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PubMed2005

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff.

BACKGROUND: The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. METHODS: A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. RESULTS: Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. CONCLUSION: AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.

Administrative Personnel↗
PubMed1996

General practice receptionists' attitudes and beliefs towards preventive medicine before and after training and support interventions.

OBJECTIVES: Receptionists are an integral part of the primary care service. We aimed to discover their views on preventive medicine issues. METHOD: One hundred and fifty receptionists from general practices in Sydney, Australia, completed a questionnaire on their attitudes and beliefs towards preventive medicine and brief intervention for alcohol. They were matched according to practice variables into a control, no, minimal, or maximal training and support condition. In all conditions except the control condition, receptionists received 5 minutes of initial training in implementing a brief intervention programme; the amount of ongoing support varied across conditions. Attitudes and beliefs were re-assessed 3 months later. RESULTS AND CONCLUSIONS: The results indicated that when no training and support were given, receptionists developed negative views towards being involved in preventive medicine activities. When training and support were provided, these negative effects were abolished.

Adolescent↗
PubMed1992

When research involves your receptionist. A checklist for GPs and staff.

General practitioners have a key role in health care. Research must continue in general practice to maintain and improve this role. Whenever research involves receptionists directly in data collection, general practitioners should understand fully the nature of the research and the workload it is likely to impose. All members of the staff can be involved in deciding whether to participate. Once your assistance is enlisted, an explicit charter of rights and responsibilities ought to ensure a secure basis for a successful collaboration.

Female↗
PubMed1993

Access to general practice and general practitioners by telephone: the patient's view.

Postal surveys were conducted among samples of patients in four practices to determine accessibility of surgeries and general practitioners by telephone. Over half of the respondents reported being unable to get through to the surgery on their first attempt. Significant differences between practices were related to the number of patients served by each incoming line. Although all of the general practitioners involved were accessible to patients by telephone, only half of the respondents knew this. Significant differences in awareness levels between practices were related to policies and methods of disseminating this information. Satisfaction with the help received from doctors by telephone was uniformly high, but patients were less satisfied with the process of contacting a doctor, particularly where receptionists questioned callers about their problem. It is suggested that practices review the adequacy of their telephone systems against a recommended standard of one incoming line per 2500 patients and consider how information about their telephone policies and services can be effectively communicated to patients. Reception staff may need additional guidance on managing telephone contacts with patients.

Family Practice↗
PubMed2002

Accurate sampling in general practice waiting room surveys: methodological issues.

OBJECTIVES: This is a pilot study to test the validity of using one research assistant to train and support reception staff at five clinics to obtain waiting room data in general practice surveys. DESIGN: A research assistant trained reception staff at five randomly chosen general practices to administer a survey to all eligible women over a two-week period. Practices were audited daily by their appointment books and where possible by billing records to check total numbers of eligible women to determine the denominator of the sample. SETTING: Five metropolitan general practices in one divisional area. PARTICIPANTS: Twenty-five receptionists distributed surveys to 1,298 women. MAIN OUTCOME MEASURES: Number of eligible women missed at each clinic. RESULTS: The number of potential subjects missed by the reception staff ranged from nil to 18% with the appointment book audit. A second audit using billing records at three clinics revealed inaccuracies of up to 50%. The ability to accurately capture eligible patients for waiting room surveys depends on good administrative systems within the practice and motivated staff. CONCLUSIONS: It is important for general practice researchers to consider and account for eligible participants who are missed from the denominator with a waiting room survey method. Valid sampling using this method can be achieved in certain practices, however this may limit the generalisability of the findings.

Adult↗
PubMed2001

How do teenagers and primary healthcare providers view each other? An overview of key themes.

BACKGROUND: Teenagers have often been asked for their opinions about health services. However, relatively few studies have involved quantitative and qualitative methods of assessing them. Furthermore, there have been no United Kingdom studies of providers' views on the health of teenagers or of providers' opinions about their role in teenage health. AIM: To determine how teenagers view primary care, to discover how primary care providers view teenage patients, and to note any differences in opinions between the two groups. DESIGN OF STUDY: Questionnaire survey, focus group discussions, and semi-structured interviews. SETTING: Two thousand two hundred and sixty-five teenage patients, 16 general practitioners (GPs), 12 practice nurses, and 12 general practice receptionists in South Wales valley communities. METHOD: Selected practices provided age-sex registers of patients aged between 14 and 18 years and questionnaires were sent to these patients. Focus groups were assembled from those teenagers who had completed and returned the questionnaire. Semi-structured interviews between one member of the study team and GP surgery staff, chosen randomly from staff lists in the selected surgeries. RESULTS: The teenagers reported a lack of knowledge of services available from primary care, a feeling of a lack of respect for teenage health concerns, poor communication skills in GPs, and a poor understanding of confidentiality issues. The providers did not always share these concerns and they also had differing views on communication and confidentiality issues. CONCLUSION: The data demonstrated important findings about how teenagers would like primary care services to be improved. There was an apparent gulf between teenagers' own opinions about health care and the opinions held by primary care providers.

Adolescent↗
PubMed1981

Blind patients.

Explore the source record for details and available documents.

Aged↗
PubMed1986

What is a good GP?

Explore the source record for details and available documents.

Consumer Behavior↗
PubMed1995

Dialog organization and functional communication in a medical assistance task by phone.

