The perceptions of occupational health in primary care

AIM: A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. METHODS: Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. RESULTS: GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. CONCLUSIONS: This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.     

Patients' perceptions of service quality dimensions: an empirical examination of health care in New Zealand.

The 1984 liberalization of the New Zealand economy has resulted in a health care sector that has become very competitive (Zwier and Clarke, 1999). The private sector is now able to supply health care services and, as a result, a greater value is being placed on patient satisfaction (Zwier and Clarke, 1999). However, despite the increasing focus on customer satisfaction, research into health care patients' perceptions of the dimensions of service quality is scarce. This can be problematic, as quality of care is an essential issue in the strategic marketing of health care services (Turner and Pol, 1995). This study takes a step towards addressing this deficiency by identifying patients' perceptions of the dimensions of service quality in health care. The findings of this study are based on the empirical analysis of a sample of 389 respondents interviewed by telephone. The findings indicate that the service quality dimensions identified in this health care specific study differ in number and dimensional structure from the widely adopted service quality dimensions first identified by Parasuraman, Berry and Zeithaml (1988): reliability, responsiveness, assurance, empathy and tangibles. The service quality dimensions identified in this study were: reliability, tangibles, assurance, empathy, food, access, outcome, admission, discharge and responsiveness. In addition, health care patients perceive the service quality dimensions relating to the core product in health care delivery (for example, outcome and reliability) as more important than the service quality dimensions relating to the peripheral product in health care delivery (for example, food, access and tangibles). Finally, the results of this study suggest that patients with different geographic, demographic, and behavioristic characteristics have different needs and wants during health care delivery and therefore perceive different service quality dimensions as important.     

Preventive health care among older women in an academic primary care practice.

PURPOSE: We sought to examine the use of preventive health services among older women and to assess how age and illness burden influence care patterns. METHODS: The charts of 299 women aged > or =80 and 229 women aged 65-79 years who did not have dementia or terminal illness at 1 academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise), and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI). RESULTS: Women aged > or =80 were more likely than women aged 65-79 to have a CCI of > or =3 (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged > or =80 and was not targeted to older women in good health. Women aged > or =80 were less likely to be screened for depression (adjusted relative risk [aRR] 0.6; 95% confidence interval [CI], 0.5-0.8), osteoporosis (aRR, 0.6; 95% CI, 0.5-0.9), or counseled about exercise (aRR 0.8; 95% CI, 0.6-0.9) than younger women, but were more likely to receive counseling about falls (aRR 1.9; 95% CI, 1.4-2.6) and/or incontinence (aRR 1.8; 95% CI, 1.2-2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%), or incontinence (20.8%) were low among all women. CONCLUSION: In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is a need to improve delivery of preventive health care to older women.     

Patients' perceptions of home health occupational therapy

Home health occupational therapy plays an important and growing role in patients' recovery. Home health treatment is unique in that the therapist is a visitor in the patient's home environment. A phenomenological approach was used to examine perceptions of five individuals who were interviewed twice to collect their impressions of home health occupational therapy. Participants' goals for therapy as solicited by home health occupational therapists and participants perceived goals were not always pursued collaboratively. Therapeutic and compensatory occupations were incorporated less often than purposeful exercise. Participants valued those occupations engaged in, despite limited physical recovery. Participants' perceptions of occupational therapists were generally positive. Participants were unprepared for discharge, which was perceived as significant and they as helpless to prevent it despite desire for continued services. Few occupations reported in their treatment coincided with participants' difficulty distinguishing between occupational and physical therapies. Continued research focused on patients' perceptions of home health occupational therapy would be useful in further examining this phenomenon and would enlighten home health occupational therapy practice.     

Service quality perceptions in primary health care centres in Greece

Context The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services.     

