A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established

Developmental Differences in the Ability to Provide Temporal Information about Repeated Events

Children (n = 372) aged 4 - 8 years participated in 1 or 4 occurrences of a similar event and were interviewed 1 week later. Compared to 85% of children who participated once, less than 25% with repeated experience gave the exact number of times they participated, although all knew they participated more than once. Children with repeated experience were asked additional temporal questions and there were clear developmental differences. Older children were more able than younger children to judge relative order and temporal position of the four occurrences. They also demonstrated improved temporal memory for the first and last relative to the middle occurrences, while younger children did so only for the first. This is the first systematic demonstration of children’s memory for temporal information after a repeated event. We discuss implications for theories of temporal memory development and the practical implications of asking children to provide temporal information

Eye Movements Provide an Index of Veridical Memory for Temporal Order

The present research examined whether eye movements during retrieval capture the relation between an event and its temporal attributes. In two experiments (N=76), we found converging evidence that eye movements reflected the veridicality of memory for temporal order seconds before overt memory judgments, suggesting that these movements captured indirect access to temporal information. These eye movements did not entirely depend on the amount of contextual cueing available (Experiment 1) and reflected the unique ordinal position of an event in a sequence (Experiment 2). Based on our results, we conclude that eye movements reflected the absolute temporal order of past events

Multi-disciplinary perspectives: application of the Consolidated Framework for Implementation Research to evaluate a health coaching initiative

Long term conditions are a leading cause of mortality and morbidity. Their management is founded on a combination of approaches involving government policy, better integration between health and care systems, and individual responsibility for self-care. Health coaching has emerged as an approach to encouraging individual responsibility and enhancing the self-management of long term conditions. This paper focuses on the evaluation of a workforce initiative in a diverse and socially deprived community. The initiative sought both to improve integration between health and care services for people with long term conditions, and equip practitioners with health coaching skills. The aim of the study was to contribute an empirical understanding of what practitioners perceive to be the contextual factors that impact on the adoption of health coaching in community settings. These factors were conceptualised using the Consolidated Framework for Implementation Research (CFIR). A stratified purposive sample of 22 health and care practitioners took part in semi-structured telephone interviews. Data were analysed using the CFIR as an analytical framework. The perceptions of trainees mapped onto the major domains of the CFIR: characteristics of the intervention, outer setting, inner setting, characteristics of individuals involved, and process of implementation. Individual patient expectations, co-morbidities and social context were central to the extent to which practitioners and patients engaged with health coaching. Structural constraints within provider services and the wider NHS were also reported as discouraging initiatives that focused on long term rewards rather than short term wins. The authors recommend further research is undertaken both to understand the role of health coaching in disadvantaged communities and ensure the service user voice is heard

Using the memoline to capture changes in user experience over time with children

In this paper, we focus on the MemoLine as a retrospective tool for capturing changes in user experience over time with children, which has had little attention from the Child Computer Interaction community. To investigate the appropriateness of the MemoLine, two studies were performed. In the first study, 16 children aged 7 to 12 were instructed to use the MemoLine at home to reflect on their 4 month experience with a music game. The second study took place in a school context, with 32 children aged 10 to 11 who used MemoLine to report on their 3 month experience with an educational game. The results suggested that children along the age spectrum of 7 to 12 were able to complete the MemoLine Instruments. In the two different contexts children were able to recall experiences relating to the game and provide data that would be useful for developers to understand how and why their experiences changed over time. Finally, the results showed that the procedural choices for the data gathering could be adjusted to a home and school context. Based on the insights from the case studies, best practices are defined to facilitate the use and further development of the method

When 1+2≠3 for Hard-working Rural Physicians

UNDERSTANDING THE challenges and rewards of rural medical practice has long seemed to be the key to designing effective programs to increase the number of rural physicians. We believe that if we could only figure out what negative aspects of rural medicine prompt physicians to leave rural communities, we could solve the attrition half of the perennial rural physician shortage problem. When we also understand what is needed to attract more physicians into rural areas, the shortage can be eliminated completely

Are Bias, Harassment, and Discrimination by Physician-Peers a Reason Why Some Physicians Leave Rural Communities?

The challenges of recruiting and, separately, retaining primary care physicians in rural and underserved settings are long-standing, but many of the fundamental factors, forces, and remedies are understood. Primary care physicians are generally drawn (recruited) to rural communities for the lifestyle, the beauty of the countryside and its outdoor activities, and the closeness of the people, in addition to the style of practice and professional challenges there. Many grew up in rural communities, but just as many simply prefer what these communities offer. Many have a personal drive to work in communities with a clear medical need and where the impact of their life’s work can be readily felt. The community, its people, the general feel of the place, and the intimate size of a rural practice and a rural medical community are principal draws

Treatment seeking behaviour and government primary health care utilisation among male civil servants in Kelantan

Background: Treatment seeking behaviour (TSB) is a sequence of remedial actions which are influenced by many factors that individuals undertake to rectify perceived ill-health. Currently, very little is known regarding TSB among men in Kelantan and their experiences towards primary healthcare utilisation (PHC) in the country especially among civil servants who are considered the largest consumers of public healthcare in Malaysia. Objectives: This study was conducted among male civil servants in Kelantan to determine the TSB and its associated factors and to explore the experiences on PHC services and TSB. Methodology: This was a concurrent parallel mixed method study which consisted of a quantitative and a qualitative part done among male civil servants in Kelantan. By using simple random sampling, a total of 402 participants were involved in the quantitative part of the study using a TSB questionnaire while the second part of the study was conducted by 6 focus group discussions. Descriptive analysis and logistic regression were performed to identify the proportion of inappropriate TSB and the factors associated with inappropriate TSB among male civil servants in Kelantan. A thematic analysis was done in the qualitative part to identify themes. Results: The proportion of inappropriate TSB among male civil servants in Kelantan was 64.6%. There were 12 significant variables identified from the seven models developed using multiple logistic regression which were associated with inappropriate TSB. They were non-Muslims (OR 2.6; 95% CI: 1.1,6.7 p= 0.041), high household income (OR 4.5; 95% CI: 1.7, 11.6 p= 0.022), married (OR 0.3; 95% CI: 0.1, 0.7 p=0.035), average assessment of illness severity (OR 0.45; 95% CI: 0.3,0.7 p=<0.001), low information about illness (OR 3.3; 95% CI:1.4, 7.8 p= 0.012), never received appropriate treatment (OR 5.4, 95% CI: 1.0, 29.5 p= 0.042), importance of cost of treatment (OR 0.2; 95% CI: 0.1, 0.4 p= <0.001), never accepting illness when having symptoms (OR 2.8; 95% CI: 0.9, 8.8 p=0.041), embarassesment expressing illness (OR 0.2; 95% CI: 0.1, 0.5 p= <0.001), much job and family responsibilities as barriers (OR 0.3; 95% CI: 0.1, 0.6 p=<0.001), easy access to medications (OR 0.4; 95% CI: 0.2, 0.7 p=0.011) and affordability as a determinant (OR 0.3; 95% CI: 0.1, 0.6 p= <0.001). Main themes which emerged from the FGD sessions were health literacy, stage of seeking treatment, self-treatment, utilization of services, privacy and attitude of healthcare workers. Conclusions: TSB among male civil servants in Kelantan was poor and factors contributing towards it were multidimensional such as socio-demographic, individual, healthcare provider, psychological, marketing, situational and socio-cultural and family factors. Collaboration is needed from all major stakeholders to improve men’s behaviour to seek treatment and increase their uptake of health services to ensure optimum health in men