This study is based on a corpus of 110 dialogs recorded in a medical assistance telephonist's workstation. Given the nature of the task, we have considered five main variables in dialog (topics) as well as their order of occurrence (sequences). These data were analyzed with a lexical analysis program. Results show a great difference between Operator/Specialist dialog and Operator/Nonspecialist dialog. Dialog "script" is very strong in the first case in which the operator merely plays a feedback role (routine procedures). If the caller is a private individual, the situation is often an indefinite problem, and the operator may have to adapt to the person (weak script) to obtain relevant information as quickly as possible (problem-solving procedures). This provides confirmation of the operator's twofold competence (efficient decision-making, dialog management).

Humans↗
PubMed2004

Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events.

STUDY OBJECTIVES: The clinical manifestations of acute coronary syndromes (ACSs) vary, and patients present frequently with symptoms other than chest pain. In this analysis, a large contemporary database has been accessed to define the frequency, clinical characteristics, and outcomes of patients presenting without chest pain across different diagnostic categories of ACS. DESIGN AND SETTING: The Global Registry of Acute Coronary Events is a multinational, prospective, observational study involving 14 countries. PATIENTS: Patients presenting to the hospital with a suspected ACS were stratified according to whether their predominant presenting symptoms included chest pain (ie, typical) or did not (ie, atypical). Demographics, medical history, hospital management, and outcomes were compared. MEASUREMENTS AND RESULTS: Of the 20,881 patients in this analysis, 1,763 (8.4%) presented without chest pain, 23.8% of whom were not initially recognized as having an ACS. They were less likely to receive effective cardiac medications, and experienced greater hospital morbidity and mortality (13% vs 4.3%, respectively; p < 0.0001) than did patients with typical symptoms. After adjusting for potentially confounding variables, increased hospital mortality rates were noted in patients with dominant presenting symptoms of presyncope/syncope (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.9), nausea or vomiting (OR, 1.6; 95% CI, 1.1 to 2.4), and dyspnea (OR, 1.4; 95% CI, 1.1 to 1.9), and in those with painless presentations of unstable angina (OR, 2.2; 95% CI, 1.4 to 3.5) and ST-segment elevation myocardial infarction (OR, 1.7; 95% CI, 1.2 to 2.2). CONCLUSION: Patients with ACSs who present without chest pain are frequently misdiagnosed and undertreated. With the exception of diaphoresis, each dominant presenting symptom independently identifies a population that is at increased risk of dying. These patients experience greater morbidity and a higher mortality across the spectrum of ACSs.

Aged↗
PubMed1976

General practice and professional coordination.

In a satellite city in South Australia, 17 miles from Adelaide, a controlled experiment in which a social worker from a local community agency has been placed in a four-man practice is demonstrating one way in which new forms of professional coordination can evolve out of already existing services. Through daily face-to-face contact, doctors, and social worker, as well as other surgery staff members, are learning ways of cooperating in unravelling the many mixed medical and psychosocial problems that present in a general practice setting. There are indications that community response to the innovation is positive because the doctors develop an assurance in making referrals, and people see the service as an extension of a known service in an already familiar setting.

Attitude of Health Personnel↗
PubMed1991

The impact of computer usage on the perceptions of hospital secretaries.

This study explored the perceptions of hospital unit secretaries regarding computer usage. Specifically, six attitudinal variables: performance, resistance, interpersonal relations, satisfaction, challenge, and work overload were examined. The study had two major findings: (1) hospital unit secretaries have positive perceptions of job performance, satisfaction, and challenge as a result of using the PHAMIS computer system and (2) hospital unit secretaries do not feel resistant to the system, overloaded with work, or inclined to increase their interpersonal interaction with coworkers. These two findings might appear contradictory on the surface, but in fact are consistent with overall positive perceptions about the PHAMIS system. The study also considered the impact of two independent variables--age and number of years at work--on the responses of subjects. The analysis indicated that together these two variables explained some variations in the values of at least two of the dependent variables--resistance and challenge. The authors therefore concluded that the installation of the hospital computer system has established a favorable working environment for those whose work is affected by it. The dramatic expansion of computer systems in nonprofit institutions as well as in profit-oriented institutions has made people more familiar with computer technology. This trend can account for the overall positive perception of the unit secretaries toward the new computer system. Moreover, training programs and the support of top management for the system may also have enhanced the positive attitude of the users.

Attitude of Health Personnel↗
PubMedDate not supplied

The quality improvement customers didn't want.

Is investing in new technology always the right choice for a company and its customers? Allan Moulter, the CEO of Quality Care, isn't sure he wants to invest in the computerized reception system that consultant Jack Zadow has outlined for him. But in this HBR case study, the argument Zadow makes is impossible to ignore. Quality Care's rivals have invested in similar systems or are planning to do so. The new system promises to take care of routine busywork, freeing staff up for other interactions with patients. It seems as if the competition hasn't even cut staff and is counting on increased customer retention to pay for the investment. And yet, Quality Care's surveys of its own customers show that they prefer the human touch when checking in. How would customers feel if the first ¿person¿ they met when they came in the door turned out to be a machine? Moulter prides himself on his responsiveness to customers. And with 86% of Quality Care's customers either satisfied or completely satisfied, aren't things fine as they are? Has Moulter considered all the facets of his predicament? How will Quality Care's staff be affected by a decision one way or another? What about the costs of upgrading the system? Can Quality Care maintain its standing without going high-tech? Would customers rebel when confronted with the proposed reception area or would they appreciate the increased efficiency? Six experts weigh the costs and benefits of technology in a service industry.

Ambulatory Care Information Systems↗