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.     

Exploring factors influencing the use of an eHealth intervention for families of children with hearing loss: An application of the COM-B model

BackgroundPrior to developing a successful eHealth intervention, it is important that we explore stakeholders’ capacity to adapt to eHealth.ObjectiveTo explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention.MethodsA qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation.ResultsThe COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals’ and families’ preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families’ and professionals’ confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions.ConclusionFindings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders’ capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services.     

"Opening a can of worms": GP and practice nurse barriers to talking about sexual health in primary care

BACKGROUND: There is evidence that health professionals do not discuss sexually related issues in consultations as often as patients would like. Although primary care has been identified as the preferred place to seek treatment for sexual health concerns, little is known either of the factors that prevent GPs and practice nurses initiating such discussions or of how they feel communication in this area could be improved. OBJECTIVE: The purpose of the present study was to identify barriers perceived by GPs and practice nurses to inhibit discussion of sexual health issues in primary care and explore strategies to improve communication in this area. METHODS: Semi-structured interviews were conducted with 22 GPs and 35 practice nurses recruited from diverse practices throughout Sheffield. RESULTS: The term 'can of worms' summarized participants' beliefs that sexually related issues are highly problematic within primary care because of their sensitivity, complexity and constraints of time and expertise. Particular barriers were identified to discussing sexual health with patients of the opposite gender, patients from Black and ethnic minority groups, middle-aged and older patients, and non-heterosexual patients. Potential strategies to improve communication about sexual health within primary care included training, providing patient information and expanding the role of the practice nurse; however, several limitations to these approaches were identified. CONCLUSION: GPs and practice nurses do not address sexual health issues proactively with patients, and this area warrants further attention if policy recommendations to expand the role of primary care within sexual health management are to be met.     

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.     

Dementia and the Over-75 Check: the role of the primary care nurse

Primary care nurses are very likely to provide a substantial part of the routine care for patients with dementia. In order to examine the knowledge and attitudes of the primary care nurses who undertake the Over-75 Check, towards assessing and managing patients with symptoms of dementia, and to assess their level of support for a clinical practice guideline, a postal questionnaire survey was undertaken of primary care nurses responsible for the Over-75 Check in 209 general practices in Gloucester, Avon and Somerset. The questionnaire ascertained some demographic information about the nurses, their training and the practice routine for the Over-75 Check. It also included a case vignette describing a typical presentation of dementia at an Over-75 Check. A 65% response rate was achieved. Only one-fifth of respondents ever used formal validated cognitive tests as part of the Over-75 Check. In response to the vignette, nearly 10% took no action at all and a further 25% simply referred the patient on. Amongst the remainder there was considerable variation regarding the tasks considered to be within their remit. The respondents strongly supported the introduction of guidelines. Given the variation in professional responsibilities between practices, it is proposed that a clinical practice guideline covering diagnosis, assessment and management of dementia should address the practice as a whole rather than be targeted to specific professionals. The guideline should prompt professionals carrying out an Over-75 Check to recognize symptoms of dementia and raise awareness of the range of tasks which need to be undertaken in confirming diagnosis, assessing needs and managing patients. Results from this study suggest that improved training and increased autonomy for primary care nurses would improve access to services for these patients and their carers.     

Management of hepatitis B immunizations and blood exposure incidents in primary care

AIM: To investigate how well primary care health care workers, with no access to an occupational health service (OHS), have managed their hepatitis B immunizations and blood exposure incidents, compared with National Health Service Trust staff, with access to an OHS. METHOD: A questionnaire was sent to 78 general practitioners (GPs), 93 general practice nurses, 81 NHS Trust consultants and 88 NHS Trust community nurses, in the Airedale area of West Yorkshire in June 2001. RESULTS: The response rate was 80%. GPs were significantly less likely than consultants to have received a hepatitis B booster vaccination after their primary course (57 versus 80%, P < 0.009) and significantly less likely to have had their blood anti-HBs test checked after their last vaccination (74 versus 94%, P < 0.011). General practice nurses were significantly less likely to fill in a blood exposure incident form after an injury than community nurses (56 versus 91%, P < 0.006). Overall, the group with access to an OHS was significantly more likely to have received a hepatitis B booster (P < 0.036), have had a blood anti-HBs test after last vaccination (P < 0.010) and to have filled in a blood exposure incident form after last blood exposure (P < 0.033), than the group without access to an OHS. CONCLUSION: Any future OHS with responsibility for primary care, should consider calling in all GPs and general practice nurses for a review of their hepatitis immunity and for education regarding the management of blood exposure incidents.     

Ready for eHealth? Health Professionals’ Acceptance and Adoption of eHealth Interventions in Inpatient Routine Care

eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p < .001), and eHealth literacy was elevated. Social influence, performance expectancy, and treatment-related internet and mobile use significantly predicted overall acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed.     

