Would you be interested in participating in a study about hospital readmissions…? Experiences with methodological strategies and techniques for recruiting GPs to participate in qualitative research

General Practitioners (GPs) are an asset in healthcare research, considering the amount of knowledge they hold about the primary healthcare service. However, GPs have proven difficult to recruit as participants in both quantitative and qualitative research (Asch, Connor, Hamilton, & Fox, 2000; Hummers-Pradier et al., 2008; Parkinson et al., 2015). The difficulties in recruiting GPs have been attributed to their great workload and their perception of a gap between the theory-laden research and their own practical work (Rosemann & Szecsenyi, 2004; Leysen et al., 2019). However, own experiences of recruiting GPs to participate in a qualitative study disclosed that the picture might be more nuanced than described in previous reports. The objective of this paper is to describe the methodological strategies and techniques for the recruitment process, and discuss the difficulties in recruiting GPs to participate in research and possible reasons for such difficulties. It was based on experiences from a recently conducted study on GPs, which aimed to increase knowledge about the GPs’ role in hospital readmissions from the primary healthcare service (Glette, Kringeland, Røise, & Wiig, 2018).publishedVersio

Exploring physicians' decision-making in hospital readmission processes - a comparative case study

© The Author(s) 2018Background Hospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs’ gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs’ and nursing home physicians’ decision making. Method The study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality. Results Seven themes describing how different factors influence physicians’ decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians’ decision-making. Conclusion Communication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs’ and nursing home physicians’ decision-making, nursing home nurses and home care nurses’ experience of hospital readmissions and discharges is needed.publishedVersio

Perspective of risk in childbirth, women’s expressed wishes for mode of delivery and how they actually give birth

Aims: The main aim of this thesis was to study a perspective of women`s expressed wishes for mode of delivery and how they actually give birth. Additional aims were to examine the notion of risk applied to childbirth, to examine what characterizes women who want to give birth as naturally as possible without painkillers or intervention and the characteristics of women who would, if possible, choose to have a cesarean section. Material and methods: The notion of risk was examined in an essay. Self-rating instruments were completed by 55,858 MoBa participants during week 30 of their pregnancy and available from The Norwegian Mother and Child Cohort Study (MoBa) by April, 2007. Individually reported information on socioeconomic factors, lifestyle factors, feelings related to childbirth, factors concerning psychosocial health, physical, psychological and sexual harassment and information on satisfaction with antenatal care health services were collected from a MoBa questionnaire. Data on the mother’s age, parity, physical health before and during the pregnancy, previous cesarean sections and actual mode of delivery were collected through a linkage to the The Medical Birth Registry of Norway. Findings: General perspectives on risk differ depending on both the person and the profession. More and more childbearing women are in danger of being considered deficient and in the danger zone. Figures on risk are not objective values, and the association between risk and security is socially and culturally determined. Personal symbols can be basic assumptions about the life one leads, and the childbearing woman has preferences of her own. Interest in natural childbirth was expressed by 72 percent and a wish for caesarean section was expressed by ten percent of the women. Positive experience from previous childbirths, first birth or third or later birth, no dread of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth. Negative experiences from previous childbirths and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section.Overall, 47 percent of the women who wanted ”as natural a birth as possible” had their preference fulfilled. The figures differed largely for primiparas and multiparas; the risk of acute caesarean sections was high among primiparas and the effects of the predictors of natural birth were stronger for primiparas than for multiparas. Conclusions:The factors that influence the chance of having a natural birth are different for primiparas and multiparas. The high rate of non-natural births among first time mothers who actually want to have a vaginal birth without interventions should call attention to the increasing incidence of cesarean section in Norway. The chance of actually having a natural birth for women with a preference for a natural birth is much larger for multiparas. Negative experiences from previous childbirths and cesarean section are, however, important factors associated with non-natural birth and should be taken into consideration in public healthMål: Det overordna målet for denne avhandlingen var å studere perspektiv omkring hvordan kvinner uttrykker at de ønsker å føde og hvordan de faktisk føder. I tillegg var målet å undersøke risikobegrepet anvendt innen fødselsomsorg, undersøke hva som karakteriserer kvinner som ønsker å føde så naturlig som mulig uten smertestillende eller intervensjon og undersøke hva som karakteriserer kvinner som ville valgt å ta keisersnitt dersom det var mulig. Materiell og metode: Avhandlingen inkludere fire artikler. Risikobegrepet drøftes i første artikkel som er et essay. De 3 andre inkluderer data fra Den norske mor og barn-undersøkelsen. Data fra 55,858 MoBa informanter var ferdigregistrert april 2007 og omfatter individuell informasjon om sosioøkonomiske faktorer, livsstilsfaktorer, følelser/opplevelser relatert til fødsel, faktorer som omhandler psykososial helse, fysiske, psykiske og seksuelle overgrep og informasjon om tilfredshet med offentlig svangerskapsomsorg. Tidligere keisersnitt og hvordan kvinnene faktisk fødte i dette svangerskapet ble hentet fra en link til Medisinsk Fødselsregister. Funn: Generelt perspektiv på risiko er forskjellig, avhengig av både person og profesjon. Stadig flere gravid/fødekvinner står i fare for å bli betraktet som utsatte/mangelfulle og i faresonen. Kalkulasjoner av risiko er ikke objektive verdier og assosiasjonen mellom risiko og sikkerhet er sosialt og kulturelt bestemt. Subjektive symbol kan være grunnleggende antagelser/forståelser i forhold til det livet en lever og blivende mødre har sine egne preferanser. Syttito prosent av kvinnene uttrykte ønske om å føde så naturlig som mulig og ti prosent av kvinnene ønsket å ta keisersnitt. Positive erfaringer fra tidligere fødsler, det å være førstegangsfødende eller ha født mer en ett barn tidligere, ikke være redd for å føde, samt å rapportere positivt i forhold til intrapsykiske fenomen, er signifikant assosiert med ønske om å føde så naturlig som mulig. Negative erfaringer fra tidligere fødsler og redsel for å føde er de to faktorene som er sterkest assosiert med ønske om keisersnitt. Samlet sett fikk 47 prosent av de kvinnene som ønsket så naturlig fødsel som mulig, oppfylt ønskene sine. Resultatet var svært ulikt mellom førstegangsfødende og fleregangsfødende; risikoen for akutt keisersnitt var høg blant førstegangsfødende og effekten av prediktorene for naturlig fødsel var sterkere i forhold til førstegangsfødende enn for fleregangsfødende. Konklusjon: Faktorene som influerer sjansen til å føde så naturlig som mulig er ulike for førstegangsfødende og for fleregangsfødende. Den høge tallet på fødsler med intervensjon hos førstegangsfødende som egentlig ønsker å føde vaginalt uten intervensjon burde fått større oppmerksomhet. Dette bør også sees i sammenheng med en stadig økende innsidens for keisersnitt i Norge. Muligheten for å få en så naturlig fødsel som mulig er mye større for fleregangsfødende. Negative erfaringer fra tidligere fødsler og tidligere keisersnitt er, likevel, viktige faktorer assosiert med ikke-naturlig fødsel og bør reflekteres over/tas i betraktning i et folkehelseperspektiv