Patients' perceptions of medical care in chronic fatigue syndrome

This study investigated perceptions of medical care among patients with chronic fatigue syndrome (CFS) referred to a specialist clinic. Sixty-eight patients completed a questionnaire survey on their overall satisfaction with medical care received since the onset of their illness, and their views on specific aspects of care. Two-thirds of patients were dissatisfied with the quality of medical care received. Dissatisfied patients were significantly more likely to describe delay, dispute or confusion over diagnosis; to have received and rejected a psychiatric diagnosis; to perceive doctors as dismissive, skeptical or not knowledgeable about CFS and to feel that the advice given was inadequate or conflicting. Satisfied patients were significantly more likely to perceive doctors as caring, supportive and interested in their illness; to state that they did not expect their doctors to cure CFS and to perceive their GP or hospital doctor as the source of greatest help during their illness. Many patients were critical of the paucity of treatment, but this was not associated with overall satisfaction. The findings suggest that medical care was evaluated less on the ability of doctors to treat CFS, and more on their interpersonal and informational skills. Dissatisfaction with these factors is likely to impede the development of a therapeutic doctor-patient alliance, which is central to the effective management of CFS. The findings suggest a need for better communication and better education of doctors in the diagnosis and management of CFS.     

Physical therapy as primary health care: public perceptions

This study investigated the public's knowledge of direct access and the role of physical therapists, and whether the public would consider using a physical therapist for primary care. Persons living in South Florida were selected at random by dialing telephone numbers. Using three-digit telephone number prefixes, four-digit suffixes were generated by rolling dice. When consent was obtained, the respondents' answers were recorded on a self-generated questionnaire. No knowledge of direct access was reported by 67.3% of the sample. Additionally, 57.4% of the sample had never been to a physical therapist. A substantial number of respondents (73.4%) stated that they would go directly to a physical therapist. Thus, the public poorly understands direct access and the role of the physical therapist. The members of the public might use physical therapists as primary care practitioners if they were aware of this option.     

Evaluating the administration of an office-based health survey in a primary care practice

Self-administered waiting room questionnaires are popular tools for gathering health information from patients, but these data cannot be used for research purposes without confirming adequate sampling of the practice population and assessing the completeness and accuracy of patients' responses. Long-term data collection also requires avoiding an imposition on clinic operations. We developed a protocol to test these questions in a 9-week pilot study of 884 survey-eligible patients visiting a family practice clinic. We found an adequate proportion of eligible patients were approached (74%) and participated (89%), they provided relatively complete (82-98%) and accurate responses, and the impact on office operations was minimal (<2 min of staff time per participant). Some demographic differences in participation and survey item completion were identified. A systematic process for testing survey performance allowed us to not only document these findings, but also to rapidly identify problems and introduce solutions while the survey was in progress.     

Medically unexplained symptoms: perceptions of physicians in primary health care

BACKGROUND: Patients presenting with multiple symptoms represent a substantial part of a GP's total work load. At the same time, these patients account for the majority of the people on long-term sick-leave in Sweden today. OBJECTIVE: The aim of this study was to explore GPs' perceptions and ways of managing patients with medically unexplained symptoms (MUS). METHODS: Five focus group discussions were conducted with a total of 27 GPs. In the collection and analysis of data, a phenomenographic approach was used. RESULTS: The GPs described how they used four different approaches to manage patients with MUS: a biomedical, a psychological, an educational and a psychosocial approach. Different approaches were used, depending on the patient and the situation, and the GPs even switched approach when working with the same patient. CONCLUSIONS: In their work with patients with MUS, GPs need support and further training to improve the way the biomedical frame of reference is integrated with the humanistic perspective.     

Community care in practice: social work in primary health care

This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.     