Barriers and facilitators to use of services following intensive family preservation services

The primary caregivers of 101 families that used short-term, intensive home-based services were interviewed 2 months after the services to ascertain use of the recommended aftercare services, perceived barriers to service use, and perceived facilitators of service use. While 88% of the families accessed at least some of the recommended services, more than 50% failed to access all of the recommended aftercare services. The most often noted barriers to service use were enabling factors at the agency or community level. Yet, many of the services were used, and the respondents indicated that professionals played a role in helping them link to services. Researchers should continue to study the use of recommended aftercare services and the relationship between aftercare service use and clinical outcomes.     

The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms

ObjectiveTo identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG).MethodsTwo focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques.ResultsPhysicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care setting.ConclusionsCompliance with CPG recommendations would be improved if these documents were brief, non-compulsory, not cost-containment oriented, more based on nursing care models, sensitive to the specific needs of primary care patients, and integrated into the computer workstation.     

Opinions,attitudes, and barriers to pediatric vaccination in Argentina

In Argentina, vaccines included in the national calendar are mandatory, free of charge, and access to vaccination services with social equity for all stages of life are guaranteed by law. However, vaccination coverages are still suboptimal and have shown a constant decrease in the last five years. This study aimed to perform a survey to describe the parent’s confidence, risk perception, sources of information and access barriers to vaccines and vaccination in Argentina. A survey was designed for parents in charge of children under 12 years of age to answer. The questionnaire was constructed based on validated questions of the international peer-reviewed literature adapted to our country’s characteristics. The survey was performed on 1,202 respondents, covering all regions of Argentina, between 19th May and 18th June 2020. To highlight, 76.6 % were female and the mean age was 40.72 (±9.36 years). 9 % participants reported to assist to the private vaccination center, while 64 % and 23 % referred to take their children to the public vaccination point (primary care center and hospital, respectively). Additionally, respondents agreed that vaccines are safe (92 %), effective (94 %), and important for children to receive them (98 %). 48 % could identify-one or more barriers to vaccination, access and affordability were the most reported ones (74 %) being the lack of vaccine the main reason. In conclusion, this study showed that the great majority of parents trust in vaccines and health care teams but access and affordability reasons emerged as the main barriers to vaccination in our country.     

Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts

Our study explored a largely unacknowledged obstacle to abortion access in Massachusetts: the unwillingness of nurses to staff abortion procedures. Evidence suggests that nurses tend to be more likely to oppose abortion than other medical professionals. However, the attitudes and practices of hospital-based nurses regarding abortion have not been thoroughly investigated. We collected qualitative information from physicians and nurse managers to understand how nurses' attitudes affect hospital-based abortion services in Massachusetts. We surveyed key respondents at all hospitals in Massachusetts where abortion services are available to any woman who requests them. Of the 20 individuals who responded (87%), 17 were physicians and 3 were nurse managers. We found that over half of physician respondents believed that the unavailability or unwillingness of nurses to staff abortions is a slight or moderate problem, and nearly a quarter of physician respondents characterized it as a large or very large problem. Thus, nurses' attitudes towards abortion and their unwillingness to assist with procedures may hinder patient access to abortion services.     

Health and health care status of African-born residents of Metropolitan Washington, DC

This study examines health status, health behaviors, and health care access and utilization among African-born residents of the metropolitan Washington, DC area. A telephone survey was administered to a random sample of 525 African-born adults. Results are compared to those for the general local and regional population. Twenty-nine percent of respondents were uninsured; 24% lacked a usual, appropriate source of primary care. Among female respondents, 44% and 34% reported never having had a mammogram or pap smear, respectively. Most health status indicators demonstrated relatively good health, but 15% of respondents reported one of the infectious diseases we investigated. Consumption of alcohol and tobacco was relatively low. African-born residents are generally at risk regarding access to health care, and certain segments (the uninsured, recent arrivals) face critical access barriers. Infectious diseases are a notable feature of health status, and use of some preventive and dental services is considerably lower than for the general population.     

Staff perceptions of care for deliberate self-harm patients in rural Western Australia: a qualitative study

ABSTRACT: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study to explores the views of regional health staff on barriers to the effective management of deliberate self-harm (DSH) and ways in which those barriers could be addressed. Semi-structured interviews were tape-recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses ( n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group.
The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important.     

