BMC Family Practice

Clinician perspectives on having point of care tests made available to them during out of hours home visiting
Dixon S, Glogowska M, Garland S, Hunt H, Lasserson D and Hayward G
Little is known about clinicians' perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them.
A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic
Shah SS, Safa A, Johal K, Obika D and Valentine S
The novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded.
Patient perspectives on health care provider practices leading to an axial spondyloarthritis diagnosis: an exploratory qualitative research study
Lapane KL, Dubé C, Ferrucci K, Khan S, Kuhn KA, Yi E, Kay J and Liu SH
The average time to a diagnosis for people with axial spondyloarthritis (axSpA) is 7-10 years. Delayed diagnosis may result in increased structural damage, worse physical function, and worse quality of life relative to patients with a timely axSpA diagnosis. Understanding patient experiences may provide insights for how to reduce diagnostic delays.
Acceptability of physician associate interns in primary care: results from a service evaluation
Cottrell E, Silverwood V, Strivens-Joyce A, Minshull L, Edwards JJ, Lawton S, Aiello M and Turner S
Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care.
Effect of a price display intervention on laboratory test ordering behavior of general practitioners
Muris DMJ, Molenaers M, Nguyen T, Bergmans PWMP, van Acker BAC, Krekels MME and Cals JWL
Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands.
Swiss GPs' preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis
Hengartner MP, Neuner-Jehle S and Senn O
GPs frequently prescribe antidepressants in mild depression. The aim of this study was to examine, how often Swiss GPs recommend antidepressants in various clinical presentations of mild depression and which factors contribute to antidepressant treatment recommendations.
The success of behavioral economics in improving patient retention within an intensive primary care practice
Groden P, Capellini A, Levine E, Wajnberg A, Duenas M, Sow S, Ortega B, Medder N and Kishore S
A minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health- Mount Sinai's intensive primary care clinic for high-cost patients- employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed.
Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651]
Howie AH, Klar N, Nash DM, Reid JN and Zwarenstein M
Printed educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications.
Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
Berkowitz RL, Bui L, Shen Z, Pressman A, Moreno M, Brown S, Nilon A, Miller-Rosales C and Azar KMJ
There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients' social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California.
Patients' and clinicians' perceptions of oral anticoagulants in atrial fibrillation: a systematic narrative review and meta-analysis
Osasu YM, Cooper R and Mitchell C
Atrial fibrillation (AF) increases the risk of developing a stroke by 20%. AF related strokes are associated with greater morbidity. Historically, warfarin was the anticoagulant of choice for stroke prevention in patients with AF but lately patients are being switched or started on direct oral anticoagulants (DOACs). DOACs are promoted as safer alternatives to warfarin and it is expected that they will be associated with fewer challenges both for patients and healthcare professionals. This systematic narrative review aimed to explore perspectives of patients and professionals on medicines optimisation of oral anticoagulation with vitamin K antagonists and DOACs in atrial fibrillation.
Patients' perception of safety climate in Irish general practice: a cross-sectional study
Madden C, Lydon S, Murphy AW and O'Connor P
Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients' perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC?
Earning opportunities and informal payment as influencing factors in medical students' speciality choice
Mohos A, Frese T, Kolozsvári L, Rinfel J, Varga A, Hargittay C, Csatlós D and Torzsa P
The Hungarian primary care system faces a severe shortage of family physicians. Medical students' perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students' knowledge about their future earning opportunities and their attitudes towards informal payment.
Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study
Åkesson KS, Sundén A, Hansson EE and Stigmar K
Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.
Willingness, beliefs, and barriers regarding the COVID-19 vaccine in Saudi Arabia: a multiregional cross-sectional study
Altulahi N, AlNujaim S, Alabdulqader A, Alkharashi A, AlMalki A, AlSiari F, Bashawri Y, Alsubaie S, AlShahrani D and AlGoraini Y
The coronavirus disease 2019 (COVID-19) has spread worldwide, and the vaccine remains the ultimate cornerstone to overcoming its long-term impact. Vaccine hesitancy might obstruct the effort to achieve herd immunity and eradicate the virus. We assessed Saudi Arabian individuals' willingness, beliefs, and barriers regarding the COVID-19 vaccine and their adherence to preventive measures during and after the pandemic.
Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains
Zhou Y, Ma Y, Yang WFZ, Wu Q, Wang Q, Wang D, Ren H, Luo Y, Yang D, Liu T and Wu X
To assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient's perspective.
A qualitative exploration of nursing undergraduates' perceptions towards scaffolding in the flipped classroom of the Fundamental Nursing Practice Course: a qualitative study
Chen L, Lin T and Tang S
Although the benefits of using a flipped classroom in nursing education have been reported, there are few published studies attempting to understand students' subjective experiences with scaffolding in a flipped classroom and the challenges they face as a result of this type of educational change. The purpose of this study was to describe students' perspectives of scaffolding in the Flipped Classroom of the Fundamental Nursing Practice Course (FNPC-FC).
Prerequisites for providing effective support to family caregivers within the primary care setting - results of a study series in Germany
Wangler J and Jansky M
General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting.
COPD - do the right thing
Sandelowsky H, Weinreich UM, Aarli BB, Sundh J, Høines K, Stratelis G, Løkke A, Janson C, Jensen C and Larsson K
A gap exists between guidelines and real-world clinical practice for the management and treatment of chronic obstructive pulmonary disease (COPD). Although this has narrowed in the last decade, there is room for improvement in detection rates, treatment choices and disease monitoring. In practical terms, primary care practitioners need to become aware of the huge impact of COPD on patients, have non-judgemental views of smoking and of COPD as a chronic disease, use a holistic consultation approach and actively motivate patients to adhere to treatment.This article is based on discussions at a virtual meeting of leading Nordic experts in COPD (the authors) who were developing an educational programme for COPD primary care in the Nordic region. The article aims to describe the diagnosis and lifelong management cycle of COPD, with a strong focus on providing a hands-on, practical approach for medical professionals to optimise patient outcomes in COPD primary care.
Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty
Barnhoorn PC, Nierkens V, Mak-van der Vossen MC, Numans ME, van Mook WNKA and Kramer AWM
Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied.
How concerned significant others experience Community Reinforcement and Family Training (CRAFT) - a qualitative study
Hellum R, Bilberg R, Bischof G and Nielsen AS
Heavy drinking causes serious harm, not only to the drinker but also to relationships and concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) is an intervention developed to help the CSOs of substance users. The aim of this study was to investigate the drivers and aims underlying CSO participation in CRAFT, as well as their experience of the intervention itself and their module preferences.
Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors' perspective
Nessler K, Ball F, Chan SKF, Chwalek M, Krztoń-Królewiecka A and Windak A
Healthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting.