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7. Improving personal continuity in general practice: a focus group study.

Author

Groot, Lex JJ, Janssen, Esther, Westerman, Marjan J, Schers, Henk J, Burgers, Jako S, Smalbrugge, Martin, Uijen, Annemarie A, van der Horst, Henriëtte E, and Maarsingh, Otto R

Subjects
OLDER patients, OLDER people, ELECTRONIC health records, CONTINUUM of care, PATIENTS' attitudes, NURSES' aides
Abstract

Background: Personal continuity is an important dimension of continuity of care in general practice and is associated with many benefits including a higher quality of GP care and lower mortality rate. Over time, changes in society and health care have challenged the provision of personal continuity. Older patients in particular experience more negative consequences from receiving discontinuous care. Aim: To explore the perspectives of GPs, older patients, practice nurses, and assistants on improving personal continuity in general practice, and to identify barriers and facilitators that affect this improvement process. Design and setting: A qualitative study using focus groups was conducted from May to August 2019. Method: We organised four focus groups: two with GPs (n = 17), one with patients (n = 7), and one with practice assistants (n = 4) and practice nurses (n = 2). Focus groups were analysed using reflexive thematic analysis. Results: Personal continuity was viewed as being provided by the entire general practice team and not just by the patient's own GP. It was suggested that investing in team communication and stability (for example, by efficient use of the electronic health records) and retaining the availability and accessibility of the patient's own GP for patient care, especially for frail older persons, (for example, by delegating tasks) could improve personal continuity. Barriers and facilitators were perceived at the individual (for example, GPs' involvement in tasks), organisation (for example, staff shortages), and societal level (for example, payment system). Conclusion: As general practice moves towards a more team-based approach to ensure personal continuity, efforts to improve personal continuity should focus on supporting team-based provision of continuous care. [ABSTRACT FROM AUTHOR]

Published
2025
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33. A phenomenology of direct observation in residency:Is Miller's ‘does’ level observable?

Author

Rietmeijer, Chris B.T., van Esch, Suzanne C.M., Blankenstein, Annette H., van der Horst, Henriëtte E., Veen, Mario, Scheele, Fedde, Teunissen, Pim W., Rietmeijer, Chris B.T., van Esch, Suzanne C.M., Blankenstein, Annette H., van der Horst, Henriëtte E., Veen, Mario, Scheele, Fedde, and Teunissen, Pim W.

Abstract

Introduction: Guidelines on direct observation (DO) present DO as an assessment of Miller's ‘does’ level, that is, the learner's ability to function independently in clinical situations. The literature, however, indicates that residents may behave ‘inauthentically’ when observed. To minimise this ‘observer effect’, learners are encouraged to ‘do what they would normally do’ so that they can receive feedback on their actual work behaviour. Recent phenomenological research on patients' experiences with DO challenges this approach; patients needed—and caused—some participation of the observing supervisor. Although guidelines advise supervisors to minimise their presence, we are poorly informed on how some deliberate supervisor participation affects residents' experience in DO situations. Therefore, we investigated what residents essentially experienced in DO situations. Methods: We performed an interpretive phenomenological interview study, including six general practice (GP) residents. We collected and analysed our data, using the four phenomenological lenses of lived body, lived space, lived time and lived relationship. We grouped our open codes by interpreting what they revealed about common structures of residents' pre-reflective experiences. Results: Residents experienced the observing supervisor not just as an observer or assessor. They also experienced them as both a senior colleague and as the patient's familiar GP, which led to many additional interactions. When residents tried to act as if the supervisor was not there, they could feel insecure and handicapped because the supervisor was there, changing the situation. Discussion: Our results indicate that the ‘observer effect’ is much more material than was previously understood. Consequently, observing residents' ‘authentic’ behaviour at Miller's ‘does’ level, as if the supervisor was not there, seems impossible and a misleading concept: misleading, because it may frustrate residents and cause supervisors t

Published
2023

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