英国的全科医疗与初级保健护理

2005年8月，作者随浙江省全科医学培训团应英国皇家全科医师学会的邀请，赴英国伦敦大学玛丽皇后学院接受为期半个月的全科医学培训，通过专题讲座、现场参观、讨论交流等方式，较系统地了解了英国的全科医疗与初级保健护理的实施情况，值得我们在实施农村社区卫生服务工作中借鉴。     

Professional and service-user perceptions of self-help in primary care mental health services

Self-help is becoming an increasingly accessible option for addressing mental health problems. Despite this, self-help is subject to a variety of interpretations, little is known about how professionals and service-users conceptualise self-help, or how service-users engage in self-help activities. This study aimed to explore the views of self-help by service-users and health professionals in one area of Scotland, including the perceptions of what constitutes self-help and how it might be used to address mental health problems in primary care. The research involved semistructured interviews with 31 primary care mental health professionals, and in-depth interviews with 34 service-users. We found that professionals and service-users describe self-help in different ways, which has great implications for referral to and implementation of self-help in primary care settings. It also emerged that self-help was not necessarily perceived to be able to address the causes of mental distress, which could leave some professionals defaulting to offering no interventions despite the fairly positive attitude service-users show to self-help strategies. Finally, professionals need to be convinced that interventions are useful, effective and accessible as there are significant barriers in professionals using self-help; if they are not convinced, such approaches will support their therapeutic approach. The research supports the need to develop methods of delivery that offer self-help as part of a broad package of care that also considers social causes of distress.     

Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study

Background

Insomnia is common leading to patients with sleep problems often presenting to primary care services including general practice, community pharmacies and community mental health teams. Little is known about how health professionals in primary care respond to patients with insomnia.

Aim

We aimed to explore health professionals'' and patients'' experiences and perceptions of the management of insomnia in primary care.

Design

We used a qualitative design and thematic approach.

Setting

Primary care in Nottinghamshire and Lincolnshire.

Method

We undertook focus groups and one‐to‐one interviews with a purposive sample of health professionals and adults with insomnia.

Results

We interviewed 28 patients and 23 health professionals. Practitioners focused on treating the cause of insomnia rather than the insomnia itself. They described providing stepped care for insomnia, but this focused on sleep hygiene which patients often disregarded, rather than cognitive behavioural therapy for insomnia (CBT‐I). Practitioners were ambivalent towards hypnotic drugs but often colluded with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended, for example together with over‐the‐counter medication. Practitioners and patients were sometimes but not always concerned about addiction. Practitioners sometimes prescribed despite these concerns but at other times withdrew hypnotics abruptly without treating insomnia. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care.

Conclusion

A better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training.     

Ethical issues in primary health care: A survey of practitioners' perceptions

While most health care is provided at the primary care level, little research has been done to document the ethical issues of such care. A stratified random sample of 702 physicians, nurses, physical therapist, and physician assistants within one southeastern state was surveyed to determine the frequency of ethical issues in primary care. The most frequently occurring issue concerned moral decisions about the amount of time to spend with each patient. A comparison of physician and nonphysician professional groups revealed significant differences in frequencies of the issues. Age had a slight impact on the responses, while gender, religion, and region of practice had none. The study showed that the most frequently occurring issues are pragmatic, not dramatic, and center on patient self-determination, adequacy of care and professional responsibility, and distribution of resources.Helen M. Robillard, R.N.-C., M.S.N., is a doctoral student in Organizational Psychology at the University of Michigan, Ann Arbor. Dallas M. High, Ph.D., is Professor in the Department of Philosophy and Associate of the Sanders-Brown Center on Aging, University of Kentucky, Lexington. Juliann G. Sebastian, R.N., M.S.N., is Associate Professor, College of Nursing, University of Kentucky, Lexington. Janet I. Pisaneschi, Ph.D., is Associate Professor and Assistant Dean, College of Allied Health Professions, University of Kentucky, Lexington. Lea J. Perritt, Ph.D., is Assistant Professor, Allied Health Education and Research, College of Allied Health Professions, University of Kentucky, Lexington. D. Mark Mahler, M.D., is Assistant Clinical Professor, Indiana University School of Medicine, Indianapolis. Requests for reprints should be addressed to: Dallas M. High, Ph.D., Professor, Department of Philosophy, University of Kentucky, Lexington, KY, 40506.