Abstract:
BACKGROUND:Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. METHODS:Semi-structured interviews, with the data subjected to thematic analysis. RESULTS:Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. CONCLUSIONS:The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Elvey R,Bailey S,Checkland K,McBride A,Parkin S,Rothwell K,Hodgson Ddoi
10.1186/s12875-018-0773-ysubject
Has Abstractpub_date
2018-06-19 00:00:00pages
89issue
1issn
1471-2296pii
10.1186/s12875-018-0773-yjournal_volume
19pub_type
杂志文章abstract:BACKGROUND:General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy im...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0484-1
更新日期:2016-07-21 00:00:00
abstract:BACKGROUND:Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged drastically. No figu...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-11
更新日期:2008-02-13 00:00:00
abstract:BACKGROUND:The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making pro...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-12
更新日期:2008-02-19 00:00:00
abstract:BACKGROUND:Previous studies have shown the importance of paying attention to lay peoples' interpretations of risk of disease, in order to explain health-related behavior. However, risk interpretations interplay with social context in complex ways. The objective was to explore how asymptomatic patients with high cholest...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-137
更新日期:2013-09-16 00:00:00
abstract:BACKGROUND:During an influenza epidemic prompt diagnosis of influenza is important. This diagnosis however is still essentially based on the interpretation of symptoms and signs by general practitioners. No single symptom is specific enough to be useful in differentiating influenza from other respiratory infections. Ou...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-12-4
更新日期:2011-02-09 00:00:00
abstract:BACKGROUND:Low participation rates among ethnic minorities in preventive healthcare services are worrisome and not well understood. The objective of this study was to explore how adults of Turkish and Moroccan origin living in the Netherlands, aged 45 years and older, can be reached to participate in health checks for ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0476-1
更新日期:2016-07-21 00:00:00
abstract:BACKGROUND:Glycated hemoglobin (HbA1c) results vary by analytical method. Use of same-visit HbA1c testing methodology holds the promise of more efficient patient care, and improved diabetes management. Our objective was to test the feasibility of introducing a same-visit HbA1c methodology into busy family practice cent...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-28
更新日期:2005-07-13 00:00:00
abstract:BACKGROUND:A cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops. METHODS:Twenty-nine practices were randomly allocated to one of thre...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-9-22
更新日期:2008-04-20 00:00:00
abstract:BACKGROUND:Since Huntington's Disease (HD) is a familial disease with an average onset in the mid-thirties, one might expect that spousal carers are concerned with providing care for off-spring who may turn out to be affected. METHODS:This study involved ten face-to-face interviews with carers of spouses affected by H...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-38
更新日期:2005-09-14 00:00:00
abstract:BACKGROUND:In order to proceed from a paper based registration to a surveillance system that is based on extraction of electronic health records (EHR), knowledge is needed on the number and representativeness of sentinel GPs using a government-certified EHR system and the quality of EHR data for research, expressed in ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-11-50
更新日期:2010-06-25 00:00:00
abstract:BACKGROUND:Chronically ill patients often experience psychosocial problems in everyday life. A biopsychosocial approach is considered to be essential in chronic care. In Dutch primary health care the current biomedically oriented clinical practice may conflict with the biopsychosocial approach. This study is aimed to e...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-14
更新日期:2012-03-12 00:00:00
abstract:BACKGROUND:Diuretics are recommended as initial treatment for hypertension. Several studies have suggested suboptimal persistence and adherence to thiazide diuretic monotherapy; this study compared patient persistence and adherence with hydrochlorothiazide (HCTZ) monotherapy to fixed-dose combinations containing HCTZ. ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-61
更新日期:2008-11-06 00:00:00
abstract:BACKGROUND:Accreditation is a widespread tool for quality management in health care. However, there is lack of research on the impact of accreditation, particularly in general practice. This study explores how general practitioners and their staff experienced the impact of a mandatory accreditation program in Denmark. ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1034-4
更新日期:2019-10-28 00:00:00
abstract:BACKGROUND:Women presenting with symptoms of acute uncomplicated urinary tract infection (UTI) are often prescribed antibiotics. However, in 25 to 50% of symptomatic women not taking antibiotics, symptoms recover spontaneously within one week. It is not known how many women are prepared to delay antibiotic treatment. W...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-71
