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General Practitioners' and patients' perceptions towards stratified care: a theory informed investigation.
- Source :
- BMC Family Practice; 8/31/2016, Vol. 17, p1-15, 15p, 4 Diagrams, 1 Chart
- Publication Year :
- 2016
-
Abstract
- Background: Stratified primary care involves changing General Practitioners' (GPs) clinical behaviour in treating patients, away from the current stepped care approach to instead identifying early treatment options that are matched to patients' risk of persistent disabling pain. This article explores the perspectives of UK-based GPs and patients about a prognostic stratified care model being developed for patients with the five most common primary care musculoskeletal pain presentations. The focus was on views about acceptability, and anticipated barriers and facilitators to the use of stratified care in routine practice. Methods: Four focus groups and six semi-structured telephone interviews were conducted with GPs (n = 23), and three focus groups with patients (n = 20). Data were analysed thematically; and identified themes examined in relation to the Theoretical Domains Framework (TDF), which facilitates comprehensive identification of behaviour change determinants. A critical approach was taken in using the TDF, examining the nuanced interrelationships between theoretical domains. Results: Four key themes were identified: Acceptability of clinical decision-making guided by stratified care; impact on the therapeutic relationship; embedding a prognostic approach within a biomedical model; and practical issues in using stratified care. Whilst within each theme specific findings are reported, common across themes was the identified relationships between the theoretical domains of knowledge, skills, professional role and identity, environmental context and resources, and goals. Through analysis of these identified relationships it was found that, for GPs and patients to perceive stratified care as being acceptable, it must be seen to enhance GPs' knowledge and skills, not undermine GPs' and patients' respective identities and be integrated within the environmental context of the consultation with minimal disruption. Conclusions: Findings highlight the importance of taking into account the context of general practice when intervening to support GPs to make changes to their clinical behaviour. Findings will inform further stages of the research programme; specifically, the intervention format and content of support packages for GPs participating in a future randomised controlled trial (RCT). This study also contributes to the theoretical debate on how best to encourage clinical behaviour change in general practice, and the possible role of the TDF in that process. [ABSTRACT FROM AUTHOR]
- Subjects :
- PAIN management
BEHAVIOR modification
CLINICAL competence
FOCUS groups
INTERVIEWING
RESEARCH methodology
MUSCULOSKELETAL system
PHYSICIAN-patient relations
GENERAL practitioners
PRIMARY health care
PROFESSIONS
PSYCHOLOGY
RESEARCH funding
DECISION making in clinical medicine
THEORY
OCCUPATIONAL roles
THEMATIC analysis
EARLY medical intervention
DATA analysis software
PATIENTS' attitudes
PHYSICIANS' attitudes
Subjects
Details
- Language :
- English
- ISSN :
- 14712296
- Volume :
- 17
- Database :
- Complementary Index
- Journal :
- BMC Family Practice
- Publication Type :
- Academic Journal
- Accession number :
- 117831667
- Full Text :
- https://doi.org/10.1186/s12875-016-0511-2