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

Abstract Objectives To explore hospital physicians’ views on readmission and discharge processes in the interface between hospitals and municipalities. Design Qualitative case study. Setting The Norwegian healthcare system. Participants Fifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients. Results The results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions. Conclusion The results of this study provide a better understanding of hospital physicians’ views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.publishedVersio

Nursing home leaders’and nurses’experiences of resources,staffing and competence levels and the relation to hospital readmissions –a case study

Background Thirty-day hospital readmissions represent an international challenge leading to increased prevalence of adverse events, reduced quality of care and pressure on healthcare service’s resources and finances. There is a need for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary healthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing home leaders experienced the resource situation, staffing and competence level in municipal healthcare services, and if and how they experienced these factors to influence hospital readmissions. Method The study was conducted as a comparative case study of two municipalities affiliated with the same hospital, chosen for historical differences in readmission rates. Nurses and leaders from four nursing homes participated in focus groups and interviews. Data were analyzed within and across cases. Results The analysis resulted in four common themes, with some variation in each municipality, describing nurses’ and leaders’ experience of the nursing home resource situation, staffing level and competence and their perception of factors affecting hospital readmissions. The nursing home patients were described as becoming increasingly complex with a subsequent need for increased nurse competence. There was variation in competence and staffing between nursing homes, but capacity building was an overall focus. Economic limitations and attempts at saving through cost-cutting were present, but not perceived as affecting patient care and the availability of medical equipment. Several factors such as nurse competence and staffing, physician coverage, and adequate communication and documentation, were recognized as factors affecting hospital readmissions across the municipalities. Conclusion Several factors related to nurses’ and leaders’ experience of the resource situation, staffing and competence level were suggested to affect hospital readmissions and the municipalities were similar in their answers regarding these factors. Patients were perceived as more complex with higher patient mortality forcing long-term nursing homes to shift towards an acute care or palliative function, and short-term nursing homes to function as “small hospitals”, requiring higher nurse competence. Staffing, competence and physician coverage did not seem to have adjusted to the new patient group in some nursing homes.publishedVersio

Would you be interested in participating in a study about hospital readmissions…? Experiences with methodological strategies and techniques for recruiting GPs to participate in qualitative research

General Practitioners (GPs) are an asset in healthcare research, considering the amount of knowledge they hold about the primary healthcare service. However, GPs have proven difficult to recruit as participants in both quantitative and qualitative research (Asch, Connor, Hamilton, & Fox, 2000; Hummers-Pradier et al., 2008; Parkinson et al., 2015). The difficulties in recruiting GPs have been attributed to their great workload and their perception of a gap between the theory-laden research and their own practical work (Rosemann & Szecsenyi, 2004; Leysen et al., 2019). However, own experiences of recruiting GPs to participate in a qualitative study disclosed that the picture might be more nuanced than described in previous reports. The objective of this paper is to describe the methodological strategies and techniques for the recruitment process, and discuss the difficulties in recruiting GPs to participate in research and possible reasons for such difficulties. It was based on experiences from a recently conducted study on GPs, which aimed to increase knowledge about the GPs’ role in hospital readmissions from the primary healthcare service (Glette, Kringeland, Røise, & Wiig, 2018)

A resilience perspective on healthcare personnels’ experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and home care services

Abstract Background The COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services. Method This study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis. Results The analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: “PHCP demonstrated high adaptive capacity while being put to the test”, “Adapting to organizational measures, with varying degree of success” and “Safeguarding the patient’s safety and quality of care, but at certain costs”. Conclusion This study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed