Family physicians' perceptions of academic detailing: a quantitative and qualitative study

Background  

The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it.     

Primary care physicians' experience with family history: An exploratory qualitative study

PurposeFamily history can guide patient care but is underused. Physician experience with family history has been inadequately characterized. The study's purpose was to assess primary care physicians' experiences with family history.MethodsA qualitative study using an existential-phenomenological approach. Primary care physicians using an electronic health record to enter family history participated in semistructured interviews. Themes were developed relating to physicians' experiences with collection and documentation of family history. A summary describing each physician's experience was developed and analyzed. The themes and experiences from each primary care physician were synthesized across all participants.ResultsPositive and negative experiences were identified. Positive experience was associated with the perceived usefulness of family history to guide patient care, confidence using family history, practice efficiency, and enhancing the physician-patient relationship. Negative experience was primarily associated with perception that family history had to be collected and process problems, although confusion about the use of family history, perceived inaccuracies and incompleteness of the information provided, time, and potential liability contributed to negative experience. Most primary care physicians had an overall positive experience with family history, although the balance of the positive and negative experiences did not seem related to the degree the electronic health record was used to enter family history.ConclusionsThe primary care physicians' experience with family history represents the synthesis of tensions between positive and negative experiences relating to collection and use. Understanding the components of the experience could inform redesign of systems to enhance the positive and reduce the negative elements.     

Patients' and physicians' perceptions and experience of hypercholesterolaemia: a qualitative study.

BACKGROUND: A better understanding of patients' and physicians' perceptions and experience of hypercholesterolaemia will help to improve cardiovascular disease prevention and aid the development of appropriate educational strategies. AIM: To identify perceptions, experience, educational needs, and barriers to learning in hypercholesterolaemic patients at high risk of cardiovascular disease. DESIGN OF STUDY: A qualitative study involving interviews with 27 hypercholesterolaemic outpatients and 21 physicians. SETTING: 21 centres in Paris, Bordeaux and Lille. METHODS: Semi-structured interviews were conducted by a sociologist with the aid of two interview guides focusing on hypercholesterolaemia. Interviews were recorded and subsequently transcribed, and qualitative analysis was performed to identify emerging themes. RESULTS: Six main themes emerged: understanding hypercholesterolaemia--a 'virtual' disease; understanding cardiovascular risk--a vague concept; lifestyle measures; long-term effects of medication; medical language difficulties; and patients' expectations and needs. Patients and physicians disagreed over the terms used to describe hypercholesterolaemia and cardiovascular risk, and the complexities of medical language. In contrast, patients and physicians agreed on the difficulties associated with implementing lifestyle changes and adhering to long-term treatment. CONCLUSIONS: The differences in perception and experience between physicians and patients indicate that physician-patient communication is sub-optimal and highlights the need to improve educational material for cardiovascular disease prevention. This analysis helps to identify appropriate educational objectives and methods for patients at risk of cardiovascular disease, and develop a structured educational programme.     

How healthcare professionals experience patient participation in designing healthcare services and products. A qualitative study in the field of spinal cord injury in Switzerland

Objectives

This study explored healthcare professionals’ accounts of patient participation, focusing particularly on aspects related to patients’ contributions to the planning and design of healthcare services and products. It aimed to determine (1) how healthcare professionals experience patient participation, (2) what factors, in their view, may inhibit or promote it; and (3) through what channels they think it can take place.

Physicians' ethical responsibilities in addressing racial and ethnic healthcare disparities

Patients belonging to racial and ethnic minority populations continue to receive lesser-quality healthcare relative to other patients, even when controlling for relevant demographic variables. Such disparities represent a significant challenge for physicians who are ethically committed to serving all patients equally, irrespective of personal characteristics. Accordingly, this report explores the ethical obligations of individual physicians and the medical profession as they pertain to racial and ethnic disparities in healthcare. To address these disparities, the AMA Council on Ethical and Judicial Affairs recommends that physicians customize the provision of medial care to meet the needs and preferences of individual patients. Moreover, physicians must learn to recognize racial and ethnic healthcare disparities and critically examine their own practices to ensure that inappropriate considerations do not affect clinical judgment. Physicians can also work to eliminate racial and ethnic healthcare disparities by encouraging diversity within the profession, continuing to investigate healthcare disparities, and supporting the development of appropriate quality measures.     

Dealing with suicidal patients – a challenging task: a qualitative study of young physicians' experiences

Background  

Suicide is a major public health problem and treating suicidal patients represents one of the most challenging and complex clinical situations for young physicians. Education of physicians is considered an important strategy in suicide prevention. Young physicians often meet suicidal patients early in their career. Limited information is available about how newly educated physicians experience treating suicidal patients. The aim of the study was to shed light on the meaning of newly educated physicians' lived experiences in treating patients at risk of committing suicide.     

