e.g., 15-minute med checks or rotating prescribers). The participants in this study had all attained functional recovery, an unusually positive outcome. Thus, their experiences and insights could have utility. As recovery-oriented mental health services expand, the integration of client voice into the use of psychiatric medications could result in more collaborative, and possibly more effective, mental health treatment.

Inserting Frontier into Dichotomies: Politics, Administration, and Agonistic Pluralism

This article employs the concept of “frontier,” from Chantal Mouffe’s political theory, to present an interpretation of the political significance of dichotomies generally, and then applies it to Woodrow Wilson’s formulation of the politics/administration dichotomy. The central premise is that dichotomies, rather than a source of frustration, serve important and necessary purposes for political and administrative life in a discursive landscape shaped by values pluralism and liberalism. In pursuing this premise, the article suggests that Frederick Jackson Turner’s thesis about the American frontier may have influenced Wilson’s thinking. The article concludes with comment regarding the possible utility of the presented argument for contemporary public administration.

‘It Will Be Our Time To Eat’: Former Renamo Combatants and Big-Man Dynamics in Central Mozambique

This article aims to contribute to the debate about the recent remobilisation of Resistência Nacional Moçambicano (Renamo), by presenting an analysis of its low- and mid-ranked veterans' post-war relationships with fellow veterans and with the Renamo leadership. It argues that former Renamo combatants' participation in post-war Renamo networks has been central for their re-integration into Mozambican politics but, at the same time, may be regarded as a source of frustration and political discontent. Based on ethnographic fieldwork conducted in Maringue, central Mozambique, the article shows that, in scholarship on armed groups, these relationships are characterised by dependency, loyalty and expectations, often referred to as ‘big-man dynamics’. The article engages critically with this concept, showing how Renamo veterans' position vis-à-vis the Renamo leadership is largely characterised by ‘waiting’. It demonstrates that Renamo veterans regard the Renamo party and the state as ‘exclusive caretakers’, which are expected to take care of the ex-combatants. However, Renamo's leaders have largely failed to meet their followers' expectations, resulting in frustration, several (though rare) cases of ‘defection’ to other political parties, but more generally a status of ‘waithood’. This analysis provides a critical exploration of the post-war dynamics of former armed groups, and sheds some light on Renamo's recent remobilisation from the perspective of the former Renamo combatants.

Examining user satisfaction with single sign-on and computer application roaming within emergency departments.

In an age where mandatory computer usage within clinical care settings is a non-negotiable term of employment, the amount of applications a provider must access to document care is rapidly increasing. Each application contains an associated username and password. The increasing frequency with which clinicians have to log in and out of different applications is a source of frustration for many healthcare professionals. Healthcare executives see lost productivity. Single sign-on with added computer application roaming capabilities on shared workstations is a viable solution for both the clinician and the organization. The aim of this study is to assess the effect of implementation of single sign-on technology with application roaming on shared workstations. This study focuses on the perception of satisfaction with the implementation of single sign-on technologies within a midsized integrated delivery health network's five emergency departments. We contribute to theory with the following: (1) the development of a construct called facilitated technology interruptions, (2) validation of the construct facilitated technology interruptions, and (3) application of a quantitative method to test the relationship between facilitated technology interruptions and user satisfaction. We surveyed five emergency departments and proposed five hypotheses. We found the positive relationship between facilitated technology interruptions and user satisfaction; the positive relationships between effort expectancy and satisfaction, and effort expectancy and willingness to recommend; and the positive relationship between satisfaction and willingness to recommend. We did not confirm the positive relationship between facilitated technology interruptions and willingness to recommend. We conclude that single sign-on technology increases user satisfaction. Other organizations may use the findings from this study and perform pre-single sign-on versus post-single sign-on evaluations. In practice, single sign-on improved productivity and ensured compliance with the Health Insurance Portability and Accountability Act, minimization of errors, and disruption for critical work.

Using photography as a method to explore adolescent challenges and resilience in type 1 diabetes.

