27,375 research outputs found

    Interpretative perspectives on the acceptance of an optional information system

    Get PDF
    Understanding the factors that contribute to the acceptance and use of information systems is a central concern in the field of information systems. Especially in cases where users are relatively free to use an information system (a so called optional information system) it is important for implementers to understand which factors determine acceptance in order to develop an effective design and implementation plan. In order to identify factors that determine acceptance, this report describes and analyses the implementation of a therapy expert system for general practitioners (GPs) in the Netherlands. The Netherlands Ministry of Health decided to implement this system with the objective to promote cost effectiveness, consistency and quality of therapies and drug prescriptions of general practitioners. This paper uses an interpretive perspective to analyze the limited acceptance of the system. While the promotion campaign focused on the system, GPs based their decision on wider contextual factors. The case demonstrates pitfalls, which come up during the implementation of such a system, and shows which factors may play a role in the decision of possible users to accept or reject such an optional information system. Different issues arise from this case. One is that users seem to differ from non-users and that perceptions about the system itself but also about non-system features affect the decision to accept. The paper uses the evidence of the case by suggesting to extend the technology acceptance model (TAM) with relevant contextual factors. It concludes by outlining its implications for implementers of optional information systems in general.

    Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review

    Get PDF
    Background Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. Methods Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). Conclusions This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed

    Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis

    Get PDF
    Objectives: To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients’ preferences, and costs. \ud Design: Randomised controlled trial. \ud Setting: Eight general practices in south Birmingham. \ud Participants: 441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg. \ud Interventions: Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice). \ud Main outcome measures: Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients’ preferences of method of blood pressure monitoring, and costs. \ud Results: 400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (-1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (£251 ($437; 364 euros) (95% confidence interval £233 to £275) versus £240 (£217 to £263). \ud Conclusions: Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care. \u

    The rituals of medicine : exploring the General Practice Consultation using simulated consultations

    Get PDF
    The consultation is a distinguishing feature of general practice compared to other medical disciplines. The relationship between the doctor and patient is crucial to the successful outcome of the consultation. Despite suggestions in the literature that interruptions to the consultation are detrimental to this relationship, there is a lack of research to support this claim.The overall aim of this study was to explore the consulting style of General Practitioners (GPs) and the impact of interruptions to the consultation to further understand GP behaviour and the doctor-patient relationship during the consultation. The implication of the study was to raise awareness for GPs of their consulting style and interaction with patients, potentially leading to changes in behaviour, resulting in better outcomes from consultations.This research involved six GPs consulting six actor-patients during two video recorded simulated consultation workshops. This research consisted of three studies. The first involved observation of GP behaviour during the simulated consultations, and the impact of interruptions to the consultation; the second involved GP and patient perceptions of behaviour during the consultations, and the impact of the interruptions; and the third involved obtaining GP and patient perspectives of behaviour and interruptions to the consultations, prompted by video footage from the consultations.In Study 1, evidence was found to support a GP consultation style whereby individual GPs showed similar behaviours during each consultation despite consulting a variety of patients. Variability in GPs ability to cope with interruptions to the consultation, and the little time spent by GPs establishing a relationship with patients regardless of the consultation being interrupted was highlighted. The findings of Study 2 supported previous reports of the frequent occurrence of interruptions to the consultation. Differences between GPs beliefs and patient perceptions of the impact of interruptions to the consultation to the doctor-patient relationship were highlighted. In Study 3, the opening sequence of the consultation was found to be of importance to the doctor-patient relationship and the outcome of the consultation.Overall, the findings of this study showed GPs inability to describe their behaviour, and a lack of awareness of their behaviour during the consultation. As a result, GPs may be missing vital cues from patients during the consultation regarding their thoughts and concerns, which may have negative consequences for the doctor-patient relationship. These implications, however, require further research. This study concluded that reflection, and mindfulness could be applied to GP consultation behaviour, using video techniques, in order to raise GP self- awareness of behaviour, improve communication, and the way that GPs relate to patients, and to improve outcomes of general practice consultations

    Implementing cardiovascular disease prevention guidelines to translate evidence-based medicine and shared decision making into general practice: theory-based intervention development, qualitative piloting and quantitative feasibility

    Get PDF
    Background: The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid. Methods: Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on "think aloud" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98). Results: Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment. Conclusions: Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research

    Preliminary effects and acceptability of a co-produced physical activity referral intervention

    Get PDF
    Objectives: To explore the preliminary effects and acceptability of a co-produced physical activity referral intervention. Study Design: Longitudinal design with data collected at baseline and post a 12-week physical activity referral intervention. Setting. Community leisure centre. Methods: 32 adults with controlled lifestyle-related health conditions took part in a physical activity referral intervention (co-produced by a multidisciplinary stakeholder group) comprising 12 weeks’ subsidised fitness centre access plus four behaviour change consultations. A complete case analysis (t-tests and magnitude-based inferences) was conducted to assess baseline-to-12-week change in physical activity, cardiometabolic, and psychological measures. Semi-structured interviews were conducted (n=12) to explore experiences of the intervention. Results: Mean improvements were observed in cardiorespiratory fitness-2 (3.6 ml.kg.-1min-1 (95% confidence interval 1.9 to 5.4) P<0.001) and moderate-to-vigorous physical activity (12.6 min.day (95% CI 4.3 to 29.6) P=0.013). Participants were positive about the support from exercise referral practitioners, but experienced some challenges in a busy and under staffed gym environment. Conclusions: A co-produced physical activity referral intervention elicited short-term improvements in physical activity and cardiometabolic health. Further refinements may be required, via ongoing feedback between stakeholders, researchers and service users, to achieve the intended holistic physical activity focus of the intervention, prior to a definitive trial

    'The big buzz': a qualitative study of how safe care is perceived, understood and improved in general practice

    Get PDF
    Background: Exploring frontline staff perceptions of patient safety is important, because they largely determine how improvement interventions are understood and implemented. However, research evidence in this area is very limited. This study therefore: explores participants’ understanding of patient safety as a concept; describes the factors thought to contribute to patient safety incidents (PSIs); and identifies existing improvement actions and potential opportunities for future interventions to help mitigate risks. Methods: A total of 34 semi-structured interviews were conducted with 11 general practitioners, 12 practice nurses and 11 practice managers in the West of Scotland. The data were thematically analysed. Results: Patient safety was considered an important and integral part of routine practice. Participants perceived a proportion of PSIs as being inevitable and therefore not preventable. However, there was consensus that most factors contributing to PSIs are amenable to improvement efforts and acknolwedgement that the potential exists for further enhancements in care procedures and systems. Most were aware of, or already using, a wide range of safety improvement tools for this purpose. While the vast majority was able to identify specific, safety-critical areas requiring further action, this was counter-balanced by the reality that additional resources were a decisive requirment. Conclusion: The perceptions of participants in this study are comparable with the international patient safety literature: frontline staff and clinicians are aware of and potentially able to address a wide range of safety threats. However, they require additional resources and support to do so

    Career Development Program for Refugee and Migrant Youth

    Get PDF
    The Career Guidance for Refugee and Migrant Young People project is an initiative of the South Metropolitan Migrant Resource Centre funded by the Department of Education and Training. It aims to develop, pilot and evaluate a career development and planning program that specifically meets the learning levels and needs of refugee youth with low levels of education, cultural life skills and English language ability

    The effect of computerisation on the quality of care in Australian general practice

    Get PDF
    This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed
    corecore