更新日期:2013-05-31 00:00:00
abstract:BACKGROUND:Delay in cancer diagnosis may have serious prognostic consequences, and some patients experience delays lasting several months. However, we have no knowledge whether such delays are associated with general practitioner (GP) characteristics. The aim of the present study was to analyse whether GP and practice ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-12-100
更新日期:2011-09-26 00:00:00
abstract:BACKGROUND:Irritable Bowel Syndrome (IBS) is a chronic, relapsing gastrointestinal disorder, that affects approximately 10% of the general population and the majority are diagnosed in primary care. IBS has been reported to be associated with altered psychological and cognitive functioning such as mood disturbances, som...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0225-x
更新日期:2015-01-28 00:00:00
abstract:BACKGROUND:Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. METHODS:Internet based survey of 3081 primary care physicians, recruited via ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0529-5
更新日期:2016-09-08 00:00:00
abstract:BACKGROUND:While increasing attention is being paid to enabling terminal patients to remain at home until death, limited information is available on the circumstances in which people at home actually die. Therefore this study aims to describe patient characteristics, functional and cognitive status and physical and psy...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-4
更新日期:2012-01-19 00:00:00
abstract:BACKGROUND:Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients' perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0596-2
更新日期:2017-02-08 00:00:00
abstract:BACKGROUND:A territory-wide diabetes management program (Risk Assessment Management Program - RAMP) was recently established, providing comprehensive management for all diabetics, helping to delineate current level of control and complications prevalence among primary care diabetic patients in Hong Kong. METHOD:This c...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-8
更新日期:2014-01-10 00:00:00
abstract:BACKGROUND:The majority of patient contacts occur in general practice but general practice patient safety has been poorly described and under-researched to date compared to hospital settings. Our objective was to produce a set of patient safety tools and indicators that can be used in general practices in any healthcar...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-110
更新日期:2014-06-05 00:00:00
abstract:BACKGROUND:People use a variety of means to find health information, including searching the Internet, seeking print sources, and talking to healthcare providers, family members, and friends. Doctors are considered the most trusted source of health information, but people may be underutilizing them in favor of searchin...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0805-7
更新日期:2018-08-29 00:00:00
abstract:BACKGROUND:The benefit of a "diagnosis" of pre-diabetes in very elderly patients is debated. How clinicians manage pre-diabetic blood results in these patients is unknown. This study aims to understand how clinicians are "diagnosing" older patients with pre-diabetic blood parameters. METHODS:Semi-structured interviews...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-0981-0
更新日期:2019-06-29 00:00:00
abstract:BACKGROUND:Obesity is an important public health problem. However, the effects of alcohol use on the risk for obesity have not been thoroughly explored. This study focuses on how frequency of alcohol use is related to the risk of obesity in a community medicine clinic population. METHODS:This study used a cross-sectio...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-17
更新日期:2005-04-22 00:00:00
abstract:BACKGROUND:Depression is a major health concern, predominantly treated by general practitioners (GPs). Problem solving therapy (PST) is recognised as an effective treatment for depression that is not widely used by GPs. This research aims to explore barriers and enablers that may influence GPs use of this treatment. M...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-8-24
更新日期:2007-04-25 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-52
更新日期:2014-03-25 00:00:00
abstract:BACKGROUND:Comorbid chronic pain and depression is a challenging dyad of conditions to manage in primary care and reporting has shown to vary by ethnic group. Whether the relationship between depression and chronic pain varies by ethnicity is unclear. This study aims to explore chronic pain and depression reporting acr...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0343-5
更新日期:2015-10-06 00:00:00
abstract:BACKGROUND:The Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the "patient-centered" use of the EHR have been published. However, the impact of training to improve EHR use during clinical enco...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-017-0640-2
更新日期:2017-05-26 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-5-6
更新日期:2004-04-01 00:00:00
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journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-5-21
更新日期:2004-10-06 00:00:00