Poor communication may impair optimal asthma care: a qualitative study

BACKGROUND: Despite asthma being primarily managed in general practice and primary care, there is little research into the issues and tools which may impact on managing poorly controlled asthma in this setting. OBJECTIVE: To explore the views of health care professionals (HCPs) towards asthma guidelines and self-management plans (SMPs) to identify why these are not used routinely in general practice. METHODS: Data from 54 HCPs [GPs and practice nurses (PNs)] in north-east Scotland were collected via qualitative interviews and focus groups. Participant views and experience of asthma guidelines and SMPs were explored. RESULTS: Participants had mainly positive attitudes towards guidelines and SMPs, although both were used only when deemed suitable by the individual. Suitability depended on individual patient issues (e.g. psychosocial factors, level of control) and/or professional issues (e.g. ease of use, time available, job roles). Patient issues were viewed as impacting on asthma control directly and, indirectly, as the main reason for not using guidelines or SMPs with a patient. HCPs reported lacking necessary communication skills for dealing with patient asthma control issues, particularly where these were non-medical. Professional and organizational issues such as training and communication were also perceived as impairing asthma management. CONCLUSION: Our findings indicate that guidelines are seen as providing the 'why' of helping asthma patients' self-manage but not the 'what to...' or 'how to...' communicate. Poor professional-patient communication seems largely to explain the poor uptake of SMPs and guideline use in general practice and primary care. This limitation is more obvious to professionals when they are working with patients with poorly controlled asthma. There is a need to identify key communication skills for effective professional-patient partnership in adult asthma management, and to develop robust strategies for effectively training GPs and PNs in enhancing these skills.     

Technological access barriers,telehealth use and health care visits in the early pandemic period

ObjectiveThis study sought to characterize the role of technological barriers in limiting access to telehealth services.MethodsThe study used data obtained from the 2020 Nebraska Annual Social Indicators Survey (NASIS). A total of 2,213 out of 8,000 respondents returned a completed survey. Multivariate models were developed to estimate the relationship between demographic characteristics, technological barriers and overall telehealth utilization. An additional model was used to estimate the relationship between telehealth use and health care visits in the past year, controlling for the available demographic characteristics. Ordinal logistic regression was used.ResultsApproximately 27.9 percent of respondents had ever used telehealth services. Individuals who had used telehealth services were significantly more likely to have seen a health care provider for reproductive health or for a specific health need in the past year. Approximately 7.2 percent of survey respondents reported access to reliable internet as a barrier to telehealth use, 9 percent reported cost of internet services as a barrier and 7.1 percent reported access to electronic devices as a barrier. Respondents over 65 and those with lower education attainment were more likely to experience barriers to accessing technology. Holding technological access constant, telehealth use was significantly lower among males, individuals over 65 and rural residents.ConclusionsFactors other than cost and access to technology may be driving lower rates of telehealth use among these populations. The findings can help policymakers and health systems strategize approaches to increase access to telehealth among underserved populations.Public abstractLimitations in technology access may limit the usefulness of telehealth in connecting underserved patients to care. This study sought to understand the role of technological barriers in limiting access to telehealth services. Using data obtained from the 2020 Nebraska Annual Social Indicators Survey (NASIS), this study summarizes telehealth use among a random sample of individuals in rural and urban Nebraska. The study then assesses whether lower access to technology is associated with reduced use of telehealth services. Approximately 7.2 percent of survey respondents reported access to reliable internet as a barrier to telehealth use, 9 percent reported cost of internet services as a barrier and 7.1 percent reported access to electronic devices as a barrier. Holding technological access constant, telehealth use was lower among males, individuals over 65 and rural residents. Factors other than access to technology may be driving lower rates of telehealth use among these populations.     

Parents' use and views of the national standard Personal Child Health Record: a survey in two primary care trusts

BACKGROUND: The Personal Child Health Record (PCHR) is a booklet given to parents in the UK, following the birth of a child, to be used as the main record of their growth, development and uptake of preventative health services. The national standard PCHR has been available since April 2004. The aim of this survey was to explore parental views of the 'new' PCHR, their experiences in receiving it, and its subsequent use, focusing on specific issues of current debate among health professionals. METHODS: A parental questionnaire (n = 89) was administered in July 2004, in 10 child health clinics located in two primary care trusts; one in central London and the other in Buckinghamshire. RESULTS: Nearly all parents (98%) reported that they used the PCHR as a record of their child's health and development and 92% reported that they 'always' took it with them when seeing healthcare staff about their child. Some parents (22%) indicated that they had not been given a satisfactory explanation as to how to use the PCHR, at the time it was issued to them. Parents reported that health visitors were more likely than other health professionals to use the PCHR both to obtain information about their child and to record information. The majority of respondents (78%) were happy for the level of maternal education to be documented in their child's PCHR. CONCLUSIONS: Parents used, appreciated and liked the design of the national standard PCHR. Health visitors and primary care staff used the PCHR more than secondary care staff. The potential benefits of the PCHR will only be maximized if other healthcare professionals respond by using it.