Patient-centered approaches to disease management are consistently recognized as valuable tools for improving health outcomes, yet studies are rarely designed to elicit adolescent perspectives. This study sought to better understand the perspectives of youths with type 1 diabetes according to key demographic variables. We conducted an exploratory study through which 40 youths were provided with disposable cameras and prompted to take five photographs each that captured what diabetes meant to them and to provide narratives to accompany their photo choices. Demographic variables examined included sex, age, disease duration, socioeconomic status (SES), race, and glycemic control (A1C). Content analysis was used for photos and open-ended responses to assign photo index scores, which were then analyzed by demographic variables using Mann-Whitney U tests for statistical significance. Analysis of photos/narratives (n = 202) revealed five main types of representations depicted by at least 50% of the young people. “Challenge” photos included diabetes supplies as tethering, food as a source of frustration, and the body as a territory for disease encroachment. “Resilience” photos included coping mechanisms and symbols of resistance. Overall, these representations were consistent across demographic categories with two exceptions. Males took more food depictions than females (P <0.005) and had fewer coping depictions (P <0.05). Youths from more affluent households were more likely to take photos of resistance (P <0.05). The use of photo index scores expands previous studies using photography by comparing demographic variation within a sample. Our findings provide insight into coping strategies and indicate that SES may provide an advantage for affluent youths in meeting diabetes-specific challenges.

The Degree of Illness Acceptance among Patients with Multiple Sclerosis

Introduction. Acceptance of chronic disease depends on patient’s personal predisposition as well as on characteristics of the disease, such as the type and severity of symptoms, its consequences in the perspective of physical and psychosocial functioning and possibilities of treatment. In particular, it seems to be difficult to accept such a disease as multiple sclerosis, the beginning of which concerns mainly young people who are forced to re-evaluate their life and modify plans for the future so that the self-portrait would not become a source of frustration and a sense of a lower esteem.Aim. The aim of the study was to assess the acceptance of the disease and to analyse the relationship of such acceptance with patients’ functional status and with self-assessment of depression.Material and Methods. The group of respondents consisted of 38 patients of the Department of Neurology in Cracow, who had been diagnosed with multiple sclerosis. In this work the method of diagnostic survey and the analysis of records were applied. Participants of the study were asked to complete such research tools as: the Beck Scale, Katz Scale, socio-demographic data inventory and the Acceptance of Illness Scale (AIS). The analysis covered their medical records and individual cards of medical orders. The obtained results were subject to statistical calculations.Results. The score of a significant number of respondents — 13 (34.2%) on the AIS Scale was qualified to the highest score ranging from 32 to 40 points. Slightly more than 1/4 of the study group (10 patients, ie. 26.3%) obta­ined a score ranging from 23 to 31 points. The smallest group of respondents achieved the lowest score, as it was qualified for the range of 5–13 points (6 persons, ie. 15.8%). The AIS Scale average score for the whole group studied was 25.08 points. Between the acceptance of the disease, and the presence and severity of depression among respondents, there is a negative correlation (r=-0.29), however it is not statistically significant (p=0.08). The value of the correlation coefficient of the AIS and Katz Scales (r=0.15) results is not statistically significant either (p=0.37).Conclusions. Acceptance of the disease in the group of people is average and similar to that encountered in other somatic diseases of chronic course. A better emotional condition seems to enhance greater acceptance of the disease. (JNNN 2015;4(1):19–23)

Reasons and Factors for Rapid Psychiatry Readmissions: an Analysis over a 36 Months Period

Introduction The patient readmission is commonly associated with the failure of the previous hospitalization/admission and is an important psychiatric and economic issue. Furthermore, it is still source of frustration to patients, their families and the teams treating them. Methods The authors propose a retrospective study investigating all the readmissions within 28 days of the last discharge in the general adult psychiatry ward of a portuguese hospital (Aveiro Hospital) from 2011 to 2013 in order to characterize the reasons and factors (social, demographic and clinical) involved. Results Over the total 1994 discharges, 88 were readmited, yielding a readmission rate of 4.4%. The main diagnose was Schizophrenia, schizotypal and delusional disorders, according to icd 10, and the main reasons for readmission were suicide and psychosis. Most previous hospitalizations have lasted less than the average length of stay during the considered period of time. Conclusions Evaluating the characteristics of readmissions promotes a better understanding of the whole process in order to devise a strategy for prevention and improvement of mental health services.