Experiences of empathy training in healthcare: A systematic review of qualitative studies

ObjectiveTo synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare.MethodsWe included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights.ResultsOur search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners’ deeper recognition of the positive impact of empathic care.ConclusionsThis review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies.Practice implicationsThese results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.     

Investigating the barriers to teaching family physicians' and specialists' collaboration in the training environment: a qualitative study

Background  

Collaboration between physicians in different specialties is often taken for granted. However, poor interactions between family physicians and specialists contribute significantly to the observed discontinuity between primary and specialty care. The objective of this study was to explore how collaboration between family physicians and specialists was conceptualised as a competency and experienced in residency training curricula of four faculties of medicine in Canada.     

Patterns of engagement between GPs and adolescents presenting with psychological difficulties: a qualitative study

Background

Psychological difficulties are common in adolescence with general practice attendees having higher rates than reported in community surveys. Yet GP identification of common mental health problems in this age group is limited. Anxiety and uncertainty around professional practice have been found among GPs and they vary in their degree of engagement with adolescents presenting with psychological difficulties.

Aim

To explore which factors influence the degree of GP engagement.

Design and setting

Qualitative study based in 18 practices in the north east of England. The practices recruited included rural, urban, and mixed populations of patients predominantly living in socioeconomically disadvantaged communities.

Method

Theoretical sampling was used to guide recruitment of GP participants continuing until theoretical saturation was reached. Data were analysed using the constant comparative method of grounded theory and situational analysis.

Results

In total 19 GPs were recruited: 10 were female, the age range was 29–59 years, with a modal range of 40–49 years. The participants collectively described a sense of their professional competence being challenged, yet reacted with varying degrees of engagement. Three themes appeared to shape a GP’s response: performance in the clinical encounter; view of adolescents and their health needs; and the GP’s own preferred epistemological framework.

Conclusion

The findings suggest that better patterns of engagement between GPs and adolescents are supported by medical education which includes input and feedback from adolescents; education about the science and psychology of adolescence; more effective working across disciplinary boundaries; and recognition of the importance of addressing psychological difficulties early.     

Barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic: A qualitative study in healthcare professionals

Background

In line with public health policy, healthcare professionals (HCPs) working in the UK's National Health Service (NHS) are encouraged to deliver opportunistic health behaviour change interventions during routine consultations. The impact of the COVID-19 pandemic on healthcare delivery has been wide-ranging, but little is known about how the pandemic has affected the delivery of health behaviour change interventions. The present study aimed to examine the barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic.

Methods

Twenty-five qualitative semi-structured interviews were conducted in January 2022 with a range of patient-facing healthcare professionals (including nurses, physiotherapists, dieticians, doctors and midwives) working in the NHS. Data were analysed using reflexive thematic analysis.

Results

Two overarching themes were generated: (1) the healthcare system's response to COVID-19, and (2) maintaining good HCP-patient relationships: reluctance and responsibility. COVID-19-related barriers included exacerbated staffing pressures and a perceived inability to use IT equipment to facilitate conversations about health behaviour change (due to poor internet connectivity or ill-equipped platforms). COVID-19-related enablers included the use of video consultations enabling less awkward and more honest conversations about health behaviours. However, some barriers and enablers remained the same as pre-pandemic, such as issues of role responsibility for discussing health behaviour change with patients, balancing holistic wellbeing advice with maintaining positive patient-HCP relationships, and reluctance to deliver opportunistic behaviour change interventions.

Discussion

The increased use of remote consultations may facilitate the delivery of opportunistic health behaviour change interventions by healthcare professionals. However, there is also a strong need to improve staffing levels, in order that staff have the psychological and physical capabilities to engage patients in these conversations.     

How information about other people's personal experiences can help with healthcare decision-making: a qualitative study

Objective

To investigate people's views of using ‘general facts’ and information about other people's ‘personal experiences’ for health-related decision-making.

Methods

Sixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts.

Results

There was less discussion of ‘general facts’; participants thought it obvious that good decisions required these. Participants reported having used ‘personal experiences’ information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use ‘personal experiences’ information was apparently moderated by assessments of personal relevance, the motives of information providers and the ‘balance’ of experiences presented.

Conclusion

People can use ‘personal experiences’ information in various ways to support their decision-making, and exercise some discrimination as they do.

Practice implications

‘Personal experiences’ information may help people in a number of ways in relation to decision-making. However, ‘personal experiences’ information does not replace the need for ‘general facts’ and care should be taken when it is used in resources for patients.