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To describe the role, contribution and value of research nurses in New Zealand community-based or primary health care research.
Research nurses are increasingly recognised as having a key role in undertaking successful research in hospitals and clinical trial units however only limited work has been undertaken to examine their role in community-based research. Undertaking health research in the community has unique challenges particularly in relation to research design and recruitment and retention of participants.
We describe four community-based research projects involving research nurses, each with particular recruitment, retention and logistical problems. Vignettes are used to illustrate the role, contribution and value of research nurses in a diverse range of community research projects.
The knowledge and skills used by research nurses in these projects included familiarity with communities, cultural competence, health care systems and practice philosophies and in particular with vulnerable populations. Their research actions and activities include competence with a broad range of research methodologies, organisational efficiency, family-centred approach, along with advocacy and flexibility. These are underpinned by nursing knowledge and clinical expertise contributing to an ability to work autonomously. These four projects demonstrate that research nurses in community-based research possess specific attributes which facilitate successful study development, implementation and outcome.
The aim of this study was to explore female community health agents’ views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information.
The study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil.
The design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings.
Participants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients’ improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele’s social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary healthcare for them.
To investigate GPs’ beliefs about complementary and alternative medicine (CAM) and its role in clinical practice.
Despite the prevalence of CAM in the United Kingdom, little is known about GPs beliefs regarding these alternative approaches to patient management and how they view it in relation to their clinical conduct and practice.
A qualitative study conducted on 19 GPs recruited from the North West of England. Semi-structured telephone interviews were analysed using an inductive thematic analysis.
Three themes emerged from the data: limited evidence base, patient demand and concerns over regulation.
Despite recognising the limited evidence base of CAM, GPs continue to see a role for it within clinical practice. This is not necessarily led by patient demand that is highly related to affluence. However, GPs raised concerns over the regulation of CAM practitioners and CAM therapies.
The purpose of this research is to explore whether general practitioners have experiences with functional foods within their clinical practice.
Previous research and editorials have suggested that general practitioners should have more involvement and knowledge of functional foods. This is due to the thought that functional foods may be consumed by their patients that could lead to other issues, such as patients not taking their medication. Therefore, research into general practitioners involvement with functional foods needs to be conducted.
In all, 10 semi-structured open interviews were used with a topic guide. These interviews where digitally audio recorded and transcribed verbatim. The transcripts where analysed using thematic analysis.
It was found that general practitioners believed they did not have a direct role with functional foods and should not be involved with discussing them with their patients. They felt that if they where to be involved with functional foods then they would need more training and information about them. They also felt that functional foods could be empowering for their patients.
To examine beliefs about irritable bowel syndrome (IBS) management among primary care physicians.
There have been considerable advances in evidence synthesis concerning management of IBS in the last five years, with guidelines for its management in primary care published by the National Institute for Health and Care Excellence (NICE).
This was a cross-sectional web-based questionnaire survey of 275 primary care physicians. We emailed a link to a SurveyMonkey questionnaire, containing 18 items, to all eligible primary care physicians registered with three clinical commissioning groups in Leeds, UK. Participants were given one month to respond, with a reminder sent out after two weeks.
One-hundred and two (37.1%) primary care physicians responded. Among responders, 70% believed IBS was a diagnosis of exclusion, and >80% checked coeliac serology often or always in suspected IBS. Between >50% and >70% believed soluble fibre, antispasmodics, peppermint oil, and psychological therapies were potentially efficacious therapies. The respondents were less convinced that antidepressants or probiotics were effective. Despite perceived efficacy of psychological therapies, 80% stated these were not easily available. Levels of use of soluble fibre, antispasmodics, and peppermint oil were in the range of 40% to >50%. Most primary care physicians obtained up-to-date evidence about IBS management from NICE guidelines. Most primary care physicians still believe IBS is a diagnosis of exclusion, and many are reluctant to use antidepressants or probiotics to treat IBS. More research studies addressing diagnosis and treatment of IBS based in primary are required.
The aim of this study is to illuminate primary health care (PHC) nurses’ experiences of physical activity referrals (PARs).
Despite extensive knowledge about the substantial health effects physical activities can produce, fewer and fewer people in our modern society regularly engage in physical activity. Within health care and, particularly, within the PHC arena, nurses meet people on a daily basis who need help to engage in a healthier lifestyle. The possibility of issuing written prescriptions for physical activities, often referred to as PARs, has been introduced as a tool to support such lifestyles. However, even though PHC nurses can prescribe physical activities, studies investigating their experience in this type of nursing intervention are rare.
For this study, 12 semi-structured interviews were conducted with PHC nurses, and the transcribed texts were analysed using a qualitative content analysis.
Two categories – PARs, an important nursing intervention, and PARs, the necessity of organisational support – reflected the nurses’ experiences in using PARs.
Our findings suggest that viewing the PAR as a complex intervention, with all that this entails, might be one approach to increasing the number of PARs being issued. Simpler systems, more time and the potential for testing the effectiveness of follow-ups could be possible ways of achieving this.
To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.
Research suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services.
The intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies.
Results show a significant increase in clinicians’ self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians’ confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.
Patient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking.
To examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development.
We scanned the literature reporting on previous PPI initiatives in primary care-led commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives.
1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfiguration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement.
Appropriate communication between general practitioners (GPs) and physiotherapists is vital for providing optimal care. Differing opinions exist as to key inclusion in this communication. This study aims to identify the key components that both GPs and physiotherapists would include in inter-professional communication.
Qualitative study design, using 14 in-depth, semi-structured telephone interviews.
Physiotherapists identified relevant past medical history, psycho-social history, yellow flags, anticipated time frame for follow-up and objective measures of current function as the more useful inclusions in written communication. GPs identified the inclusion of a working diagnosis, treatment summary and likely long-term outcomes as the key components to effective communication.
Effective interprofessional communication requires the provision of information that is both succinct and relevant. While there are individual preferences, this study suggests that certain key characteristics exist, and the inclusion of these in interprofessional communication may lead to improved communication and patient outcomes.
Obesity is a major public health issue and primary care practitioners are well placed to opportunistically raise the issue of overweight or obesity with their patients.
Aim and methods
This study investigated the prevalence of weight discussion in primary care consultations with overweight and obese patients, in a practice in Fife, Scotland, and described weight-related communication using video analysis.
Weight was raised in 25% of consultations with overweight and obese patients. GPs initiated weight discussion more often than patients; however, these attempts were often blocked by patients. Weight-related outcomes were more common when patients initiated the weight discussion. This study confirms the potential of video analysis for understanding primary care weight discussion. It also suggests that GPs may benefit from a communication-based intervention to tackle patient blocking behaviours and contributes to the evidence suggesting that interventions targeted to increase the prevalence of weight-related discussions with their patients are needed.
To explore GPs’ perceptions of their role in primary prevention, barriers experienced and willingness to accommodate an automated, computer-tailored intervention.
General practice is an attractive setting for primary prevention of chronic disease. Due to constraints in time and knowledge it is underutilised.
Telephone interviews of 13 GPs in Brisbane, Australia, whose patients were previously involved in a lifestyle change research project. Qualitative responses were grouped into themes.
GPs perceived their role in lifestyle change as ‘educators’, ‘supporters’ and ‘prompters’. Smoking and physical activity were addressed more often than alcohol and salt intake. Longer lifestyle-focussed consultations and computer-generated reminders were suggested to overcome barriers. A computer-tailored approach was appreciated due to its minimal impact on practice routine. GPs understand their role in primary prevention but need help to overcome barriers. GP initiated consultations focusing on lifestyle and prevention along with computer support systems could improve capability for prevention in general practice.