Factors of Stress, Burnout, and Frustrations Experienced by Athletic Training Students

Purpose: College students are at a risk for increased levels of stress and burnout, and those enrolled in healthcare degree programs are more likely to experience higher levels due to balancing demanding roles. Our purpose was to assess sources of stress, burnout, and/or frustration in athletic training students (ATSs) of different academic standings. Methods: Data were collected through the use of an original, 33-question questionnaire. An inductive approach was used to analyze the data and multiple analyst triangulation and interpretive member checks were used to secure credibility. Results: 27 male and female ATSs from freshman, sophomore, junior, and senior classes from one institution voluntarily participated within this study. We were able to identify distinct themes of stress and burnout for each class of ATSs. Freshman reported concern for the time demand from the major and a desire to have more hands-on activity involved with their clinical education experiences. The sophomores reported feeling stressed regarding the expectation to retain information and the expectations to perform hands-on duties, as well as their ability to balance academic and clinical responsibilities. Challenging coursework, pressure during clinical experiences, and social conflicts appeared as themes for the junior ATSs. Finally, the seniors stated a fear of not achieving professional proficiency was a source of frustration. Conclusions and Recommendations: Based on our findings, efforts should be made to assist student time management practices, improve communication between preceptors and students, and make expectations of the athletic training program (ATP) faculty and preceptors clear. Such measures could help influence other positive changes within ATPs to improve the learning environment for ATSs.

The Pleasures and Pain of Mental Health Case Management

Among mental health case managers, burnout is rife and turnover rates are high, resulting in significant costs to agencies and compromising service quality. This study examines sources of frustration and satisfaction among case managers and the potential impact of these factors on recruitment and retention rates. In this exploratory study interviews were conducted with 40 mental health case managers who shared their observations on aspects of work that they enjoy and find least satisfying. The responses point to predictable sources of frustration such as paperwork, and productivity standards—while interactions with the recipients, outreach work, and the variety and flexibility in their jobs were sources of satisfaction. Results have implications for consumers of mental health services, front line workers, and organizational culture and practices.

Differential Response family assessments: Listening to what parents say about service helpfulness

An increasing number of Child Protective Services (CPS) systems are implementing Differential Response (DR) approaches in which lower-risk families are served through a family assessment response that emphasizes a family centered approach and the provision of concrete and preventative services. Quantitative survey data collected from parents suggests that those who receive family assessments are more engaged, receive more concrete services, and have higher overall satisfaction than those who receive a traditional investigation; yet little is known about which services provided through a family assessment are most helpful to parents. This qualitative study sought input from 20 parents who received a DR family assessment response in order to provide an in-depth analysis of which aspects of their CPS experience they perceived as most helpful. Results suggest that a positive and emotionally supportive relationship with the caseworker was of utmost significance. Other caseworker-provided services were described as helpful, particularly those that helped parents establish or improve relationships with others, including advocacy with other service providers, mediation of family disagreements, and coaching on parenting or relationship skills. Material support, such as providing cash assistance for rent or furniture, was helpful when received but occurred less frequently and was sometimes a source of frustration when accompanied by lengthy waits for assistance. These findings have implications for CPS practice, including enhancing caseworkers’ relationship-building and engagement skills through pre-service educational coursework and in-service trainings; allowing caseworkers adequate time to develop supportive relationships with parents; and reducing the institutional barriers that delay the provision of concrete support.

Human resource management practices in a medical complex in the Eastern Cape, South Africa: assessing their impact on the retention of doctors.

Human resource management (HRM) practices have the potential to influence the retention of doctors in the public health sector. To explore the key human resource (HR) practices affecting doctors in a medical complex in the Eastern Cape, South Africa. We used an open-ended questionnaire to gather data from 75 doctors in this setting. The most important HR practices were paying salaries on time and accurately, the management of documentation, communication, HR staff showing that they respected and valued the doctors, and reimbursement for conferences and special leave requests. All these practices were judged to be poorly administered. Essential HR characteristics were ranked in the following order: task competence of HR staff, accountability, general HR efficiency, occupation-specific dispensation adjustments and performance management and development system efficiency, and availability of HR staff. All these characteristics were judged to be poor. HRM practices in this Eastern Cape medical complex were inadequate and a source of frustration. This lack of efficiency could lead to further problems with regard to retaining doctors in public sector service.

Interplay between spin-glass clusters and geometrical frustration.

The presence of spin-glass (SG) order in highly geometrically frustrated systems is analyzed in a cluster SG model. The model considers infinite-range disordered interactions among cluster magnetic moments and the J(1)-J(2) model couplings between Ising spins of the same cluster. This model can introduce two sources of frustration: one coming from the disordered interactions and another coming from the J(1)-J(2) intracluster interactions (intrinsic frustration). The framework of one-step replica symmetry breaking is adopted to obtain a one-cluster problem that is exactly solved. As a main result we create phase diagrams of the temperature T versus intensity of the disorder J, where the paramagnetic-SG phase transition occurs at T(f) when T decreases for high-J values. For low-J values, the SG order is absent for antiferromagnetic clusters without intrinsic frustration. However, the SG order can be observed within the intracluster intrinsic frustration regime even for lower intensity of disorder. In particular, the results indicate that the presence of small clusters in geometrically frustrated antiferromagnetic systems can help stabilize the SG order within a weak disorder.

Volatility in federal funding of energy R&D

Funding for Research and Development in any given industry or technology is considered essential to its ongoing competitiveness and longevity. This paper analyzes the allocation of federal R&D funding for energy between 2000 and 2012. The results show that funding for energy R&D is very volatile for both the aggregate energy research types, such as coal or nuclear power, and specific research areas, such as carbon capture and sequestration or nuclear waste reprocessing. While overall funding levels are often sources of frustration, budgetary volatility may be as much of a problem.

EPA-0428 – Self boundaries breakdown: psychological assessment of fibromyalgia syndrome case

The evidence of fibromyalgia syndrome are: absence of biological damage and resistance to drug treatment . Studies have shown that personality features of patients with fibromyalgia are markedly different from patients with rheumatoid arthritis and other syndromic conditions united by a change in the perception of pain, and from normal control group. The clinical features is embodied in the difficulty of recognizing and regulating their emotions, rigidity and perfectionism, high expectations, overestimation of their actual skills that becomes a source of frustration and insecurity. Is reported a clinical case of a 39 years old female patient, diagnosed with severe fibromyalgia syndrome with onset of symptoms in response to highly stressful event. Psycho-diagnostic assessments was performed through: WAIS-R, Projectives Test (Draw a Person Test, Tree Test, Family Drawing Test, Fay Test), Rorschach and MMPI-2. The psycho-diagnostic evaluation showed a precarious and unstable structure, as supported by an unstable, poorly defined, rigid and not permeable, and especially affected Self boundaries . The defective function of border and filter between soma and psyche, about what is inside and out, prohibits’ access to quality and intensity of emotional life which can only find expression in the body. The report case, in an exemplary manner, explains the mind-body disconnection, and requires further studies as fibromyalgia syndrome is probably the major psychosomatic illness.

Barriers to Teacher Motivation for Professional Practice in the Ghana Education Service

In Ghana, several education initiatives for promoting the quality of education have excluded the issue of teacher motivation. Well-motivated teachers are likely to be more committed to their profession and this could lead to desirable learning outcomes. This research attempted to identity and analyse what teachers in public pre-tertiary schools in Ghana perceived as barriers to their motivation towards professional practice. Employing mainly a qualitative approach, the research revealed that the sources of frustration and stress in participants' professional practice related to unfavourable conditions of service in the Ghana Education Service. Suggestions for improvement in the conditions of service of teachers in public pre-tertiary schools in Ghana are explored.

Wicked Art: Marketing, Augustine, and the Demonic

Marketing and popular culture have long been a source of frustration for youth ministers who are serious about fostering Christian discipleship in young people. Teaching youth to swim in baptismal ...

Screening for H7N9 influenza A by matrix gene-based real-time reverse-transcription PCR

Rapid detection of novel influenza A strains, including H7N9, is pivotal to ensuring appropriate public health-based responses and real-time reverse-transcription polymerase chain reaction (RT-PCR) methods are used typically for this purpose. However, the utility of such methods can be undermined by ongoing sequence variations, particularly when targeting the variable influenza A haemagglutinin (HA) and neuraminidase (NA) genes. This may often be a source of frustration for clinical laboratories that are implementing methods in preparation for potential pandemics as primers and probe targets may need to be checked regularly and updated. In this study, screening methods were developed for H7N9 influenza A strains based on the highly-conserved influenza A matrix gene. Three assays were developed and evaluated in parallel, and included two methods which simply involved inclusion of a single H7N9 probe sequence into an established influenza A and B multiplex RT-PCR (FluAB-PCR). The detection limits of the methods were compared using ten-fold dilutions of H7N9 RNA, and the specificity of the methods were tested using 32 influenza A RT-PCR-positive samples and a panel of 18 influenza A isolates, including representives of seasonal H3N2, seasonal H1N1, pandemic H1N1, H5N1, H5N3, H9N2 and H7N7. The detection limits of the three methods were the same, and no cross-reactions were observed with sH3N2, sH1N1, pH1N1 or H5N1. However, cross-reactions were observed with H5N3, H9N2 and H7N7. Overall, the results show that the methods are useful for front-line screening for H7N9.

Frustration: a challenge in chronic conditions.

Many people live their lives with chronic conditions. Eighty percent of people who seek medical treatments suffer from chronic diseases (1). In USA 26% of adults have more than one chronic condition such as arthritis, hypertension, and diabetes (2). Many times patients have persistent or recurrent pain (chronic non-cancer pain) which make the condition worse. Chronic non-cancer pain causes significant morbidity, interfering with a patient's ability to perform activities of daily living, family life, and employment, and is in associate with significant psychological stress (3).Chronic conditions effect patients, their families, communities and health systems. Sometimes patients and their families are facing continual and perdurable struggle to control the disease or its complications (4). Frustration might be a result of these continuous and endless struggles. Heart failure is also amongst one of the most disturbing chronic conditions with different consequences. In this issue Ghanbari et al. have presented result of a study on cognitive functions of heart failure patients. These patients are in the risk of frustration (5). Frustration is a complex emotion and its effects are huge. Sources of frustration include interference with everyday activities, the interruption of life goals and roles and the unpredictability of pain (6). Frustration can have many negative consequences. Sometimes patients stop their self-care activities or even stop their essential prescription. Many times frustration ends up to depression and a deep feeling of anger. People may lose their interest in life. I have heard many times from patients that they prefer to die then continuing their current situation. Patients need more support during these hard times. Nurses can be a source of support for these patients. How can we help these patients? First, patients should feel our supportive presence (7). We should identify the frustration and its causes. Patients should feel that we are beside them not in front of them. We should never blame patients for their non-compliance behaviors but we should understand their reactions and see what we can do. Second, patient should feel that they are in good hands and under best possible treatments. Maybe we should go to details of patients' management. The physicians should be available easily. The difficulty of getting prescription medications and lack of continuity of care make the patients more frustrated (8). Third, the peer supported groups can be a great help, especially for children. They can share their feelings and experiences and support each other (9). Support groups are groups of people who gather to share common problems and experiences associated with a particular problem, condition, illness, or personal circumstance. In a support group, people are able to talk with other folks who are like themselves -people who truly understand what they're going through- and can share the type of practical insights that can only come from a firsthand experience (10). Nurses can be active in creating these supportive groups. The last and maybe the most important action is that we should move from disease-focused model of care, to patient-centered models (11). These models have a long history and strong roots in nursing profession but still their implementation in every-day care settings seem to be far away from reality. Finally frustration is an important concept in chronic care that even can be suggested as a new nursing diagnosis. This condition needs to be identified and professional interventions need to be implemented to support patients in their long and painful struggle.

How can 21st century public health research overcome the long-standing frustration associated with dietary assessment?

Dr Nisreen Alwan and Janet Cade from the Nutritional Epidemiology Group at the University of Leeds investigate how information and communication technology methods can be used to standardise dietary assessment and close the data gap to reduce global disease burdens.Back in 1981, Doll and Peto said; 'Diet is a chronic source of frustration and excitement for epidemiologists'.1 Thirty years later, this is still the case. Studying the association between diet and health is becoming an increasingly important and topical area of health research in the second decade of the 21st century. For example, all of the top three most read research papers in the British Medical Journal at the time this article was written were in the field of nutritional epidemiology.2,3,4 Diet features very strongly as a risk factor for the top adverse health outcomes in the recently published Global Burden of Disease Study 2010 (GBD 2010).5 Out of the top twenty leading risk factors contributing to the burden of disease in 2010, six are dietary factors (diet low in fruits, nuts and seeds, whole grains, vegetables, seafood omega-3 fatty acids, and diet high in sodium), and another seven are directly linked to diet (high blood pressure, high body mass index, high fasting plasma glucose, childhood underweight, iron deficiency, suboptimal breastfeeding and high total cholesterol).5These findings highlight big opportunities for disease prevention, but they also raise big challenges and frustrations as Doll and Peto pointed out. One of the greatest challenges in specifying causal links between dietary exposures and disease and identifying successful public health nutritional interventions is the profound problem of measurement error. This is associated with all the commonly used dietary assessment methods in population health research, such as food frequency questionnaires; food diaries; and interviewer-administered dietary recalls. Measurement error of dietary exposures comes up as a study limitation in almost any research study linking diet to health outcomes. There are also other significant obstacles to obtaining high quality population level dietary data. These include the relatively high cost associated with the current dietary assessment tools of administering, mailing, collecting and coding dietary data, as well as the low participant response rate due to the time and effort associated with completing them. There has been little progress during the last 30 years in developing new methods that attempt to address these obstacles. Innovative population level dietary assessment methods that combine accuracy and reliability with feasibility, acceptability and low cost to assess nutritional exposures and deliver dietary interventions on a large population scale are urgently needed.The rapidly increasing use of information and communication technology globally, including the Internet and smartphones, provides a golden opportunity to achieve this. A recent World Bank report states that about three-quarters of the world's population has access to a mobile phone.6 The number of mobile subscriptions globally has grown from fewer than one billion in 2000 to over 6 billion in 2012, of which nearly five billion were in developing countries. More than 30 billion mobile applications (apps) were downloaded in 2011, with evidence of use across both the social and economic spectrum.6 Using internet and smartphone app-based dietary assessment tools linked to automated food databases to instantly generate macro- and micro-nutrient data is a promising new development for the future. …

Physical activity on prescription (PAP) from the general practitioner’s perspective – a qualitative study

BackgroundPhysical activity on prescription (PAP) is a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and there is limited information about GPs’ attitudes to counselling using PAP as a tool. The aim of the study was to explore and understand the meaning of prescribing physical activity from the general practitioner’s perspective.MethodsThree focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south of Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed verbatim, analysed using qualitative content analysis.ResultsThe analysis resulted in four categories: The tradition makes it hard to change attitude, Shared responsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear guidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but they do not prescribe physical activity as a treatment. Physician’s education focuses on the use of pharmaceuticals. The responsibility for patients’ physical activity level is shared with other health professionals, the patient and society. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration. PAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to emphasize an increased level is considered to be redundant and the GPs think it should be administered by someone else in the health care system. Scepticism about the result of the method was also expressed.ConclusionsThere is uncertainty about using PAP as a treatment since physicians lack education in non-pharmaceutical methods. The GPs do not regard the written referral as a prioritized task and rather refer to other professionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and arrangements for the method to gain credibility and become everyday practice among GPs.